The document discusses principles of ventilation including indications for ventilation such as support through illness or reversal of hypoxemia. It describes modes of ventilation including controlled, pressure control, volume control, continuous positive airway pressure, and pressure support. It also discusses patient management considerations for ventilated patients such as monitoring, suctioning, sedation, positioning, nutrition, communication, and readiness to wean from ventilation. Complications of ventilation are also briefly outlined.

1. Ventilation: Basic Principles

2. Introduction to Ventilation Principles Indications for Ventilation Modes of Ventilation Objective of Ventilation Patient Management Weaning Complications Overview

3. Airway Compromise (potential) Respiratory Failure pH: <7.25 PaCO 2 : >50 mmHg PaO 2 : <50 mmHg Increased Work of Breathing Head Injury Management Indications for Ventilation

4. Support though illness Reversal of hypoxemia Reversal of acute respiratory acidosis Relief of respiratory distress Resting of the ventilatory muscles Decrease in oxygen consumption Reduction in intracranial pressures Stabilisation of the chest wall Objective of Ventilation

5. freq Vt MV I:E ratio Trigger Ramp Modes of Ventilation Pmax Paw fspn MVspn  PEEP

6. Controlled Pressure Control (PC) Volume Control (VC) Supported Continuous Positive Airway Pressure (CPAP) Pressure Support (PS) Combined SIMV (PC) + PS SIMV (VC) + PS Modes of Ventilation

7. Modes of Ventilation: Control C ontrolled M echanical V entilation: The Minute Volume is determined by the ventilator The patient has no option to override the ventilator

9. Modes of Ventilation: Control P ressure C ontrol: A preset peak inspiratory pressure is delivered to the patient at a preset respiratory rate Volume is not preset and is determined by the mechanics of ventilation. (elasticity, compliance, resistance, pressure, gravity)

10. Modes of Ventilation: Control V olume C ontrol: A preset tidal volume is delivered at a present respiratory rate 7 – 10 mls/kg 50kg = 350 – 500mls 70kg = 490 – 700mls 90kg = 630 – 900mls

11. Modes of Ventilation: Support C ontinuous P ositive A irway P ressure: A spontaneous breathing mode, where the patient generates their own breath The ventilator maintains a constant positive pressure on expiration (PEEP) Aims to increase Functional Residual Capacity

12. Modes of Ventilation: Support P ressure S upport: A spontaneous breathing mode Need for additional support to achieve optimal tidal volumes Ventilator delivers a constant preset pressure on inspiration CPAP + PS = BiPAP

13. Modes of Ventilation: Combined S ynchronised I ntermitted M andatory V entilation: Similar to IMV If the patient initiates a breath and the ventilator synchronises so the ventilator doesn’t deliver a breath at the same time

14. Modes of Ventilation: Combined SIMV (PC) + PS : Pressure controlled ventilation with pressure support on spontaneous breaths SIMV (VC) + PS : Volume controlled ventilation with pressure support on spontaneous breaths

15. SIMV (VC) + PS Freq: 10 Vt: 500 (MV = 5.0) PEEP: 5 PS: 10

16. Monitoring Suctioning Other Sedation Positioning Oral and Eye Care Nutrition Elimination Communication Physiotherapy Patient Management

17. ECG SpO 2 ETCO 2 Alarm limits Air Entry / Work of Breathing Ventilator observations and alarm limits Full assessment Patient Management: Monitoring

18. PRN Increasing airway pressures Decreasing SpO 2 Increased work of breathing Pre-oxygenate (100% oxygen) Less than 15 Seconds Patient Management: Suctioning

19. Patient Management: Other Sedation Propofol, Morphine and Midazolam Positioning 2/24; consider prone ventilation Oral and eye care 2/24 Nutrition Commence ASAP Gastric ulcer prophylaxis

20. Patient Management: Other Elimination - NGT, IDC, Abdominal assessment Communication Physiotherapy - Assessment of ventilation status

21. Readiness to wean Cardiovascular stability PaO2 > 60mmHg on FiO2 < 0.4 PEEP < 5 and PS < 10 Intact ventilatory drive Absence of major organ system failure Normal range electrolytes (Ca++, K+, MgSO4 muscle strength) Intact ventilatory drive Psychological – pt awareness, gradual process. Weaning

22. Process of weaning Do not exhaust patient Spontaneous breathing trials Decrease FiO2 Decrease PS and PEEP Decrease SIMV rate Failure to wean RR >35, SpO2 <90%, HR >140, anxiety, diaphoresis, use of accessory muscles Weaning

23. Airway Aspiration, decreased clearance of secretions, predisposition to infection Endotracheal Tube Tube kinking, sputum plug, right main bronchus intubation, tube migration, cuff failure, laryngeal oedema Mechanical Ventilator malfunction, hypoventilation, hyperventilation, barotrauma, pneumothorax Complications

24. Questions