The document outlines the fundamental principles of ventilation, including respiratory anatomy and physiology, indications, modes of ventilation, and patient management. It discusses mechanics such as elasticity, compliance, and pressure, and explores various ventilation modes such as controlled mechanical ventilation and pressure support. Additionally, it addresses potential complications and the importance of monitoring and patient management strategies.

1. Ventilation: Basic Principles Jamie Ranse Registered Nurse Emergency Department The Canberra Hospital

2. Introduction to Ventilation Principles Respiratory Anatomy and Physiology Indications for Ventilation Modes of Ventilation Patient Management Complications Questions Overview

3. Ventilation is the movement of air into and out of the alveoli. Introduction Hudak, et al, 1997, Critical Care Nursing: A Holistic Approach (7th Edn) , Lippincott, Philadelphia, USA

4. Mechanics of Ventilation: Elasticity Compliance Resistance Pressure Gravity Introduction Hudak, et al, 1997, Critical Care Nursing: A Holistic Approach (7th Edn) , Lippincott, Philadelphia, USA

5. Respiratory Structures Respiratory Zones Partitioning of Respiratory Pressures Boyles Law Respiratory Volumes and Capacity Ventilation and Perfusion Anatomy and Physiology

6. Anatomy and Physiology Porth CM, 1998, Pathophysiology (5 th Edn) , Lippincott, Philadelphia, USA Respiratory Structures

7. Anatomy and Physiology Porth CM, 1998, Pathophysiology (5 th Edn) , Lippincott, Philadelphia, USA Respiratory Zones

8. Anatomy and Physiology Porth CM, 1998, Pathophysiology (5 th Edn) , Lippincott, Philadelphia, USA Partitioning of Respiratory Pressures

9. Anatomy and Physiology Porth CM, 1998, Pathophysiology (5 th Edn) , Lippincott, Philadelphia, USA Boyles Law Increase V = Decreased P Decreased V = Increased P

10. Anatomy and Physiology Porth CM, 1998, Pathophysiology (5 th Edn) , Lippincott, Philadelphia, USA Boyles Law Air flows from a region of higher pressure to a region of lower pressure. To initiate a breath, airflow into the lungs must be precipitated by a drop in alveolar pressures.

11. Anatomy and Physiology Porth CM, 1998, Pathophysiology (5 th Edn) , Lippincott, Philadelphia, USA Respiratory Volumes and Capacity

12. Anatomy and Physiology perfusion without ventilation = shunt normal ventilation and perfusion ventilation without perfusion = dead space airway venous blood arterial blood Porth CM, 1998, Pathophysiology (5 th Edn) , Lippincott, Philadelphia, USA Ventilation and Perfusion

13. 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 Hudak, et al, 1997, Critical Care Nursing: A Holistic Approach (7 th Edn) , Lippincott, Philadelphia, USA

14. 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 Hudak, et al, 1997, Critical Care Nursing: A Holistic Approach (7 th Edn) , Lippincott, Philadelphia, USA

15. freq Vt MV I:E ratio Trigger Ramp Modes of Ventilation Diepenbrock NH, 1999, Quick Reference to Critical Care, Lippincott, Philadelphia, USA: P166. Pmax Paw fspn MVspn  PEEP

16. 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 Diepenbrock NH, 1999, Quick Reference to Critical Care, Lippincott, Philadelphia, USA: P166.

17. 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

19. 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)

20. 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

21. 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

22. 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

23. 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

24. 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

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

26. Monitoring Suctioning Other Sedation Positioning Oral and Eye Care Patient Management

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

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

29. Patient Management: Other Sedation Propofol, Morphine and Midazolam Positioning 2/24 Oral and eye care 2/24

30. 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

31. Questions

32. Ventilation: Basic Principles Jamie Ranse Registered Nurse Emergency Department The Canberra Hospital