More about ventilator

1. DURGAWATHY SUBRAMANIAN
14170
WAD ICU PUSAT PERUBATAN UNIVERSITI MALAYA

2.  The mechanical ventilator device functions as :
 a substitute for the bellows action of the thoracic cage and diaphragm
 maintain ventilation automatically for prolonged periods.
 It is indicated when:
 the patient is unable to maintain safe levels of oxygen or CO2 by
spontaneous breathing even with the assistance of other oxygen delivery
devices.
 a patient is unable to maintain a patent airway, adequate gas exchange, or
both, despite aggressive pulmonary management, more invasive support
with intubation and mechanical ventilation must be considered.
 The goal of mechanical ventilation:
 to maintain alveolar ventilation appropriate for the patient’s metabolic
needs and to correct hypoxemia and maximize oxygen transport

3.  Negative-pressure ventilators
 iron lungs
 Allow long-term ventilation without artificial airway
 Maintain normal intrathoracic haemodynamics
 Uncomfortable, limit access to patient.

5.  Positive-pressure ventilators
 Uses pressure above atmospheric pressure to push air into
lungs
 Requires use of artificial airway
 Types:
1. Pressure cycled
2. Time cycled
3. Volume cycled

7. SETTING FUNCTION USUAL PARAMETER
Respiratory rate ( RR ) Number of breaths delivered
by the ventilator per minute
Usually 4 – 20 breaths per
minute
Tidal volume ( VT ) Volume of gas delivered
during each ventilator
breath
Usually 5-15mls/kg
Fractional inspired
oxygen ( fio2 )
Amount of oxygen delivered
by ventilator to patient
21% to 100% : usually set to
keep PaO2 > 60 mmhg and
SaO2 > 90%
Inspiratory : expiratory
( I : E ) ratio
Length of inspiration
compared to length of
expiration
Usually 1:2 or 1:1.5 unless
inverse ratio ventilation is
required.
Pressure limit Maximum amount of
pressure the ventilator can
use to deliver breath
10-20 cm h20 above peak
inspiratory pressure,
maximum is 35 cm h20
Positive end expiratory
pressure ( peep )
• Improve oxygenation
• Diminish the work of
breathing
5 – 7 cmh20

8.  Servo i  Puritan Bennett

9.  Drager  Avea Servo U

10.  HFOV ( high frequency oscillatory ventilation )
 is a type of mechanical ventilation that uses a constant distending pressure
(mean airway pressure [MAP]) with pressure variations oscillating around
the MAP at very high rates (up to 900 cycles per minute).
 Indications:
1.Failure of conventional ventilation in the term infant (Persistent
Pulmonary Hypertension of the Newborn [PPHN], Meconium Aspiration
Syndrome
2. Air leak syndromes (pneumothorax, pulmonary interstitial emphysema
[PIE])
3.Failure of conventional ventilation in the preterm infant (severe RDS, PIE,
pulmonary hypoplasia) or to reduce barotrauma when conventional
ventilator settings are high.

11. Ventilatory mode Common uses
Volume modes
A/C
- A respiratory rate and tidal volume are
preset
SIMV
- As with A/C mode the respiratory rate
and tidal volume are preset.
Initial mode of ventilation for patient too
weak to perform the work of breathing.
As a long term mode of ventilation.
As a weaning mode.

12. VENTILATOR MODE COMMON USES
Pressure modes
PCV
PSV
APRV
CPAP
For patients with conditions in which compliance is
decreased and the risk for barotrauma is high.
For patients with persistent hypoxemia despite a
high fio2
As a weaning mode.
Used in combination with SIMV to decrease work of
breathing by helping to overcome resistance created
by ETT
For patient with high airway pressure to reduce
airway pressure and lower minute volume while
allowing spontaneous breathing.
As a weaning mode.
For spontaneous breathing to improve oxygenation.
As a weaning mode

13.  Troubleshooting is identification and resolution of technical
malfunctions in the patient-ventilator system.
 All ventilators are equipped with visual and audible alarms
which notify the user problems.
 It warn of technical / patient events that required the attention.
 Sign of patients with ventilation problem
• Agitation
• Spo2 less than 90%
• Falling heart rate

14.  Apnoea
 High pressure alarm
 Low pressure alarm
 High inspiratory volume alarm
 Low inspiratory volume alarm
 High tidal volume
 Low tidal volume
Ensure alarm knobs/switches are turned on and functional

15. ALARMS CAUSE SHOOTING
apnoea • No breath was delivered for
the operator set apnoea
time.
• Because spontaneous
ventilation is too high or
patient effort is too minimal
• Trigger level set improperty
• Check the patient- aroused
if needed.
• Consider switching over to
any mandotary mode.
• Go up on rate
• Set trigger level
appropriately.
Low spo2 • High resistant due to various
clinical reasons
• Disconnect patient from
ventilator
• Manual bag with ambu
bag.

16. ALARMS CAUSE SHOOTING
Air/o2 blender continuous
alarm
• Supply pressure inadequate • Insert the gas hose fittings (
air & o2 ) correctly into the
wall outlets.
• Ensure wall outlets has
adequate pressure
Low pressure / low minute
ventilation / low exhaled
volume / disconnection
The measured PIP is lesser than
the set minimum level because of
• Cuff leak
• Leak in the circuit
• Connection maybe loose
• Endotracheal tube ( ett )
displacement.
• Disconnection
• Inadequate flow
• Evaluate cuff pressure at
regular intervals.
• Reinflate if leak is noticed.
• Changed ett tube
• Check circuits, junctions-
tighten or replace.
• Check ett placement.
position it properly.
• Reconnect ventilator.

17. ALARMS CAUSE SHOOTING
High pressure alarm The measured peak inspiratory pressure is
great than set level because of
• High secretions in airway
• Partial block of ett
• Kinking of tube
• Biting the tube
• Condensation water in the tube
• Cuff herniation
• Deep right sided intubation
• Fighting the ventilator
• Cough
• increased airway resistance/ decreased
compliance because of
• Bronchospasm
• Atelectasis
• Fluid overload
• Pneumothorax
• Suctioning
• Release tubings.
• Bite block insertion.
• Empty the tubings and
water traps
• Deflate and reinflate cuff.
• Reposition the ett
• Reposition the patient.
• Reassurance sedation and
medication ( pain )
• Medication
• Bronchodilators
• Adjust the settings vT &
increase rate or increase
peep ( peak pressure to be
monitored )
• Needle decompression

18. ALARM CAUSE SHOOTING
High tidal volume • Patient trying to take more
volume of air
• Increase flow rate
• increase tidal volume
Low tidal volume • Wrong setting
• Bronchospasm
• Leaking cuff
• Water condensation
• Readjust setting
• Bronchodilator
• Reinflate cuff/ change ett
• Empty condensate water in
circuit.

19.  Remove patient from ventilator
 Initiate manual ventilation
 Check patency of airway
 Once patient stabilized, undertake more detailed assessment
and management

20.  Never ignore an alarm
 Never mute the alarm regularly
 Find out for yourself what alarm is on
 Check the patient
 Do not silence the alarm