Mechanical Ventilator
triggered to produce inhalation. The sensitivity of
A mechanical ventilator is a machine that generates
a controlled flow of gas into a patient’s airways.
Oxygen and air are received from cylinders or wall
outlets, the gas is pressure reduced and blended
according to the prescribed inspired oxygen tension
(FiO2), accumulated in a receptacle within the
machine, and delivered to the patient using one of
many available modes of ventilation.
Indications :
 Maintain oxygenation e.g patients with
respiratory arrest, CVA patients
Contraindications:
DNR request
Types of Ventilators:
o Pressure-cycled Ventilators - delivers a
volume of gas to the airways using positive
pressure during inspiration. The positive
pressure is delivered until the preselected
pressure has been reached. When the preset
pressure has been reached, the machine
cycles into exhalation.
o Volume-Cycled Ventilators – delivers a
present tidal volume or inspired gas. The
tidal volume that has been preselected is
delivered to the client regardless of the
pressure required to deliver this volume. A
pressure limit can be set to prevent the
occurrence of dangerously high airway
pressures.
o Time-cycled Ventilators – terminate when
a preset inspiratory time has elapsed. In
most of these devices, a pressure limit is
also incorporated
o Flow-cycled Ventilators – are triggered to
stop when a preset flow rate has been
achieved
Triggering Mechanisms
Time-triggered inhlation is used to manage
clients who cannot breathe on their own. The
ventilator will trigger a breath after a preset time,
serving as a back-up in case a client’s own breathing
rate falls below a preset value.
Negative pressure inhalation is triggered by the
initial negative pressure that begins inspiration. As
soon as the client initiates a breath, the ventilator is
the system is set to reduce the workload of
breathing. Pressure fluctuations (e.g. hiccoughs,
leaks) can cause premature triggering.
Flow-triggered inhalation occurs when the client
can initiate a breath. The ventilator completed the
breath by sensing the flow of air into the chest. This
system works well in combination with positive end-
pressure (PEEP).
Volume-triggered ventilation occurs when the
ventilator completes the breath to maximize inhaled
gas volumes.
Alarms Ventilators have several alarms to assist
with their safe use.
Nursing Management:
Neuromuscular Blocking agents
sedation is often necessary to maintain ventilation
by creating a synchronus respiratory pattern and
reduce O2 demand.
Most common agents: Vecuronium (Norcuron) and
pancuronium (pavulon). Do not inhibit pain or
awareness
Suctioning
because the client loses ability to cough while on
mechanical ventilation and secretions tend to pool
and obstruct the airways, suctioning is often
required.
Weaning
gradual removal of te mechanical ventilator; the
physician decides when to wean the patient from the
ventilator. It is usually based on ABG readings and
assessment made by nurses and respiratory
therapists. The length of time required for successful
weaning generally relates to the underlying disease
process and to the client’s state of health before the
ventilator was used.
2 Types of weaning:
Rapid weaning – The rapid (t-piece) weaning
techniques is used when mechanical ventilation has
been instituted briefly. Place the client in a semi-
high fowlers position. Reduce the ventilator’s
respiratory rate to no more thatn half the original
rate. Obtain ABG values in 30 minutes. If these
values are at or near beaseline level, place the client
on a T piece at the same FiO2. Obtain ABG value in
30 minutes. If the ABGs are again at or near the
baseline level and the respiratory rate is below 25-
30 bpm, the client may be extubated. Apply a face
tent to deliver oxygen and humidity

Gradual weaning – this technique is used after

prolonged mechanical ventilation or if a
neuromuscular disorder is present. The first step is
to ascertain whether spontaneous breathing is
present. Once spontaneous breathing has been
established, slowly reduce the amount of ventilator
support. Continue to reduce ventilator support until
the client can accept full responsibility for his or her
own ventilator requirements. Thei process may ba
accomplished through increasingly longer periods on
a T piece (followed by periods of CMV support) or by
decreasing the rate of intermittent mandatory
ventilations (IMV) or synchronized IMV (SIMV)
breaths. This technique may tke weeks or even
months. Patience is crucial