MECHANICAL VENTILATOR

Mechanical ventilator is an automatic machine designed to provide all or part of the work of the
body must do to move gas into and out of lungs. The act of moving air into and out of the lungs
is called breathing or more formally, ventilation.

A ventilator is a device used to provide assisted respiration or replace spontaneous breathing

Types of ventilator

• Positive pressure ventilator: it works by increasing the pressure in the patients airway and
forcing air in to the lungs

Negative pressure ventilator

• It creates a negative pressure environment around the patients chest, thus sucking
air in to lungs

Setting ventilator parameters

Settings are based on the patient’s status (ABGs,

Body weight,

level of consciousness and

muscle strength)

PARAMETERS OF MECHANICAL VENTILATION

• Respiratory Rate (f) :-Normally 10-20b/m

• Tidal Volume (VT) :-5-15ml/kg

• Oxygen Concentration(FIO2):-b/w 21-90%

• I:E Ratio:-1:2

• Flow Rate:-40-100L/min

• Sensitivity/Trigger:- 0.5-1.5 cm H2O

• Pressure Limit:-10-25cm H2O

• PEEP :- Usually, 5-10 cmH2O

Indication for mechanical ventilation

 Apnea
 Clinical signs of increased work of breathing ( asthma, CCOPD, pneumonia, cardiogenic
pulmonary edema, ARDS)
 Tachypnea
 Impending respiratory failure.
 Shock
 Airway Compromise (potential)
 Respiratory Failure

pH: <7.25

PaCO 2 : >50 mmHg

PaO 2 : <50 mmHg

 Increased Work of Breathing

 Head Injury Management

Modes of ventilation

It is a method or the way, in which a breath is delivered by altering or changing the available
variables.

A mode is nothing but how a ventilator performs the work of respiratory muscles.

A ventilator mode can be also defined as a set of operating characteristics that controls how
the ventilator functions

Components of mode

• Type of breath

• Control variable

• Phase variable

• Conditional variable

• Type of breath

• mandatory breath

• Ventilator does the work

• Ventilator controls start and stop

 • Spontaneous breath

• Patient takes on work

• Patient controls start and stop

• Control variable

• Pressure control: volume may vary

• Volume control :- pressure may vary

• Time control: pressure, flow volume may vary

• Dual control : PC + VC

• Control variable

• Pressure control: volume may vary

• Volume control :- pressure may vary

• Time control: pressure, flow volume may vary

• Dual control : PC + VC

CONTROLLED MANDATORY VENTILATION

( CMV)

• INDICATION

• Provide maximum ventilatory support

• To reduce agitation

• Helps to heal chest wall injury

Synchronized intermittent mandatory ventilation ( SIMV)

• It is a mixture of mechanical ventilation and spontaneous breathing.

• Preset number of mandatory breaths are delivered while patient breaths spontaneously
between mandatory breaths

PEEP

Definition

• Positive end expiratory pressure

 • Application of a constant, positive pressure such that at end exhalation, airway pressure
does not return to a 0 baseline

• Used with other mechanical ventilation modes such as A/C, SIMV, or PCV

• Referred to as CPAP when applied to spontaneous breaths

• Increases functional residual capacity (FRC) and improves oxygenation

• Recruits collapsed alveoli

• Splints and distends patent alveoli

• Redistributes lung fluid from alveoli to perivascular space

• Normally set - 5 cm H 2 O

CPAP

Definition

• Continuous positive airway pressure

• Application of constant positive pressure throughout the spontaneous ventilatory cycle

• No mechanical inspiratory assistance is provided

• Requires active spontaneous respiratory drive

• Same physiologic effects as PEEP

• May decrease WOB

• Tidal volume and rate determined by patient

• Often final form of support before extubation

• 10 cm H2O

Complications associated with mechanical ventilation

 Gastrointestinal tract complications

o Stress related mucosal diseases
o Motility disturbances
o Acalculus cholecystitis
 Hepatic complications
 Due to institution of PPV there is significant reduction in cardiac output which
causes proportional drop in global hepatic blood flow.
 Pneumoperitonium

The mechanism involves airflow dissection through over-distended alveoli in to

the pulmonic perivascular sheaths. The pocket of air dissects to the mediastinum
to cause free air in the peritoneal sac.

 Cardiovascular complications
o Arrhythmias
o Myocardial ischemia
 Renal complications ( renal failure)
 Infectious complications
o Ventilator associated infections
o Catheter related bacteremia
o Nosocomial diarrhea
o Wound infections
o Suppurative thrombophlebitis
o Endocarditis
 Hematological complications
o Anemia
o Thrombocytopenia
 Neuromuscular complications
Critical illness polyneuropathy is an acute axonal sensory motor polyneuropathy,
mainly affecting the lower limb nerves of critically ill patients. Manifestations
include one limb weakness, persistent respiratory failure or respiratory muscle
weakness.
 Venous thromboembolism
 Barotrauma
 Broncho pleural fistula
 Oxygen toxicity

ALARMS IN MECHANICAL VENTILATOR

ALARM POTENTIAL CAUSES INTERVENTIONS

High peak inspiratory  Blockage of ET tube  Assess lung sounds
pressure (secretions, kinked  Suction airway for
tubing, ppatient biting secretions
ET tube)  Insert bite block or
 Coughing administer sedation.
 Bronchospasm  Assess breath sounds
 Lower airway for increased
 obstruction
 Pulmonary edema
 Pneumothorax
Low pressure alarm  Air leak in ventilator
circuit or in the ET
cuff
Low O2 saturation  Pulse oxymeter
malpositoned
 SpO2 cable unplugged
Apnea  Breaths are not being
taken by the patient or
triggered on ventilator
consolidation,
wheezing, and
bronchospasm.
 Locate leak in the
ventilator system.
 Check pilot balloon as
an indicator of ET
tube cuff failure.
 Replace tubing as per
policy.
 Ensure ventilator
oxygen supply is
connected
 Ensure pulseoxymeter
is positioned correctly
 Verify all cables
plugged in.
 Assess patient for
respiratory distress
 Assess patient effort.
 Check system for
disconnections

Management of ventilator supported patients

Patient Goals:

• Patient will have effective breathing pattern.

• Patient will have adequate gas exchange.

• Patient’s nutritional status will be maintained to meet body needs.

• Patient will not develop a pulmonary infection.

• Patient will not develop problems related to immobility.

• Patient and/or family will indicate understanding of the purpose for mechanical ventilation.

Nursing Interventions

• Observe changes in respiratory rate and depth; observe for the use of accessory muscles.

• Observe for tube misplacement- note and post cm. Marking at lip/teeth after x-ray
confirmation
• Prevent accidental extubation by taping tube securely, checking q.2h.; restraining/sedating
as needed.

• Inspect thorax for symmetry of movement. Determines adequacy of breathing pattern;

asymmetry may indicate hemothorax or pneumothorax.

• Measure tidal volume and vital capacity.

• Asses for pain

• Monitor chest x-rays

• Maintain ventilator settings as ordered.

• Elevate head of bed 60-90 degrees. This position moves the abdominal contents away
from the diaphragm, which facilitates its contraction.
• • Monitor ABG’s. Determines acid-base balance and need for oxygen.
• • Observe skin color and capillary refill. Determine adequacy of blood flow needed to
carry oxygen to tissues
• Observe for tube obstruction; suction; ensure adequate humidification.
• • Provide nutrition as ordered, e.g. TPN, lipids or parental feedings.
• • Use disposable saline irrigation units to rinse in-line suction; ensure ventilator tubing
changed q. 7 days, in-line suction changed q. 24 h.; ambu bags changes between patients
and whenever become soiled.
• Assess for GI problems. Preventative measures include relieving anxiety, antacids or H2
receptor antagonist therapy, adequate sleep cycles, adequate communication system.
• • Maintain muscle strength with active/active-assistive/passive ROM and prevent
contractures with use of span-aids or splints.
• Explain purpose/mode/and all treatments; encourage patient to relax and breath with the
ventilator; explain alarms; teach importance of deep breathing; provide alternate method
of communication; keep call bell within reach; keep informed of results of
studies/progress; demonstrate confidence.