MECHANICAL

VENTILATION
What is Mechanical Ventilation?

- Mechanical Ventilation is any

means which physical devices
or machines are used to either
assist/support or replace
spontaneous respiration.
- Artificial form of breathing
 CLASSIFICATION OF MECHANICAL
VENTILATION
1. Negative-pressure ventilators
• Creates a negative (subatmospheric) extrathoracic pressure to provide a
pressure gradient.
• Physiologically, this type of assisted ventilation is similar to spontaneous
ventilation.
• Negative pressure ventilators are simple to use and do not require
intubation of the airway
• It is inappropriate for the unstable or complex patient or the patient whose
condition requires frequent ventilatory changes
• 2 Types:
• Tank (“iron lungs”)
• Chest Cuirass
Emerson Iron Lung
NEV 100 + Neumo suit
2. Positive-pressure ventilators
• Creates a positive intrapleural pressure in presence of
atmospheric extrathoracic pressures.
• Blows air into the lungs.
• These ventilators are widely used in the hospital setting
and are increasingly used in the home for patient with
primary lung disease.
Negative vs. Positive Pressure Ventilation
 BASIC TYPES OF MECHANICAL
VENTILATOR
1. Electrical – Rely on electricity to drive motors, electromagnets,
potentiometers, computers, etc
2. Pneumatic –Depend entirely on a compressed gas source for
power, non-magnetic and MRI friendly.
Examples: IPPB (bird mark), transport ventilators
3. Combined (electrical/pneumatic) Microprocessor
Ventilators – Pneumatically powered, electronically or
microprocessor controlled ventilators.
- Pneumatic power provides the energy to deliver the breath to the
patient
- Electrical power energizes the microprocessor to control special
valves that regulate the characteristics of the breath delivered
(inspiration and expiration)
- Most current ventilators are this type.
 INDICATIONS
1. Acute Respiratory Failure

2. To improve gas exchange

3. To reduced the work of breathing

4. To avoid complications while maintaining

optimal conditions for recovery.
 ACUTE RESPIRATORY FAILURE
1. Type I – Hypoxemic Respiratory Failure
- Hypoxemia is defined as an acute reduction in PaO2
of 10% or more over a period ranging from several
minutes to several hours. Emergent treatment
should be initiated when the PaO2 is less than
60mm Hg indicating a rapid decline in the oxygen
content of blood and subsequent tissue hypoxia.
- low SpO2, PaO2 and A-a gradients
- adjust FiO2 and PEEP
2. Type II – Hypercapneic Respiratory
Failure
- Ventilatory respiratory failure (hypercapnia) is
diagnosed by a PaCO2 > 50mm Hg.
- PaCO2 is elevated creating an uncompensatory
respiratory acidosis.
- need to blow off gas
- adjust Vt and RR
 PHYSIOLOGICAL INDICATORS FOR VENTILATORY SUPPORT, CLASSIFIED BY
THE MECHANISM UNDERLYING RESPIRATORY FAILURE

MECHANISM Normal Values Support Indicated

Inadequate alveolar ventilation

PaCO2 (mmHg) 35 – 45 > 55
pH 7.35 - 7.45 < 7.20
Inadequate lung expansion
Tidal Volume (Vt) ml/kg 5-8 <5
Vital Capacity (VC) ml/kg 8-10 < 10
Respiratory Rate 12 – 20 > 35
Inadequate muscle strength
Maximum Inspiratory pressure - 80 – 100 > - 20
(cmH2O)
Vital Capacity (VC) ml/kg 65 - 75 < 10
Maximum Voluntary Ventilation 120 – 180 < 2 x VE
MVV (L/min)
Increased Work of breathing
Minute Ventilation (VE) 5–6 > 10
VD / VT (% ) 0.25 – 0.40 > 0.60
Hypoxemia
P(A-a)O2 on 100% oxygen (mmHg) 25 - 65 > 350
PaO2/FiO2 350 – 450 < 200
GOALS OF MECHANICAL VENTILATION
- The goal of mechanical ventilation is to
improve ventilation, oxygenation, lung
mechanics and
patient comfort while preventing
complications.
- Mechanical ventilators provide supportive
therapy.
- The ventilator is not a cure for any disorder,
rather it allows support of breathing while
disease processes are treated.
 INITIATION OF MECHANICAL
VENTILATOR
1. Equipment set-up

2. Type of Ventilaton

3. Mode of Ventilation

4. Initial Settings

5. Alarms

6. Attach patient to the ventilator

 Short Self Test (SST)
• An SST verifies the integrity of the patient circuit
tubing by measuring its leak rate and compliance.
• It also tests critical hardware components,
including the safety valve, and flow sensors.
• Perform an SST after every patient circuit change.

WARNING:
Never initiate an SST while the ventilator is connected to a
patient.
Do not use a ventilator that has failed an SST.
EXTENDED SELF TEST(EST)
Verifies the overall integrity of the ventilator by testing
all critical hardware and subsystems and components.
It is performed between patients as part of preventive
maintenance or anytime the operational integrity of the
ventilator is in question.
 RT’s Responsibilities on Mechanically Ventilated
Patients

• Manipulation of control knobs for delivery of ventilation.

• Continuous monitoring of patient’s condition and observation
of vital signs.
• Check interaction of patient on Mechanical ventilator.
• Setting of alarms/ monitors and displays
• In line nebulization, suctioning, CPT
• Changing of ventilator circuitry.
• ABG extraction and analysis
 WORKSHEET

• In a 1 whole sheet of bondpaper, draw and create a diagram of the ventilator

setup (from the ventilator to the patient)

• Take a photo of your output and upload it to CeLo under MV Assignments

• Deadline: Aug 25 (Friday)