Obj: AT The end of this presentation ,the audience will be able

to:
1.Define Mechanical ventilation
2. list type of Mechanical ventilation
3. list indication for use mechanical ventilation.
4. Discuss parameters (setting) and MODES for (MV).
5. Discuss type of alarm in (MV) and causes of each alarm.
6. list most common complication for (MV).
7.Define weaning of Mechanical ventilation.
8.discuss criteria of readiness to weaning.
9.discuss method of weaning
10.Define Weaning failure
Definition:
It is a Machine that moves air in and out of the patient lungs
to maintain alveolar ventilation appropriate for the patient's
metabolic need and to correct hypoxemia and maximize
oxygen transport.

Types:
1. Negative pressure: not used / Iron lung. - Suction pulls the lungs
outward, so air enter from the mouth

2.Positive pressure: Invasive: ETT, tracheostomy.

Indication for using :
1)respiratory failure: there are some symptoms that may make us to
put pt on MV such:
-Sao2 less than 60% ( o2 saturation on HB )
normal range(95-100 %)
-Pao2: less than 50 mm hg (O2 on the artery)
Normal range (80-100)
Mild:60-80mmhg
Moderate:40-59mmhg
Severe: less than 40 mmHg
-Paco2:more than 50 mmHg
Normal range (35 -45 mmHg)
- PH : less than 7.25
Normal range (7.35-7.45)
-tachypnea: more than 30C/min
-Bradypnea
2)severe hypoxia
3) inability to maintain patent airway
4)inadequate gas exchange
5)respiratory muscle fatigue (diaphragm, intercostal muscles,
sternocleidomastoid)
6)coma: because of suppression of cough this may lead of inspiration
of secretion.
Parameters:
1.RR: cycle per minute (12-20)
Tachypnea more than 20
Bradypnea less than 12
2. Tidal volume: amount of air that is inhale and exhale on each breath
*Calculated according to pt. WT(10-15 * pt wt)
-inspirited tidal volume: amount of air enter lung.
-expiated tidal volume: amount of air exit from lung each breath.

3. Minute ventilation (m-v, v-dote): volume of air enters and out on

lung per minute
(M-V=T.V*RR) Normal range (5-8 L/min)
Less than normal may indicate leak or disconnect of system.
4.fraction of inspired oxygen(FIO2):percentage of oxygen that enter
lung on each breath and detected by ABG'S.
Normal range (21-100%)
5. positive end expiration pressure (peep): amount of air that remain
in in alveoli after exhalation to prevent alveoli collapse.
Normal range (5-15cm H2o)
6. Inspiration to expiration ratio(R:I ratio):
Ratio between inspiration and expiration times.
Normal range (1:1.5 to 1:2)
7. Flow rate: flow which control how fast of tidal volume is delivered
by MV. *Normal range (60-100)L/min
8. Trigger sensitivity: how much effort pt Must generate to in order to
trigger breath from the machine
9.Sigh: hyperoxygenation /intermittent inflation of lung with large
volume of air.

Ventilator modes:
*according to level of contusions and pt's ability for breathing.
1.ACV:assist control ventilator assists control mode, Pt is only initiate
breathing.
-Often used as initial mode of ventilation.
Disadvantages Hyperventilation air trapping: may require sedation and
paralysis.
2.CMV:continues /complete/ control mandatory ventilation
( when pt under sedation... All the cycle is mandatory to MV.)
3.SIMV:synchronise intermittent mandatory ventilation: allow
spontaneous breathing

Advantages: Allows spontaneous breath (tidal volume determined by

patient between vent baths
weaning is accomplished by gradually lowering the set rate and
allowing patient to assure more work
Disadvantages: Patient ventilator asynchrony possible.
4.Pressure-controlled ventilation (PCV):
Used to limit plateau pressures that can cause barotrauma, severe
ARDS.
Disadvantages:
Patient–ventilator asynchrony possible, necessitating
sedation/paralysis.
5.Pressure-support ventilation (PSV):
Assets spontaneous breathing, deliver pressure during inspiratory
phase.
Indication: Intact respiratory drive in patient necessary, Used as a
weaning mode, and in some cases of desynchrony (occurs when
either the initiation and/or termination of mechanical breath is not in
time agreement with the initiation and termination of neural
inspiration, respectively, or if the magnitude of mechanical assist does
not respond to the patient's respiratory demand)
-Advantages:
Decreases work of breathing, increases patient comfort; can be
combined with SIMV to allow a more comfortable mode.
-Disadvantages: Should not be used in patients with acute
bronchospasm or with altered mental status with reduced
spontaneous breathing.
6.continues positive airway pressure(cpap):
-noninvasive without ETT by mask
-invasive
Give pt constant amount of air to prevent collapse.
Used for pt with obstructive sleep apnea /COPD.
Used for CO2 washing.
7.bipap: If you have trouble breathing, COPD, nocturnal
hypoventilation a BiPap machine can help push air into your lungs. You
wear a mask or nasal plugs that are connected to the ventilator. The
machine supplies pressurized air into your airways. It is called “positive
pressure ventilation” because the device helps open your lungs with
this air pressure.
8. positive end expiration pressure (peep)
* maintain patent alveoli and increase time for gas exchange.

Alarm:
-High pressure alarm:
*secretions. *kinked tube. *pt bites the ETT.
*pt fighting (breath against the ventilator).
-Sedation
*bronchospasm. *water in the tube.
-low pressure alarm:
Any displacement or Disconnection in the ETT.
Complication of mechanical ventilator:
1.trauma
• barotrauma
• Volutrauma
2. Hemodynamic 3. O2 toxicity 4.aspiration 5. tracheal damage
6. Gi ulcer (stress ulcer) 7.oral ulcer 8.fistula 9.UTI

Ventilator-associated pneumonia (VAP) is a type of lung infection that

occurs in people who are on mechanical ventilation breathing
machines in hospitals. As such, VAP typically affects critically ill persons
that are in an intensive care unit (ICU). VAP is a major source of
increased illness and death

The most common cause of ventilator-associated pneumonia is micro

aspiration of bacteria that colonize the oropharynx and upper airways
in seriously ill patients.

Treatment: Selecting the appropriate antibiotic depends on the

duration of mechanical ventilation. Late onset VAP (> 4 days) requires
broad spectrum antibiotics whereas early onset (≤ 4 days) can be
treated with limited spectrum antibiotics
Weaning is a gradual transition from full invasive ventilatory support to
spontaneous ventilation with minimal support.
It may involve either an immediate shift from full ventilatory support
to a period of breathing without assistance from the ventilator (i.e., a
spontaneous breathing trial [SBT]) or a gradual reduction in the
amount of ventilator support.

Several techniques can be used to conduct the SBT:

-T-tube (T-piece) trial
-Pressure support ventilation
-Continuous positive airway pressure
The duration of the SBT can be between 30 minutes to 2 hours
Criteria:
Patient:
1-Hemodynamic stable: patient does not receive any medication that
supportive hemodynamic (dopamine, dobutamine, norepinephrine)
or sedation (relaxation respiratory muscle).
2-GCS 3-ABG’s within normal
PH=7.35-7.45 PaCO2= less than 50 mmHg SO2=more than 90%
4-ascultaion 5-chest X-ray (rule out any chest infection)
6-HB
Ventilator:
1-PEEP <=5 cmH2O
2-PSV <=10 cmH2O
3-T.V <=500 ml/m
4-R.R=4 cycle/m
5-FIO2<=40%
Steps of weaning:
-gradual reduction in mandatory rate during SIMV
-gradual reduction in pressure support ventilation (PSV)
-spontaneous breathing through a T-piece with nebulizer (salbutamol)
and with flow meter O2

-ABG’s
-spontaneous breathing with ventilator on ‘flow by’ and PSV=0 with
PEEP=0
*during weaning, give dexamethasone (nebulizer, I.V) to increase
effectiveness of salbutamol. Avoid vasopressor and sedation.
Technique:
1-The patient should be in an upright sitting position.
2-Both the ETT and oral cavity are suctioned
3-Deflated of cuff
4-Inspiration: pt take deep breathing
5-After the removal of the ETT, suction the oral cavity and ask the
patient to take a deep breath and cough out all secretions.
6-The patient should be placed on supplemental oxygen afterward.
7-observed very carefully over the next few hours.
8-chest physiotherapy.
9-Frequent airway suction should be considered to prevent re-
intubation.
10-spirometer

Weaning failure:
Is defined as the failure to pass a spontaneous-breathing trial or the
need for reintubation within 48 hours following extubating.
Tolerance criteria:
1-RR >35 2-SaO2 <90% 3-T.V 5ml/Kg or less
4-Evidance of respiratory distress ( labored respiratory pattern,
anxiety, HR higher or lower baseline)
5-decrease LOC 6-V/S 7-ABG’s 8-ECG (Arrhythmia)
9-Diaphorases