Mechanical Ventilation

Chapter 25 Respiratory Care

Modalities

Indications for Ventilation

Improving oxygenation & ventilation

Decreasing amount of oxygen & work
of
breathing
Provides respiratory support until
lung function is adequate

INDICATIONS FOR MECHANICAL

VENTILATION (Chart 25-11)

Pa02 < 50mm Hg with Fi02 >0.60

Pa02 > 50mm Hg with pH < 7.25
Vital capacity < 2 times tidal volume
Negative inspiratory force < 25 cm H20
Respiratory rate > 35 minute

(Brunner & Suddarth, 2010)

Types of Ventilators

NEGATIVE PRESSURE VENTILATORS

POSITIVE PRESSURE VENTILATORS

Iron Lung, Body wrap, Chest Cuirass

Not frequently used
Pressure- Cycled
Time-Cycled
Volume-Cycled----most commonly used

NON-INVASIVE POSITIVE PRESSURE

VENTILATION (NIPPV)

CPAP, BiPAP

Ventilator Modes

Assist-Control Ventilation

Volume in ccs

Intermittent Mandatory Ventilation (IMV)

Synchronized Intermittent Mandatory
Ventilation (SIMV)
Pressure Support Ventilation (PSV)
Airway pressure release ventilation (APRV)
Proportional assist ventilation (PAV)

Figure 25-9 Waveforms illustrations

Nasal CPAP/BiPAP

Nasal Pillow

Full Face BiPAP

Monitoring Ventilator
Controls & Settings

Tidal Volume 6 to 12 mL/kg

Rate or breaths/min-usually 12 to 16
FiO2 setting
Set Mode (AC, SIMV, etc) & PEEP 5 to 15 cm H20
pressure
Sigh if applicable 1 to 3/hour
ABGs after 20 minutes, adjust Fi02
Water in tubing, disconnection or kinking to tube
Alarms (turned on and functioning)
Monitor O2 Saturation

Nursing Management

Prevention of Ventilator Associated Pneumonia (VAP)

Monitoring for complications of

Barotrauma/Pneumothorax

Frequent oral care and suctioning of pharyngeal secretions

HOB elevated 30-45 degrees
Daily Sedation cessation and daily weaning trials

Application of positive pressure to lungs, high mean airway

pressures lead to alveolar rupture

Troubleshooting Problems with Mechanical Ventilation

Patient Problems
Ventilator Problems

Nursing Management

Assessment

VS, respiratory rate and pattern, breath

sounds
Evaluation of spontaneous ventilatory effort
Potential evidence of hypoxia (skin color)
Adventitious breath sound (may need
suctioning)
Evaluate patients comfort and anxiety level
Adequate nutrition

Ventilator Weaning

Criteria

Patient Preparation

Stable vital signs, ABGs

Improvement in the disease or condition
that caused the need for mechanical
ventilation
Consider the patient as a whole

Methods

SIMV, PSV, T-piece, Trach mask

Questions?