Ventilasi Mekanik & Interpretasi

GCS
Tri Antika Rizki Kusuma Putri
Mengapa Ventilator?
• Impending or existing respiratory failure
• Failure to oxygenate (inadequate exchange of gases at
the alveolar level, as seen in acute respiratory distress
syndrome [ARDS])
• Failure to ventilate (decreased mental status or
decreased lung compliance)
• Combination of both
• Airway protection
Apa yang harus diperhatikan?
• What type of airway is in place?
• What are the ventilator settings and what do they
all mean?
• What do I do if the vent alarms?
• What to I do if the vent fails?
• How do I plan treatment in conjunction with vent
weaning?
Airway Management

Endotracheal Tube (ETT)

● Can be placed orally
(most common) or
nasally
● Passes through the vocal
cords

Tracheostomy tube
● Cuff or cuff less
● Inserted below the vocal
cords
● Used in more long-term
airway management
 Ventilator Settings

Actual respiratory
rate

Type of ● Tidal Volume

respirati ● PEEP
on ● Mode (type of assist given by
vent)
● Rate (Breaths per minute.Adjusted
Mode based on patient’s own
Set respiratory FiO respiratory rate)
rate 2
PEEP ● FiO2(amount of O2 being
delivered)
 Ventilator Settings

Positive End-Expiratory Pressure Oxygen Therapy

(PEEP)
● Pressure given in expiratory phase to ● Prolonged exposure to high levels of
prevent closure of the alveoli and allow oxygen can be toxic to the lungs
increased time for O2 exchange ● High FiO2 (>.5) can lead to atelectasis
● Used in pts who haven’t responded to ● Balancing act between FiO2 and PEEP
treatment and are requiring high amount
of FiO2
● PEEP will lower O2 requirements by
recruiting more surface area
● Normal PEEP is approximately 5cmH20.
Can be as high as 20cmH20
 Mode ventilator
Controlled Ventilation
● Ventilator meginiasiasi semua usaha
nafas, mengatur rate dan tidal volume
● Ventilator mem-BLOCK semua usaha
napas spontan
● Biasanya digunakan di setting OR
(paralyzed and sedated patients)
Assist Control (A/C)
● Ventilator tidak akan mem blok usaha
napas spontan dari pasien, bahkan
diberikan tambahan TV
● Mesin set pada minimum rate sehingga
apnea tidak akan terjadi meski tidak ada
usaha napas spontan dari pasien
● Kerugian: hiperventilasi, vent
dysynchrony, breath-stacking
Assist Control “Breath-
(A/C) Stacking”
 Mode ventilator

Synchronized Intermittent
Ventilation (SIMV)
● Mirip dengan mode A/C, tetapi pasien bisa
bernapas spontan diantara assisted
breaths
● Bisa menggunakan primary mode atau
ketika weaning mode
● Bisa menyebabkan low RR pada pasien
yang tidak memberikan napas spontan
 Mode ventilator

Pressured Support Ventilation

(PSV)
● Biasa juga disebut “spontaneous mode”
● Mesin memberikan pressure tambahan
● Pasien kontrol rate, tidal volume, dan
minute ventilation
● TV berubah-ubah
 Mode ventilator
Continous Positive Airway Pressure
(CPAP)
● Positive airway pressure diberikan pada
saat inspirasi dan ekspirasi
● Mesin men suplai oksigen
● Meningkatkan pertukaran gas
● Usaha napas spontan dari pasien
● Bisa juga diberikan secara non invasive
dengan menggunakan masker oksigen
terutama pada pasien yang sering
mengalami sleep apnea
Bi-Level Airway Pressure (BiPAP)
● Menggunakan masker bi-pap
● Mirip dengan CPAP (but can be set at one
pressure for inhalation and another for
exhalation)
● Biasa digunakan pda pasien sleep apnea,
maupun pasien CHF dan gagal napas
untuk pencegahan intubasi
Alarm

● Sekret
● Kinked tubing/malposition
ETT
● Pasien menggigit
tubing/fighting vent
● Water in tube/water
traping
● Bronchospasm
● Pneumothorax
● Decreased compliance
Consciousness Level

Consciousness can be
defined as a state of
awareness of self and
environment.

Terdapat 2 komponen
kesadaran: arousal &
cognition

Arousal RAS
Assessment
The AVPU scale
Alert, Verbal/Voice, Pain,
Unrensponsive

Glasgow Coma
Scale
E-4, V-5, M-5
Assessment
Assessment
Assessment