Ventilator alarms are critical safety features

in mechanical ventilation that are designed to

alert healthcare professionals to changes in
patient status or device function that may
require immediate attention
it play a pivotal role in ensuring patient safety
by monitoring for conditions such as low
oxygen levels, high pressure, and
disconnections
•High Priority Alarms: Indicate immediate threats to patient
safety, such as apnea, high pressure, and disconnections. These
require urgent attention.
•Medium Priority Alarms: Warn of conditions that could
potentially harm the patient if not addressed promptly, like low or
high PEEP and low battery.
•Low Priority Alarms: Include informational alerts that do not
directly threaten patient safety but signify issues needing eventual
correction, such as maintenance reminders.
 HIGH PRESSURE
A high ALARM
pressure alarm in mechanical ventilation is triggered
whenever the circuit pressure exceeds a preset limit during the
inspiratory phase of breathing. Typically, this preset high
pressure limit is set approximately 10 cmH2O above the peak
inspiratory pressure (PIP).

The high pressure alarm is common in patients with

respiratory conditions that lead to decreased lung compliance
or increased airway resistance.
 CAUSES:

Coughing
Accumulation of secretions
Biting the endotracheal tube
Kinking in the circuit or artificial airway
Impingement of the endotracheal tube against
the carina
Herniation of the endotracheal tube cuff
 TROUBLESHOOTIN
G
•Perform endotracheal suctioning if indicated.
•Insert a bite block or pharyngeal airway to prevent the patient
from biting the tube.
•Check for and rectify any kinks in the circuit or artificial
airway.
•Administer a bronchodilator to relieve bronchospasm.
•Reposition the endotracheal tube if it is not correctly placed.
•Check for and remove any water in the circuit.
•Evaluate and address patient-ventilator asynchrony.
•Inspect for a malfunction of the inspiratory or expiratory
valves.
 LOW PRESSURE ALARM
A low pressure alarm in mechanical ventilation is
triggered whenever the peak inspiratory pressure
(PIP) decreases below a preset level. This most
commonly occurs due to a leak or disconnection in
the system.
The preset low pressure level for this alarm is
typically set around 5-10 cmH2O below the PIP.
 TROUBLESHOOTING
•Check for a leak or disconnection in the circuit.
•Inspect the exhalation valve for leaks.
•Ensure all connections are secure and tight.
•Examine the pilot balloon for leaks.
•Verify that the endotracheal tube is correctly
positioned.
•Ensure the endotracheal tube cuff is adequately
inflated.
•Adjust the ventilator settings as necessary.
Note: If this alarm is triggered, the nurse
/respiratory therapist must promptly ensure that the
patient is being ventilated adequately. If the cause
of the alarm is unknown, the patient should be
manually ventilated until the source of the leak is
identified.
 LOW volume ALARM
A low volume alarm in mechanical ventilation is
triggered whenever the expiratory volume falls
below a preset low volume threshold. This alarm
ensures that the patient is receiving and exhaling a
minimum tidal volume.
 TROUBLESHOOTING
•Checking for leaks or disconnections in the circuit.
•Inspecting the exhalation valve for leaks.
•Ensuring all connections are secure.
•Examining the pilot balloon for leaks.
•Verifying that the endotracheal tube is correctly
positioned.
•Ensuring the endotracheal tube cuff is adequately
inflated.
•Adjusting the ventilator settings as necessary.
Note: If a leak or disconnection is detected, the
nurse/respiratory therapist must promptly ensure that the
patient is adequately ventilated. Manual breaths should be
provided if necessary until the source of the problem is
identified and corrected.
 High frequency ALARM
A high frequency alarm in mechanical ventilation is triggered
whenever the total breathing frequency exceeds a preset high
frequency limit. This alarm aids in preventing tachypnea and
hyperventilation.

This alarm may sound due to auto-triggering from an incorrect

sensitivity setting or as an indication of respiratory distress in the
patient. In such cases, identifying and correcting the cause promptly
is crucial.
Adjust the sensitivity setting to prevent false triggers.
Perform endotracheal suctioning if secretions are likely
causing increased respiratory effort.
Increase the level of pressure support to ease the patient’s
work of breathing.
Increase the inspiratory flow setting to meet the patient’s
demand.
Adjust the FiO2 (fraction of inspired oxygen) setting to ensure
adequate oxygenation.
Administer pain or anxiety medication as indicated to manage
underlying causes of increased respiratory rate.
 Apnea ALARM
An apnea alarm in mechanical ventilation is triggered
whenever the breathing frequency falls below a preset low
frequency limit. This alarm ensures that the patient receives a
minimum number of breaths.
Most ventilators are equipped with a preset apnea period,
typically around 20 seconds. However, some ventilator models
allow the operator to adjust this time limit to suit the
patient’s needs better.
The apnea alarm is most commonly triggered by a
disconnection of the circuit from the endotracheal tube.
Check for leaks or disconnections in the circuit.
Inspect for leaks or disconnections in the artificial
airway.
Increase the amount of ventilator support to assist the
patient’s breathing efforts.
Adjust the sensitivity setting to ensure the ventilator
responds appropriately to the patient’s breathing
attempts.
Note: Should this occur, the nurse/respiratory
therapist must immediately ensure the patient is
ventilated by delivering manual breaths until the
source of the disconnection is identified and
corrected.
 HIGH PEEP
ALARM
A high PEEP alarm in mechanical ventilation is
triggered whenever the level of PEEP exceeds a
preset high limit. This alarm helps ensure that the
patient is not subjected to excessive PEEP, which
could be harmful.
The high PEEP alarm is most commonly
triggered by auto-PEEP or air trapping, a
condition where positive pressure persists
in the alveoli at the end of the exhalation
phase. This can increase the patient’s work
of breathing and potentially lead to
respiratory distress.
Prolong the patient’s expiratory time to reduce the buildup of
auto-PEEP.
Review ventilator settings to ensure they are appropriate for the
patient’s current condition.
Check for and correct any factors that may contribute to
increased airway resistance or decreased lung compliance, similar
to those that trigger a high-pressure alarm.

Note: These measures aim to alleviate the underlying causes of high

PEEP, thereby reducing the risk of respiratory distress and improving
patient comfort.
 Low PEEP ALARM
A low PEEP alarm in mechanical ventilation is
triggered when the level of PEEP falls below a
preset low limit.

This alarm ensures that the patient receives the

desired level of PEEP, which is crucial for
maintaining open alveoli and improving
oxygenation.
The low PEEP alarm is most commonly triggered by leaks in
the circuit tubing or the endotracheal tube cuff. As such, this
alarm may be caused by similar issues that lead to low
pressure/volume alarms.

Another potential cause for a low PEEP alarm is the patient’s

active inspiration, which can lower the positive end-
expiratory pressure level below the preset alarm threshold.

This scenario may occur if the inspiratory flow setting does

not meet the patient’s inspiratory demand, causing an
unintended drop in PEEP.
 Inspect and ensure the integrity of the circuit
tubing and endotracheal tube cuff to identify
and fix any leaks.
 Adjust the inspiratory flow setting to better
match the patient’s inspiratory effort,
ensuring the desired PEEP level is
maintained throughout the breathing cycle.
 General Troubleshooting Tips
•Assess the Patient First: Before adjusting ventilator settings,
always assess the patient’s clinical status and ensure their airway is
clear and secure.
•Check Ventilator Settings: Verify that the ventilator settings are
appropriate for the patient’s current condition.
•Inspect the Equipment: Regularly inspect the ventilator and its
accessories for any signs of malfunction or disconnection.
•Educate the Staff: Ensure that all staff members are familiar with
the ventilator’s alarms and know the initial steps for
troubleshooting.
Note: Timely and effective troubleshooting of
ventilator alarms is crucial in ensuring the
safety and well-being of patients requiring
mechanical ventilation.