January 2019

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Caring for the Mechanically Ventilated Patient

Mechanical ventilation is utilized in intensive care and long-term care settings to assist patients
who require additional respiratory support. This handy reference guide provides critical patient
care essentials, tips for trouble-shooting ventilator alarms, and potential complications.

Care Essentials for Patients on Mechanical Ventilation

• Maintain a patent airway. Per policy, note endotracheal (ET) tube position (centimeters)
and confirm that it is secure.
• Assess oxygen saturation, bilateral breath sounds for adequate air movement, and
respiratory rate per policy.
• Check vital signs per policy, particularly blood pressure after a ventilator setting is
changed. Mechanical ventilation increases intrathoracic pressure, which could affect
blood pressure and cardiac output.
• Assess patient’s pain, anxiety and sedation needs and medicate as ordered.
• Complete bedside check: ensure suction equipment, bag-valve mask and artificial airway
are functional and present at bedside. Verify ventilator settings with the prescribed
orders.
• Suction patient only as needed, per facility policy; hyperoxygenate the patient before
and after suctioning and do not instill normal saline in the ET tube; suction for the
shortest time possible and use the lowest pressure required to remove secretions.
• Monitor arterial blood gas (ABG) after adjustments are made to ventilator settings and
during weaning to ensure adequate oxygenation and acid-base balance.
• To minimize the risk for ventilator-associated pneumonia (VAP), implement best
practices such as strict handwashing; aseptic technique with suctioning; elevating head
of bed 30-45 degrees (unless contraindicated); providing sedation vacations and
assessing patient’s readiness to extubate; providing peptic ulcer disease prophylaxis;
providing deep vein thrombosis prophylaxis; and performing oral care with
chlorhexidine, per your facility policy.

VENTILATOR ALARMS
Alarm Potential Causes Interventions
High Peak Inspiratory Pressure • Blockage of ET tube • Assess lung sounds.
(PIP) (secretions, kinked tubing, • Suction airway for
patient biting on ET tube) secretions.
• Coughing • Insert bite block or
• Bronchospasm administer sedation
• Lower airway obstruction per orders if patient is
• Pulmonary edema agitated or biting on
• Pneumothorax ET tube.
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• Ventilator/patient • Assess breath sounds

dyssynchrony for increased
consolidation,
wheezing, and
bronchospasm; treat
as ordered.

Low Pressure Alarm • Air leak in ventilator circuit • Locate leak in

or in the ET tube cuff ventilator system.
• Check pilot balloon as
an indicator of ET tube
cuff failure.
• Replace tubing as
needed, per policy.
Low Minute Ventilation • Low air exchange due to • Check for
shallow breathing or too disconnection or leak
few respirations in the system.
• Assess patient for
decreased respiratory
effort.
Low O2 Saturation (SpO2) • Pulse oximeter • Ensure ventilator
malpositioned oxygen supply is
• SpO2 cable unplugged connected.
• Ensure pulse oximeter
is positioned correctly.
• Verify all cables are
plugged in.
• Assess patient for
respiratory distress.
Apnea • Breaths are not being • Assess patient effort.
taken by the patient or • Check system for
triggered on the ventilator disconnections.

COMPLICATIONS RELATED TO MECHANICAL VENTILATION

Patient Complication Potential Causes Interventions
Cardiovascular issues • Decrease in venous return • Assess for adequate
to the heart due to volume status by
positive pressure applied checking heart rate,
to the lungs. blood pressure,
central venous
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pressure and urine

output.

Barotrauma/Pneumothorax • Positive pressure applied • Notify healthcare

to lungs. provider.
• Elevated mean airway • Prepare patient for
pressures may rupture possible chest tube
alveoli. insertion.
• Avoid high pressure
settings for patients
with chronic
obstructive
pulmonary disease
(COPD), acute
respiratory distress
syndrome (ARDS), or
history of
pneumothorax.
Infection • Breaks in ventilator circuit. • Use aseptic technique.
• Decreased mobility. • Provide frequent
• Impaired cough reflex. mouth care.
• Support proper
nutritional status.

References:
Courey, A., Overview of mechanical ventilation. UpToDate. Retrieved from
https://www.uptodate.com/contents/overview-of-mechanical-ventilation

Han, M. Management and prognosis of patients requiring prolonged mechanical ventilation. UpToDate. Retrieved
from https://www.uptodate.com/contents/management-and-prognosis-of-patients-requiring-prolonged-mechanical-
ventilation

Kane, C., & York, N. (2012). Understanding the Alphabet Soup of Mechanical Ventilation. Dimensions of
Critical Care Nursing, 31(4), 217-222. doi: 10.1097/DCC.0b013e318256e2fd

Miller, N. (2013). Set the Stage for Ventilator Settings. Nursing Made Incredibly Easy. 11(3), 44–52. doi:
10.1097/01.NME.0000428429.60123.f7