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Presentation On Ventilator Management

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0% found this document useful (0 votes)
190 views46 pages

Presentation On Ventilator Management

Uploaded by

sofiamansoor
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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MANAGING PATIENT ON

MECHANICAL
VENTILATION
Presented by Ms. Anny Amirali & Ms. Ambreen
Merchant Acknowledgement:
Ms. Rozina Somani
OBJECTIVE
2 S the end of presentation participant’s will be able
By
to Review the Anatomy and Physiology of

the respiratory system


 Identify causes of acute spontaneous ventilation
failure and indications for initiating mechanical
ventilation
 Discuss the basic terminologies related to
ventilator
 Define Invasive and non Invasive Ventilation
OBJECTIVE
3 S
 Describe types and modes of mechanical

 ventilation
List down trouble shootings related to
mechanical ventilation
 Describe Nursing care of patient on
mechanical ventilation
 Relate complications associated with
mechanical ventilation
 Explain methods for weaning patient from
mechanical ventilation
PHYSIOLOGY OF BREATHING
4

INSPIRATION
 The diaphragm lowers and flattens, the

intercostal muscle contracts lifting the chest


up and out to increase the size of chest cavity.
Subsequently, the intra pleural and the intra
alveolar pressure becomes negative in relation
to atmospheric pressure, air moves into the
lungs.
EXPIRATION
5

 Expiration is a process. Following


passive
inspiration, the diaphragm
and
muscle intercostal
relax and the lungs recoil. The recoil
generates positive alveolar pressure relative to
atmospheric pressure and air flow out of the
lungs.
GAS
EXCHANGE
The process of gas exchange consists of 4 steps
7
 VENTIALTION
Is the movement of gasses in and out of the alveoli.
 DIFFUSION OF O2 AND CO2

Occurs at the pulmonary capillary level


 OXYGENATED BLOOD TRANSPORTATION TO

THE LT SIDE OF THE HEART.


Oxygenated blood in the pulmonary capillary is
transported via pulmonary vein to Lt side of heart.
 DIFFUSION OF O2 AND CO2

Occurs at cellular level based on concentration gradient.


O2 enters the cell and CO2 leaves the cell.
WHAT IS MECHANICAL
VENTILATIOR?
A mechanical ventilator is a machine that
generates a controlled flow of gas into a
patient’s airways. Oxygen is received
from wall outlets, the gas is pressure
reduced and blended according to the
modes of ventilation.
CAUSES OF ACUTE
VENTILATION
9
FAILURE
 Neurological impairment

 Neuromuscular impairment

 Primary respiratory impairment

 Trauma to the chest wall

 Post cardiac arrest

 Post surgery
INDICATION
S
⚫ Chronic Obstructive Pulmonary Disease(COPD)
⚫ Clinical Deterioration
⚫ Respiratory Muscle Fatigue
⚫ Coma
⚫ Hypotension
⚫ Tachypnea or Bradypnea
⚫ Blood gases showing persistent hypoxemia
⚫ Acute partial pressure of carbon dioxide (PCO2) of
>50 mm Hg (36-44) with pH <7.25
⚫ Neuromuscular disease
Basic Terminologies of Ventilators

⚫ Tidal Volume: (Vt) :


The volume of air inspired or expired in a single
breath during regular breathing. Also called tidal
(about
air 500 ml)
⚫ Minute Volume (MV): volume of air inspired or
expired by a person from lungs in a minute.
⚫ Respiratory Rate (RR): The respiration rate is the
number of breaths a person takes per minute
⚫ Fraction of Inspired Oxygen (FiO2): The
percentage of oxygen in the air inhaled, either on
off the ventilator. FiO2 ranges are from 21% (e.g. in
or
room air) to 100% (e.g. pure oxygen)
Basic Terminologies of ventilators

⚫ IE Ratio: Duration of inspiration to duration of


expiration Rate: 1:2 to 1:1.5 unless inverse
ratio ventilation is desired

⚫ Peak Inspiratory Pressure: A measurement of


pressure in the lungs at the end of the inspiratory
phase of ventilation. It is reflected on the airway
pressure manometer of the ventilator.
Basic Terminologies of ventilators
 PEEP Positive End Expiratory Pressure (PEEP)
Positive pressure applied at the end of expiration of
ventilator breaths3–5 cm H2O

Sensitivity
Is used to determine the amount of effort needed to
initiate an assisted breath. It is normally set at 2cm of
H20.
TYPES OF MECHANICAL
VENTILATORS
NEGATIVE PRESSURE
VENTILATION
16
(Iron Lungs)

Muscle contracts and pull outwards as
well as the diaphragm pulling downward
to create a negative pressure in the thorax,
causing respiration to occur. It is non
invasive ventilation. first used in Boston
Children’s Hospital in 1928
POSITIVE PRESSURE
VENTIALTION
18


Most common method for ventilating
patient in acute care setting. Gases pushed
inside the lungs through ETT or TT
tubes. Higher pressure is generated
outside of the patient’s body. Positive
pressure is created in the pleural, alveolar
and thoracic regions.
OETT Tubes
CYCLING IN VENTILATOR
24

The ventilator providing support can be divided into

⚫ VOLUME CYCLED

⚫ PRESSURE CYCLED

⚫ CV = Controlled ventilation, without allowances for


spontaneous breathing.
MODES OF VENTILATION
VOLUME CONTROL
26 VENTILATION
It delivers preset Vt at a preset
respiratory rate. Is delivered to patients
having no respiratory efforts e.g.
◦ Chemically paralyzed patients
◦ Cervical spine injuries
◦ Head injuries
PRESSURE CONTROL
VENTIALTION

In pressure control, a pressure control breath


is delivered at a set rate. The tidal volume is
determined by the preset pressure limit.

Minimizes the threat of barotrauma


 Can be used safely in pediatric patients
ASSIST CONTROL
28 VENTIALTION
It delivers preset Vt when ever the patient exerts
negative Inspiratory effort or triggers the
ventilator. A preset rate ensures that patient
receives adequate set ventilation regardless of
spontaneous efforts..
This is used in patient with normal respiratory
drive who are unable to sustain a normal Vt.
SYNCHRONIZED INTERMITTENT
MANDATORY VENTILATION
29
(SIMV)
 This mode delivers preset volume at preset rate
and permits the patient to breath spontaneously
at his or her own rate and depth between
ventilator breaths. The preset breaths are
synchronized with the patient spontaneous effort
and help to prevent patient and ventilator
asynchrony.
 It is used as weaning mode.
CONTINOUS POSITIVE
AIRWAY PRESSURE
30
(CPAP)
 No mandatory breaths are delivered, all

ventilation is spontaneously initiated. A


base line pressure level (CPAP) is provided
constantly with intend to prevent alveolar
collapse.
NONINVASIVE VENTIALTION: BIPAP

31

⚫ BIPAP is a mode that can be used non


invasively to assist spontaneous ventilation.
BIPAP is essentially a CPAP generator that is
able to maintain two different levels of
pressure. It allows to set an inspiratory
positive airway pressure (IPAP), and an
expiratory positive airway pressure (EPAP).
NON INVASIVE VENTILATION
TROUBLE SHOOTINGS IN THE
34 VENTIALTION
 Patient biting the tube
 Water in ventilator tubing
 Kinked tubing
 Coughing as ventilator deliver breath
 Gagging or attempting to talk
CARE OF A PAITENT ON
MECHANICAL VENTIATLION
35
CARE OF A PAITENT ON
MECHANICAL
36 VENTIATLION
GENERAL SAFEY MEASURES

 Keep O2, functioning suctioning apparatus,


rebreathing or ambu bag at bed side all the time.
 Keep OETT/TT of same size at the bed side.
 Keep emergency drugs ready if patient condition is
unstable.
 Keep chest tube insertion equipment read
 Stethoscope should be available for routing or
emergency auscultation
ROUTINE
37 CARE
 Staff must be aware of the reasons for intubation so
that better care could be planned
 Educate patient and family reason of intubation and

mechanical ventilation
 Provide psychological support to patient and

family
 Check and document ventilator parameters q hrly

including mode, FIO2, Vt, peak and mean


airway pressure. I: E ratio may be available if
needed.
ROUTINE
38 CARE
 Assess and document Vital Sign every hourly.
 Patient O2 saturation should be maintained at more
than or equal to 90%.
 Auscultate chest at least once per shift and
document the findings
 Never leave patient unattended
 Never put the alarms off of monitor and
ventilator
ROUTINE
39 CARE
 Assess condition of OETT/ TT site for sore
or inflammation respectively
 Change OETT site if sore is observed
 Provide hygiene measures as per hospital
protocol
 Perform ROM exercise at least once per shift to
prevent DVT
ROUTINE CARE
40

⚫ Change OETT holder at least 48 hrly and as


needed considering all safety precaution.
⚫ Change TT dressing at least 24 hrly and
document condition of TT site
⚫ Change nebulization set every 72 hrly
⚫ Never try to reinsert the TT tube unless stoma
is matured and reinsertion is recommended.
Perform oral intubation
⚫ After each substantial change in ventilator
support, the patient should be observed for
clinical changes.
COMPLICATIONS OF MECHANICAL
VENTIALTION
41

PULMONARY SYSTEM

 Baro trauma
 Tracheal damage
 Damage to oral (Lip soars) and nasal mucosa
 Aspiration
 Infection
 ventilator dependence or inability to wean
WEANIN
42 G
 ASSESSMENT PARAMETERS INDICATING
READINESS TO WEAN
 UNDERLYING CAUSE FOR MECHANICAL
VENTILATION RESOLVED
🞑 Improved chest X ray
🞑 Minimal Secretion
🞑 Normal Breath Sounds
 HEMODYNAMIC STABILITY
🞑 Respiratory rate less than 25/min
🞑 Spontaneous Vt 4-5 ml/kg
 ADEQUATE ABG RESULTS WITHOUT
HIGH
FIO2/PEEP
WEANIN
43
 G OF CONCIOUSNESS;
ADEQUATE LEVEL
PROTECTIVE REFLEX INTACT (GAG)
 GOOD NUTRITIONAL STATUS AND
HYDRATION
 ABSENCE OF FACTORS THAT IMPAIR WEANING
🞑 Infection
🞑 Anemia
🞑 Fever
🞑 Electrolyte imbalance
🞑 Fatigue
🞑 Pain
🞑 Sleep deprivation
🞑 Abdominal distension
Reference
s
44

 Coyer.F.M,Wheller.M.K,(2007).Nursing care of the


Mechanically ventilated patient:What does the
evidence say.Intensive critical careNursing;23(2);71-
80
 Ferrer. R, Artiges. A. Clinical Review: Non-antibiotic
Strategies For Prevetning Ventilator Associated Pneumonia.
Critical care.2002; 6 (1): 45-51
 Sole. M. L, Lamborn. M. L, Hartshorn. J. C. (2001).
Introduction to critical care nursing (3rd Ed). Philadelphia:
W.B. Saunders.
Reference
s
45

⚫ Tortora. G.T. (2000). Principles of anatomy and physiology.


Philadelphia: John Wiley and Sons

⚫ Tasota.F.J,Dobbin.K,(2000). Weaning Your patient From


Mechanical Ventilation.Nursing ,30(10),41-49.

⚫ Urden.D.L,Stacy.M.K&Lough.E,.M (2006).Critical care


Nursing Diagnosis and Management.(5th Ed).Mosby.
Thank You

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