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CARE OF PATIENT ON VENTILATOR
Dr. Jayesh Patidar
(PhD, M.Sc. Nursing)
MECHANICAL VENTILATOR
Functions for below thorasic cage & diaphragm. It can maintain ventillation automatically for prolonged time. It is indicated in patient who unable to maintain safe level of oxygen or CO2 by sopntanous brathing even with assistantance.
INDICATIONS• Mechanical failure of ventilation 1. Neuromuscular disease
2. Central nervous system disease
3. CNS depression
4. Musculoskeletal disease
5. Thoracic malformation/ trauma
• Disorders of pulmonary gas exchange1. Acute respiratory failure
2. Chronic respiratory failure
3. Left ventricular failure
4. Pulmonary disease resulting in difusion or
perfusion abmornality
Mode DefinitionControl
Assist-Control
Intermittent Mandatory
Ventilation (IMV)
Synchronized Intermittent
Mandatory
Ventilation (SIMV).
Rate and volume of breaths are controlled
by the ventilator
All breaths are ventilator assisted and
deliver a preset tidal volume, including
spontaneous breaths.
Ventilations are delivered at a preset rate
and tidal volume. Spontaneous breaths
can occur at the patient's rate and tidal volume.
SIMV is synchronized with the patient's spontaneous breathing to reduce competition between spontaneous efforts and machine.
Volume- Cycled Modes of Ventilation
Cont………
Pressure Support Ventilation (PSV
Augments the patient's inspiratory effort with a
selected amount of inspiratory pressure. This
pressure is maintained throughout the inspiratory
cycle, allowing the patient to select rate, tidal volume,
And timing. May be used in conjunction with SIMV
and CPAP.
Positive End-Expiratory Pressure (PEEP)
PEEP is the addition of positive End-Expiratory
pressure to the airway at the end of Pressure (PEEP)
expiration;
Continuous
Positive Airway
Pressure (CPAP).
CPAP is spontaneous breathing with a fixed amount
of pressure applied to the airway throughout the
respiratory cycle
Mode Recommended UseControl Anesthetized or paralyzed patients with no
spontaneous respiratory efforts.
Assist - control Patient who are able to initiate spontaneous ventilations, but require greater tidal volume than they can generate.
Intermittent Mandatory Ventilation (IMV) Synchronized Intermittent Mandatory Ventilation (SIMV)
Patients who have spontaneous ventilations and
need ventilator support. Patients who can initiate
Spontaneous ventilations with adequate tidal
Volume but need a backup rate. Useful as a
weaning mode with some patients.
Pressure Support Ventilation (PSV)
Those who have a stable ventilator drive and
can generate enough negative airway pressure
(-20 to -25) to trigger the pressure support. Used
as weaning mode, to augment patient's
spontaneous efforts, and decrease the work of
breathing.
Cont………
Positive End-Expiratory
Pressure (PEEP)
Continuous
Positive Airway
Pressure (CPAP)
Increases FRC to decrease or prevent
alveolar collapse.
Trouble shoting alarams of ventilation
Display message
Possible Cause Remedy
HIGH CONTINOUS PRESSURE
CHECK TUBING
AIRWAYS PRESSURE TOO HIGH
Airway is higher than set PEEP plus 15 cm H2O for more than 15 sec.
Disconnected pressure transducer block pressure transducer Water in expiratory limb. Wet bacterial filter clogged bacterial filter.
Kinked/blocked tubing. Mucus or secretion plug in ETT or airways client coughing or fighting.
Check client, Check circuit Check ventilator setting and alarm limit.
Check ventilator internal replace filter, remove water from tubing Check heater wire. Refer to service.
Check client, Check ventilator setting and alarm limit.
Display message
Possible Cause Remedy
LIMITED PRESSURE
EXPRIED MINUTE VOLUME TOO HIGH
EXPRIED MINUTE VOLUME TOO LOW
Kinked/blocked Mucus in tubing coughing / fighting patient. Increased client activity ventilator auto cycling. Improver alarm setting low flow transducer.
Low spontaneous client breathing activity. Leakage in cuff. Improver alarm setting.
Check client, Check ventilator setting and alarm limit.
Check client Check trigger sencesitivity and alarm setting. Dry the flow transducer.
Check client cuff pressure circuit pause time and graphics.
Display message
Possible Cause Remedy
EXPRIED MINUTE VOLUME DISPLAY READS
APNEA ALARM
PEEP/CPAP & OR PLATEAV PRESSURE FAILS TO BE MAINTAIN
Flow transducer faulty Circuit disconnected from client
Time between two consecutive insperatory effort exceeds.
Adult : 20 sec.
Pead : 15 sec.
Neonate : 10 sec
Leakage in cuff and client circuit Improper alarm limit setting.
Replace flow transducer connect Y piece to client.
Check client and ventilator setting
Check cuff pressure Check client circuit check pause time and graphics to verify consider more ventilatory support .
Care at patient on ventilator :-
Endotracheal tube care
Feeding
Hygiene
Avoid bed sores by
Maintain patients safety
Records and reports
WEANING :- Weaning is the word used
to describe the process of gradually removing the patient from ventilator and restoring spontaneous breathing after a period of mechanical ventilator.
Criteria For Weaning Trial :-- Respiratory criteria :-
Minute ventilation < 15/Lmin
Respiratory rate < 38 breaths / min
Tidal volume > 325 ml
Max inspiratory pressure < -15 cm H2O
FiO2 < 50%
Other Criteria :-
Improvement, correction or stabilization of the active
disease process.
Nutritional and fluid balance maintained
Adequate physical strength & mental alertness.
Stable cardiovascular, renal & cerebral status.
Optimal level of alertness blood gases electrolytes, hemoglobin & other laboratory tests.
Steps of weaning :-
A B G Evaluation
CPAP mode
T- piece
Extubation :- Do suctioning Give chest physiotherapy & nebulization keep crash cart & Intubations tray ready Remove ETT, do suctioning & nebulization & oxygenation.
Non invasive ventilator if required.
Oxygen by mask.
Continue monitoring in each step.
COMPLICATIONS OF VENTILATION :-
i) Intubetion Realated :-Early :-
HypoxiaRight mainstem intubationOesophagal intubation Upper airway trauma Hypo-tension Aspiration
Late :-Cuff leak, sinusitisUpper airway stenosisSelf extubation
ii) Ventilator related :-• Disconnection• Malfunction
iii) Suctioning related :-HypoxemiaArrhythmias
iv) Ventilation related :-Nosocomial InfectionHomodynamic effectPneumothoraxOxygen toxicityRespiratory AlkalosisIncreased I.C.P.
NURSING MANAGEMENTInability to sustain spontaneous ventilation related to imbalance between ventilatory capacity ventilator demand. Impaired gas exchange and ineffective breathing pattern related to underlying disease process and artificial airways and ventilator system.Ineffective airways clearance related to cough and increased secretions formation in the lower tracheobronchial tree from ET tube.Anxiety related to dependence on CMV for breathing.High risk for complication of CMV and positive pressure ventilation (PPV). Risk for infection related to impaired primary defenses in respiratory tactAltered nutrition : Less than body requirements related to lack ability to eat while on ventilator and increased metabolic needs. Impaired verbal communication related to mute sate when ET tube is in place.Altered oral mucous membranes related to nothing by mouth (NPO) status.
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