Mechani
cal
ventilat
or
definiti
on It is a life-saving treatment supportive therapy
•
used to assist patients who are unable to maintain
adequate oxygenation &/or carbon dioxide
elimination
v Ventilator is Specially Designed Pump that
improve:
v Ventilation
v Oxygenation
v Lung Mechanics
v Patient comfort while preventing complications
Goals:
Decrease • Decrease Work of Breathing
• Increase Alveolar
Increase Ventilation
• Maintain ABGs values
Maintain within normal range
• Improve Distribution of
Improve Inspired Gases
Possible Events Leading to respiratory
failure (use MV)
Nervous system Head trauma Cervical (C1–C6) fractures Overdose
Muscular system Myasthenia gravis
(Primary—diaphragm) (Secondary— Guillain-Barré
respiratory)
Skeletal system Flail chest , Kyphoscoliosis
Respiratory system Obstruction, Airways Laryngeal edema, Bronchitis,
Asthma
Alveoli Emphysema, Pneumonia, Fibrosis
Pulmonary circulation Pulmonary embolus
Cardiovascular system Congestive heart failure Fluid overload Cardiac surgery
Myocardial infarction
Types of MV:
1. 1.Negative Pressure Ventilators:
(Mimic Spontaneous Breaths)
Applied externally to decrease
atmospheric pressure surrounding
the thorax to initiate inspiration
2. Ex: Iron Lung
3. 2.Positive pressure ventilator:
Creates positive intrapleural pressure in
presence of atmospheric extra thoracic
pressure
MV
parts:
Parameters Tidal volume: (tV)
• Is the amount of air delivered to the patient with
on each ventilator breath
ventilator: • TV is only set for volume-controlled modes of
ventilation
• Setting:
• TV is based on patient’s ideal body weight (IBW)
• Normal tidal volume is between 10 & 12 ml/kg of
IBW
• Large TV can cause ventilator-induced lung
injury (Volutrauma )
Parameters Fraction of Inspired O2 (FIO2)
on Ø Is the percentage of oxygen delivered to the
ventilator: patient
Ø Oxygen fraction concentration that ranges 21%
to 100%
Ø The usual goal is to use the minimum Fio2
required to have a PaO2 > 60 mm Hg or O2
saturation >90%
Ø Long-term toxicity at >60%
Positive End-Expiratory Pressure (PEEP)
Paramete • Pressure given in expiratory phase to prevent
closure of the alveoli & allow increased time for O2
rs on MV: exchange
• It is added to increase functional residual capacity
(FRC) & allow for a decrease in the FiO2
• Therapeutic PEEP usually ranges from 10-30cm
H2O in adults
• Improves oxygenation & gas exchange
• Diminishes the Works of breathing
Respiratory Rate (RR)
Paramete • The number of breaths delivered each
rs on MV: minute.
• The set Ventilatory rate is the minimum
number of breaths delivered to the
patient per minute
• Usually 12-14/min may be increased or
• decreased as indicated by arterial
CO2levels
v Volume Ventilation: Volume is
constant (pre set) & pressure will vary
with patient’s lung compliance
v Pressure Ventilation: Pressure is
constant (pre ser) & volume will vary
with patient’s lung compliance
Volume vs.
Pressure
Ventilation
Modes of • Assist-Control(A/C)
Ventilation
• Controlled Mandatory Ventilation(CMV)
• Synchronized Intermittent M&atory Ventilation (SIMV)
• Continuous Positive Airway Pressure (CPAP)
• Bi-Level Positive Airway Pressure
(BiPap)
• Breath initiated by patient unless rate falls below
selected respiratory rate
• Each breath’s pressure or volume is preset
Most commonly used
Assist-
•
• If the client does not trigger breath, ventilator will
deliver breath
Control • The actual respiratory rate is equal to the A/C rate plus
any patient-triggered breaths per minute
• All breaths in the assist-control mode receive the same
FiO2 & tidal volume
• Disadvantage:
• inc Respiratory rate > Hyperventilation > Respiratory
Alkalosis
A/C mood
• CMV completely controls the patient’s ventilation
• It “locks out” the patients own spontaneous efforts at
breathing
Controlled • The rate that is set on the ventilator is exactly what the
patient receives & no more
Mandatory
Ventilation(CMV) • CMV mode is used for patients who are
(pharmacologically paralyzed, comatose, brain death,
severe ICP, muscle paralysis)
• The major disadvantage of CMV mode is that it is not
synchronized with the efforts of the patient
• Must use sedatives, neuromascular blockers
CMV
• The patient may also draw spontaneous breaths in-
between mandatory breaths
Synchronize
d • Spontaneous breaths utilize the set air/oxygen mix
(FiO2). Unlike A/C, breaths that the patient takes
Intermittent Spontaneously do not trigger or cycle the
ventilator
M&atory
Ventilation • A mandatory breath delivered too soon after a
spontaneous one
(SIMV)
• Suitable for weaning.
Continuous Positive
Airway Pressure
(CPAP) § Patient’s own spontaneous
respirations
§ Requires intubation or tight fitting
mask
§ Maintains positive pressure during
the entire respiratory cycle (5-15 cm
H2O)
Bi-Level Positive Airway Pressure
(BiPap)
• Non-invasive ventilation
• airway pressure strategy that applies independent
positive airway pressure to both inspiration &
expiration
• Initial settings of IPAP & EPAP are 8cm & 4cm of H2O
respectively
• Set IPAP to obtain level of pressure support
• - Improve Ventilation
• Set EPAP to obtain level of CPAP
• - Improve Oxygenation
SUMMAR
Y:
Complication:
• *1*Ventilator-associated pneumonia (VAP)
• a new infection of the lung parenchyma that develops within 48 hours after
intubation
• Put pt on semi fowler position.
• *2*(barotrauma, volutrauma)
• refers to rupture of the alveolus with subsequent entry of air into the pleural space
(pneumothorax)> chest tube.
• *3*Oxygen toxicity >>> can lead to mild tracheobronchitis and absorptive
atelectasis
• Keep FIO2 60% and less during 24hr, then even lower
withdrawing the patient from
dependence on the ventilator.
Begin during the daytime
Weaning: Place the patient in an upright
position.
stop sedation
correct acid-base disturbance
Weaning
• GENERAL REQUIREMENTS (‘WEAN SCREEN’)
lung disease is stable/ resolving
low FiO2 (< 0.5) and PEEP (< 5-8cmH2O) requirement
haemodynamic stability (little to no vasopressors)
able to initiate spontaneous breaths (good neuromuscular function)
• Discontinue weaning if:
PH<7.3, PCO2>50torrs , PO2 < 60torrs.
The patient becomes anxious , fatigued.
Arrhythmias , homodynamic deterioration.
care for ventilated patient:
• Check placement by: Auscultate for bilateral breath sounds and observe for symmetrical chest
expansion.
• Suctioning/Oral care
• Assess the patient’s peripheral circulation for decreased cardiac output. (WHY?)
pulse oximetry reflects the arterial oxygen saturation.
• Be sure that ventilator alarms are on at all times .
• Administer a sedative to relax the patient.
• Covering and lubricating eyes.
• Provide emotional support.
• ABGs every 30min at first hr. Then every 4hr or as needed.
• VS.
THANK YOU
BY TEACHER. RAHAF GHARABAH
