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Mechanical ventilation 2

Mechanical ventilation

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Mechanical ventilation 2

  1. 1. PRESENTED BY THARA NOEL 1 Year MSc Nursing Student Lourdes college of Nursing Chembumukku
  2. 2.  Mechanical ventilation is ventilation of the lungs by artificial means usually by a ventilator. A ventilator delivers gas to the lungs with either negative or positive pressure
  3. 3. To improve ventilation To improve tissue oxygenation To decrease work of breathing To improve patient’s comfort
  4. 4. Acute respiratory Failure Prophylactic ventilatory support Hyperventilation Therapy
  5. 5. POSITIVE PRESSURE VENTILATOR  Volume cycled ventilator Pressure cycled Ventilator  Time cycled Ventilator NEGATIVE PRESSUR VENTILATOR Iron Lung
  6. 6.  The iron lung also known as the Drinker and Shaw tank, was developed in 1929  It was refined and used in the 20th century largely as a result of the polio epidemic that struck the world in the 1940s.
  7. 7.  The machine is, in effect, a large elongated tank, which encases the patient up to the neck. The neck is sealed with rubber gasket so that the patient's face (and airway) are exposed to the room air.
  8. 8.  In the iron lung by means of a pump, the air is withdrawn mechanically to produce a vacuum inside the tank, thus creating negative pressure. This negative pressure leads to expansion of the chest, which causes a decrease in intrapulmonary pressure, and increases flow of ambient air into the lungs.  As the vacuum is released, the pressure inside the tank equalizes to that of the ambient pressure, and the elastic coil of the chest and lungs leads to passive exhalation.
  9. 9.  Fraction of inspired oxygen (FIO2)  Tidal Volume (VT)  Peak Flow/ Flow Rate  Respiratory Rate/ Breath Rate / Frequency ( F)  Minute Volume (VE)  I:E Ratio (Inspiration to Expiration Ratio)  Sigh
  10. 10.  The percent of oxygen concentration that the patient is receiving from the ventilator. (Between 21% & 100%) (room air has 21% oxygen content).  Initially a patient is placed on a high level of FIO2 (60% or higher).  Subsequent changes in FIO2 are based on ABGs and the SaO2.
  11. 11.  The volume of air delivered to a patient during a ventilator breath.  The amount of air inspired and expired with each breath.  Usual volume selected is between 5 to 15 ml/ kg body weight)
  12. 12.  The speed of delivering air per unit of time, and is expressed in liters per minute.  The higher the flow rate, the faster peak airway pressure is reached and the shorter the inspiration;  The lower the flow rate, the longer the inspiration.
  13. 13.  The number of breaths the ventilator will deliver/minute (10-16 b/m).  Total respiratory rate equals patient rate plus ventilator rate.
  14. 14.  The volume of expired air in one minute .  Respiratory rate times tidal volume equals minute ventilation VE = (VT x F)  In special cases, hypoventilation or hyperventilation is desired
  15. 15.  The ratio of inspiratory time to expiratory time during a breath (Usually = 1:2)
  16. 16.  Sigh is a deep breath that has a greater volume than the tidal volume.  It provides hyperinflation and prevents atelectasis.  Sigh volume :------------------Usual volume is 1.5 –2 times tidal volume.  Sigh rate/ frequency :---------Usual rate is 4 to 8 times an hour.
  17. 17.  The way the machine ventilates the patient  How much the patient will participate in his own ventilatory pattern.  Each mode is different in determining how much work of breathing the patient has to do.
  19. 19. Continuous mandatory Ventilation Assist control /Intermittent Mandatory Ventilation  Synchronized Intermittent mandatory ventilation
  20. 20.  Ventilation is completely provided by the mechanical ventilator with a preset tidal volume, respiratory rate and oxygen concentration  Ventilator totally controls the patient’s ventilation i.e. the ventilator initiates and controls both the volume delivered and the frequency of breath.  Client does not breathe spontaneously.  Client can not initiate breathe
  21. 21.  The ventilator provides the patient with a pre-set tidal volume at a pre-set rate .  The patient may initiate a breath on his own, but the ventilator assists by delivering a specified tidal volume to the patient. Client can initiate breaths that are delivered at the preset tidal volume.  Client can breathe at a higher rate than the preset number of breaths/minute
  22. 22.  The total respiratory rate is determined by the number of spontaneous inspiration initiated by the patient plus the number of breaths set on the ventilator.  In A/C mode, a mandatory (or “control”) rate is selected.  If the patient wishes to breathe faster, he or she can trigger the ventilator and receive a full- volume breath.
  23. 23.  Often used as initial mode of ventilation  When the patient is too weak to perform the work of breathing (e.g., when emerging from anesthesia).
  24. 24.  The ventilator provides the patient with a pre-set number of breaths/minute at a specified tidal volume and FiO2.  In between the ventilator-delivered breaths, the patient is able to breathe spontaneously at his own tidal volume and rate with no assistance from the ventilator.  However, unlike the A/C mode, any breaths taken above the set rate are spontaneous breaths ..
  25. 25.  The tidal volume of these breaths can vary drastically from the tidal volume set on the ventilator, because the tidal volume is determined by the patient’s spontaneous effort.  The ventilator detects the patient’s spontaneous breathing, and waits until the patient exhales before delivering another mechanical breath.  Ventilators breaths are synchronized with the patient spontaneous breathe. ( no fighting)
  26. 26.  Used to wean the patient from the mechanical ventilator.  Weaning is accomplished by gradually lowering the set rate and allowing the patient to assume more work
  27. 27. 1. Pressure-controlled ventilation (PCV) 2. Pressure-support ventilation (PSV) 3. Positive end expiratory pressure (PEEP) 4. Continuous positive airway pressure (CPAP) 5. Noninvasive bi-level positive airway pressure ventilation (BiPAP)
  28. 28. 6. Airway pressure release ventilation(APRV) 7. Volume assured pressure support ventilation 8.High frequency oscillatory ventilation.
  29. 29.  In Pressure Control Ventilation (PCV), the ventilator generates the preset pressure during a preset inspiratory time at the preset respiratory rate. The pressure is constant during the inspiratory time and the flow is decelerating.
  30. 30.  Spontaneous mode of ventilation. The patient initiates every breath and ventilator delivers support with the preset pressure value. With support from the ventilator, the patient also regulates his own respiratory rate and tidal volume.
  31. 31. Pressure support ventilation augments patient’s spontaneous breaths with positive pressure boost during inspiration i.e. assisting each spontaneous inspiration.
  32. 32. Positive pressure applied at the end of expiration during mandatory/ ventilator breath.It Prevent atelactasis or collapse of alveoli and Improve gas exchange & oxygenation. PEEP refers to devices that impose positive pressure only at the end of the exhalation
  33. 33.  Form of positive airway pressure ventilator, which applies mild air pressure on a continuous basis to keep the airways continuously open in people who are able to breathe spontaneously on their own. It is an alternative to positive end- expiratory pressure(PEEP).
  34. 34.  Both modalities stent the lungs' alveoli open and thus recruit more of the lung's surface area for ventilation. CPAP devices apply continuous positive airway pressure throughout the breathing cycle. CPAP can be used for both intubated and non intubated patients.
  35. 35.  BiPAP is a noninvasive form of mechanical ventilation provided by means of a nasal mask or nasal prongs, or a full-face mask with inspiration and exhalation pressures above atmospheric levels .
  36. 36. The system allows the clinician to select two levels of positive- pressure support:  An inspiratory pressure support level (IPAP)  An expiratory pressure called EPAP
  37. 37. APRV is a pressure control mode of mechanical ventilation that utilizes an inverse ratio ventilation strategy. IRV is a strategy of ventilating the lungs in such a way that the amount of time the lungs are in inhalation is greater than the amount of time they are in exhalation, allowing for a constant inflation of the lungs. The exhalation time is shortened usually to less than one second to maintain alveoli inflation.
  38. 38.  VAPS (Volume Assured Pressure Support) Breaths start out as Pressure Supported ,pressure added to each spontaneous breath, but as inspiratory flow begins to decrease, the ventilator checks the delivered volume against a Target Vτ that the clinician has set.
  39. 39. A unique mode of mechanical ventilation that uses non conventional gas exchange mechanism to deliver ventilation at very low tidal volume and high breathing frequencies(200-900).
  40. 40.  A humidified mixture of air and oxygen flows continuously across the ventilator circuit, with an initial pressure of approximately 35 pounds per square inch , a respiratory rate of 100 to 150 breaths per minute and an inspiratory fraction less than 40 percent .  At the same time, gas flowing out of the circuit crosses a low-pass filter. A valve on the outflow limb controls the outgoing flow rate.
  41. 41.  Mean airway pressure is increased by increasing the resistance to expiratory flow.  High-frequency oscillations are generated by a piston-driven pump that actively pushes gas into the circuit during the inspiratory phase and actively pulls gas out of the circuit during the expiratory phase.
  42. 42.  keeping the lung inflated for extended period of time to maximize alveolar recruitment and gas exchange.  HFV uses very high breathing frequencies (120-900 breaths/min) coupled with very small tidal volumes
  43. 43.  ILV is ventilating the left and right lungs selectively for managing unilateral lung disease or injury in patients who have failed conventional modes of mechanical ventilation
  44. 44.  Weaning is the process of decreasing the amount of support that the patient receives from the mechanical ventilators and the patient assumes a greater proportion of the ventilator effort.
  45. 45.  T-Piece Trial  Continuous positive airway pressure weaning  Synchronized intermittent mandatory ventilation weaning  Pressure support ventilation weaning
  46. 46.  Awake and alert  Hemodynamic ally stable, adequately resuscitated, and not requiring vasoactive support  Arterial blood gases (ABGs) normalized or at patient’s baseline - PaCO2 acceptable - PH of 7.35 – 7.45 - PaO2 > 60 mm Hg , - SaO2 >92% - FIO2 ≤40%
  47. 47.  Chest x-ray reviewed for correctable factors; treated as indicated,  Major electrolytes within normal range,  Hematocrit >25%,  Core temperature >36°C and <39°C,  Adequate management of pain/anxiety/agitation,  Adequate analgesia/ sedation (record scores on flow sheet),  No residual neuromuscular blockade.
  48. 48. I- Airway Complications, II- Mechanical complications, III- Physiological Complications, IV- Artificial Airway Complications.
  49. 49. 1- Aspiration 2- Decreased clearance of secretions 3- Nosocomial or ventilator-acquired pneumonia
  50. 50. 1- Hypoventilation with atelectasis with respiratory acidosis or hypoxemia. 2- Hyperventilation with hypocapnia and respiratory alkalosis 3- Barotraumas a-Pneumothorax b- Subcutaneous emphysema c- Pneumomediastinum, . 4- Alarm “turned off” 5- Failure of alarms or ventilator 6- Inadequate nebulization or humidification 7- Overheated inspired air, resulting in hyperthermia
  51. 51. 1- Fluid overload with humidified air and sodium chloride (NaCl) retention. 2- Depressed cardiac function and hypotension 3- Stress ulcers 4- Paralytic ileus 5- Gastric distension
  52. 52. 1- Tube kinked or plugged 2- Rupture of piriform sinus 3- Tracheal stenosis or tracheomalacia 4- Mainstem intubation with contra lateral lung atelectasis 5- Cuff failure 6- Sinusitis 7- Otitis media 8- Laryngeal edema
  53. 53. 1- Acute hemorrhage at the site 2- Air embolism 3- Aspiration 4- Tracheal stenosis 6- Failure of the tracheostomy cuff 7- Laryngeal nerve damage 8- Obstruction of tracheostomy tube 9- Pneumothorax 10- Subcutaneous and mediastinal emphysema 11- Swallowing dysfunction 12- Tracheoesophageal fistula 13- Infection 14- Accidental decannulation with loss of airway
  54. 54.  Impaired spontaneous ventilation  Ineffective airway clearance  Anxiety related to unknown outcome  Deficient knowledge  Risk for complications related mechanical ventilation.
  55. 55. 1-Maintain airway patency & oxygenation 2- Promote comfort 3- Maintain fluid & electrolytes balance 4- Maintain nutritional status 5- Maintain urinary & bowel elimination 6- Maintain eye , mouth and cleanliness and skin integrity 7- Maintain mobility/ musculoskeletal function
  56. 56. 8- Maintain safety 9- Provide psychological support 10- Facilitate communication 11- Provide psychological support & information to family 12- Responding to ventilator alarms /Troublshooting ventilator alarms 13- Prevent nosocomial infection 14- Documentation