Settings Use and Maintenance of Mechanical Ventilator - Nursing

2. Mechanical ventilation is defined as the use
of a mechanical device to assist the
respiratory muscles in the work of
breathing and to improve gas exchange.

3.  Helps to gain control over the airway and over the work of breathing.
 Replaces the work of exhausted or temporarily inadequate respiratory
muscles.
 Allows large doses of narcotic analgesics or neuromuscular blocking agents
to be used where clinically indicated.
 The physiologic benefit of mechanical ventilation are reversal of gas
exchange abnormalities, alteration of pressure-volume relationships in the
respiratory system, and reduction in the work of breathing.

4.  Acute Respiratory Distress Syndrome
 Type I and Type II Respiratory Failure
 General Anasthesia
 Bradypnea or Apnea with Respiratory
Arrest
 Respiratory Muscle Weakness
 Cardiac Arrest
 Sedation or Paralysis for a
procedure
 Respiratory Acidosis
 Severe Hypoxia

5. INVASIVE
NON
INVASIVE

6. INVASIVE

7. NON
INVASIVE

8. AMBU Bag Cardiac Monitor Suction Equipment

9. Oxygen Source Stethoscope Ventilator Circuit

10. Bain Circuit Universal Precaution
Equipment
Mechanical
Ventilator

11.  Fraction of inspired oxygen (FiO2): It is the amount of oxygen delivered to
the patient. It is adjusted to maintain O2 saturation of >90%.
 Respiratory rate (RR): It is the number of breaths/min.
 Tidal volume (TV): It is the amount of air delivered with each ventilator
breath. It is usually set at 6-8 mL/kg.

13.  Positive End Expiratory Pressure (PEEP): It is the pressure maintained in
lungs at end of expiration. It is used to improve oxygenation by opening
collapsed alveoli, improving ventilation/perfusion,increasing oxygenation. It
can be used to reduce the FiO2.
 Peak Inspiratory Pressure (PIP): PIP value is used to set high and low
pressure alarms. The increased PIP may indicate decreased lung compliance
or increased lung resistance.

15.  I:E ratio refers to the ratio of inspiratory time:expiratory time. In normal
spontaneous breathing, the expiratory time is about twice as long as the
inspiratory time.
 Minute Volume (MV): Volume of gas the ventilator will deliver to the patient
in one minute. Minute volume = respiratory rate x tidal volume. Example:
RR 10 x 600 ml TV = 6 liter MV

17. MODES OF VENTILATOR
Controlled
Modes
Volume
Control (VCV)
Pressure
Control (PCV)
Supported
Modes
Pressure
Support (PSV)
Volume
Support (VSV)
Combination
Modes
SIMV
(VCV+PSV)
SIMV
(PCV+PSV)

18.  Tidal volume is preset
 Breaths are delivered at a preset frequency/rate
 Pressure is variable throughout the delivered breath Flow is constant
throughout the breath
 Suits well for unresponsive or heavily sedated.
 This high level of respiratory support is frequently required in patients who
have been resuscitated, have acute respiratory distress syndrome (ARDS), or
are paralyzed or sedated.

19.  A pressure level is preset
 Breaths are delivered at a preset frequency / rate
 Pressure is constant throughout the delivered breath
 Tidal and minute volume are variable
 Flow is variable throughout the breath.

20.  In this mode, the patient receives a preset inspiratory pressure when he
begins a breath. If he does not begin a breath, no breaths are delivered.
 If duration of Apnea exceeds the apnea alarm limit the ventilator will either
alarm or switch to control mode.
 In this mode of ventilation, the tidal volume depends on lung compliance
and resistance and the patient’s inspiratory effort.

21.  Tidal volume and Breaths are preset
 A patient-adapted constant inspiratory support is supplied when activated
by patient effort
 If duration of Apnea exceeds the apnea alarm limit the ventilator will either
alarm or switch to control mode.

22.  In this mode not all spontaneous breaths are assisted, leaving the patient to
draw some breaths on his own.
 Patient receives a preset inspiratory pressure when he begins a breath. If he
does not begin a breath, ventilator will begin.

23. High pressure limit
 Secretions, coughing or gagging. Pt fighting ventilator (vent asyncrony).
Condensate (water) in tubing. Kinked or compressed tubing. Increased
resistance (bronchospasm). Decreased compliance (pulmonary edema,
pneumothorax)
Low pressure limit
 Total or partial disconnect. Loss of airway (total or partial extubation). ET
tube/trach cuff leak (pt speaking, grunting)

24. Apnea alarm
• Respiratory arrest. Oversedation. Change in pt condition. Loss of airway
(total or partial extubation)
Ventilator inoperative or low battery
 Machine malfunction. Unplugged, power failure, or internal battery not
charged.

25. Weaning is the gradual reduction of ventilatory support. It involves
either decreasing the number of machine breath or decreasing the amount of
pressure support.

26.  Adequate oxygenation. Pa02 >60 mm Hg
 Hemodynamic stability.
 No myocardial ischemia or clinically significant hypotension.
 Temperature <38°C.
 No significant acid-base disturbance

27.  Hygiene
 Mouth Care
 Eye Care
 Back Care
 Positioning
 Elimination
 Regular palpation of the colon
 Endotracheal Tube Care
 DVT Prophylaxis
 Monitoring Sedation