CARE OF PATIENT

ON VENTILATOR
 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
spontaneous breathing even
with assistance.
 INDICATIONS
Mechanical failure of ventilation
1. Neuromuscular disease (eg.Amyothropic Lateral
Sclerosis(ALS/Lou Gehrig’s Disease)
2. Central nervous system disease
(eg.Alzheimer’s,dementia,stroke)
3. CNS depression (eg.Sleep disturbance, hallucination)
4. Musculoskeletal disease (eg.Osteoarthritis,gout,
rheumatoid arthritis)
5. Thoracic malformation/ trauma(pectus
excavatum(sunken chest), pectus
carinatum(protruding chest)
Disorders of pulmonary gas exchange
6. Acute respiratory failure
7. Chronic respiratory failure
8. Left ventricular failure
9. Pulmonary disease resulting in difusion or
perfusion abnormaly
 Volume- Cycled Modes of Ventilation

Mode Definition
Control Rate and volume of breaths are controlled
by the ventilator
Assist-Control All breaths are ventilator assisted and
deliver a preset tidal volume, including
spontaneous breaths.
Intermittent Mandatory Ventilations are delivered at a preset
rate
and tidal volume. Spontaneous breaths
Ventilation (IMV) can occur at the patient's rate and tidal volume.
SIMV is synchronized with the patient's
Synchronize spontaneous breathing to reduce competition
d Intermittent between spontaneous efforts and machine.
Mandatory
Ventilation (SIMV).
Cont………

Pressure Support Augments the patient's inspiratory effort with a

Ventilation (PSV 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- PEEP is the addition of positive End-Expiratory

Expiratory Pressure pressure to the airway at the end of Pressure
(PEEP) (PEEP)
expiration;
Continuous CPAP is spontaneous breathing with a fixed amount
Positive Airway of pressure applied to the airway throughout the
Pressure (CPAP). respiratory cycle
Mode Recommended Use
Control 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 Patients who have spontaneous ventilations and
Ventilation (IMV) need ventilator support. Patients who can
Synchronized initiate Spontaneous ventilations with adequate
Intermittent Mandatory
Ventilation (SIMV) tidal Volume but need a backup rate. Useful as
a weaning mode with some patients.
Pressure Support Those who have a stable ventilator drive and
Ventilation (PSV) 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 Increases FRC to decrease or prevent

Pressure (PEEP) alveolar collapse.
Continuous
Positive Airway
Pressure (CPAP)
 Trouble shoting alarams of ventilation

Display Possible Cause Remedy

message
HIGH Airway is higher than set Check client, Check circuit
CONTINOU PEEP plus 15 cm H2O for Check ventilator setting and
S more than 15 sec. alarm limit.
PRESSURE
Disconnected pressure Check ventilator internal
CHECK transducer block pressure replace filter, remove water
TUBING transducer Water in from tubing Check heater
expiratory limb. Wet bacterial wire. Refer to service.
filter clogged bacterial filter.

Kinked/blocked tubing. Check client, Check

Mucus or secretion plug in ventilator setting and alarm
AIRWAYS ETT or airways client
PRESSURE limit.
coughing or fighting.
TOO HIGH
Display Possible Cause Remedy
message
LIMITED Kinked/blocked Mucus in Check client, Check
PRESSURE tubing coughing / ventilator setting and alarm
fighting patient. limit.

Increased client activity

EXPRIED ventilator auto cycling. Check client Check trigger
MINUTE Improver alarm setting low sencesitivity and alarm
VOLUME TOO flow transducer. setting. Dry the flow
HIGH transducer.

Low spontaneous client

EXPRIED Check client cuff pressure
breathing activity. Leakage
MINUTE circuit pause time and
in cuff. Improver alarm
VOLUME TOO graphics.
setting.
LOW
Display Possible Cause Remedy
message
EXPRIED MINUTE Flow transducer faulty Replace flow transducer
VOLUME DISPLAY Circuit disconnected from connect Y piece to
READS client client.

APNEA ALARM Time between two Check client

consecutive insperatory and ventilator
effort exceeds. setting
Adult : 20 sec.
Pead : 15 sec.
Neonate : 10 sec
PEEP/CPAP & OR Leakage in cuff and client Check cuff pressure
PLATEAV circuit Improper alarm limit Check client circuit
setting. check pause time and
PRESSURE FAILS
TO BE MAINTAIN 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 :-
Minute ventilation < 15/Lmin
- Respiratory criteria :-
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 :-
Hypoxia
Right mainstem intubation
Oesophagal intubation
Upper airway trauma
Hypo-tension
Aspiration
Late :-
Cuff leak, sinusitis
Upper airway stenosis • narrowing of the upper
Self extubation airway between the larynx
and the trachea
ii) Ventilator related :-
• Disconnection
• Malfunction

iii)Suctioning related :-
Hypoxemia
Arrhythmias

iv)Ventilation related :-
Nosocomial Infection
• They can make it easier or harder
Hemodynamic effect for your blood to get to your organs
Pneumothorax • and
is a tissues.
collection of air outside the
Oxygen toxicity lung but within the pleural cavity.
• Oxygen toxicity can cause a variety
Respiratory Alkalosis of complications affecting multiple
Increased I.C.P. organ systems. CNS complications
primarily include tonic-clonic
convulsions and amnesia.
NURSING MANAGEMENT
Inability 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
tact
Altered 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.