Basics Mechanical Ventilation
BasicsMechanical Ventilation
Control
• Volume Control – volume limited, volume targeted and Pressure
Variable
• Pressure Control– pressure limited, pressure targeted and
Volume Variable
• Dual Control– volume targeted (guaranteed) pressure
limited
Mode• Mandatory
– CMV• Continuous Mandatory Ventilation
• Assist– Intermittent Mandatory Ventilation
• SIMVSynchronized Intermittent Mandatory Ventilation
– Pressure Support• CPAP / PEEP
Continuous Positive Airway Pressure Positive End Expiratory Pressure
• Spontaneous
Flow Pattern
Indications for mechanical ventilation
Extra-pulmonary NS:- OD sedatives, Coma, failure of resp centers
Neuromuscular: - injury, MG, GB, diaphragmatic dysfunction, ALS, electroly imbalances
Musculoskeletal:- injury, flail chest
Pulmonary airway obstruction, non-compliant lung tissue
Goals
- maintain alveolar ventilation
- deliver oxygen
- administer gases under pressure
- main positive end expiratory pressure (PEEP) - reduce the work of breathing
Potential Complications from Mechanical Ventilation
A Effects on the cardiovascular system - decreased cardiac output due to decreased venous return, increased right ventricular afterload and decreased left ventricular compliance B. Barotrauma (esp. with PEEP) - consequence of high
pressure in airways - overdistention of the alveoli causing rupture; gas escapes into interstitial spaces leading to subcutaneous emphysema, pneumothorax C. Oxygen toxicity D. Acid-Base Disturbances E. Water Imbalances (fluid volume excess) F. GI Bleeding
Potential Complications from Mechanical Ventilation
G. CNS Disturbances
H. Potential Infection
I. I. Fighting the Ventilator - breathing out of synchrony with ventilator
Reasons - hypoxia, airway obstruction, ventilator malfunction, anxiety, etc.
Intervention - ALWAYS ASSESS FIRST, then troubleshoot, consider sedation
J. Sleep deprivation & Psychological consequences K. Mechanical Failure
Nursing Care of the Ventilated Patient
A. Use of Paralyzing Agents
B. Possible Nursing Diagnostic stems for the Patient receiving mechanical ventilation
Impaired communication
Alteration in nutrition
Ineffective airway clearance
Impaired Gas Exchange (actual/ Potential) Ineffective breathing pattern (actual/ potential) Anxiety
• Q&A
• End
• Prepared by SNM, Med• 20 Aug 07