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Mechanical Ventilation
for Nursing
Melissa Dearing, BS, RRT-NPS, RCP
Associate Professor of Respiratory Care
Curtis Shelley, BS, RRT-NPS, RCPRespiratory EducatorHermann Childrens Hospital
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Indications for
Mechanical Ventilation
Airway Compromiseairway
patency is in doubt or patient may
be at risk of losing patency
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Indications for Mechanical
Ventilation
Respiratory Failure2 Types
Hypoxemic Respiratory Failure
Hypercapnic Respiratory Failure
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Hypoxemic Respiratory
Failure
PaO2 < 60 mmHg in an
otherwise healthy individual
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Hypercapnic Respiratory
Failure
PaCO2> 50 mmHg in an otherwise
healthy individual
AKA Ventilatory Failure
Caused by increased WOB, ventilatory
drive, or muscle fatigue
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Indications for Mechanical
Ventilation
Need to Protect the Airway
For some reason the patients ability
to sneeze, gag or cough has been
dulled and aspiration is possible.
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Contraindications for an
Artificial Airway
When a pts desire to not be
resuscitated has been expressed
and is documented in the pts chart
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Establishing an Artificial
Airway
Adult female 8.0
Adult male 9.0
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Miller vs. MacIntosh Blades
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Intubation Procedure
Check and Assemble Equipment:
Oxygen flowmeter and O2tubing
Suction apparatus and tubingSuction catheter or yankauer
Ambu bag and mask
Laryngoscope with assorted blades
3 sizes of ET tubes
Stylet
Stethoscope
Tape
Syringe
Magill forceps
Towels for positioning
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Intubation Procedure
Position your patient into the sniffing
position
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Intubation Procedure
Preoxygenate with 100% oxygen to
provide apneic or distressed patient
with reserve while attempting to
intubate.
Do not allow more than 30 seconds to
any intubation attempt.
If intubation is unsuccessful, ventilate
with 100% oxygen for 3-5 minutes
before a reattempt.
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Intubation Procedure
Insert Laryngoscope
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Intubation Procedure
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Intubation Procedure
After displacing the epiglottis
insert the ETT.
The depth of the tube for a male
patient on average is 21-23 cm at teeth
The depth of the tube on average for a
female patient is 19-21 at teeth.
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Intubation Procedure
Confirm tube position:
By auscultation of the chest
Bilateral chest rise
Tube location at teethCO2 detector(esophageal
detection device)
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Intubation Procedure
Stabilize the ETT
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Intubation Procedure
Video on Intubation:
http://youtube.com/watch?v=eRkleyIJi9U&fe
ature=related
http://youtube.com/watch?v=eRkleyIJi9U&feature=relatedhttp://youtube.com/watch?v=eRkleyIJi9U&feature=relatedhttp://youtube.com/watch?v=eRkleyIJi9U&feature=relatedhttp://youtube.com/watch?v=eRkleyIJi9U&feature=related5/28/2018 Mechanical Ventilation for Nursing
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Mechanical Ventilators
Different Types of Ventilators
Available:
Will depend on you place of
employment
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Mechanical Ventilators
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Mechanical Ventilators
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Mechanical Ventilators
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Mechanical Ventilators
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Mechanical Ventilators
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High Frequency Mechanical
Ventilator
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Ventilator Settings
Terminology
A/C: Assist-Control
IMV: Intermittent Mandatory VentilationSIMV: Synchronized Intermittent
Mandatory Ventilation
Bi-level/Biphasic: Non-inversedPressure Ventilation with Pressure
Support (consists of 2 levels of pressure)
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Ventilator Settings
Terminology (cont)
PRVC: Pressure Regulated Volume
Control
PEEP: Positive End Expiratory Pressure
CPAP: Continuous Positive Airway
Pressure
PSV: Pressure Support Ventilation
NIPPV: Non-Invasive Positive Pressure
Ventilation
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VOLUME vs. PRESSURE
VENTILATION
Volume ventilation: Volume is
constant and pressure will vary withpatients lung compliance.
Pressure ventilation: Pressure is
constant and volume will vary withpatients lung compliance.
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MODES of VENTILATION
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Control Mode
Delivers pre-set volumes at a pre-set
rate and a pre-set flow rate.
The patient CANNOT generate
spontaneous breaths, volumes, or flowrates in this mode.
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Control Mode
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Assist/Control Mode
Delivers pre-set volumes at a pre-set rate and a pre-set flow rate.
The patient CANNOT generatespontaneous volumes, or flow ratesin this mode.
Each patient generated respiratory
effort over and above the set rateare delivered at the set volume andflow rate.
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A/C cont.
Negative deflection,
triggering assisted
breath
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Delivers a pre-set number of breaths at a
set volume and flow rate.Allows the patient to generate
spontaneous breaths, volumes, and flow
rates between the set breaths.Detects a patients spontaneous breath
attempt and doesnt initiate a ventilatory
breathprevents breath stacking
SYCHRONIZED
INTERMITTENT MANDATORY
VENTILATION (SIMV):
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SIMV cont.
Machine BreathsSpontaneous Breaths
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PRESSURE REGULATED
VOLUME CONTROL (PRVC):
This is a volume targeted, pressurelimited mode. (available in SIMV orAC)
Each breath is delivered at a setvolume with a variable flow rate and
an absolute pressure limit. The vent delivers this pre-set volume
at the LOWEST required peakpressure and adjust with each breath.
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PRVC
POSITIVE END
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POSITIVE END
EXPIRATORY PRESSURE
(PEEP):
This is NOT a specific mode, but is rather anadjunct to any of the vent modes.
PEEP is the amount of pressure remaining inthe lung at the END of the expiratory phase.
Utilized to keep otherwise collapsing lungunits open while hopefully also improvingoxygenation.
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PEEP cont.
PEEP is theamount of
pressure
remaining in the
lung at the END
of the expiratory
phase.
Pressure above zero
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Demonstration of PEEP
http://youtube.com/watch?v=oKH7CtsEgH
w
http://youtube.com/watch?v=oKH7CtsEgHwhttp://youtube.com/watch?v=oKH7CtsEgHwhttp://youtube.com/watch?v=oKH7CtsEgHwhttp://youtube.com/watch?v=oKH7CtsEgHw5/28/2018 Mechanical Ventilation for Nursing
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Continuous Positive Airway
Pressure (CPAP):
This IS a mode and simply means that a pre-set pressure is present in the circuit and
lungs throughout both the inspiratory andexpiratory phases of the breath.
CPAP serves to keep alveoli from collapsing,resulting in better oxygenation and less
WOB. The CPAP mode is very commonly used as a
mode to evaluate the patients readiness forextubation.
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HIGH FREQUENCY
VENTILATION
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Comparison of HFOV
& Conventional Ventilation
Differenc es CMV HFOV
Rates 0 - 150 180 - 900
Tidal Volume 4 - 20 ml/kg 0.1 - 3 ml/kg
Alveolar Press 0 - > 50 cmH2O 0.1 - 5 cmH2O
End Exp Volume Low Normalized
Gas Flow Low High
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Oxygenation
Oxygenation is primarily controlled by the
Mean Airway Pressure (Paw) and the FiO2.
Mean Airway Pressure is a constant pressure
used to inflate the lung and hold the alveoli
open.
Since the Paw is constant, it reduces theinjury that results from cycling the lung open
for each breath
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Video on HFOV
http://youtube.com/watch?v=jLroOPoPlig
http://youtube.com/watch?v=jLroOPoPlighttp://youtube.com/watch?v=jLroOPoPlig5/28/2018 Mechanical Ventilation for Nursing
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Initial Settings
Select your mode of ventilation
Set sensitivity at Flow trigger mode
Set Tidal Volume
Set Rate
Set Inspiratory Flow (if necessary)
Set PEEP Set Pressure Limit
Humidification
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Post Initial Settings
Obtain an ABG (arterial blood gas)
about 30 minutes after you set your
patient up on the ventilator.
An ABG will give you information about
any changes that may need to be made
to keep the patients oxygenation and
ventilation status within a physiologicalrange.
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ABG
Goal:
Keep patients acid/base balance within
normal range:
pH 7.357.45
PCO2 35-45 mmHg
PO2 80-100 mmHg
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TROUBLESHOOTING
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TROUBLESHOOTING
Anxious Patient
Can be due to a malfunction of the ventilator
Patient may need to be suctioned
Frequently the patient needs medication for anxietyor sedation to help them relax
Attempt to fix the problem
Call your RT
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Low Pressure Alarm
Usually due to a leak in the circuit.
Attempt to quickly find the problem
Bag the patient and call your RT.
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High Pressure Alarm
Usually caused by:
A blockage in the circuit (water
condensation)
Patient biting his ETT
Mucus plug in the ETT
You can attempt to quickly fix the
problem
Bag the patient and call for your RT.
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Low Minute Volume Alarm
Usually caused by:
Apnea of your patient (CPAP)
Disconnection of the patient fromthe ventilator
You can attempt to quickly fix the
problem Bag the patient and call for your
RT.
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Accidental Extubation
Role of the Nurse:
Ensure the Ambu bag is attached to theoxygen flowmeter and it is on!
Attach the face mask to the Ambu bagand after ensuring a good seal on thepatients face; supply the patient withventilation.
Bag the patient and call foryour RT.
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OTHER
Anytime you have concerns,alarms, ventilator changes or any
other problem with yourventilated patient.
Call for your RT
NEVER hit the silencebutton!