Mechanical ventilation

1. PRESENTED BY
THARA NOEL
1 Year MSc Nursing Student
Lourdes college of Nursing
Chembumukku

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

4. To improve ventilation
To improve tissue oxygenation
To decrease work of breathing
To improve patient’s comfort

5. Acute respiratory Failure
Prophylactic ventilatory support
Hyperventilation Therapy

6. POSITIVE PRESSURE
VENTILATOR
 Volume cycled ventilator
Pressure cycled Ventilator
 Time cycled Ventilator
NEGATIVE PRESSUR
VENTILATOR
Iron Lung

7.  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.

11.  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.

12.  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withdrawn mechanically to produce a vacuum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.

13.  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

14.  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.

15.  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)

16.  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.

17.  The number of breaths the
ventilator will deliver/minute (10-16
b/m).
 Total respiratory rate equals
patient rate plus ventilator rate.

18.  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

19.  The ratio of inspiratory time to expiratory
time during a breath
(Usually = 1:2)

20.  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.

21.  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.

22. VOLUME
MODE
PRESSURE
MODE

23. Continuous mandatory
Ventilation
Assist control /Intermittent
Mandatory Ventilation
 Synchronized Intermittent
mandatory ventilation

24.  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

25.  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

26.  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.

27.  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).

28.  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 ..

29.  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)

30.  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

31. 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)

32. 6. Airway pressure release
ventilation(APRV)
7. Volume assured pressure support
ventilation
8.High frequency oscillatory ventilation.

33.  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.

34.  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.

35. Pressure support ventilation
augments patient’s spontaneous
breaths with positive pressure
boost during inspiration i.e.
assisting each spontaneous
inspiration.

36. 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

37.  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).

38.  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.

40.  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 .

41. The system allows the clinician to
select two levels of positive-
pressure support:
 An inspiratory pressure support
level (IPAP)
 An expiratory pressure called
EPAP

42. 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.

43.  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.

44. 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).

46.  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.

47.  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.

48.  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

51.  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

55.  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.

56.  T-Piece Trial
 Continuous positive airway pressure
weaning
 Synchronized intermittent
mandatory ventilation weaning
 Pressure support ventilation weaning

58.  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%

59.  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.

60. I- Airway Complications,
II- Mechanical complications,
III- Physiological Complications,
IV- Artificial Airway Complications.

61. 1- Aspiration
2- Decreased clearance of secretions
3- Nosocomial or ventilator-acquired
pneumonia

62. 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

63. 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

64. 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

65. 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

66.  Impaired spontaneous ventilation
 Ineffective airway clearance
 Anxiety related to unknown outcome
 Deficient knowledge
 Risk for complications related mechanical
ventilation.

67. 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

68. 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