What is mechanical ventilation?and what does it do?
type of therapy that helps you breathe or breathes for you. It improves gas exchange and decreases the work of breathing until the cause is identified and corrected.
What is tidal volume?
What is the normal range?
Risks of tidal volume?
volume of air delivered during a ventilator supplemented breath. (amount of air in/out of the lungs during each respiratory cycle.)
normal range = 6-12 ml/kg
high TV = Barotrauma
low TV = Atelectasis
What is FI02?
(fraction of inspired oxygen)
the concentration or percentage of oxygen in the air we inhale.
ex. room air is 21%
-FI02 greater than 50% increases the risk of oxygen toxicity.
What is the rate of ventilation?
the breaths per minute that is administered to the patient.
- between 4-20 breaths/min
- follows the normal respiratory rate of 12-20, anything as low as 4 are going to be extra breaths the patient may need.
What is PEEP?
(positive end-expiratory pressure)
the pressure applied to the airway during ventilator exhalation to keep the lungs partially expanded.
- decreases the amount of FI02 needed.
- most common is PEEP 5
- use caution in COPD & ARDS
What is SIMV mode?
(synchronized intermittent mechanical ventilation)
preset tidal volume, preset minimum ventilator rate (minimum breaths) in coordination with patient breaths.
What does a high pressure alarm indicate?
High Blockage!
(2 PB sandwiches make you SCK)
Pneumothorax
Pulmonary Edema
Biting
Secretions
Coughing
Kinking
What does a low pressure alarm indicate?
Loss of connection!
Leaking air!
Cuff leak
ETT displacement
disconnection
What is a normal arterial 02?
60-80
What are the two types of NON invasion positive pressure ventilators ?
- CPAP delivers continuous positive airway pressure to keep the airways open.
- BIPAP delivers bilateral positive airway pressure to help patients breath during inspiration and expiration. (first step before intibation)
What is terminal weaning?
withdrawing mechanical ventilation when survival of the patient is not expected. It requires a gradual decrease in ventilator settings to do less for the patient.
- family should be educated on what it will look and sounds like, how they may feel and what is to be expected before the wean begins.
- the patient should be sedated and comfortable.
- Life Quest should be called for organ donation several hours prior to weaning.
What are the complications of mechanical ventilation?
ventilator associated pneumonia, barotrauma, pneumothorax, pneumomediastinum, cardiovascular and GI complications.
What are the preventions for ventilator associated pneumonia (VAP) ?
- HOB 30 degrees of higher
- ETT w/ subglotic suction
- RASS; how awake/how drowsy
- daily weaning assessments w/ daily sedation weaning (not on paralyzed or unstable pts)
- daily delirium checks
- frequent oral care (Q2 hours)
VAP Signs & Symptoms
fevers, sudden respiratory distress, increase in WBC, purulent tracheal drainage/secretions, new infiltrates on chest xray.
What is barotrauma and the symptoms?
“over inflated lungs” from positive pressure ventilation rupturing the alveolar sacs.
- those with ARDS & COPD are at greater risk.
S/S: SOB, chest pain, increase heart rate, blood pressure and respirations, with a decrease in blood oxygen levels.
What is pneumothorax and the symptoms?
abnormal collections of air in the space between the lungs and the chest wall that constricts chest expansion.
S/S: unequal chest expansion, decreased/absent breath sounds, reduced arterial oxygenation, difficulty breathing.
- decrease tidal volume and insertion of chest tube.
What is pneumomediastinum and the symptoms?
presence of air in the mediastinum (center on the chest) due to air escaping some where in the body.
S/S: severe chest pain, SOB, subcutaneous emphysema (rice crispy sounds) and a crunching sounds during cardiac cycle.
- requires a chest tube
What are the cardiovascular complications?
- increase in thoracic pressure
- decrease in venous return (collapsed veins)
- decreases in cardiac output
What are the GI complications?
- stress ulcers
- opioid constipation
- decreased nutrition
- decreased fluids
How do we care for a patient on mechanical ventilation?
- frequent oral care
- pain assessment
- sedation assessment
- frequent turning but make sure to group your care and promote rest.
- monitor vitals and oxygenation status
What are signs of distress in a ventilated patient? and what to look for during weaning?
- nasal flaring, increase WOB
- groaning or LOC
- pale or sweating
- restlessness/anxiety
- abnormal lung sounds
- wheezing
- accessory muscle use
- increased HR, BP, RR
- decreased SP02
Maintaining patent airway:
- lung sounds every 2-4 hours
- repositioning every 2 hours, bad lung side down is the best.
- cooled humidification
- hydration
- secretion management
- SP02 trend monitoring
Promoting spontaneous ventilation:
- HOB 30 or higher
- Q2 turning w/ suctioning first
- ABGs & SP02 monitoring
- Improve rest and conserve energy
- supplemental oxygen
Enhancing cardiac output:
- maintain SBP >90, MAP >60, and urine output >30
- Q4 neuro checks
- Q4 lung auscultation
- monitor cardiac rhythm
- I&O, weigh ALL fluid thats leaves the body. (stool, urine, sweat, weeping sounds etc.)
- daily weights
- pain assessments
