List some indications for mechanical ventilation
- Airway protection → preventive measure
- Cardiac arrest → life saving measure
- Management of ICP → creation of alkalosis
- vasoconstriction → dec cerebral blood flow/dec ICP
- Airway obstruction → maintenance of patient airway
- Surgery or trauma → general anesthesia
List and define/describe several key mechanical ventilation vocab terms
- FiO2 → fraction of inspired O2
- Tidal volume → normal amount of air ventilated at rest (mL)
- PEEP → positive end expiratory pressure (cmH20)
- Flow → L/min
- RR → breaths/min
what are the two main types of ventilation?
- Invasive
- intubation of artificial airway into trachea
- endotracheal tube, nasotracheal tube, tracheostomy
- Non-invasive (NIV)
- BiPAP or CPAP
- last step before intubation
what is the difference between BiPAP and CPAP?
- BiPAP → Bilevel Positive Airway Pressure
- whole point is to lower the pressure when someone exhales to allow more CO2 out, they have no problem breathing air in but trouble getting the air out
- CPAP → Continous Positive Airway Pressure
- think of a dog w/head out the window and breathing
what is a tracheostomy?
a procedure in which an opening in the neck is made and a tube placed into the trachea below the vocal cords
used when pt is unable to be weaned from ventilator or if the airway is blocked/obstructed (tumor, traumatic injury)
List the modes of ventilation
- Volume Control (VC)
- Pressure Control (PC)
- Assist Control (AC)
- Pressure regulated volume control (PRVC)
- Synchronous intermittent mandatory ventilation (SIMV)
- Pressure Support Ventilation
- Volume Support (VS)
- CPAP
describe VC
Volume control
- present tidial volume is delivered at a set RR
- used when pt has no spontaneous breathing
- Peak pressures can vary depending on pts lung compliance and resistance
- pressure from ventilator will increase if pt’s lung compliance reduces (stiff lung = increased resistance)
- can lead to high pressures
describe PC
Pressure control
- predetermined amount of pressure at a set rate
- ventilator determines inspiratory time
- pt has no spontaneous breathing
- PEEP used to increase arterial O2, improve lung compliance
- prevents collapse, makes lungs easier to inflate
describe AC
Assist Control
- delivers a specific amount of tidal volume
- forces air down into lungs
- pt or ventilator can trigger when breaths are taken
- High level of respiratory support
describe PRVC
Pressure Regulated Volume Control
- combines pressure and volume controlled ventilation
- preset tidal volume is delivered at a set rate, but with lowest possible pressure
- Helps prevent barotrauma
describe SIMV
Synchronous intermittent mandatory ventilation
- used to assist pts who have some, but not sufficient breathing
- pts can breathe in between each machine assisted breath
- Used for weaning
- Delivers certain number of breaths in coordination w/respiratory effort of pt
- does have increased work of breathing
describe Pressure Support Ventilation
- small amount of pressure occurs on inspiration
- pt initates all breahts
- assists pt in making a spontaneous breath
- delivers a specific pressure
- ventilator assists, but pt regulates the RR and tidal volume
describe VS
Volume support
- tidal volume and PEEP are set
- pt initiates breathing
- ventilator delivers support in proportion to pt’s inspiratory effort and target volume
T/F: CPAP is often synonymous w/spontaneous breathing trial
TRUE
when looking at a ventilator what do PT’s care/need to know?
- the mode the ventilator is in
- RR
- FiO2
- PEEP
what are the 3 main sedative drugs a pt on mechanical ventilation may be on?
- Propofol
- Precedex
- Fentanyl
what does a red alarm mean? Yellow alarm?
- Red alarm
- high pressure
- circuit disconnected
- apnea
- Yellow alarm
- low tidal volume
- high RR
- low minute ventilation
- low inspiratory pressure
List the 5 major factors to consider during weaning?
- Respiratory demand and ability of NMSK system to cope w/O2 demand
- Oxygenation
- CV performance
- Psychological factors
- Adequate rest and nutrition
List weaning signs of distress
- Tachypnea >30 breaths/min
- Decreased pH <7.25-7.30 w/increased PaCO2
- Paradoxical breathing patterns
- O2 saturation <90%
- HR change of >20 bpm
- BP change >20 mmHg
- Agitation, panic, diaphoresis, cyanosis, angina, or arrhythmias
where should a pt be scored on the Richmond Agitation Sedation Scale for us to work with them?
-1 and -2 but if we can get to 0 that’s even better
list contraindications to PT regarding mechanical ventilation
- comatose, unresponsive, does not follow commands
- severe agitation/combativeness
- PEEP > 10cm H20 or FiO2 > 0.6
- Uncontrolled active bleeding
what are some mechanical ventilation complications
prolonged vent support may lead to:
- skin breakdown (decubitus ulcers)
- Joint contractures
- Deconditioning
list some mechanical ventilation implications for acute care PT
- AROM
- Resistive therapeutic exercises
- Aerobic activities (OH presses, boxing)
- Bed mobility → rolling
- Reaching activities w/emphasis on trunk rotation
- Head and neck therapeutic exercises and positioning - extensors
- Diaphragmatic breathing
