Care of patient on ventilator

1. CARE OF PATIENT ON
VENTILATOR
Dr. Jayesh Patidar
(PhD, M.Sc.
Nursing)

2. MECHANICAL
VENTILATOR
Functions for below thorasic cage
& diaphragm. It can maintain
ventillation automatically for
prolonged time. It is indicated in
patient who unable to maintain
safe level of oxygen or CO2 by
sopntanous brathing even with
assistantance.

3. INDICATIONS
•Mechanical failure of ventilation
1.Neuromuscular disease
2.Central nervous system disease
3.CNS depression
4.Musculoskeletal disease
5.Thoracic malformation/ trauma
•Disorders of pulmonary gas exchange
1.Acute respiratory failure
2.Chronic respiratory failure
3.Left ventricular failure
4.Pulmonary disease resulting in difusion or
perfusion abmornality

4. Mode Definition
Control
Assist-Control
Intermittent Mandatory

Ventilation (IMV)
Synchronized
Intermittent
Mandatory
Ventilation (SIMV).
Rate and volume of breaths are controlled
by the ventilator
All breaths are ventilator assisted and
deliver a preset tidal volume, including
spontaneous breaths.
Ventilations are delivered at a preset rate
and tidal volume. Spontaneous breaths
can occur at the patient's rate and tidal volume.
SIMV is synchronized with the patient's
spontaneous breathing to reduce competition
between spontaneous efforts and machine.
Volume- Cycled Modes of Ventilation

5. Cont………
Pressure Support
Ventilation (PSV
Augments the patient's inspiratory effort with a
selected amount of inspiratory pressure. This
pressure is maintained throughout the inspiratory
cycle, allowing the patient to select rate, tidal
volume,
And timing. May be used in conjunction with SIMV
and CPAP.
Positive End-
Expiratory Pressure
(PEEP)
PEEP is the addition of positive End-Expiratory
pressure to the airway at the end of Pressure
(PEEP)
expiration;
Continuous
Positive Airway
Pressure (CPAP).
CPAP is spontaneous breathing with a fixed amount
of pressure applied to the airway throughout the
respiratory cycle

6. Mode Recommended Use
Control Anesthetized or paralyzed patients with no
spontaneous respiratory efforts.
Assist - control Patient who are able to initiate spontaneous
ventilations, but require greater tidal volume than
they can generate.
Intermittent Mandatory
Ventilation (IMV)
Synchronized
Intermittent Mandatory
Ventilation (SIMV)
Patients who have spontaneous ventilations and
need ventilator support. Patients who can initiate
Spontaneous ventilations with adequate tidal
Volume but need a backup rate. Useful as a
weaning mode with some patients.
Pressure Support
Ventilation (PSV)
Those who have a stable ventilator drive and
can generate enough negative airway pressure
(-20 to -25) to trigger the pressure support. Used
as weaning mode, to augment patient's
spontaneous efforts, and decrease the work of
breathing.

7. Cont………
Positive End-Expiratory
Pressure (PEEP)
Continuous
Positive Airway
Pressure (CPAP)
Increases FRC to decrease or prevent
alveolar collapse.

8. Trouble shoting alarams of ventilation
Display
message
Possible Cause Remedy
HIGH
CONTINOU
S
PRESSURE
CHECK
TUBING
AIRWAYS
PRESSURE
TOO HIGH
Airway is higher than set
PEEP plus 15 cm H2O for
more than 15 sec.
Disconnected pressure
transducer block pressure
transducer Water in
expiratory limb. Wet bacterial
filter clogged bacterial filter.
Kinked/blocked tubing.
Mucus or secretion plug in
ETT or airways client
coughing or fighting.
Check client, Check circuit
Check ventilator setting and
alarm limit.
Check ventilator internal
replace filter, remove water
from tubing Check heater
wire. Refer to service.
Check client, Check
ventilator setting and alarm
limit.

9. Display
message
Possible Cause Remedy
LIMITED
PRESSURE

EXPRIED
MINUTE
VOLUME TOO
HIGH
EXPRIED
MINUTE
VOLUME TOO
LOW

Kinked/blocked Mucus in
tubing coughing / fighting
patient.

Increased client activity
ventilator auto cycling.
Improver alarm setting low
flow transducer.

Low spontaneous client
breathing activity. Leakage
in cuff. Improver alarm
setting.
Check client, Check
ventilator setting and alarm
limit.
Check client Check trigger
sencesitivity and alarm
setting. Dry the flow
transducer.
Check client cuff pressure
circuit pause time and
graphics.

10. Display
message
Possible Cause Remedy
EXPRIED MINUTE
VOLUME DISPLAY
READS
APNEA ALARM

PEEP/CPAP & OR
PLATEAV
PRESSURE FAILS
TO BE MAINTAIN
Flow transducer faulty
Circuit disconnected from
client
Time between two
consecutive insperatory
effort exceeds.
Adult : 20 sec.
Pead : 15 sec.
Neonate : 10 sec
Leakage in cuff and client
circuit Improper alarm limit
setting.
Replace flow transducer
connect Y piece to
client.
Check client and
ventilator setting
Check cuff pressure
Check client circuit
check pause time and
graphics to verify
consider more
ventilatory support .

11. Care at patient on ventilator :-
Endotracheal tube care
Feeding
Hygiene
Avoid bed sores by
Maintain patients safety
Records and reports

12. WEANING :-
Weaning is the word used
to describe the process of gradually
removing the patient from ventilator
and restoring spontaneous breathing
after a period of mechanical ventilator.
Criteria For Weaning Trial :-
-Respiratory criteria :-
Minute ventilation < 15/Lmin
Respiratory rate < 38 breaths /
min
Tidal volume > 325 ml
Max inspiratory pressure < -15 cm H2O
FiO2 < 50%

13. Other Criteria :-
Improvement, correction or stabilization of the
active
disease process.
Nutritional and fluid balance maintained
Adequate physical strength & mental alertness.
Stable cardiovascular, renal & cerebral status.
Optimal level of alertness blood gases
electrolytes, hemoglobin & other laboratory
tests.

14. Steps of weaning :-
A B G Evaluation
CPAP mode
T- piece
Extubation :- Do suctioning Give
chest physiotherapy & nebulization
keep crash cart & Intubations tray
ready Remove ETT, do suctioning &
nebulization & oxygenation.
Non invasive ventilator if
required.
Oxygen by mask.
Continue monitoring in each
step.

15. COMPLICATIONS OF VENTILATION :-

i)Intubetion Realated :-
Early :-
Hypoxia
Right mainstem intubation
Oesophagal intubation
Upper airway trauma
Hypo-tension
Aspiration
Late :-
Cuff leak, sinusitis
Upper airway stenosis
Self extubation

16. ii) Ventilator related :-
•Disconnection
•Malfunction
iii) Suctioning related :-
Hypoxemia
Arrhythmias
iv) Ventilation related :-
Nosocomial Infection
Homodynamic effect
Pneumothorax
Oxygen toxicity
Respiratory Alkalosis
Increased I.C.P.

17. NURSING MANAGEMENT
Inability to sustain spontaneous ventilation related to imbalance
between ventilatory capacity ventilator demand.
Impaired gas exchange and ineffective breathing pattern related to
underlying disease process and artificial airways and ventilator
system.
Ineffective airways clearance related to cough and increased
secretions formation in the lower tracheobronchial tree from ET tube.
Anxiety related to dependence on CMV for breathing.
High risk for complication of CMV and positive pressure ventilation
(PPV).
Risk for infection related to impaired primary defenses in respiratory
tact
Altered nutrition : Less than body requirements related to lack ability
to eat while on ventilator and increased metabolic needs.
Impaired verbal communication related to mute sate when ET tube is
in place.
Altered oral mucous membranes related to nothing by mouth (NPO)
status.