mechanical ventilation

1. MECHANICAL VENTILATION

2. BASICS ……????? Respiration-Ventilation 3D Medical Animation.avi

3. Mechanics of Breathing - 1 2.avi

4. Intubation and Mechanical Ventilation.avi

5. MEANING A mechanical ventilator is a positive- or negative-pressure breathing device that can maintain ventilation and oxygen delivery for a prolonged period

6. INDICATIONS Protection of airway Respiratory arrest or rate < 8/min Tachypnoea > 35/min Inability to tolerate oxygen mask/CPAP/NIV, e.g. agitation,confusion Removal of secretions Hypoxaemia ( Pa O2 < 8 kPa (< 60 mmHg); Sp O2 < 90%),despite CPAP with F iO2 > 0.6

7. Hypercapnia if conscious level impaired or risk of raised intracranial pressure Worsening respiratory acidosis Vital capacity falling below 1.2 L in patients with neuromuscular disease Removing the work of breathing in exhausted patients

8. CLINICAL CONDITIONS Post-operative • e.g. After major abdominal or cardiac surgery

9. Respiratory failure ARDS Acute severe asthma Pneumonia Aspiration COPD Smoke inhalation, burns

10. Circulatory failure Low cardiac output: cardiogenic shock Following cardiac arrest Pulmonary oedema

11. Neurological disease Coma of any cause Status epilepticus Drug overdose Respiratory muscle failure (e.g. Guillain–Barré syndrome, poliomyelitis, myasthenia gravis) Head injury: to avoid hypoxaemia and hypercapnia , and reduce intracranial pressure Bulbar abnormalities causing risk of aspiration (e.g. cerebrovascular accident, myasthenia gravis)   Multiple trauma

12. TERMINOLOGY TRIGGER TIDAL VOLUME RESPIRATORY RATE POSITIVE END EXPIRATORY PRESSURE FLOW RATE INSPIRATORY TIME EXPIRATION

13. Intermittent positive pressure ventilation (IPPV)

14. Controlled mandatory ventilation (CMV)

15. Synchronised intermittent mandatory ventilation (SIMV)

16. Pressure-controlled ventilation (PCV)

17. Pressure support ventilation (PSV)/Assisted spontaneous breathing (ASB)

18. Positive end-expiratory pressure (PEEP)

19. Continuous positive airways pressure (CPAP)

20. Bi-level positive airway pressure ( BiPAP /BIPAP)

21. Non-invasive positive pressure ventilation (NIPPV/NIV)

22. Inverse ratio ventilation

23. High-frequency ventilation ( hfv )

24. Liquid ventilation

25. INITIAL VENTILATOR SETTINGS Assess the mode Tidal volume and rate Patient or time triggered MINUTE VENTILATION=RATE X TIDAL VOLUME IMV AND SIMV TOTAL MINUTE VENTILATION= MINUTE VOLUME MACHINE+ MINUTE VOLUME SPONTANEOUS

26. TOTAL MINUTEVOLUME= (MACHINE TIDAL VOLUME X MACHINE RATE )+ AVERAGE SPONATANEOUS TIDAL VOLUME X SPONATNEOUS RATE) INSPIRATORY FLOW RATE= SET MINUTE VENTILATION/PERCENTAGE INSPIRATORY TIME X 0.01 AIRWAY RESISTANCE = INCREASING PEAK PRESSURE- PLATEAU PRESSURE/ INSPIRATORY FLOW(L/S )

27. FIO2 REQUIRED = PaO2 DESIRED PaO2 /PAO2 PaCO2 X 12.5) 1 PB- PH2O

28. INITIAL PaO2/FiO2 = DESIRED PaO2/FiO2 Optimal peep DO2 = QT X CAO2 Alveolar ventilation VA =( VT – V D) F PaCO2 = 0.863X VCO2/ VA

29. ASSESSING THE EQUIPMENT

30. COMPLICATIONS

31. MANAGEMENT

32. WEANING Vital capacity:10 to 15 mL /kg Maximum inspiratory pressure (MIP) at least –20 cm H2O Tidal volume: 7 to 9 mL /kg Minute ventilation: 6 L/min Rapid/shallow breathing index: below 100 breaths/minute/L; PaO2 _60 mm Hg with FiO2 less than 40%

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34. NURSE WHAT YOU DO..???

35. REFERENCES Mason R.J, Braaddus V.C.Murray and Nadel`s :Textbook of Respiratory Medicine. 5 th edn . Philadelphia:Saunders;2010. George R.B,Light R.W. Chestmedicine:Essentials of Pulmonary and Critical Care Medicine. 4 th edn . Philadelphia:Lippincott;2000. Fauci AS, Braunwald E, Kasper DL, Hauser SL, Longo DL, Jameson JL, et al., editors. Harrison’s principles of internal medicine. 17th ed. New York: McGraw Hill; 2008 Johnson J.Y.Brunner anD Suddharth`s:Textbook of Medical Surgical Nursing. 11 th edn . Philadelphia:Lippincott;2008. Black M.J, Hawks H.K. Medical Surgical Nursing. 7 th edn . Missouri: Saunders;2005