MECHANICAL VENTILATION Tek.ppt Jiregna Eticha

Mechanical Ventilation slideshare

1. BASIC MECHANICAL
VENTILATION
Tekalign Markos (BSN,MCVN,)
03/02/25 1

2. COURSE OUTLINE
1.Types and modes of mechanical ventilation.
2.Intubation and Weaning criteria.
3.Ventilator alarm and its causes.
4.Nursing consideration in weaning.
03/02/25 2

3. Mechanical Ventilation is ventilation of the
lungs by artificial means usually by a ventilator.
Delivery of Ventilation and Supplemental
Oxygen with a Mechanical Ventilator to Support
a Patient Experiencing Respiratory Failure.
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4. PURPOSES:
To maintain or improve ventilation & tissue
oxygenation.
To decrease the work of breathing &
improve patient’s comfort.
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5. Principles of ventilator
principle 1:- ventilation
facilitates co
2
release and maintain normal paco
2
principle 2 :- oxygenation
maximizes o
2
delivery to blood and tissue perfusion.
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6. INDICATIONS:
1- Acute respiratory failure due to:
•Mechanical failure, failure of the normal respiratory
neuromuscular system e.g. Myasthenia Gravis
•Musculoskeletal abnormalities, such as chest wall trauma
(flail chest)
•Infectious diseases of the lung such as pneumonia,
tuberculosis.
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7. 2- Abnormalities of pulmonary gas exchange as in:
Obstructive lung disease in the form of asthma, chronic
bronchitis or emphysema.
Conditions such as pulmonary edema, atelectasis,
pulmonary fibrosis.
Patient who has received general anesthesia as well as post
cardiac arrest.
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8. CRITERIA FOR INSTITUTION OF
VENTILATORY SUPPORT:
a. Pulmonary function studies
b. Arterial blood gas analyses
c. Clinical impression

9. CRITERIA FOR INSTITUTION
OF VENTILATORY SUPPORT:
ParametersParameters Ventilation indicatedVentilation indicated Normal rangeNormal range
A- Pulmonary functionA- Pulmonary function
studiesstudies::
• Respiratory rate Respiratory rate
(breaths/min).(breaths/min).
• Tidal volume (ml/kgTidal volume (ml/kg
body wt)body wt)
• Vital capacity (ml/kg Vital capacity (ml/kg
body wt)body wt)
• Maximum InspiratoryMaximum Inspiratory
Force (cm HOForce (cm HO
2) )
> >3535
< <55
< <1515
-<-<2020
10-2010-20
5-75-7
65-7565-75
75-10075-100
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10. CRITERIA FOR INSTITUTION OF
VENTILATORY SUPPORT:
ParametersParameters Ventilation Ventilation
indicatedindicated
Normal Normal
rangerange
B- Arterial bloodB- Arterial blood
GasesGases
• PHPH
• PaOPaO
2 (mmHg) (mmHg)
• PaCOPaCO
2 (mmHg) (mmHg)
< <7.257.25
< <6060
> >5050
7.35-7.457.35-7.45
75-10075-100
35-4535-45
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11. CRITERIA FOR INSTITUTION OF
VENTILATORY SUPPORT:
Clinical Impression
1. Use of Accessory Muscles
2. Inability to Speak in Full Sentences
3. Paradoxical Respirations
4. Altered Mental status
5. Cardiopulmonary Arrest: When Respirations and
Pulse Cease
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12. EXERCISES
1. A 27 years old male patient came to ER with ARF
due to musculoskeletal abnormalities. His
pulmonary function studies showed as RR=40bpm
and MIF> -21cmH2O.
Did he need MV support? If yes, why?
03/02/25 12

13. EXERCISES…
2. A 50 years old female patient was admitted with
diagnosis of cardiogenic shock secondary to
anterior and posterior MI. Her ABG analyses were
PaCO2=50mmHg and PaO2=40 mmHg
Did she need MV support ? If yes, why?
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14. TYPES OF MECHANICAL VENTILATORS:
Negative-pressure ventilators
Positive-pressure ventilators.
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15. NEGATIVE-PRESSURE
VENTILATORS
•Early negative-pressure ventilators were known
as “iron lungs.”
•The patient’s body was encased in an iron
cylinder and negative pressure was generated .
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16. 0
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17. Draw backs
They limit positioning and movement and
They lack adaptability to large or small body
torsos (chests) .
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18. POSITIVE-PRESSURE
VENTILATORS
Positive-pressure ventilators deliver gas to
the patient under positive-pressure, during
the inspiratory phase.
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19. POSITIVE-PRESSURE….
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21. POSITIVE-PRESSURE….
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22. TYPES OF POSITIVE-PRESSURE
VENTILATORS
1- Volume Ventilators.
2- Pressure Ventilators
3- High-Frequency Ventilators
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23. 1- VOLUME VENTILATORS
•The volume ventilator is commonly used
in critical care settings.
•The basic principle of this ventilator is
that a designated volume of air is
delivered with each breath.
•The amount of pressure required to
deliver the set volume depends on :-

- Patient’s lung compliance (∆V/∆P)
-Patient–ventilator resistance factors.
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24. Therefore, peak inspiratory pressure (PIP ) must
be monitored in volume modes because it varies
from breath to breath.
With this mode of ventilation, a respiratory rate,
inspiratory time, and tidal volume are selected
for the mechanical breaths.
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25. EXERCISE
1. X and Y were admitted for ARF and they have
been on the MV with following parameters V
x
=450ml and ∆P
x
=10cmH2O
∆V
y
=510ml and ∆P
y
=5cmH2
i.Find out the lung compliances of patient X and Y.
ii.VY=450/10=45
iii.VX=510/5=102
ii. Which patient was more risky for barotrauma?
Why?
iii. What should you have considered to reduce
barotrauma?

26. 2- PRESSURE VENTILATORS
•The use of pressure ventilators is
increasing in critical care units.
•A typical pressure mode delivers a
selected gas pressure to the patient early
in inspiration, and sustains the pressure
throughout the inspiratory phase.
•By meeting the patient’s inspiratory flow
demand throughout inspiration, patient
effort is reduced and comfort increased.
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27. A pressure is consistent with these
modes, volume is not.
Volume will change with changes in
resistance or compliance,
With pressure modes, the pressure level
(inspiratory pressure) to be delivered is
selected, and rate and inspiratory time
are preset as well.
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28. 3- HIGH-FREQUENCY
VENTILATORS
High-frequency ventilators use small tidal
volumes (1 to 3 mL/kg) at frequencies greater
than 100 breaths/minute.
The high-frequency ventilator accomplishes
oxygenation by the diffusion of oxygen and
carbon dioxide from high to low gradients of
concentration.
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29. This diffusion movement is increased if the
kinetic energy of the gas molecules is increased.
A high-frequency ventilator would be used to
achieve lower peak ventilator pressures, thereby
lowering the risk of barotrauma.
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30. Ventilators are classified according to
how the inspiratory phase ends. The
factor which terminates the inspiratory
cycle reflects the machine type.
They are classified as:
1- Pressure cycled
ventilator
2- Volume cycled ventilator
3- Time cycled ventilator
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31. 1- VOLUME-CYCLED VENTILATOR
Inspiration is terminated after a preset
tidal volume has been delivered by the
ventilator.
The ventilator delivers a preset tidal
volume (VT), and inspiration stops when
the preset tidal volume is achieved.
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32. 2- PRESSURE-CYCLED
VENTILATOR
In which inspiration is terminated when a
specific airway pressure has been reached.
The ventilator delivers a preset pressure;
once this pressure is achieved, end
inspiration occurs.
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33. 3- TIME-CYCLED VENTILATOR
In which inspiration is terminated when a
preset inspiratory time, has elapsed.
Time cycled machines are not used in adult
critical care settings.
They are used in pediatric intensive care areas.
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34. VENTILATOR MODE
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.
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35. MODES OF MECHANICAL
VENTILATION
A- Volume Modes
B- Pressure Modes
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36. A- VOLUME MODES
1-Control mode (CM)
2- Assist-control (A/C)
3- Synchronized intermittent
mandatory ventilation (SIMV)
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37. 1- CONTROL MODE (CM) CONTINUOUS
MANDATORY VENTILATION ( CMV)
•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 and vent
blocks spontaneously breaths
•Client can not initiate breathe
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38. 2- ASSIST CONTROL MODE A/C
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
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39. 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/
she can trigger the ventilator and receive
a full-volume breath.
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40. 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).
Disadvantages:
Hyperventilation,
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41. A/C’S MODE SUMMARY
1.Mandatory breaths/preset RR
2. Patient initiated +MV assisted breaths
3. Total respiratory rate =Preset RR + Pt
Initiated RR
4. Preset tidal volume
5. Constant tidal volume

42. 2- SYNCHRONIZED INTERMITTENT
MANDATORY VENTILATION (SIMV)
The ventilator provides the patient with a pre-
set number of breaths/minute at a specified tidal
volume and FiO
2.
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 taken through the ventilator circuit.
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43. 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.
Adding pressure support during
spontaneous breaths can minimize the
risk of increased work of breathing.
Ventilators breaths are synchronized
with the patient spontaneous breathe.
( no fighting)
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44. 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
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45. SIMV’S SUMMARY
1.Pre-set tidal volume
2. Pre-set RR
3.Pt’s RR with out assist of MV + his/her own
Tv
4. Total RR=pt’s +Pre-set RR
5. Tidal volume always varies.
6. weaning

46. B- PRESSURE MODES
1- Pressure-controlled ventilation (PCV)

2- Pressure-support ventilation (PSV)
3- Continuous positive airway pressure (CPAP)
4- Positive end expiratory pressure (PEEP)
5- Noninvasive bilevel positive airway pressure ventilation
(BiPAP)
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47. 1- PRESSURE-CONTROLLED VENTILATION
MODE( PCV)
The PCV mode is used
It is used when the patient has persistent
oxygenation problems despite a high FiO
2 and
high levels of PEEP.
The inspiratory pressure level, respiratory rate,
and inspiratory–expiratory (I:E) ratio must be
selected.
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48. oClient does not breathe spontaneously and
vent blocks spontaneously breaths
The flow is highest at the beginning of
inspiration( i.e when the volume is lowest
in the lungs).
Used to limit plateau pressures that can
cause barotrauma & Severe ARDS
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49. Tidal volume varies, with compliance and
airway resistance, must be closely
monitored.
Sedation and the use of neuromuscular
blocking agents are frequently indicated.
Inverse ratios are used. The “unnatural”
feeling of this mode often requires muscle
relaxants to ensure patient–ventilator
synchrony.
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50. Inverse ratio ventilation (IRV) mode :-
inspiratory time is equal to, or longer
than, expiratory time (1:1 to 4:1).
Inverse I:E ratios are used in conjunction
with pressure control to improve
oxygenation by expanding stiff alveoli by
using longer distending times, thereby
providing more opportunity for gas
exchange and preventing alveolar
collapse.
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51. As expiratory time is decreased, one must
monitor for the development of
hyperinflation or auto-PEEP.
When the PCV mode is used, the mean
airway and intrathoracic pressures rise,
potentially resulting in a decrease in
cardiac output and oxygen delivery.
Therefore, the patient’s hemodynamic
status must be monitored closely.
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52. 2- PRESSURE SUPPORT
VENTILATION ( PSV
•The patient breathes spontaneously while
the ventilator applies a pre-determined
amount of positive pressure to the
airways upon inspiration.
•Helps to overcome airway resistance and
reducing the work of breathing.
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53. Indicated for patients with small spontaneous
tidal volume and difficult to wean patients.
Patient must initiate all pressure support
breaths.
Pressure support ventilation may be combined
with other modes such as
SIMV or used alone for a spontaneously
breathing patient.

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54. The patient’s effort determines the rate,
inspiratory flow, and tidal volume.
In PSV mode, the inspired tidal volume and
respiratory rate must be monitored closely to
detect changes in lung compliance.
It is a mode used primarily for weaning from
mechanical ventilation.
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55. 3- CONTINUOUS POSITIVE AIRWAY
PRESSURE(CPAP)
•Constant positive airway pressure during
spontaneous breathing
•CPAP allows the nurse to observe the ability of
the patient to breathe spontaneously while still
on the ventilator.
•CPAP can be used for intubated and non-
intubated patients.
•It may be used as a weaning mode and for
nocturnal ventilation (nasal or mask CPAP)

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56. 4- POSITIVE END EXPIRATORY
PRESSURE (PEEP)
Positive pressure applied at the end of
expiration during mandatory \ ventilator breath
positive end-expiratory pressure with positive-
pressure (machine) breaths.
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57. USES OF CPAP & PEEP
Prevent atelactasis or collapse of alveoli

Improve gas exchange & oxygenation

Treat hypoxemia refractory to oxygen
therapy.(prevent oxygen toxicity
Treat pulmonary edema ( pressure help
expulsion of fluids from alveoli
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58. 5- NONINVASIVE BILATERAL POSITIVE
AIRWAY PRESSURE VENTILATION (BIPAP)
•BiPAP is a noninvasive form of mechanical ventilation
provided by means of a nasal mask or nasal prongs, or a
full-face mask.
•The system allows the clinician to select two levels of
positive-pressure support:
•An inspiratory pressure support level (referred to as IPAP)
•An expiratory pressure called EPAP (PEEP/CPAP level).
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59. ASSIGNMENT
1. Write about PEEP and auto-PEEP. How
they differ each other?
Don’t forget that !!!
•Don’t write more than two pages with font
size 12 and double spaced.
•Don’t use internet or website to do this
assignment. Use hard copy books from
library. Bring it with you on 18/11/2014
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60. 0
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61. Thank You!!
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62. COMMON VENTILATOR SETTINGS
PARAMETERS/ CONTROLS

Fraction of inspired oxygen (FIO
2)
Tidal Volume (VT)
Peak Flow/ Flow Rate
Respiratory Rate/ Breath Rate / Frequency ( F)
Minute Volume (VE)
I:E Ratio (Inspiration to Expiration Ratio)
Sigh
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63. ● FRACTION OF INSPIRED OXYGEN
(FIO
2
)
•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 FIO
2 (60% or higher).

•Subsequent changes in FIO
2
are based on
ABGs and the SaO
2.
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64. 
In adult patients the initial FiO
2 may be set at 100%
until arterial blood gases can document adequate
oxygenation.

An FiO
2 of 100% for an extended period of time can
be dangerous ( oxygen toxicity) but it can protect
against hypoxemia
For infants, and especially in premature infants,
high levels of FiO
2 (>60%) should be avoided.

Usually the FIO
2
is adjusted to maintain an SaO
2
of
greater than 90% (roughly equivalent to a PaO
2 >60
mm Hg).

Oxygen toxicity is a concern when an FIO
2 of
greater than 60% is required for more than 25 hours
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65. Signs and symptoms of oxygen toxicity :-
1- Flushed face
2- Dry cough
3- Dyspnea
4- Chest pain
5- Tightness of chest
6- Sore throat
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66. ● TIDAL VOLUME (VT)
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)
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67. In the volume ventilator, Tidal volumes of
10 to 15 mL/kg of body weight were
traditionally used.
the large tidal volumes may lead to
(volutrauma) aggravate the damage
inflicted on the lungs
For this reason, lower tidal volume
targets (6 to 8 mL/kg) are now
recommended.
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68. ● PEAK FLOW/ FLOW RATE
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.
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69. ● RESPIRATORY RATE/ BREATH RATE /
FREQUENCY ( F)
The number of breaths the ventilator will
deliver/minute (10-16 b/m).
Total respiratory rate equals patient rate
plus ventilator rate.
The nurse double-checks the functioning
of the ventilator by observing the
patient’s respiratory rate.
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70. For adult patients and older children:-
With COPD
A reduced tidal volume
A reduced respiratory rate
For infants and younger children:-
A small tidal volume
Higher respiratory rate
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71. ● MINUTE VOLUME (VE)
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
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72. In a patient with head injury,
Respiratory alkalosis may be required to promote cerebral
vasoconstriction, with a resultant decrease in ICP.
In this case, the tidal volume and respiratory rate are increased
( hyperventilation) to achieve the desired alkalotic pH by
manipulating the PaCO
2
.
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73. In a patient with COPD

Baseline ABGs reflect an elevated PaCO
2
should not
hyperventilated. Instead, the goal should be restoration of the
baseline PaCO
2
.
These patients usually have a large carbonic acid load, and
lowering their carbon dioxide levels rapidly may result in
seizures.
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74. ● I:E RATIO (INSPIRATION TO
EXPIRATION RATIO):-
The ratio of inspiratory time to expiratory
time during a breath
(Usually = 1:2)
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75. ● SIGH
A deep breath.
A 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.
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76. ● PEAK AIRWAY PRESSURE:-
In adults
If the peak airway pressure is persistently above
45 cmH
2
O, the risk of barotrauma is increased
and efforts should be made to try to reduce the
peak airway pressure.
In infants and children
It is unclear what level of peak pressure may
cause damage. In general, keeping peak
pressures below 30 is desirable.
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77. ● PRESSURE LIMIT
On volume-cycled ventilators, the
pressure limits the highest pressure
allowed in the ventilator circuit.
Once the high pressure limit is reached,
inspiration is terminated.
Therefore, if the pressure limit is being
constantly reached, the designated tidal
volume is not being delivered to the
patient.
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78. ● SENSITIVITY(TRIGGER
SENSITIVITY)
The sensitivity function controls the
amount of patient effort needed to
initiate an inspiration
Increasing the sensitivity, decreases the
amount of work the patient must do to
initiate a ventilator breath.
Decreasing the sensitivity increases the
patient needs to initiate inspiration and
increases the work of breathing.
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79. •The most common setting for pressure
sensitivity are -1 to -2 cm H2O
•The more negative the number the
harder it to breath.
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80. Q AND A
1.PT WAS RECENTLY INTUBATED, SET ON AC.
VT=500ML
RR= 20BREATHS/MINUTE,
FLOW RATE =60LITTER/MINUTE (CONSTANT)
REQUIRED
A. TOTAL CYCLE TIME (TCT)
B. INSPIRATORY TIME TI
C. EXPIRATORY TIME TE
D. I: E RATIO
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81. A.TCT=60sec/min/20brth/min
=3sec
B.Ti=VT (l)/flow(l/sec)
Flow=60L/min/60sec/min=1L/sec
Ti=0.5L/1L/sec=0.5 sec
C. Te=TCT_Ti
=3sec-0.5sec=2.5sec
D.I:E=Ti/Ti=Te/Ti=1/1=2.5/0.5
=1:5
E. MV=VT*RR=500ML*20brth/min=1000ml/min
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81

82. ENSURING HUMIDIFICATION AND
THERMOREGULATION
•All air delivered by the ventilator passes
through the water in the humidifier, where it is
warmed and saturated.
•Humidifier temperatures should be kept close to
body temperature 35 ºC- 36.5ºC.
•In some rare instances (severe hypothermia), the
air temperatures can be increased.
•The humidifier should be checked for adequate
water levels
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82

83. An empty humidifier contributes to
drying the airway, often with resultant
dried secretions, mucus plugging and less
ability to suction out secretions.
Humidifier should not be overfilled as
this may increase circuit resistance and
interfere with spontaneous breathing.
As air passes through the ventilator to
the patient, water condenses in the
corrugated tubing. This moisture is
considered contaminated and must be
drained into a receptacle and not back
into the sterile humidifier.
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83

84. If the water is allowed to build up,
resistance is developed in the circuit and
PEEP is generated. In addition, if
moisture accumulates near the
endotracheal tube, the patient can
aspirate the water.
 The humidifier is an ideal medium for
bacterial growth.
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84

85. COMPLICATIONS OF MECHANICAL
VENTILATION:-
I- Airway Complications,

II- Mechanical complications,
III- Physiological Complications,
IV- Artificial Airway Complications.
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86. I- AIRWAY COMPLICATIONS
1- Aspiration
2- Decreased clearance of secretions
3- Nosocomial or ventilator-acquired
pneumonia
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87. II- MECHANICAL COMPLICATIONS
1- Hypoventilation with atelectasis with
respiratory
acidosis or hypoxemia.
2- Hyperventilation with hypocapnia and
respiratory alkalosis
3- Barotrauma
a- Closed pneumothorax,
b- Tension pneumothorax,
d- Subcutaneous emphysema.
4- Inadequate nebulization or humidification
5- Overheated inspired air, resulting in
hyperthermia
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88. III- PHYSIOLOGICAL
COMPLICATIONS
1- Depressed cardiac function and hypotension
2- Stress ulcers
3- Paralytic ileus
4- Gastric distension
5- Starvation
6- Dysynchronous breathing pattern
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89. IV- ARTIFICIAL AIRWAY
COMPLICATIONS
A- COMPLICATIONS RELATED TO
ENDOTRACHEAL TUBE:-
1- Tube kinked or plugged
2- Rupture of piriform sinus
3- Tracheal stenosis
4- Cuff failure
5- Sinusitis
6- Otitis media
7- Laryngeal edema
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90. B- COMPLICATIONS RELATED TO
TRACHEOSTOMY TUBE:-
1- Acute hemorrhage at the site
2- Air embolism
3- Aspiration
4- Tracheal stenosis
5- Erosion into the innominate artery.
6- Failure of the tracheostomy cuff
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91. TRACHEOSTOMY…
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
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92. VENTILATOR ALARMS:-
Mechanical ventilators comprise audible and visual alarm
systems, which act as immediate warning signals to altered
ventilation.
Alarm systems can be categorized according to volume and
pressure (high and low).
High-pressure alarms warn of rising pressures.
Low-pressure alarms warn of disconnection of the patient from
the ventilator or circuit leaks.
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93. RESPONDING TO ALARMS
•If an alarm sounds, respond immediately because the problem
could be serious.
•Assess the patient first, while you silence the alarm.
•If you can not quickly identify the problem, take the patient off
the ventilator and ventilate him with a resuscitation bag
connected to oxygen source until the physician arrives.

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94. Alarms must never be ignored or disalarmed.
Ventilator malfunction is a potentially serious problem.
Nurse checks every 2 to 4 hours, and recurrent alarms may
alert the clinician to the possibility of an equipment-related
issue.
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94

95. When device malfunction is suspected, a second person
manually ventilates the patient while the nurse or therapist
looks for the cause.
If a problem cannot be promptly corrected by ventilator
adjustment, a different machine is procured so the ventilator in
question can be taken out of service for analysis and repair by
technical staff.
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95

96. CAUSES OF VENTILATOR ALARMS
High pressure alarm
Increased secretions
Kinked ventilator tubing or endotracheal tube (ETT)
Patient biting the ETT
Water in the ventilator tubing.
ETT advanced into right mainstem bronchus.
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96

97. Low pressure alarm
•A cuff leak
•A hole in the tubing (ETT or ventilator tubing)
•A leak in the humidifier
Oxygen alarm
•The oxygen supply is insufficient or is not properly
connected.
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97

98. High respiratory rate alarm
Episodes of tachypnea,
Anxiety,
Pain,
Hypoxia,
Fever.
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98
-

99. Apnea alarm
•During weaning, indicates that the patient has a slow
Respiratory rate and a period of apnea.
•Apnea criteria :-prevent profound Hypoxia
During weaning
1.Apnea time
2.Set RR
3.Set Tidal Volume
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99

100. Temperature alarm
Overheating
Improper water levels

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101. METHODS OF WEANING
1- T-piece trial,
2- Continuous Positive Airway Pressure (CPAP) weaning,
3- Synchronized Intermittent Mandatory Ventilation (SIMV)
weaning,
4- Pressure Support Ventilation (PSV) weaning.
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101

102. 1- T-PIECE TRIAL
It consists of removing the patient from the ventilator and
having him / her breathe spontaneously on a T-tube connected
to oxygen source.
During T-piece weaning, periods of ventilator support are
alternated with spontaneous breathing.
The goal is to progressively increase the time spent off the
ventilator.
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102

103. 2-SYNCHRONIZED INTERMITTENT
MANDATORY VENTILATION ( SIMV)
WEANING
SIMV is the most common method of weaning.
It consists of gradually decreasing the number of
breaths delivered by the ventilator to allow the patient
to increase number of spontaneous breaths
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103

104. 3-CONTINUOUS POSITIVE AIRWAY
PRESSURE (CPAP) WEANING
When placed on CPAP, the patient does all the work of
breathing without the aid of a back up rate or tidal volume.
No mandatory (ventilator-initiated) breaths are delivered in this
mode i.e. all ventilation is spontaneously initiated by the
patient.
Weaning by gradual decrease in pressure value
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104

105. 4- PRESSURE SUPPORT
VENTILATION (PSV)WEANING
The patient must initiate all pressure support breaths.
During weaning using the PSV mode the level of pressure
support is gradually decreased based on the patient maintaining
an adequate tidal volume (8 to 12 mL/kg) and a respiratory rate
of less than 25 breaths/minute.
PSV weaning is indicated for :-
- Difficult to wean patients
- Small spontaneous tidal volume.
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106. WEANING READINESS CRITERIA
•Awake and alert
•Hemodynamically stable, adequately resuscitated, and not
requiring vasoactive support
•Arterial blood gases (ABGs) normalized or at patient’s baseline
- PaCO
2
acceptable
- PH of 7.35 – 7.45
- PaO
2
> 60 mm Hg ,
- SaO
2
>92%
- FIO
2
≤40%
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107. Positive end-expiratory pressure (PEEP) ≤5 cm H
2O
F
< 25 / minute
Vt 5 ml / kg
VE 5- 10 L/m (f x Vt)
VC
> 10- 15 ml / kg
Adequate management of pain/anxiety/agitation,
Adequate analgesia/ sedation (record scores on flow sheet),
No residual neuromuscular blockade.
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108. SIGNS OF WEANING INTOLERANCE
CRITERIA
Diaphoresis
Dyspnea & Labored respiratory pattern
Increased anxiety ,Restlessness, Decrease in level of
consciousness
Dysrhythmia,Increase or decrease in heart rate of
> 20 beats
/min. or heart rate
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109. •Increase or decrease in blood pressure of
> 20 mm Hg
Systolic blood pressure
>180 mm Hg or <90 mm Hg
•Increase in respiratory rate of
> 10 above baseline or > 30
Sustained respiratory rate greater than 35 breaths/minute
•Tidal volume ≤5 mL/kg, Sustained minute ventilation
<200
mL/kg/minute
•SaO2
< 90%, PaO2 < 60 mmHg, decrease in PH of < 7.35.
Increase in PaCO
2
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109

110. 0
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111. Thank You !!
03/02/25 111