Presentation about use type function of ventilator.pptx

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1. CARE AND BASIC SETTING OF PORTABLE VENTILATOR

2. objective To identify indications  of ventilator Able to understand the basic care of a ventilator Able to know the basics of using a ventilator Able to find out the complications of the ventilator

3. DEFINITION Ventilatiom - is a process air in and out from lungs Oxygenation - The process of oxygen exchange in the alveolar occurs in the alveolar through the oxygen diffusion in the alveoli into the red blood cells Ventilator:   A machine that mechanically assists a patient in the exchange of oxygen and carbon dioxide, a process sometimes referred to as artificial respiration

4. Purpose of Mechanical Ventilation Air is delivered in patients with compromised ventilation To oxygenate the different organs of the body To expel the carbon dioxide in the lungs To provide comfortable breathing pattern to patients experiencing shortness of breath To breathe for patients who are seriously compromised ventilation such as in comatose, brain damaged, or patients with spinal cord injuries 

5. Indication for mechanical ventilator use 1) Continuous decrease in oxygenation 2) Increase arterial carbon dioxide 3) Persistent acidosis 4) Respiratory failure: Apnea / respiratory arrest Inadequate ventilation (acute vs chronic) Inadequate oxygenation Chronic respiratory insufficiency with FTT Compromised airway patency

6. 5) Cardiac insufficiency​ Eliminate the work of breathing​ To reduce the oxygen consumption​ 6) Neurologic dysfunction​ Central hypoventilation and frequent apnea​ Comatose patient with GCS < 8​ Inability to protect the airway​ 7) ABG Results​ 8) If the patient is under the following conditions:​ Multiple trauma​ Shock​ Multi-organ failure​ Drug overdose​ Thoracic or abdominal surgery​ Neuromuscular disorders​ Inhalation injury​ COPD

7. Example type of ventilator at hsnz

8. Care of portable  ventilator There are 3 type for care of portable ventilator 1) Before using ventilator 2) When using ventilator 3) After using ventilator

9. before Preparation 1) Make sure device have complete item, and ready to use - tubing, filter, test lung (for check) , oxygen supply, machine in good condition 2) Check the machine every shift, test and calibrate to make sure there no error at the machine, e.g , tubing leak, machine disfunction 3) Make sure right setting and mode to use for patient base on indication

10. When using ventilator - Elevate patient 30 – 45 degree to minimize  aspiratIon and gastric content - Make sure give sedation - Suction - Mouthcare everyday - Change ventilator tubing - Make sure the setting compatible to patient - Alert when the problem when alarm beeping

11. after Turn off the machine properly Disconnect O2 supply and tubing Immerse tubing in disinfectant solution about 15 min, and after that put in warmer to remove water vapour in tubing

12. BASIC VENTILATOR PARAMETER MODE TIDAL VOLUME RATE FiO2 PEEP FLOW RATE I:E RATIO

13. MODE SYNCHRONIZED INTERMITTENT MANDATORY VENTILATION (SIMV) VOLUME-CONTROLLED VENTILATION PRESSURE SUPPORT VENTILATION DUAL CONTROL MODE CONTROLLED MANDATORY VENTILATION (CMV) ASSIST/CONTROL(AC) CONTINOUS POSITIVE AIRWAY PRESSURE

14. SYNCHRONIZED INTERMITTEnT MANDATORY VENTILATION (SIMV) Ventilator delivers either assisted breaths to the patient at the beginning of a spontaneous breath or time-triggered mandatory breaths Mandatory breaths are synchronized with the patient's spontaneous breathing efforts so as to avoid breath stacking Spontaneous frequency and tidal volume taken by the patient ind SIMV mode are totally dependent on the patient's breathing effort

15. INDICATIONS FOR SIMV MODE -The primary indication for SIMV is to provide partial ventilatory support to the patient Advantage of SIMV mode  1) maintains respiratory muscle strength/avoids muscle atrophy 2) reduces ventilation to perfusion mismatch 3) decreases mean airway pressure

16. Complications of SIMV Mode - The desire to wean the patient too rapidly, leading first to a high work of spontaneous breathing and ultimately to muscle fatigue and weaning failure

17. Volume-controlled ventilation - Set volume delivered with each breath - Volume delivery fixed, pressure vary, depending upon pulmonary compliance and airway resistance Advantage - ability to regulate both tidal volume and minute ventilation 

18. PRESSURE-CONTROLLED VENTILATION - Peak inspiratory pressure for each mechanical breath - Pressure remains constant, volume and minute ventilation will vary with changes in the patient's pulmonary compliance or airway resistance - The advantage of the pressure-controlled mode is that the lungs can be protected from excessive pressures, preventing ventilator-induced lung injury (VILI)

19. PRESSURE SUPPORT - used to augment a patient's breathing effort by reducing the airflow resistance during spontaneous breathing ( the artificial airway, ventilator circuit and secretion). - Pressure support is available in modes of ventilation that allows spontaneous ( e.g , SIMV, PSV )

20. PRESSURE SUPPORT VENTILATION - lower the work of spontaneous breathing and augment a patient's spontaneous tidal volume - patient-triggered, pressure-limited and flow-cycled - PSV + SIMV, significantly lowers the oxygen consumption requirement presumably due to the reduced work of breathing 1) increase the patient's  spontaneous tidal volume 2) decrease the patient's spontaneous frequency

21. Pressure-supported breaths are considered spontaneous because 1) they are patient-triggered 2) the tidal volume varies with the patient's inspiratory flow demand 3) inspiration lasts only for as long as the patient actively inspires 4) inspiration is terminated when the patient's inspiratory flow demand decreases to a preset minimal value

22. Indication for PSV - weaning from mechanical ventilation Disadvantages - Each breath must be initiated by the patient. Central apnea may occur if the respiratory drive is depressed due to sedative, critical illness or excessive ventilation - Relatively high levels pressure support (> 20 cm H2O) are required to prevent alveolar collapse ( which can lead to cyclic atelectasis and ventilator-associated lung injury

23. Dual Control Mode - is a combined mode between two control variables - when VCV and PCV are combined, the patient receives mandatory breaths that are volume-targeted, pressure-limited and time-cycled

24. CONTROLLED MANDATORY VENTILATION (CMV) Continuous mandatory ventilation or control mode, the ventilator delivers the preset tidal volume at a time-triggered frequency CHARACTERISTIC DESCRPITION Type of breath Each breath delivers a mechanical tidal volume Triggering mechanism Every breath in the control mode is time-triggered Cycling mechanism I nspiration is terminated by the delivery of a preset tidal volume ( volume-cycled)

25. Indications for control mode 1) Tetanus or other seizure activities that interrupt the delivery of mechanical ventilation 2) complete rest for the patient typically for a period of 24 hours 3) patients with a crushed chest injury in which spontaneous inspiratory efforts produce significant paradoxical chest wall movement

26. Complication of CMV - In a sedated or apneic patient, potential for apnea and hypoxia if the patient should become disconnected from the ventilator or the ventilator should fail to operate - rapid disuse atrophy of diaphragm fibers - prolonged mechanical ventilation leads to diaphragmatic oxidative injury , elevated proteolysis and reduced function of diaphragm

27. ASSIST/CONTROL(AC) The mandatory mechanical breaths may be either patient-triggered by the patient's spontaneous inspiratory efforts ( assist) or time-triggered by a preset frequency Inspiration in the AC Mode is terminated by volume cycling. When the preset tidal volume is delivered, the ventilator is cycled to expiration Provide full ventilatory support for patients when they are first placed on mechanical ventilation

28. I ndications for AC Mode -patient with stable respiratory drive and can therefore trigger the ventilator into inspiration Advantages of AC Mode -patient's work of breathing requirement is very small -allows the patient to control the frequency and therefore the minute volume required to normalize the patient's PaCO2 Complications of AC Mode -alveolar hyperventilation (respiratory alkalosis)

29. CONTINOUS POSITIVE AIRWAY PRESSURE  Deliver of a continuous level of positive airway pressure It is functionally similar to PEEP The ventilator does not cycle during CPAP, no additional pressure above the level of CPAP is provided and patients must initiate all breaths most commonly used in the management of 1) Sleep related breathing disorder 2) cardiogenic pulmonary edema 3) Obesity hypoventilation syndrome CPAP may be given via a facemask, nasal mask or endotracheal tube

30. TIDAL VOLUME Set between 6 – 8 ml/kg of predicted body weight     eg   Mr X body weigh 60 x 8 = 480 ml  < below 6 ml/kg for patient for patient Acute Respiratory Distress Syndrom (ARDS).      eg pulmonary edema, increase o lung compliance Emphysema, decrease of   lung volume pneumonectomy

31. rate Normal rate 12-20 per minute The number of breathes per minute that is intended to provide eucapneic ventilation ( PaCO2 at patient's normal) Frequencies of 20/min or higher are associated with auto-PEEP and should be avoid. - high ventilator frequency, inadequate inspiratory flow and air trapping contribute to the development of auto-PEEP

32. fio2 Fraction of inspired Oxygen - The initial FIO2 may be set at 100%  - Should be evaluated by means of ABG after stabilization of the patient Should be adjusted accordingly to maintain a PaO2 between 80 and 100 mm Hg. After stabilization of the patient, the FIO2 is best keep below 50% to avoid oxygen induced lung injuries Monitor  SpO2, maintaining >/= 96% 

33. Positive end-expiratory pressure (peep) PEEP reinflates collapsed alveoli and supports and maintains alveolar inflation during exhalation - increase the functional residual capacity - useful to treat refractory hypoxemia The initial PEEP level may be set at 5cm H20 Auto-PEEP is present when the end-expiratory pressure does not return to baseline pressure at the end of expiration

34. 1) INCREASE VENTILATION/PERFUSSION ( V/Q) 2) IMPROVES OXYGENATION 3) DECREASE WORK OF BREATHING IMROVE VENTILATON INCREASE FUNCTIONAL RANGE CONDITION   ( FRC ) DECREASE THE PRESSURE THRESHOLD FOR ALVEOLAR INFLATION PEEP

35. COMLPLICATION OF PEEP 1) Decrease venous return and cardia output 2) Barotrauma 3) increased intracranial pressure 4) Alterations of renal functions and water metabolism Alteration = perubahan

36. Flow rate The peak flow rate is the maximum flow delivered by the ventilator during inspiration The inspiratory flow needs to be sufficient to overcome pulmonary and ventilator impedance otherwise the work of breathing is increased. Peak flow rates of 60 L minute per minute may be sufficient Higher rates are frequently necessary in patients with bronchoconstriction

37. An insufficient peak flow rate is characterized by - dyspnea - spuriously low peak inspiratory pressures - scalloping of the inspiratory pressure tracing

38. I:e ratio The Inhalation : Exhalation (I:E) ratio is the ratio of inspiratory time to expiratory time It is usually kept in the range between 1:2 and 1:4 A larger I:E ratio    -possibility of air trapping    -auto-PEEP Inverse I:E ratio - correct refractory hypoxemia in ARDS patients

39. VENTILATOR NON INVENSIVE VENTILATOR INVENSIVE VENTILATOR BIPAP CPAP INTUBATED

40. Non-invasive ventilation  - Use support administered through a face mask, nasal mask, air usually with added oxygen is given through mask under positive pressure, such as BIPAP and CPAP Invasive ventilation  - is positive pressure delivered to the patient’s lungs via an endotracheal tube or a tracheostomy tube.

41. BILEVEL POSITIVE AIRWAY PRESSURE (BIPAP) The pressurized air settings of the BiPAP include: Inspiratory positive airway pressure (IPAP) : This is the pressure the machine provides as you inhale. The BiPAP provides a higher IPAP than the CPAP. So, when you inhale, the BiPAP supports your breath as you take it in. Expiratory positive airway pressure (EPAP) : This is the pressure the machine provides when you exhale. The BiPAP offers a lower pressure that allows you to breathe out comfortably.

42. CONTINUOS POSITIVE AIRWAY PRESSURE a method of positive pressure ventilation used with patients who are breathing spontaneously,  done to keep the alveoli open at the end of exhalation and thus increase oxygenation and  reduce the work of breathing.  When the same principle is used in mechanical ventilation, it is called  positive end-expiratory pressure

43. TYPE INDICATION BIPAP sleep apnea, COPD, asthma, heart conditions and others CPAP Asthma, Bronchiolitis, Obstructive sleep apnea syndrome, Pneumonia, Muscle fatigue, impending of respiratory muscles, Myopathies

44. CPAP | definition of CPAP by Medical dictionary (thefreedictionary.com) Care Of A Ventilator Patient (micunursing.com) Care For Patient With Mechanical Ventilator (rnspeak.com)