Mechanical Ventilation

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2. PRESNTED BY,
Dr. Ravi Raj Kumar (PT)
Cardio - pulmonary physiotherapist
Asso Prof in Physiotherapy
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4.  Mechanical Ventilation is ventilation of the
lungs by artificial means usually by a
ventilator.
 A ventilator delivers gas to the lungs with
either negative or positive pressure.
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5. • NATURALBREATHING
– Negativeinspiratory force
– Airpulledinto lungs
• MECHANICALVENTILATION
– Positiveinspiratory pressure
– Airpushedinto lungs
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6.  To maintain or improve ventilation, & tissue
oxygenation.
 To decrease the work of breathing & improve
patient’s comfort
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7.  AIRWAY OBSTRUCTION – airway patency is in
doubt or patient may be at risk of losing
patency
 RESPIRATORY FAILURE – 2 Types
Hypoxemic Respiratory Failure
Hypercapnic Respiratory Failure
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8.  PaO2 < 60 mmHg in an otherwise healthy
individual
HYPERCAPNIC RESPIRATORY
FAILURE
o PaCO2 > 50 mmHg in an otherwise
healthy individual
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9.  Endotracheal Intubation:
◦ Placement of tube into trachea
through mouth or nose
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•The Macintosh blade is the most widely
used of the curved laryngoscope blades,
while the Miller blade is the most popular
style of straight blade.
•Both Miller and
Macintosh laryngoscope blades are
available in sizes 0 (neonatal) through 4
(large adult).

13.  After displacing the epiglottis insert
the ETT.
The depth of the tube for a male
patient on average is 21-23 cm
at teeth
 The depth of the tube on average for
a female patient is 19-21 at teeth.
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Confirm tube position:
By auscultation of the
chest
Bilateral chest rise
Tube location at teeth

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15.  ET tube suctioning removes thick mucus and
secretions from the trachea and lower airway
that you are not able to clear by coughing.
Suctioning is done every 2nd hourly to
improve the oxygenation and to make the
tube patent.
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16.  Maintain correct placement
 Maintain proper inflation
 Maintain/monitor ventilation and oxygenation
 Maintain tube patency
 Mouth care; repositioning ET; promote
communication
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17.  Negative-pressure ventilators
 Positive-pressure ventilators
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18.  Mechanical ventilation in which
various devices that surround the
thorax are used in such a way that
the development
of negative pressure causes
thoracic expansion and thus
inhalation; the release of
the negative pressure allows the
thorax to relax and thus the lungs
to exhale.
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NEGATIVE-PRESSURE VENTILATORS

19.  Early negative-pressure
ventilators were known as “iron
lungs.”
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20.  Positive-pressure
ventilation mean
s that airway
pressure is
applied at the
patient's airway
through an
endotracheal or
tracheotomy
tube.
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21. 1- Volume Ventilators.
2- Pressure Ventilators
3- High-Frequency Ventilators
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22.  The basic principle of this ventilator is that a
designated volume of air is delivered with
each breath.
 Therefore, peak inspiratory pressure (PIP )
must be monitored in volume modes because
it varies from breath to breath.
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23.  A typical pressure mode delivers a selected
gas pressure to the patient early in
inspiration, and sustains the pressure
throughout the inspiratory phase.
 Volume will change with changes in
resistance or compliance, Therefore, exhaled
tidal volume is the variable to monitor
closely.
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24.  High frequency ventilation is a type
of mechanical ventilation which utilizes a
respiratory rate greater than 4 times the
normal value and very small tidal volumes.
High frequency ventilation is thought to
reduce ventilator-associated lung injury (VALI),
especially in the context of ARDS and acute
lung injury. This is commonly referred to
as lung protective ventilation.
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25.  RATE: An optimal method for setting the
respiratory rate has not been established. For
most patients, an initial respiratory rate between
12 and 16 breaths per minute is reasonable
 TRIGGER :Sensitivity of breathing. Concerns how
much inspiratory or “trigger” effort is required
from the ventilator to recognize that the patient
is trying to inhale
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26.  TIDAL VOLUME :is the amount of air delivered
with each breath. The appropriate initial tidal
volume depends on numerous factors, most
notably the disease for which the patient
requires mechanical ventilation. tidal
volume is approximately 500 mL per
inspiration or 7 mL/kg of body mass.
 (PEEP):positive end-expiratory pressure
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27.  FiO2:Fraction of Inspired Oxygen
 PS: Pressure Support
 PC: Pressure Control
 PIP: Peak Inspiratory Pressure
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28.  Assist-Control Ventilation
 Pressure Support Ventilation
 Synchronized Intermittent Mandatory
Ventilation
 Control Continuous Positive Airway Pressure (CPAP)
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29. •Delivers pre-set volumes at a pre-set
rate and a pre-set flow rate.
•The patient cannot generate
spontaneous breaths, volumes, or flow
rates in this mode.
•Each patient generated respiratory
effort over and above the set rate are
delivered at the set volume and flow
rate
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30.  Pressure support ventilation is
a spontaneous mode of ventilation also
named Pressure Support Ventilation (PSV).
The patient initiates every breath and
the ventilator delivers support with the preset
pressure value. With support from
the ventilator, the patient also regulates their
own respiratory rate and their tidal volume..
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31. SYNCHRONIZED INTERMITTENT
MANDATORY VENTILATION
(SIMV)
• Delivers a pre-set number of breaths
at a set volume and flow rate.
• Allows the patient to generate
spontaneous breaths, volumes, and
flow rates between the set breaths.
• Detects a patient’s spontaneous
breath attempt and doesn’t initiate a
ventilator breath – prevents breath
stacking.
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32. CONTINUOUS POSITIVE AIRWAY
PRESSURE (CPAP)
• This is a mode and simply means that a pre-set
pressure is present in the circuit and lungs
throughout both the inspiratory and expiratory
phases of the breath.
• CPAP serves to keep alveoli from collapsing,
resulting in better oxygenation and less WOB.
• The CPAP mode is very commonly used as a
mode to evaluate the patients readiness for
extubation.
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33. •Set sensitivity at Flow trigger mode
•Set Tidal Volume
•Set Rate
•Set Inspiratory Flow (if necessary)
•Set PEEP
•Set Pressure Limit
•Humidification
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34. Assessment:
1- Assess the patient
2- Assess the artificial airway (tracheostomy
or endotracheal tube)
3- Assess the ventilator
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35. 1-Maintain airway patency & oxygenation
2- Promote comfort
3- Maintain fluid & electrolytes balance
4- Maintain nutritional state
5- Maintain urinary & bowel elimination
6- Maintain eye , mouth and cleanliness and
integrity:-
7- Maintain mobility/ musculoskeletal
function:-
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36. 8- Maintain safety:-
9- Provide psychological support
10- Facilitate communication
11- Provide psychological support &
information to family
12- Responding to ventilator alarms
/Troublshooting
ventilator alarms
13- Prevent nosocomial infection
14- Documentation 36

37.  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 An
ambu bag connected to oxygen source
until the physician arrives.
 Alarms must never be ignored or
disarmed.
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38. High pressure alarm
 Increased secretions
 Kinked ventilator tubing or endotracheal
tube (ETT)
 Patient biting the ETT
 Water in the ventilator tubing.
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•Disconnected tubing
•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.

40. HIGH RESPIRATORY RATE ALARM
•Episodes of tachypnea,
•Anxiety,
•Pain,
•Hypoxia,
APNEA ALARM
During weaning, indicates that the patient has a slow Respiratory rate and a
period of apnea.
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41. LOW PRESSURE ALARM
•Usually due to a leak in the
circuit.
•Attempt to quickly find the problem
Bag the patient and call your
INTENSIVIST
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42. HIGH PRESSURE ALARM
Usually caused by:
•A blockage in the circuit (water condensation)
•Patient biting his ETT
•Mucus plug in the ETT
•You can attempt to quickly fix the problem
•Bag the patient and call for your INTENSIVIST
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Usually caused by:
•Apnea of your patient (CPAP)
•Disconnection of the patient
from the ventilator
•You can attempt to quickly fix the
problem
•Bag the patient and call for your
INTENSIVIST.

44. Never silence
the ventilator
alarm
First
address the
problem
Then silence
the alarm
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45.  Role of the -----:
◦ Ensure the Ambu bag is attached to the oxygen
flowmeter and it is on!
◦ Attach the face mask to the Ambu bag and after
ensuring a good seal on the patient’s face; supply
the patient with ventilation.
◦ Bag the patient and call for your DOCTOR.
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46.  Anytime you have concerns, alarms, ventilator
changes or any other problem with your
ventilated patient.
•Call for your Doctor.
NEVER hit the silence button!
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