Introduction to Mechanical Ventilation
Introduction to Mechanical Ventilation
Slide Addendum
Slide 3
• Prophylactic Ventilatory Support is when we can foresee that a patient will need vent support (ex. victim of house fire or tumor)
• Want to intubate and ventilate before failure occurs
Slide 4
• Proper immobilization ventilation can be from spinal surgery
Slide 5
• Tidal volume is usually controlled by the vent
• Tidal volume varies from person to person
• Tidal volume can be estimated by using height and ideal weight calculations
• PEEP is the pressure in the alveoli at the end of expiration
• PEEP keeps the alveoli open and prevents collapse
• Typical PEEP for an intubated patient is 5
• Normal PEEP is 3
• It is rare for a ventilated patient to be set at 0 PEEP
Slide 6
• The Minute Ventilation (VE) is the average of respirations + tidal volume
• VE is usually 6-8
• Inspiratory:Expiratory Ratio can be used to manipulate respirations (COPD-blow off CO2)
• I:E Ration is the ratio at which the patient is breathing
• 1:2 would mean that the inspiration is 1 second and the expiration is 2 seconds
• Increase the I to increase oxygen
• Increase the E to allow longer air time
Slide 7
• A chest cuirass may be used for ALS patients
• A chest cuirass expands with negative pressure
• Can be painful
• Short-term therapy
Slide 13
• FiO2 is the percentage of oxygen we are taking in
• Room air is 21% FiO2
• Control modes mean that we have total control of tidal volume and respirations
• On support mode, we help the patient out
Slide 14
• Assist control gives us total control
• No spontaneous breathing by patient
• Not a very safe mode, due to set volume and the possibility of breath stacking
• Not pressure regulated
• May cause trauma to the airway
Slide 15
• PCV is a control mode
• Works off pressure, not tidal volume setting
• Sets pressure control (Ex. 30 sonometers)
• Patients with COPD require pressure
• Tidal volume is based on pressure
Slide 16
• PRVC is a control mode
• We regulate the volume
• Ventilator regulates the pressure
• The respiratory therapist sets a pressure limit
• Ex. 14rr/min and 500cc tidal volume
• If the ventilator senses a problem, it will back off by 5 sonometers of pressure
• The ventilator will reduce the pressure three times, and then will alarm
• Even though it backs off the pressure, it will still deliver the same volume
• Suction the patient
• Are they too awake?
• Are they in pain?
• Listen to breath sounds
• Has the tube moved?
Slide 17
• SIMV is in sync with the patient
• Support mode, synchronizes with the patient
• Used when trying to wean (see: weaning protocol)
• Set rate, but allows patient to take a spontaneous breath with pressure support
• Very quick weaning takes about 6 hours (Ex. CVRU patients)
• Pressure supported breathing allows the patient to breathe on their own again, but supports the breath
Slide 18
• PSV is pressure support only
• No rate is set
• Patient must be breathing on their own
• Consider any medications that may alter the respiratory drive
• This is a weaning mode
Slide 19
• The is no set rate for volume support
• Set tidal volume
• When the patient breathes, they will get the assigned tidal volume
Slide 20
• CPAP offers constant pressure through inspiration and expiration
• Pressure does not change
Slide 26
• Barotrauma results when pressure is kept too high, leads to ARDS
• Volutrauma is too much tidal volume
Slide 27
• Prevent VAP with frequent mouth care, suctioning, and maintaining the bed at 30 degrees
Slide 29
• Rapid weaning patients are CVRU ( ................
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