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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