VENTILATORS

Muhammad Abdullah
❖Learning Objectives
• Identify the mechanics of breathing
• Identify indicators for mechanical ventilation
• Identify two types of ventilators
• Identify the Modes of Ventilation
• Discuss the Adjuncts to Mechanical Ventilation
• Identify the components of Ventilator Settings
• Describe the Nursing Care of the Mechanically
• Ventilated Patient
• Discuss Arterial Blood Gases
 COMPONENTS OF RESPIRATORY SYSTEM:

• Nasal Oral Cavities

• Nasopharynx
• Oropharynx
• Epiglottis
• Larynx
• Trachea
• Left Right Bronchus
• Left Right Lung
• Alveoli
 PATHOPHYSIOLOGY OF BREATHING:

• During breathing, air is inhaled through the airway into millions of tiny sacs where
gas exchange takes place (alveoli). Then the air mixes with the carbon dioxide-rich
gas coming from the blood. This air is then exhaled back through the same airways
to the atmosphere. Normally this pattern repeats itself from 12 – 20 times a
minute, but can increase or decrease to meet our bodys needs.
• The gas exchange that takes place as described above is the main function of the
lungs. It is required to supply oxygen to the blood for distribution to the cells of the
body, and to remove the carbon dioxide that the blood has collected from the cells
of the body.
 PATHOPHYSIOLOGY OF BREATHING:

• Gas exchange in the lungs occurs only in the smallest airways and the alveoli. It does
not take place in the conducting airways (pathways) that carry the gas from the
atmosphere. The volume of these conducting airways is called the anatomical dead
space because it does not participate directly in the gas exchange.
• Gas is carried through the conducting airways through a process called convection.
• Gas is exchanged between the alveoli and the blood through diffusion.
• In normal, healthy lungs the drive to breathe comes from the need to regulate
carbon dioxide levels in the blood, not from a desire to inhale oxygen.
 PATHOPHYSIOLOGY OF BREATHING:

• One of the biggest factors that determines whether breathing is producing

enough gas exchange to keep a person adequately oxygenated is the
ventilation that each breath is producing.
• Ventilation is expressed as the volume of gas entering or leaving the lungs in
a given amount of time. It can be calculated by multiplying the inhaled (or
exhaled) volume of a gas (Tidal Volume) times the breathing rate.
• For example: A person breathing in 0.5 Liters per respiration, who breathes
12 times a minute, has a volume of 6 Liters/minute
 PATHOPHYSIOLOGY OF BREATHING:
• During normal breathing, the body selects a combination of tidal volume that is large
enough to clear the dead space and add fresh gas to the
alveoli, and a breathing rate that ensures the correct amount of ventilation is produced.
• There are two sets of forces that can cause the lungs and chest wall to expand the forces
that are produced by the muscles of respiration when they contract and the force produced
by the difference between the pressure at the airway opening and the pressure on the outer
surface of the chest wall.
• In normal respiration, the muscular force is the only one that comes into play, when the
respiratory muscles do the needed work to expand the chest wall, decreasing the pressure
on the
outside of the lungs so they expand, which draws air into the lungs.
 PATHOPHYSIOLOGY OF BREATHING:

• When respiratory muscles are not able to do the work required for
ventilation, the pressure at the airway opening, and/or the pressure at the
outer surface of the chest wall can be manipulated to produce breathing
movements.
• When altering either of those pressures, you can do so in one of two ways.
Either increase the pressure at the mouth and nose, so that air is
forced into the lungs or lower the pressure on the chest wall external
surface.
 BREATHING Contd:

• When respiratory muscles are not able to do the work required for
ventilation, the pressure at the airway opening, and/or the pressure at the
outer surface of the chest wall can be manipulated to produce breathing
movements.
• When altering either of those pressures, you can do so in one of two ways.
Either increase the pressure at the mouth and nose, so that air is forced into
the lungs or lower the pressure on the chest wall external surface.
❖Indications for Mechanical Ventilation
• Acute dyspnea
• Significant respiratory acidosis
• Acute or impending ventilator failure
• Severe oxygenation deficit despite high supplemental oxygen delivery
• Secretion/Airway Control
• Apnea, Respiratory Arrest
 MECHANICAL VENTILATION:

❖POSITIVE PRESSURE VENTILATION:

• Uses the technique of applying positive pressure
(relative to atmospheric pressure) to the airway
opening
❖NEGATIVE PRESSURE VENTILATION:
• Uses the technique of applying negative pressure
(relative to atmospheric pressure) to the
external body surface
 POSITIVE PRESSURE VENTILATORS:
❖For safe operation of the ventilator, the following things are required:
• Patient Interface: The ventilator delivers gas to the patient through a set of flexible tubes
called a patient circuit. This can have one or two tubes. The circuit typically connects the
ventilator to the patient to either an endotracheal tube or tracheostomy tube.
• Power Sources: Typically powered by electricity or compressed gas. The ventilator is usually
connected to separate sources of compressed air and compressed oxygen. Because
compressed gas has all the moisture removed, a humidifier is needed to moisten the gases
being delivered to the patient.
• Control System: This ensures the patient receives the desired breathing pattern. It
involves setting the parameters of the size of the breath, how fast it is brought in out, and
how much effort the patient must exert to signal the ventilator to start a breath.
• Monitors: A pressure monitor, as well as volume and flow sensors to provide alarms if
readings are outside the desired range.
 NEGATIVE PRESSURE VENTILATORS:
❖For safe operation of the automatic ventilator, the following things are
required
• Patient Interface: The patient is placed inside a chamber with his or her head extending
outside the chamber. The chamber may encase the entire body except the head(iron
lung) or it may enclose just the rib cage and abdomen (cuirass pronounced cure-ahs). It
is sealed to the body where the body where the body extends outside the chamber.
• Power Sources: Electricity powered, to run a vacuum pump that periodically evacuates
the chamber to produce the required negative pressure.
• Control System Sets breathing patterns.
• Monitors Alarms.
 MODES OF MECHANICAL VENTILATION:

• CMV
• AC
• SIMV
• CPAP
• PS
• PEEP
 MODES OF MECHANICAL VENTILATION:

❖CMV:
• The patient receives a set respiratory rate at set time intervals with a consistent tidal
volume. This is generally only used with much sedation or paralytics, because patient
efforts do not trigger the delivery of a breath by the machine.
This is used when the patient must not expend energy to breathe.
 MODES OF MECHANICAL VENTILATION:

❖Assist Control (AC):

• The patient receives a set respiratory rate at set time intervals with a consistent
tidal volume, but when the patient initiates a breath on their own, the preset tidal
volume is delivered. This decreases the patient's effort of breathing and ensures
volume delivery.
 MODES OF MECHANICAL VENTILATION:

❖Synchronized Intermittent Mandatory Ventilation (SIMV):

• The patient receives a preset respiratory rate at a set tidal volume, but the
machine allows for the patient to breathe spontaneously during the machine breaths. If
the patient breathes near the time that the machine is prepared to deliver the preset
volume, the machine will deliver the preset tidal volume. The breaths that the patient
initiates in between the machine breaths are not supplemented by the
machine. It is usually tolerated well by the patient, because of the synchronicity
involved.
 MODES OF MECHANICAL VENTILATION:

❖CONTINUOUS POSITIVE AIRWAY PRESSURE (CPAP):

• Used either intermittently during long-term weaning as a way to strengthen the
muscles, or as a final step before removing the patient from the ventilator, to see how
they tolerate the lack of ventilatory assistance. All breaths are generated by the
patient, and the patients effort determines the tidal volume. The machine simply
provides a continuous airway pressure, supplemental oxygen, and apnea alarms. The
continuous airway pressure makes the effort of breathing easier for the patient.
 MODES OF MECHANICAL VENTILATION:

• PRESSURE SUPPORT (PS):

When this mode is used, the patient initiates the breath, and the inspiration
ends when a preset flow amount is delivered. The positive pressure is applied
throughout inspiration and helps to increase the amount of tidal volume the
patient pulls in and decreases the energy the patient has to use.
 MODES OF MECHANICAL VENTILATION:

❖Positive End Expiratory Pressure (PEEP)

• PEEP is the application of continuous airway pressure throughout expiration. The
presence of this pressure in the airway prevents the complete collapse of the alveoli
and helps maintain that pressure until the next inspiration cycle begins.
 COMPONENT OF VENTILATOR SETTING:

• RATE
• TIDAL VOLUME
• PERCENTAGE OXYGEN
• PEEP
 COMPONENT OF VENTILATOR SETTING:

❖TIDAL VOLUME:
• Tidal volume is the amount of gas the the ventilator is to provide to the patient with
each breath. This volume will vary based on each
patients' height, weight, and gender. To calculate a very rough estimate of tidal
volume, you can use 10 - 15cc per kilogram of body weight. So, a 75lb. patient might
have an ordered tidal volume of 750cc.
 COMPONENT OF VENTILATOR SETTING:

❖Rate:
• The rate is the number of times the ventilator is set to provide a breath to the patient.
This may vary from 8-20 breaths per minute.
 COMPONENT OF VENTILATOR SETTING:

❖PERCENTAGE OF OXYGEN:
• The percentage of oxygen supplied to the patient with every breath. This can be as low
as 40 to as much as 100. Higher oxygen percentages for
long periods of time increase the patients' risk for oxygen toxicity and other pulmonary
complications.
 COMPONENT OF VENTILATOR SETTING:

• PEEP:
❖PEEP can be added to the regular ventilator settings, to provide the positive end
expiratory pressure that helps to prevent the complete collapse of the alveoli.
COMPLETE VENTILATOR:
A. GAS-MIXTURE AND GAS-METERING ASSEMBLY
B. INSPIRATORY UNIT
C. EXPIRATORY UNIT
D. EXPIRATORY FLOW SENSOR
E. BAROMETRIC PRESSURE SENSOR
F. PRESSURE MEASUREMENT ASSEMBLY
G. CALIBRATION ASSEMBLY
H. OXYGEN SENSOR
I. MEDICATION NEBULIZER ASSEMBLY