NCM 118 - RLE

MECHANICAL x
Leny Baguio
Week 3: Topic 1 VENTILATION

MECHANICAL VENTILATION o Controlled hyperventilation

- A life-sustaining therapy which a (patient with severe head injury)

ventilator provides partial or full support CLASSIFICATION OF VENTILATORS

for patients with respiratory failure - Classified according to the method by
- A positive- or negative-pressure breathing which they support ventilation
device that can maintain ventilation and NEGATIIVE-PRESSURE VENTILATORS
oxygen delivery for a prolonged period - Iron Lung (Drinker Respirator Tank)
- Integral part of nursing care, clinical care o Rarely utilized
MAIN GOALS: o During polio epidemics
- Maintain adequate gas exchange - Body Wrap (Pneumo-Wrap) and Chest
- Rest the respiratory muscles Cuirass (Tortoise Shell)
- Decrease the oxygen cost of breathing o Portable devices
INDICATIONS o Require rigid cage or shell to
- Laboratory Values create a negative-pressure
o PaO 2 <55 mmHg (↓ oxygenation) chamber around the thorax and
o PaCO 2 >50 mmHg and pH <7.32 abdomen
(acidosis) o Proper fit and system leaks = used
o Vital Capacity <10 mL/kg only with carefully selected
o Negative inspiratory force <25 cm patients
H2O POSITIVE-PRESSURE VENTILATORS
o FEV1 <10 mL/kg - Most widely used approach
⚠️ Conditions such as: thoracic or abdominal - MV deliver gas to the lung with positive-
surgery, drug overdose, neuromuscular pressure ventilation (PPV) appled through
disorders, inhalation injury, COPD, multiple an endotracheal tube, a tracheostomy or a
trauma, shock, multisystem failure, and coma tight-fitting mask.
may lead to respiratory failure and the need for - Includes:
mechanical ventilator. a. Volume-Cycled Ventilators
- Clinical Manifestations o Most commonly used PPV
o Apnea or bradypnea o Deliver a preset volume of air w/
o Respiratory distress with confusion each inspiration
o Decreased work of breathing not o Delivered – the ventilation cycles
relieved by other interventions off and exhalation occurs passively
o Confusion with need for airway o Volume delivered is constant =
protection ensure consist, adequate breaths
o Circulatory shock

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 NCM 118 - RLE
MECHANICAL x
Leny Baguio
Week 3: Topic 1 VENTILATION

a. Avea o Protect the lung from pressure

▪ Both ventilator and monitor injury
neonatal, pediatrics, and d. Noninvasive PPV
adult patients o Can be given via face masks that
▪ Can deliver noninvasice cover the nose and mouths
ventilation with Heliox to o Nasal masks or other oral or nasal
adult and pediatric patients devices (nasal pillow/small nasal
b. Puritan-Bennett 840 Ventilator cannula)
System o Eliminates need for endotracheal
▪ Has volume, pressure and intubation/tracheostomy
mixed modes designed for o ↓ risk for nosocomial infections
adult, pediatric, infant (pneumonia)
ventilation o For pt with: acute or chronic respi

May experience barotrauma = pressure failure, acute pulmo edema, COPD,

required to deliver may be excessive. CHF, or a sleep-related breathing

Damages alveolar capillary membrane, or disorder

it may leak in to surrounding tissues. o Not for: respiratory arrest, serious

dysrhythmias, cognitive
b. Pressure-Cycled Ventilators
impairment, head/facial trauma
o Cycle on – delivers a flow of air
(inspiration) until it reaches a o Continuous positive airway

preset pressure – Cycle off, pressure (CPAP) provides pressure

to the airways throughout the
expiration occurs passively
respiratory cycle
Major Limitation: volume of air/O 2 can vary
▪ Best for obstructive sleep
as the pt’s airway resistance or compliance
apnea as the positive
changes → tidal volume delivered may be
pressure acts as a splint
inconsistent → compromised ventilation
(keeps upper airway and
c. High-Frequency Oscillatory Support
trachea open)
Ventilators
▪ Must be breathing
o Deliver very high respiratory rates
independently
(180-900 breaths/m)
o Bilevel PAP (BiPAP) offers
o Accompanied with very low tidal
independent control of inspiratory
volumes and high air pressures
and expiratory pressures while
o Used to open alveoli in situations w
providing pressure support
closed small airways (atelectasis
ventilation (PSV)
and ARDS)
▪ Delivers 2 levels of PAP via

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nasal or oral mask, nasal

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 NCM 118 - RLE
MECHANICAL x
Leny Baguio
Week 3: Topic 1 VENTILATION

pillow, or mouthpiece with a o Monitoring progress: record RR,

tight seal minute volume, spontaneous and
▪ Often used for patients who machine-generated tidal volume,
require ventilatory FiO 2, and ABG levels
assistance at night (severe SYNCHRONIZED INTERMITTENT MANDATORY
COPD or sleep apnea) VENTILATION (SIMV)
▪ Most successful with highly - Delivers a preset tidal volume and # of
motivated patients breaths per minute.
VENTILATOR MODES - Between ventilator-delivered breaths, the

CONTROLLED MECHANICAL VENTILATION pt can breathe spontaneously with no

- Provide full ventilatory support by assistance from the ventilator on those

delivering a preset tidal volume and extra breaths (ventilator senses pt

respiratory rate breathing efforts & does not initiate a

- Indication: pt who are apneic breath in opposition to the pt’s efforts)

↓
CONTINUOUS MANDATORY VENTILATION (CMV)
Bucking the ventilator is reduced
- Assist-control Ventilation
spontaneous breathing continues
- Provide full ventilatory support by
↓
delivering a preset tidal volume and ↓preset # of ventilator breaths & pt does
respiratory rate more of the breathing
- If the pt initiated a breath between the - Can be used to provide partial/full
machine’s breaths, the ventilator delivers ventilatory support
at the preset volume ( assisted breath) - NSG INTERVENTIONS
- Every breath is the preset o Monitoring progress: record RR,
volume/pressure regardless if it is minute volume, spontaneous and
initiated by the patient/ventilator machine-generated tidal volume,
INTERMITTENT MANDATORY VENTILATION (IMV)
FiO 2, and ABG levels
- Combination of mechanically assisted CONTINUOUS POSITIVE AIRWAY PRESSSURE (CPAP)

breaths and spontaneous breaths - Provide continuous pressure throughout

- Mechanical Breaths – delivered at preset the respiratory cycle
intervals and preselected tidal volume - When the pt breaths in, the ventilator
regardless of the patient’s efforts machine will provide one constant
- Allows pt to use their own muscles for pressure during the inspiration
ventilation (help prevent muscle atrophy) - When the pt breaths out, the ventilator will
- Lowers mean airway pressure (assist in continue that inward pressure during the
preventing barotrauma) entire expiration
- NSG INTERVENTIONS
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 NCM 118 - RLE
MECHANICAL x
Leny Baguio
Week 3: Topic 1 VENTILATION

- Used on pt with: respiratory disorders, - With every breath, the ventilator

acute pulmonary edema, obstructive sleep synchronizes with he pt’s ventilatory
apnea, obesity hypoventilation syndrome efforts
PRESSURE SUPPORT VENTILATION (PSV) - “Additional muscle” to the pt’s effort as
- Applies a pressure plateau to the airway the depth and frequency of breaths are
throughout the patient-triggered controlled by the pt
inspiration to decrease resistance within HIGH-FREQUENCY VENTILATION (HFV)
the tracheal tube and ventilator tubing - New technique of ventilation
- Pt strength ↑ = pressure support is reduced - Gives RR that greatly exceed the rate of
gradually normal breathing
- SIMV backup rate may be added for extra - 3 TYPES:
support 1. High-Frequency Positive Pressure
- NSG ACTIONS Ventilation (HFPPV) – rate 60-150 per
o Must closely observe the pt’s RR minute
and tidal volumes on initiation of 2. High-Frequency Jet Ventilation (HFJV)
PSV – rate 240 – 660 per minute
o May be necessary to adjust the 3. High-Frequency Oscillatory Ventilation
pressure support to avoid (HFOV) – rate 300 – 900 per minute
tachypnea or large tidal volumes o Advantage: ability to promote gas
AIRWAY PRESSURE RELEASE VENTILATION (APRV) exchange while using tidal volumes
- A time-triggered, pressure-limited, time- that are < the dead space
cycled mode of mechanical ventilation o Can maintain oxygenation and
- Allows unrestricted, spontaneous ventilation while using minimal
breathing throughout the ventilatory cycle tidal volume = minimize
- Allows alveolar gas to be expelled through barotrauma → reduce morbidity
the lungs’ natural recoil associated w/ ventilator
- (suggested) it causes less ventilator- management of an illness
induced lung injury and fewer adverse HOW ARE PATIENTS ON VENTILATORS
effects on cardiocirculatory function and
MONITORED?
associated with lower need for sedation
- Mostly on ICU
and neuromuscular blockade
- Hooked up to a monitor (HR, RR, BP,
PROPORTIONAL ASSIST VENTILATION (PAV)
O 2 Sat)
- New mode of support
- Chest X-ray (CXR), blood gases
- Provides partial ventilatory support
- Make Judgements (adjust the ventilator if
- It generates pressure in proportion to the
necessary)
pt’s inspiratory efforts

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 NCM 118 - RLE
MECHANICAL x
Leny Baguio
Week 3: Topic 1 VENTILATION

HOW LONG IS A VENTILATOR USED? - Lung damage

- Ventilator can be lifesaving, but its use has o The pressure into the lungs can

some risks damage the lungs

- Doesn’t fix the problem, just helps support o Use low amount of pressure needed

a person until other treatments become - Side effects of medication

effective or the person gets better on their o Pain medication = confused and

own delirious

- “Weaning” process of getting the pt off - Inability to discontinue ventilator support

the ventilator
- May be only for a few hour or days
- Depends on many factors:
o Overall strength
o How well their lungs before
o How many other organs are
affected (brain, heart, kidneys)
HOW DOES A PATIENT FEEL WHILE ON A
VENTILATOR?
- The ventilator causes no pain, but the tube
may cause discomfort (coughing or
gagging)
- Cannot talk when an ET tube passes
between the vocal cords into the windpipe
- Cannot eat by mouth
- Feel uncomfortable
o You may give medicine (sedatives
or pain control)

RISKS OF MECHANICAL VENTILATION

- Infections
o Pneumonia – treated w/ antibiotics
- Collapsed Lung (pneumothorax)
o A part of the lung can become weak
and develop a hole ( air leakage)
o Severe = death
o To re-expand = tube is inserted into
the chest to drain the air that is
leaking out
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