DEFINITION

“Mechanical ventilation is the use of a ventilator to move room air or oxygen enriched air into and out of
the lungs mechanically to maintain proper levels of oxygen and carbon dioxide in the blood.”
Mechanical ventilation alone does not treat or reverse the underlying pathology leading to the need for
ventilator support. Rather, it is applied as one of the support systems until the reversal of the pathological
condition, so that the patient may then become weaned from mechanical ventilation.

GOAL
 Improve gas exchange
 Relive respiratory distress
 Improve pulmonary mechanics
 Permit lung and airway healing
 Avoid complication

TARGET
 Reverse hypoxemia/Relieve acute respiratory acidosis
 Reverse respiratory muscle fatigue Prevent and reverse atelectasis
 Improve lung compliance/Maintain lung and airway function
 Prevent disuse respiratory muscle dystrophy

PURPOSES
 To maintain gas exchange in case of acute and chronic respiratory failure.
 To maintain ventilator support after CPR.
 To reduce pulmonary vascular resistance.
 To excrete increased CO2 production.
 To give general anesthesia with muscle relaxants.

INDICATIONS
 Acute respiratory failure
 Apnea or impending inability to breath
 Severe Hypoxia/Hypoxemia
 Respiratory muscle fatigue
 Cardiac Insufficiency
 Neurological problems
 Therapeutic and prophylactic
 Respiratory failure: An inability of the heart and lungs to provide adequate tissue oxygenation or
removal of carbon dioxide.
 Hypoxemic respiratory failure – lung failure
 Hypercapnic respiratory failure – pump failure
 Neuromuscular diseases : Myasthenia Gravis, Guillain-Barre Syndrome, and Poliomyelitis (failure of
the normal respiratory neuromuscular system)
 Musculoskeletal abnormalities :Such as chest wall trauma .
 Infectious diseases of the lung such as pneumonia, tuberculosis.
 Obstructive lung disease in the form of asthma, chronic bronchitis or emphysema.
 Conditions such as pulmonary edema, atelectasis, pulmonary fibrosis.
 Patients who has received general anesthesia as well as post cardiac arrest patients requires
ventilatory support until they have recovered from the effects of the anesthesia or out from a Danger.

TYPES OF MECHANICAL VENTILATION

 Invasive ventilation or conventional mechanical ventilation (MV) &

 non invasive ventilation (NIV).
 OR
 Positive Pressure Ventilation &
 Negative pressure ventilation.
Non Invasive Ventilation: “Ventilatory support that is given without establishing endo- tracheal
intubation or tracheostomy is called Non invasive mechanical ventilation.”

Invasive Ventilation: “Ventilatory support that is given through endotracheal intubation or tracheostomy
is called as Invasive mechanical ventilation.”

Negative pressure:
 Producing Neg. pressure intermittently in the pleural space/ around the thoracic cage. • e.g.: Iron Lung
Positive pressure:
 Delivering air/gas with positive pressure to the airway.
 e.g.: BIPAP & CPAP ( O2 mask , Nasal cannula etc.
 Elongated tank, which encases the patient up to the neck. The neck is sealed with a rubber gasket, the
patient's face are exposed to the room air.
 These exert negative pressure on the external chest decreasing the intra-thoracic pressure during
inspiration, allows air to flow into the lungs, filling its volume.
 The cessation of the negative pressure causes the chest wall to fall and exhalation to occur.
 The patient’s body was encased in an iron cylinder and negative pressure was generated
 The iron lung are still occasionally used today.
 These are simple to use and do not require intubations of the airway; consequently, they are especially
adaptable for home use.
 It is used mainly in chronic respiratory failure associated with neuromuscular conditions such as
poliomyelitis, muscular dystrophy and myasthenia gravis.

1. The use of negative-pressure ventilators is restricted in clinical practice, however, because they limit
positioning and movement and they lack adaptability to large or small body torsos (chests).

POSITIVE PRESSURE VENTILATION

 Positive pressure ventilation inflate the lungs by exerting positive pressure on the airway forcing the
alveoli to expand during inspiration.
 Expiration occurs passively.
 Positive-pressure ventilators require an artificial airway (Endotracheal or tracheostomy tube) in
invasive ventilation and in NIV includes BiPAP Mask , O2 mask , Nasal mask/cannula , O2 high
concentrated reservoir mask etc.
 Inspiration can be triggered either by the patient or the machine.

INVASIVE MECHANICAL VENTILATION

Invasive mechanical ventilation is implemented once a cuffed tube is inserted into the trachea to allow
conditioned gas (warmed, oxygenated, and humidified) to be delivered to the airways and lungs at
pressures above atmospheric pressure.
Ventilatory support that is given through endotracheal intubation or tracheostomy is called as Invasive
mechanical ventilation

POSITIVE INVASIVE PRESSURE VENTILATION

Positive invasive pressure ventilation deliver gas to the patient under positive-pressure, during the
inspiratory phase.

Modes of mechanical ventilation are the techniques that the ventilator and patient work together to
perform the respiratory cycle.
(1) Pressure Cycled Modes
 (2) Volume Cycled Modes
(3) Time Cycled Modes

Pressure- Controlled Ventilation

 (i) Continuous Positive Airway Pressure(CPAP)
 (ii) Bi-Level (Bi-Phasic) positive airway- pressure (BiPAP)
 (iii) Pressure Support Ventilation (PSV)
 (iv) Pressure Assist/ Control Ventilation (PCV)
 (v)Pressure- Controlled Inverse Ratio- Ventilation

Complication
 Hypotension
 Pneumothorax
 Decreased Cardiac Output
 Nosocomial Pneumonia
 Positive Water Balance
 Increased Intracranial Pressure (ICP)
 Sinusitis and nasal injury Mucosal lesions Aspiration,
 GI bleeding,
 Patient discomfort due to pulling or jarring of ETT or tracheostomy,
 High PaO2, Low PaO2

Nursing Management
 Check the Air and oxygen connections
 Connect the Ventilator tubes to ventilator
 Connect the chest lung to the ventilator tubing's Make sure that you correctly connected the tubing's and
check for any looseness
 Connect the servo guard (From the patient)
 Connect the filter (To the Patient)
Check the tubing’s for any leakage
 Change the Bacteria filter
 Change the bacteria filter

PLAN OF CARE FOR THE VENTILATED PATIENT

Patient Goals:
 Patient will have effective breathing pattern.
 Patient will have adequate gas exchange.
 Patient’s nutritional status will be maintained to meet body needs.
 Patient will not develop a pulmonary infection.
 Patient will not develop problems related to immobility.
 Patient and/or family will indicate understanding of the purpose for mechanical ventilation.

Nursing Interventions
o Observe changes in respiratory rate and depth; observe for the use of accessory muscles.
o Observe for tube misplacement- note and post cm. Marking at lip/teeth after x-ray confirmation
o Prevent accidental extubation by taping tube securely, checking q.2h.; restraining/sedating as needed.
o Inspect thorax for symmetry of movement. Determines adequacy of breathing pattern; asymmetry may
indicate hemothorax or pneumothorax. . Measure tidal volume and vital capacity.
o Asses for pain
o Monitor chest x-rays • Maintain ventilator settings as ordered.
o Elevate head of bed 60-90 degrees. This position moves the abdominal contents away from the
diaphragm, which facilitates its contraction
 . • Monitor ABG’s. Determines acid-base balance and need for oxygen.
o Observe skin color and capillary refill. Determine adequacy of blood flow needed to carry oxygen to
tissues.
o Observe for tube obstruction; suction; ensure adequate humidification
 . • Provide nutrition as ordered, e.g. TPN, lipids or parental feedings.
o Use disposable saline irrigation units to rinse in-line suction; ensure ventilator tubing changed q. 7 days,
in-line suction changed q. 24 h.; ambu bags changes between patients and whenever become soiled.
o Assess for GI problems. Preventative measures include relieving anxiety, antacids or H2 receptor
antagonist therapy, adequate sleep cycles, adequate communication system.
o Maintain muscle strength with active/active-assistive/passive ROM and prevent contractures with use of
span-aids or splints.
o Explain purpose/mode/and all treatments; encourage patient to relax and breath with the ventilator;
explain alarms; teach importance of deep breathing; provide alternate method of communication; keep
call bell within reach; keep informed of results of studies/progress; demonstrate confidence.