Mechanical Ventilation

Prepared by:
Kausar Ali Dawar
Semester 7th Generic BSN
Vertex College Of Nursing
Abbottabad
 Mechanical Ventilation
When someone cannot breath on his own then a
machine called Ventilator is used to give him
breaths for survival.
 Ventilator Indications for Newborns
• Not crying immediately after birth
• HR <100 Bpm
• RR >60 Bpm, SPO2 dropping (Apnea can occur in
this case).
 Ventilator Indications for Adults
• Patient cannot protect the airway as GCS <8 and Pt. is
having a head injury.
• If in ABGs PaO2 <60mmHg that cannot be improved
with non-invasive ventilation.
• Type II respiratory failure (Lungs cannot remove CO2)
• COPD patient cannot breath on his own.
• Drugs induced respiratory failure e.g Amiodarone,
Methotrexate, Chemotherapy
 Ventilator Indications for Adults
• Interstitial lung diseases which can lead to
lungs fibrosis and making lungs stiff and patient
cannot breath e.g SLE, Rheumatoid Arthritis,
Sjogren’s syndrome etc.
• General Anesthesia
• GBS which causes acute muscle weakness.
• Myasthenia Gravis which causes chronic muscle
weakness.
 Ventilator indication using ABGs
Test Result Normal range
PH <7.25 7.35 - 7.45
PaCO2 >55mmHg 35 - 45
PaO2 <70mmHg 80 - 100
SPO2 ≤70% 95 - 100
 Ventilator Parameters
1. FiO2
2. PEEP
3. I:E
4. VT
5. Trigger Sensitivity
6. RR (12- 16 for adults)
 FiO2
• It stands for fraction of inspired oxygen.
• Ventilator give fix volume of air with each
breath and fix concentration of O2.
• Oxygen concentration can be adjusted according
to patient SPO2 level.
 PEEP
• It means positive end expiratory pressure.
• We normally we set it to 4mmHg or 5mmHg.
• It prevent the alveoli from collapsing during
expiration.
• It can cause hypotension by reducing venous
return so keep it off during hypotension or
general anesthesia.
 I:E Ratio
• It means inspiration to expiration time.
• More inspiration time means giving a deep breath.
• More expiration time means breathing out full air.
• Normally we set it 1:2.0
• In COPD cases the main problem is air trapping in
alveoli, So we must remove the trapped air inside
lungs using I:E ratio 1:3.0 or 1:4.0 and PEEP 4mmHg.
(High PEEP also means maintaining COPD.)
 Vt
• VT means Tidal volume.
• It is the volume of air given by vent with each
breath.
• Its normal value is 5 - 10ml/kg.
• Best preferred value is 7ml/kg.
• If weight = 50kg then 50×7= 350ml/kg.
 Trigger Sensitivity
• When a patient wants to take breath with self effort
then vent senses pt. effort and allow him to take extra
breaths. Such breaths are called patient triggered
breaths.
• If pt. cannot take breaths with self effort then vent
senses it and start giving ventilator triggered breaths
according to set rate.
• In vent we set it to 0.5L/mint.
 Modes
There are about 600 plus vent modes but we focus on 4
important mode.

• VC-CMV
• VC-SIMV
• VC-AC
• Spontaneous Mode
 Modes

VC-CMV VC-AC VC-SIMV

• Vt = 350ml • Vt = 350ml • Vt = 350ml
• RR = 12b/m • RR = 12b/m • RR = 12b/m

NOTE: All the modes are same when the patient has no effort or heavily
sedated and paralyzed.
 Modes

VC-CMV VC-AC VC-SIMV

• Vt = 350ml • Vt = 350ml • Vt = X
• RR = 12b/m • RR = X • RR = X

NOTE: All the modes are different when the patient has some effort.
 High Peak Pressure Alarm!
• VC means Volume control.
• This mode is used when lungs are elastic.

• PC means Pressure control.

• This mode is used when lungs are stiff because if pressure was
not controlled then high pressure will rupture the alveoli and
patient will die.

• Note:
If Volume = K If Volume = X
then Pressure = X then Pressure = K
 Patient is fighting with Vent
• Normally patients don’t do such things while on
mechanical but in some cases if such things
happens then there will not be effective
ventilation.
• So for this continues heavy sedation and
paralysis is required that will also prevent the
patient from self extubation.
 Drugs for sedation and paralysis
Midazolam
Loading dose i/v: 0.1 - 0.5mg/kg
Continues infusion dose: 1 - 2mcg/kg/min

Suxamethonium
Loading dose i/v: 1mg/kg
Onset Time: 30 - 60 seconds
Duration Time: 3 - 5 minutes

Atracurium
Loading dose i/v: 0.3 - 0.6mg/kg
Continues infusion dose: 0.3 to 0.6mg/kg/min
Duration time Approximately: 30 - 60 minutes
Thank
You