Mechanical Ventilation Flashcards
When do we intubate?
8
Unable to maintain airway- unresponsive or losing responsiveness
Apnea-dec RR
Airway obstruction
High risk aspiration
Resp distress
Paralysis of muscles
Pt can’t breathe on own- too tired
To clear secretions
What do we do during intubation
During intubation: BVM with 100% oxygen (ambu), RSI drugs- sedative, analgesic, paralytic
Advantages of PEEP 5
keep alveoli open, allows
oxygenation at lower FiO2, used in cases of fluid
in lungs-ARDS for example
Normal PEEP is 5 cm H20 but can go as high as 20 cm H20 for
serious conditions to keep lungs open
Disadvantages of PEEP 6
impairs venous return,
Barotrauma- pneumo- hard for patient to expire, water and NA increase, edema
What are the possible complications of positive pressure ventilation 10
Increased thoracic pressure-decreased venous return
Barotrauma
Alveolar hypoventilation- (resp acidosis) may have to increase RR on vent
Alveolar hyperventilation-(resp alkalosis) may have to decrease RR on vent
VAP-pneumonia
Water/sodium retention
Impaired cerebral blood flow-IICP
GI ulcers
Nutrition –need enteral feedings
Pressure ulcers
VAP
S/S and Bundle 6
S/S: inc WBCs, inc fluids in lungs, inc temp, purulent drainage, crackles
Prevention with interventions referred to as VAP bundle – HOB up 30-45 degrees, no changing of vent tubing, oral care with chlorhexidine, sedation vacation- wake up patient and reassess need for vent- q 24 hrs, early mobility, ET tube with suction
Deep endotracheal suctioning only happening when
Visible secretions present in tubing
Sudden resp distress
Aspiration
Increased pressure readings from vent (high pressure alarm)
Increased coughing or increased RR
If thick secretions noted
need to increase intake of fluids (via enteral feedings) or IV fluids, saline put into airway not effective to thin out secretions
When can we extubate
Preweaning-10
Weaning-3
Weaning outcome-4
Lungs are better/clear- cause of resp failure fixed
Pt can initiate inspiration
Neurostatus – Awake & alert, therefore, can protect airway
MM strength
SpO2 >90%
Vent settings dropped – PEEP less than 5-8
pH >7.25
Hemodynamic stability
Drugs are titrated to provide comfort but allow the patient to be awake enough to assist
Awake-SAT
Breathing-SBT
Coordination/choice of sedation
Delirium assessment-CAM
Early mobility
Extubation, suction, Hyper 0 reassess
room O2
low flow NC
Simple face mask
Venturi mask
Non-rebreather
High flow NC
RA-@1%
low flow NC 1-6 each l adds 4%/L
Simple face mask 6-12L 35-60%
Venturi mask Fixed depends on adapter
Non-rebreather 10-15 100%
High flow NC up to 60 30-100%
ET tube vs Tracheostomy
less than 20 days= ET longer=Trach
Complications of ET intube
Head/neck immobility, chipped teeth, increases secretions, tube occlusion-biting
lip line for ET tube
21-23cm
Suctioning Risks for vent
Hypoxemia, bronchospasm, IICP, DysR, Mucosal damage
Complications of intubation and tx
Unplanned extubation- Bag them 100%
Aspiration0 from secretions above cuff- subglottic suction and NG/OG tube
