Mechanical Ventilation Flashcards
Mechanical Ventilation
Controlling Modes
- Continuous Mandatory Ventilation
- SIMV - Synchronized intermittent mandatory ventilation
- Tidal Volume/Rate/PEEP
- Report would be something like, “pt is on AC of 16 with TV of 500 and a peep of 5”. [AC is the mode and 16 is the rate]
Mechanical Ventilation
- Priority- monitor and evaluate pt response to vent.
— When caring for ventilated pt, the pt comes first, ventilator comes second
— Assess
— When alarms sound: assess pt:
—- Breathing, color, O2 sat - Manage vent system
— Perform and document vent and equipment checks
— Check vent settings as ordered - Prevent complications
Mechanical Ventilation Nursing care
- Address concerns of pt & family
— Mechanical vent causes anxiety
— Encourage expression of their concerns
— Be supportive through process - Plan methods of communication
— Pen/paper, picture board, electronic tablet
— Anticipate needs
— Provide sense of control over environment
— - Urge to participate in self care
Vent considerations-Nsg Assessment
Identify problems with ventilation that may be causing anxiety:
- Tube blockage from kinks or secretions
- Acute resp problems (pneumothorax or pain)
- Sudden decrease in O2 levels
- Level of dyspnea
- Ventilator malfunction
- *Prevent Alarm Fatigue
Vent considerations-Nsg Assessment 2
Assess need for sedation:
- Allow vent to provide full support of ventilation
- To decrease patients anxiety
- Medications frequently used for sedation:
— Lorazepam (Ativan)
— midazolam (Versed)
— dexmedetomidine (Precedex)
— propofol (Diprivan)
Vent considerations-Nsg Assessment 3
Neuromuscular blocking agents (paralytic agents):
- Used to paralyze pt if PEEP level can not be maintained with sedatives
- Used in extreme cases during ventilation
— Paralysis allows pt to be ventilated more easily
— Paralytic agents improve oxygenation, inflammation, and mortality
Neuromuscular blocking agents (paralytic agents) frequently used:
- Succinylcholine- used temporarily as a 1x dose-only when intubating pt.
— cisatracurium (Nimbex)
— rocuronium (Zemuron)
— vecuronium (Norcuron)
*Nursing assessment is essential to minimize the complications related to neuromuscular blockade. The patient may have discomfort or pain but cannot communicate these sensations. In addition, frequent oral care and suctioning may be needed.
Train of 4: done on pts with paralytic
- measure amount of parlalytic to be given
Mechanical Ventilation Ventilator Controls:
Volume Controlled
- Ventilator is programmed to deliver preset volume of air &/or Oxygen (Vt).
- Well known/researched, freq used, and will more often than not deliver intended volume.
- *Increased risk for barotrauma, not physiologically “normal”.
Mechanical Ventilation Ventilator Controls:
Pressure Controlled
- Ventilator is programmed to deliver preset pressure. Inspiration ends when the peak inspiratory pressure (PIP) is reached.
- *Decreased risk for barotrauma, more physiologically “normal”.
- Decreased effectiveness with patients that have decreased compliance, fibrosis, or pulmonary hypertension
Volume Controlled MODES
- Controlled ventilation (CV)
- Assist- Control (AC)
- Synchronized Intermittent Mandatory ventilation (SIMV)
— Positive pressure ventilation
— Preset volume delivered in synchrony with pt breathing
— Pt breaths spontaneously
— Keeps muscles intact
— May be used as part of weaning from ventilator
Pressure Controlled MODES
- Pressure support ventilation (PSV)
- Airway pressure release ventilation (APRV)
- Positive end-expiratory pressure (PEEP)
- Continuous positive airway pressure (CPAP)
Controlled Ventilation (CV)
- Controlled Mandatory Ventilation (CMV)
- Used for pts who are unable to initiate breath
— Ex. Guillain Barre, polio - Delivers set tidal volume of oxygen at a preset rate
- This is the simplest mode but is used less frequently than others
Assist-Control Mode (AC)
- Used with those who can breathe spontaneously- but have weak muscles of respiration.
- Tidal volume and vent. rate are pre-set.
- Will deliver oxygen with out client effort.
— But if pt does inspire, it will respond to that effort. - *Careful- hyperventilation/resp alk can result
SIMV Synchronized intermittent mandatory ventilation
- Ventilator breaths are correlated with client breathing
- Pt can breathe naturally in between
- Used as a primary mode as well as a weaning mode
Pressure Support
- Pt initiates EVERY breath but is supported by vent with positive inspiratory pressure assistance
- This mode decreases the work of breathing
- Used for weaning pts from mechanical vents
- Minimal to absent sedation
- Can be used to strengthen respiratory muscles
Airway Pressure Release Ventilation (APRV)
- New research suggests evidence in favor of using APRV for patients in severe ARDS
- *In this mode, Inhalation is longer than expiration
- *Facilitates spontaneous breathing by delivering continuous positive airway pressure (CPAP)
- High continuous positive airway pressure is delivered for a long duration then falls to lower pressure for a shorter duration.
