MECHANICAL VENTILATOR
Caring for a patient on a mechanical ventilator involves close monitoring, ongoing
assessment, and various interventions to ensure the patient’s safety, comfort, and respiratory
support. Here are key components of care:
1. Monitoring and Assessment:
Respiratory Parameters:
Tidal volume (VT): Ensure it's set appropriately for the patient’s lung size
and condition.
Respiratory rate (RR): Ensure this is consistent with the patient’s needs.
Oxygenation (FiO2 and SpO2): Adjust FiO2 to maintain oxygen saturation
levels typically between 92-98%.
PEEP (Positive End-Expiratory Pressure): This helps keep alveoli open,
preventing atelectasis.
Ventilator Mode: Adjust based on the patient’s condition (e.g., assist-control,
pressure support, synchronized intermittent mandatory ventilation).
End-tidal CO2 (ETCO2): Use to assess ventilation efficiency and the
patient’s respiratory status.
ABG (Arterial Blood Gas): Regularly monitor ABG to assess oxygenation,
ventilation, and acid-base status.
Chest X-ray: To assess lung condition and placement of the endotracheal tube.
2. Ventilator Settings and Adjustments:
Volume-Controlled or Pressure-Controlled Ventilation: Depending on the
patient’s condition (e.g., ARDS may benefit from pressure-controlled modes to avoid
barotrauma).
Weaning Parameters: Gradually reduce ventilator support when the patient is ready
to breathe independently, monitoring for signs of distress or fatigue.
Suctioning: Keep the airways clear from secretions by suctioning the endotracheal
tube or tracheostomy tube as needed to prevent obstruction and infection.
3. Patient Comfort and Sedation:
Sedation and Analgesia: Most patients on a mechanical ventilator require sedation
(e.g., propofol, fentanyl) to prevent discomfort, anxiety, or agitation. Ensure adequate
sedation levels with frequent assessments.
Paralytics: In some cases, (e.g., severe ARDS or during surgical procedures),
neuromuscular blockers might be used. Continuous monitoring is required to prevent
complications like prolonged paralysis.
Oral Care: Regular oral hygiene to prevent ventilator-associated pneumonia (VAP).
Use chlorhexidine mouthwash or swabs.
Positioning: Ensure the patient is positioned to optimize lung expansion and reduce
pressure sores. Turn every 2 hours or as needed.
4. Prevention of Ventilator-Associated Complications:
Ventilator-Associated Pneumonia (VAP) Prevention:
Elevate the head of the bed to 30-45 degrees.
Maintain adequate humidification of the ventilator circuit.
Use closed suction systems.
Regularly assess the need for antibiotics and early removal of the ventilator.
Barotrauma and Volutrauma: Monitor for signs of trauma to the lungs such as
pneumothorax, subcutaneous emphysema, or pulmonary haemorrhage. Keep airway
pressures within safe limits.
5. Nutritional Support:
Enteral Nutrition: Ensure adequate nutrition, as mechanical ventilation increases
metabolic demand.
Monitoring for Gastric Distention or Aspiration: Check for signs of intolerance to
enteral feeding and maintain gastric ph.
6. Psychosocial and Communication Needs:
Communication: Patients on mechanical ventilation are unable to speak. Use
alternative methods (e.g., writing boards, gestures, or communication devices) to
assess needs and provide comfort.
Emotional Support: Ventilated patients often feel anxiety, isolation, and frustration.
Providing emotional support and keeping the patient informed is crucial.
7. Daily Care and Hygiene:
Ventilator Circuit and Tube Care: Change ventilator circuits and filters as per
protocols. Check for leaks or kinks in the tubing.
Endotracheal or Tracheostomy Care: Regular inspection for signs of infection,
patency, and correct placement. Suction when necessary to prevent clogging.
8. Weaning Process:
Assess Readiness for Extubation: Gradual weaning is important and involves
assessing the patient’s ability to maintain oxygen levels, clear secretions, and breathe
effectively on their own.
Spontaneous Breathing Trials (SBT): These are often used to assess whether a
patient can be extubate.
Extubation Protocol: Once the patient is stable, ensure all necessary steps are taken
for safe extubation, and monitor closely for re-intubation.
9. Emergency Situations:
Ventilator Alarm Management: Be familiar with the various alarm types (e.g., high-
pressure, low-pressure, low tidal volume) and how to address them.
Failed Extubation or Respiratory Distress: Be prepared for reintubation if the
patient cannot maintain oxygenation or ventilation after extubation.
10. Family Communication:
Involve Family: Keep the family updated on the patient's condition, treatment plan,
and expected recovery course.
Emotional Support for Family: Ventilated patients can be critically ill, and family
members may experience high levels of anxiety and distress.
