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![ The roman physician Galen may
have been the first to describe
mechanical ventilation: "If you
take a dead animal and blow air
through its larynx [through a
reed] you will fill its bronchi and
watch its lungs attain the
greatest distention."](https://image.slidesharecdn.com/mechanicalventilation-231217105847-e408b047/75/MECHANICAL-VENTILATION-SOME-OF-THE-BASICS-pptx-10-2048.jpg)
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Similar to MECHANICAL VENTILATION-SOME OF THE BASICS.pptx
MECHANICAL VENTILATION-SOME OF THE BASICS.pptx
- 1. Dr. Ajil Antony MBBS,MS, MRCS(Edin.), FIAGES
- 2. Mechanical ventilationis typically used after an invasive intubation, a procedure wherein an endotracheal or tracheostomy tube is inserted into the airway. It is used in acute settings such as in the ICU for a short period of time during a serious illness. It may be used in a nursing or rehabilitation institution if patients have chronic illnesses that require long-term ventilation assistance
- 10. The romanphysician Galen may have been the first to describe mechanical ventilation: "If you take a dead animal and blow air through its larynx [through a reed] you will fill its bronchi and watch its lungs attain the greatest distention."
- 11. Vesalius too describes ventilationby inserting a reed or cane into the trachea of animals.
- 12. In 1908George Poe demonstrated his mechanical respirator by asphyxiating dogs and seemingly bringing them back to life.
- 13. In medicine,mechanical ventilation is a method to mechanically assist or replace spontaneous breathing
- 14. Acute lunginjury (including ARDS, trauma) Apnea with respiratory arrest, including cases from intoxication Chronic obstructive pulmonary disease (COPD) Acute respiratory acidosis as in paralysis of the diaphragm due to Guillain-Barré syndrome, Myasthenia Gravis spinal cord injury, or the effect of anaesthetic and muscle relaxant drugs
- 15. Increased workof breathing as evidenced by significant tachypnea, retractions, and other physical signs of respiratory distress Hypoxemia as in sepsis, shock, congestive heart failure Neurological diseases such as Muscular Dystrophy Amyotrophic Lateral Sclerosis
- 16. The twomajor types of Mechanical Ventilation are 1. Negative pressure and 2. Positive Pressure ventilation The main form of mechanical ventilation is positive pressure ventilation, which works by increasing the pressure in the patient's airway and thus forcing air into the lungs. Less common today are negative pressure ventilators (for example, the "iron lung") that create a negative pressure environment around the patient's chest, thus sucking air into the lungs
- 17. Mechanical VentilatorSettings regulates the rate, depth and other characteristics of ventilation. Settings are based on the patient's status (ABGs, Body weight, level of consciousness and muscle strength)
- 19. Respiratory Rate(f) :-Normally 10- 20b/m Tidal Volume (VT) :-5-15ml/kg Oxygen Concentration (FIO:)-b/w 21- 90% I:E Ratio:-1:2 Flow Rate:-40-100L/min Sensitivity/Trigger:-0.5-1.5 cm H2O Pressure Limit:-10-25cm H2O PEEP - Usually, 5-10 cmH2O
- 20. Facemask Airway Laryngeal mask Tracheal intubaton Tracheostomy
- 21. Controlled MandatoryVentilation (CMV) Asst-Control Mandatory Ventilation (ACV) Synchronized Intermittent Mandatory Ventilation(SIMV) Positive Expiratory End Pressure(PEEP) Continuous Positive Airway Pressure (CPAP) Pressure Support Ventilation (PSV)
- 23. In thismode the ventilator provides a mechanical breath on a preset timing. Patient respiratory efforts are ignored. This is generally uncomfortable for children and adults who are conscious and is usually only used in an unconscious patient. It may also be used in infants who often quickly adapt their breathing pattern to the ventilator timing
- 24. In thismode the ventilator provides a mechanical breath with either a pre-set tidal volume or peak pressure every time the patient initiates a breath. Traditional assist- control used only a pre-set tidal volume- when a preset peak pressure is used this is also sometimes termed Intermittent Positive Pressure Ventilation or IPPV. However, the initiation timing is the same-both provide a ventilator breath with every patient effort.
- 25. In mostventilators a back-up minimum breath rate can be set in the event that the patient becomes apnoeic. Although a maximum rate is not usually set, an alarm can be set if the ventilator cycles too frequently. This can alert that the patient is tachypneic or that the ventilator may be auto-cycling (a problem that results when the ventilator interprets fluctuations in the circuit due to the last breath termination as a new breath initiation attempt)
- 26. In thismode the ventilator provides a pre-set mechanical breath (pressure or volume limited) every specified number of seconds Within that cycle time the ventilator waits for the patient to initiate a breath using either a pressure or flow sensor. When the ventilator senses the first patient breathing attempt within the cycle, it delivers the preset ventilator breath.
- 27. If thepatient fails to initiate a breath, the ventilator delivers a mechanical breath at the end of the breath cycle. Additional spontaneous breaths after the first one within the breath cycle do not trigger another SIMV breath. SIMV is frequently employed as a method of decreasing ventilatory support (weaning) by turning down the rate, which requires the patient to take additional breaths beyond the SIMV triggered breath.
- 28. PEEP isfunctionally the same as CPAP, but refers to the use of an elevated pressure during the expiratory phase of the ventilatory cycle. After delivery of the set amount of breath by the ventilator, the patient then exhales passively. The volume of gas remaining in the lung after a normal expiration is termed the functional residual capacity (FRC),
- 29. The FRCis primarily determined by the elastic qualities of the lung and the chest wall. In many lung diseases, the FRC is reduced due to collapse of the unstable alveoli, leading to a decreased surface area for gas exchange and intrapulmonary shunting, with wasted oxygen inspired. Adding PEEP can reduce the work of breathing (at low levels) and help preserve FRC.
- 30. A continuouslevel of elevated pressure is provided through the patient circuit to maintain adequate oxygenation, decrease the work of breathing, and decrease the work of the heart (such as in left-sided heart failure - CHF). Note that no cycling of ventilator pressures occurs and the patient must initiate all breaths. In addition, no additional pressure above the CPAP pressure is provided during those breaths. CPAP may be used invasively through an endotracheal tube or tracheostomy or non- invasively with a face mask or nasal prongs
- 31. When apatient attempts to breath spontaneously through an endotracheal tube, the narrowed diameter of the airway results in higher resistance to airflow, and thus a higher work of breathing. PSV was developed as a method to decrease the work of breathing in-between ventilator mandated breaths by providing an elevated pressure triggered by spontaneous breathing that "supports" ventilation during inspiration
- 32. Hypotension Pneumothorax Decreased Cardiac Output Nosocomial Pneumonia Positive Water Balance Increased Intracranial Pressure (ICP) Alarms tumed off or nonfunctional Mucosal lesions Sinusitis and nasal injury Aspiration, GI bleeding •Inappropriate ventilation (respiratory acidosis or alkalosis) •Thick secretions •Patient discomfort due to pulling or jarring of ETT or tracheostomy •High PaO2 •Low PaO2 •Anxiety and fear •Dysrhythmias or •vagal reactions during or after suctioning, Incorrect PEEP setting •Inability to tolerate ventilator mode.
- 33. How tokeep the Ventilator ready to receive the case? Check the Air and oxygen connections Connect the Ventilator tubes to ventilator Connect the airway to the ventilator tubing's Make sure that you correctly connected the tubing's and check for any looseness Check the tubing's for any leakage Change the Bacteria filter
- 34. 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
- 35. Observe changesin respiratory rate and depth; Observe for the use of accessory muscles. Observe for tube misplacement- note and post cm. Marking at lip/teeth after x-ray confirmation Prevent accidental extubation by taping tube securely, checking q.2h.; restraining/sedating as needed
- 36. Mouthcare Suctioningoral and nasal cavity Nutrition Bedsore