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Mechanical Ventilation: The Basics and Beyond

Mechanical Ventilation: The Basics and Beyond

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Mechanical Ventilation: The Basics and Beyond

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  1. Mechanical Ventilation: The Basics and Beyond Presented By: Diana Gedamke, BSN, RN, CCRN Marion College - Fond du Lac Masters of Nursing Student

  2. Module 1 Definitions and Purpose of Mechanical Ventilation

  3. Mechanical Ventilation Mechanical Ventilation was first described in 1555 “…an opening must be attempted in the trunk of the trachea, into which a tube of reed or cane should be put; you will then blow into this, so that the lung may rise again…and the heart becomes strong…” Andreas Vesalius (1555)

  4. Mechanical Ventilation • First used in patient care during the polio epidemic of 1955 • Use of the “negative pressure” – Iron Lung

  5. Mechanical Ventilation • The “Iron Lung” ventilator encloses the patient’s body except for head & neck • The air is evacuated to produce a negative pressure around the chest cage, resulting in chest wall & alveolar expansion. • Medical students became human ventilators as they manually ran the bellows

  6. Mechanical Ventilation • The first “positive pressure” ventilator was used at Massachusetts General Hospital • Positive pressure ventilation is achieved by applying positive pressure (greater than atmospheric pressure) at the airway opening. • Produces a trans-airway pressure gradient that generates an inspiratory flow, which results in the delivery of a tidal volume. • Increasing the positive pressure being applied to the lungs will result in larger tidal volume being delivered

  7. Indications for MV (% in 8 Countries) • Acute Respiratory Failure (66%) • Coma (15%) • Acute Exacerbation of COPD (13%) • Neuromuscular Disorders (5%) Esteban et al. How is mechanical ventilation employed in the intensive care unit? An international utilization review. Am J RespirCritCare Med 2000;161: 1450 - 1458. Table from Esteban, et al % in USA

  8. Indications for MV • Acute Respiratory Failure • ARDS • Heart Failure • Pneumonia • Sepsis • Aspiration • Complications of Surgery • Trauma

  9. Objectives of MV • Decrease WOB • Reverse life-threatening hypoxemia or acute progressive respiratory acidosis • Protect against ventilator-induced lung injury • Wean and extubate as soon as possible

  10. Review of Anatomy & Physiology • Please click on the link within this module for a review of the anatomy and physiology for the respiratory system. • Review of A & P - Respiratory

  11. Definitions • Respiration – The process of breathing involves 4 steps 1) Ventilation – the movement of air in and out of the lungs to the alveolus (air sacs) 2) External Respiration – process of gas exchange between the alveoli (in the lungs) and the blood.

  12. Definitions (continued) • 3) Gas Transport – The transfer of oxygen from the lungs to the cells of your body. Oxygen is transported by the hemoglobin in your red blood cells, while carbon dioxide is primarily transported as bicarbonate ion (HCO3). • 4) Internal Respiration – Gas exchange occuring between the blood and systemic tissue cells