1 / 25

MECHANICAL VENTILATION

MECHANICAL VENTILATION. INTUBATION. Endotracheal Intubation: Placement of tube into trachea through mouth or nose Indications: Upper airway obstruction Facilitate secretion removal For positive pressure ventilation. Endotracheal Tube. Endotracheal Tube Placement.

yardan
Télécharger la présentation

MECHANICAL VENTILATION

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. MECHANICAL VENTILATION

  2. INTUBATION • Endotracheal Intubation: • Placement of tube into trachea through mouth or nose • Indications: • Upper airway obstruction • Facilitate secretion removal • For positive pressure ventilation

  3. Endotracheal Tube

  4. Endotracheal Tube Placement

  5. Complications of Endotracheal Intubation • Improper placement • Esophageal intubation • Right mainstream intubation • Management: auscultate, CXR, bilateral respiration, mark point at lips/nose

  6. Complications of Endotracheal Intubation • Cuff problems • Ineffective seal leads to aspiration • Too much pressure leads to tracheal necrosis • Use minimal occluding volume (keep pressure <20 mm Hg) • Suction throat before deflation

  7. Nursing Role: Intubation • Maintain correct placement • Maintain proper inflation • Maintain/monitor ventilation and oxygenation • Maintain tube patency • Mouth care; repositioning ET; promote communication

  8. Complications of Extubation • Laryngeal edema or spasm • Respiratory failure

  9. Mechanical Ventilation • Air/O2 moves in and out of lungs via machine • Types Ventilators • Negative Pressure • Positive Pressure* • Ventilator Settings • Rate • Tidal volume • FIO2 • Pressure limit • PEEP • Alarms etc

  10. Mechanical Ventilation • Three types Positive Pressure Ventilators • Volume-cycled: terminates breath when preset volume delivered • Time-cycled: terminates breath after preset time elapsed • Pressure-cycled: terminates when present airway pressure achieved

  11. Volume-Cycled Ventilators:Modes • Controlled mechanical ventilation • Preset volume • Preset rate • Unable to trigger (initiate a breath)

  12. Volume-Cycled Ventilators:Modes • Assist-Control ventilation • Preset volume • Present rate • Can trigger and receive more than preset rate • Patient-triggered breaths are delivered at preset volume

  13. Volume-Cycled Ventilators:Modes • Synchronized Intermittent Mandatory ventilation (SIMV) • Preset volume and rate • Spontaneous breathing • Spontaneous breaths not assisted (patient’s own volume) • Often used for weaning

  14. Other Ventilation Maneuvers • PEEP • Positive end-expiratory pressure • Application positive pressure during ventilation • Increases distension of alveoli • Prevents alveolar collapse • “Recruits” previously collapsed alveoli

  15. Other Ventilation Maneuvers • PEEP • Increases surface area available for gas exchange • Allows delivery lower FIO2: reducing risk O2 toxicity • Complications • Reduced CO • Barotrauma

  16. Other Ventilation Maneuvers • CPAP • Continuous positive airway pressure • Continuous (i.e., inspiration and expiration) positive pressure applied to airway • For spontaneously breathing patients

  17. Other Ventilation Maneuvers • Pressure Support Ventilation (PSV) • Positive pressure applied only on inspiration • Applied to spontaneous breaths only • Supports inspiratory effort • Patient determines inspiratory length and rate • Often used for weaning

  18. Mechanical Ventilation: Complications • CVS • Increased intrathoracic pressure • Reduced CO • Pulmonary • Barotrauma (trauma d/t pressure) • Pneumothorax • Pneumomediastinum • Subcutaneous emphysema

  19. Mechanical Ventilation: Complications • Pulmonary • Alveolar hypoventilation • Cuff leak • Ventilator settings • Secretions • Atelectasis

  20. Mechanical Ventilation: Complications • Pulmonary • Alveolar hyperventilation • Due to hypoxemia, fear, pain, anxiety → alkalosis • RX: sedate, analgesia, communication, correct hypoxemia • Due to inappropriate ventilator settings • high tidal volume • High rate • Pulmonary Infection • Upper airway defenses bypassed

  21. Mechanical Ventilation: Complications • Neurological complications • Positive pressure ventilation → increased intrathoracic pressure • interferes with venous drainage; increased ICP • GI • Stess ulcers and GI bleeds; Rx with H2 receptor blockers • MV → Gastric and bowel dilation

  22. Mechanical Ventilation: Complications • Musculoskeltal • Muscle atrophy d/t immobilization • Mobilize • ROM • Psychologic • Stress • Communication very important • Sedate, explain, family visits, pain management • Facilitate expression of needs

  23. Weaning • Criteria • Effective cough • Adequate respiratory muscle strength

  24. Weaning • Approaches to weaning • T-piece (spontaneous breathing for short periods of time) • SIMV, PSV

  25. Weaning • Monitor closely • resp rate • accessory muscle use • shallow respirations • paradoxical breathing • ABGs • rising PCO2 → acidosis • falling PO2 • BP (↓ or ↑) • LOC (restless, tiring, somnolence, anxiety) • Pulse oximeter

More Related