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Mechanical Ventilation

Presented by:
Joahnna Marie A. Abuyan, RN
MECHANICAL VENTILATION

-Indicated when alveolar
ventilation is inadequate
to maintain blood oxygen
and carbon dioxide
levels.

Indications
Apnea or acute ventilator failure
Hypoxemia unresponsive to oxygen
therapy alone
Increased work of breathing with
progressive client fatigue

Types of Ventilators

Negative- pressure ventilators

Positive-pressure Ventilators






Negative- pressure ventilators

- Create negative (subatmospheric) pressure
externally to draw the chest outward and air into
the lungs, mimicking spontaneous breathing.

- Used by clients with neuromuscular disorders and
primarily require ventilator support during sleep.

- Examples iron lung, cuirass ventilator, PulmoWrap

Cuirass Ventilator
Pulmowrap
Iron Lung
The story of Dianne Odell

Dianne Odell was a Tennessee woman who spent most
of her life in an iron lung. She contracted "bulbo-spinal"
polio at age 3 in 1950 and was confined to an iron lung
for the rest of her life.
Born: February 13, 1947, Tennessee, United States
Died: May 28, 2008
Education: Freed-Hardeman University


Ms Odell was diagnosed with
"bulbo-spinal" polio several
years before a vaccine was
discovered that stopped the
spread of the crippling disease
affecting children.

Despite being confined inside
the iron lung, she managed to
get a high school diploma,
take courses at a college and
write a book.


Power cut: Dianne Odell chats at home with her mother
Geneva Odell via a mirror which is mounted above her iron lung

Iron lungs - or negative pressure ventilators - were first used in the 1920s.
They work by producing pressure on the lungs that causes them to expand
and contract so that patients can breathe.
Odell's iron lung, similar to those used during the US polio epidemics that
peaked in the 1950s, was a cylindrical chamber with a seal at the neck.
Tragedy: Dianne Odell watches her favorite soap opera at home in
Jackson, Tennessee, in 2004
Brother-in law Will Beyer said: ''We did everything we could do but we
couldn't keep her breathing.
''Dianne had got a lot weaker over the past several months and she just
didn't have the strength to keep going.''
Her home near Memphis, Tennessee, suffered a lengthy power failure and
relatives were unable to start a back-up generator.
Authorities said the electrical failure had been caused by a tree falling on a
power line.











Positive-pressure Ventilators

- used more often especially in
treating acute respiratory failure.

- It pushes air into the lungs, rather
than drawing it in like negative-
pressure ventilators.

- It increases lung volume.

- Helps redistribute fluid from the
alveolar to the interstitial space.

- Helps reduce the oxygen demand
caused by increased work of
breathing.








The control panel used to set the mode, rate, limits, and percentage of
oxygen delivered.


MODES OF VENTILATION

Continuous Positive Airway Pressure (CPAP)

- Applies positive pressure to the airways of a
spontaneously breathing client.
- Used to help maintain open airways and
alveoli, decreasing the work of breathing.

Bilevel Ventilators (BiPAP)


- Provide inspiratory positive airway pressure as
well as airway support during expiration
- Used at night with a tight fitting mask.

Assist- Control Mode Ventilation (ACMV or AC)

- Frequently used to initiate mechanical ventilation and
when the client is at risk for respiratory arrest.
- Client can trigger ventilator to deliver breaths at
preset volume or pressure and inspiratory flow rate;
- Breaths will be delivered at preset rate if client does
not initiate.

Synchronized Intermittent Mandatory Ventilation
(SIMV)

- Mandatory breaths delivered by ventilator are
synchronized with clients inspiratory effort.
- Allows the client to breathe spontaneously,
without ventilator assistance, between delivered
ventilator breaths.


Positive End-Expiratory Pressure (PEEP)
- Requires intubation and can be applied to any of the previously
describes ventilator modes
- Positive pressure is maintained in the airways during exhalation and
between breaths
- Keeping alveoli open between breaths improves ventilation-
perfusion relationships and diffusion across the alveolar-capillary
membrane.
- Reduces hypoxemia and allows use of lower percentages of
inspired oxygen
- Useful for treating ARDS

Pressure Support Ventilation (PSV)


- Ventilator-assisted breaths are delivered when
the client initiates an inspiratory effort.
- Decreases the work of breathing.
- Used in combination with SIMV when the
respiratory drive is depressed.

Pressure-Control Ventilation (PCV)

- Controls pressure within the airways to reduce the risk of
airway trauma.
- Ventilation is time triggered and time cycled, but pressure is
limited.
- Ventilator maintains a reset airway pressure though
inspiration. Because all breaths are controlled by the
ventilator, heavy sedation may be required to prevent
competition between inspiratory effort and ventilator control.


Complications

Nosocomial Pneumonia
Oral secretions and gastric contents can enter the respiratory tree through
the open epiglottis.
Barotrauma (Volutrauma)
Lung injury due to alveolar overdistention.
Subcutaneous emphysema, pneumothorax, peumomediastinum
Cardiac output falls
Stress Ulcers

Weaning

- the process of removing ventilator support and re-
establishing spontaneous, independent respirations.
- Begins only after the underlying process causing
respiratory failure has been corrected or stabilized.

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