Ventilation:

Basic
Principles
 Overview
• Introduction to Ventilation Principles
• Respiratory Anatomy and Physiology
• Indications for Ventilation
• Modes of Ventilation
• Patient Management
• Complications
• Questions
 Introduction
• Ventilation is the movement of air into and
out of the alveoli.

Hudak, et al, 1997, Critical Care Nursing: A Holistic Approach (7th Edn), Lippincott, Philadelphia, USA
 Introduction
Mechanics of Ventilation:
• Elasticity
• Compliance
• Resistance
• Pressure
• Gravity

Hudak, et al, 1997, Critical Care Nursing: A Holistic Approach (7th Edn), Lippincott, Philadelphia, USA
 Anatomy and Physiology
• Respiratory Structures
• Respiratory Zones
• Partitioning of Respiratory Pressures
• Boyles Law
• Respiratory Volumes and Capacity
• Ventilation and Perfusion
 Anatomy and Physiology
Respiratory Structures

Porth CM, 1998, Pathophysiology (5th Edn), Lippincott, Philadelphia, USA

 Anatomy and Physiology
Respiratory Zones

Porth CM, 1998, Pathophysiology (5th Edn), Lippincott, Philadelphia, USA

 Anatomy and Physiology
Partitioning of Respiratory Pressures

Porth CM, 1998, Pathophysiology (5th Edn), Lippincott, Philadelphia, USA

 Anatomy and Physiology
Boyles Law
Increase V =
Decreased
P

Decreased V =
Increased P

Porth CM, 1998, Pathophysiology (5th Edn), Lippincott, Philadelphia, USA

 Anatomy and Physiology
Boyles Law
• Air flows from a region of higher pressure
to a region of lower pressure.
• To initiate a breath, airflow into the lungs
must be precipitated by a drop in alveolar
pressures.

Porth CM, 1998, Pathophysiology (5th Edn), Lippincott, Philadelphia, USA

 Anatomy and Physiology
Respiratory Volumes and Capacity

Porth CM, 1998, Pathophysiology (5th Edn), Lippincott, Philadelphia, USA

 Anatomy and Physiology

airway
venous blood arterial blood
Ventilation
and
Perfusion

perfusion without normal ventilation ventilation without

ventilation = shunt and perfusion perfusion = dead space

Porth CM, 1998, Pathophysiology (5th Edn), Lippincott, Philadelphia, USA

 Indications for Ventilation
• Airway Compromise (potential)
• Respiratory Failure
– pH: <7.25

–PaCO : >50 mmHg

2

–PaO : <50 mmHg2

• Increased Work of Breathing

• Head Injury Management
Hudak, et al, 1997, Critical Care Nursing: A Holistic Approach (7th Edn), Lippincott, Philadelphia, USA
 Objective of Ventilation
• Support though illness
• Reversal of hypoxemia
• Reversal of acute respiratory acidosis
• Relief of respiratory distress
• Resting of the ventilatory muscles
• Decrease in oxygen consumption
• Reduction in intracranial pressures
• Stabilisation of the chest wall
Hudak, et al, 1997, Critical Care Nursing: A Holistic Approach (7th Edn), Lippincott, Philadelphia, USA
 Modes of Ventilation
• freq • Pmax
• Vt • Paw
• MV
• fspn
• I:E ratio • MVspn
• Trigger

• Ramp
• PEEP
Diepenbrock NH, 1999, Quick Reference to Critical Care, Lippincott, Philadelphia, USA: P166.
 Modes of Ventilation
• Controlled
– Pressure Control (PC)
– Volume Control (VC)
• Supported
– Continuous Positive Airway Pressure (CPAP)
– Pressure Support (PS)
• Combined
– SIMV (PC) + PS
– SIMV (VC) + PS
Diepenbrock NH, 1999, Quick Reference to Critical Care, Lippincott, Philadelphia, USA: P166.
 Modes of Ventilation:
Control
Controlled Mechanical Ventilation:
• The Minute Volume is determined by the
ventilator
• The patient has no option to override the
ventilator
 Modes of Ventilation:
Control
Pressure Control:
• A preset peak inspiratory pressure is
delivered to the patient at a preset
respiratory rate
• Volume is not preset and is determined by
the mechanics of ventilation.
(elasticity, compliance, resistance,
pressure,
gravity)
 Modes of Ventilation:
Control
Volume Control:
• A preset tidal volume is delivered at a
present respiratory rate
• 7 – 10 mls/kg
50kg = 350 – 500mls
70kg = 490 –
700mls 90kg = 630
– 900mls
 Modes of Ventilation:
Support
Continuous Positive Airway Pressure:
• A spontaneous breathing mode, where the
patient generates their own breath
• The ventilator maintains a constant
positive pressure on expiration (PEEP)
• Aims to increase Functional Residual
Capacity
 Modes of Ventilation:
Support
Pressure Support:
• A spontaneous breathing mode
• Need for additional support to achieve
optimal tidal volumes
• Ventilator delivers a constant preset
pressure on inspiration

CPAP + PS = BiPAP
 Modes of Ventilation:
Combined
Synchronised Intermitted Mandatory
Ventilation:
• Similar to IMV
• If the patient initiates a breath and the
ventilator synchronises so the ventilator
doesn’t deliver a breath at the same time
 Modes of Ventilation:
Combined
SIMV (PC) + PS:
• Pressure controlled ventilation with
pressure support on spontaneous breaths

SIMV (VC) + PS:

• Volume controlled ventilation with
pressure support on spontaneous breaths
SIMV (VC)
+ PS

Freq: 10
Vt: 500
(MV = 5.0)
PEEP: 5

PS: 10
 Patient Management

• Monitoring
• Suctioning
• Other
– Sedation
– Positioning
– Oral and Eye Care
 Patient Management:
Monitoring
• ECG
• SpO 2

• ETCO2
• Alarm limits
• Air Entry / Work of Breathing
• Ventilator observations and alarm limits
• Full assessment
 Patient Management:
Suctioning
• PRN
– Increasing airway pressures
–Decreasing SpO2

– Increased work of breathing

• Pre-oxygenate (100% oxygen)
• Less than 15 Seconds
 Patient Management:
Other
• Sedation
– Propofol, Morphine and Midazolam
• Positioning
– 2/24
• Oral and eye care
– 2/24
 Complications
• Airway
– Aspiration, decreased clearance of
secretions, predisposition to infection
• Endotracheal Tube
– Tube kinking, sputum plug, right main
bronchus intubation, tube migration, cuff
failure, laryngeal oedema
• Mechanical
– Ventilator malfunction, hypoventilation,
hyperventilation, barotrauma, pneumothorax
Questions
Ventilation:
Basic
Principles
Jamie Ranse
Registered Nurse
Emergency Department
The Canberra Hospital