Basics

Mechanical Ventilation
 Control
• Volume Control
– volume limited, volume targeted and Pressure
Variable
• Pressure Control
– pressure limited, pressure targeted and
Volume Variable
• Dual Control
– volume targeted (guaranteed) pressure
limited
 Mode
• Mandatory
– CMV
• Continuous Mandatory Ventilation
• Assist
– Intermittent Mandatory Ventilation
• SIMV
Synchronized Intermittent Mandatory Ventilation
– Pressure Support
• CPAP / PEEP
Continuous Positive Airway Pressure
Positive End Expiratory Pressure
• Spontaneous
Flow Pattern
Indications for mechanical ventilation

Extra-pulmonary
NS:- OD sedatives, Coma, failure of resp centers

Neuromuscular: - injury, MG, GB, diaphragmatic

dysfunction, ALS, electroly imbalances

Musculoskeletal:- injury, flail chest

Pulmonary
airway obstruction, non-compliant lung tissue
 Goals
- maintain alveolar ventilation
- deliver oxygen
- administer gases under pressure
- main positive end expiratory pressure (PEEP)
- reduce the work of breathing
Potential Complications from Mechanical Ventilation

A Effects on the cardiovascular system - decreased

cardiac output due to decreased venous return, increased
right ventricular afterload and decreased left ventricular
compliance
B. Barotrauma (esp. with PEEP) - consequence of high
pressure in airways - overdistention of the alveoli
causing rupture; gas escapes into interstitial spaces
leading to subcutaneous emphysema, pneumothorax
C. Oxygen toxicity
D. Acid-Base Disturbances
E. Water Imbalances (fluid volume excess)
F. GI Bleeding
Potential Complications from Mechanical Ventilation

D. CNS Disturbances
E. Potential Infection
F. I. Fighting the Ventilator - breathing out of synchrony
with ventilator
Reasons - hypoxia, airway obstruction, ventilator
malfunction, anxiety, etc.
Intervention - ALWAYS ASSESS FIRST, then
troubleshoot, consider sedation
J. Sleep deprivation & Psychological consequences
K. Mechanical Failure
Nursing Care of the Ventilated Patient

C. Use of Paralyzing Agents

D. Possible Nursing Diagnostic stems for the
Patient receiving mechanical ventilation
Impaired communication
Alteration in nutrition
Ineffective airway clearance
Impaired Gas Exchange (actual/ Potential)
Ineffective breathing pattern (actual/ potential)
Anxiety
• Q&A

• End

• Prepared by SNM, Med

• 20 Aug 07