Presentation Transcript
BasicsMechanical Ventilation :BasicsMechanical Ventilation
Control :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 :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 :Flow Pattern
Indications for mechanical ventilationExtra-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 :Indications for mechanical ventilationExtra-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
Slide 24:Goals
- maintain alveolar ventilation
- deliver oxygen
- administer gases under pressure
main positive end expiratory pressure (PEEP)
reduce the work of breathing
Slide 25: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
Slide 26:Potential Complications from Mechanical Ventilation
CNS Disturbances
Potential Infection
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
Slide 27:Nursing Care of the Ventilated Patient
Use of Paralyzing Agents
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
Slide 28:Q&A
End
Prepared by SNM, Med
20 Aug 07