Mechanical Ventilation & Weaning Lecture Notes PDF

Mechanical Ventilation &Weaning Dr. Aida Faried Abdelwanees Lecturer of Critical Care and Emergency Nursing  Objectives By the end of this lecture the students will be able to: Indicate purposes of mechanical ventilation Mention the indications...

Mechanical Ventilation &Weaning Dr. Aida Faried Abdelwanees Lecturer of Critical Care and Emergency Nursing  Objectives By the end of this lecture the students will be able to: Indicate purposes of mechanical ventilation Mention the indications of establishing mechanical ventilation Indicate criteria for institution of ventilator support Classify positive-pressure ventilators Differentiate between ventilator settings/parameters/controls Identify modes of mechanical ventilation Explain methods of weaning Indicate Weaning Criteria /Parameters Identify nursing role in weaning Misr University for Science & Technology (MUST)  Outlines Introduction to mechanical ventilation. Purposes of mechanical ventilation. Indications for mechanical ventilation. Criteria for institution of ventilator support. Ventilator types. Ventilator Modes. Ventilator setting Ventilator alarms. Complications of mechanical ventilation. Weaning from mechanical ventilation. Nursing role in weaning  Introduction to Mechanical Ventilation Mechanical ventilation is a supportive therapy used to assist patients who are unable to maintain adequate oxygenation or carbon dioxide elimination. These patients usually exhibit signs of acute respiratory failure. The ventilator is not a cure for any disorder; rather it allows support of breathing while disease processes are treated.  Definition A ventilator is a machine that delivers and controls the flow of gas to a patient. Mechanical ventilation is the process of using artificial means (ventilator) to facilitate O2 and CO2 transport between the atmosphere and alveoli (lungs ventilation) that deliver gas to the lung with either negative or positive pressure.  Purposes of Mechanical Ventilation 1. Supporting the pulmonary system until the cause is corrected. 2. Providing appropriate oxygen supplementation. 3. Reducing work of breathing. 4. Increasing patient comfort during respiration  Indications for Mechanical Ventilation Ventilation abnormalities Respiratory muscle dysfunction (Respiratory muscle fatigue) Neuromuscular disease (Gallian Barree syndrome) Decreased ventilatory drive with increased WOB (Cardiopulmonary arrest) Increased airway resistance or obstruction (COPD)  Indications for Mechanical Ventilation Oxygenation abnormalities Severe hypoxemia (Acute hypoxemic respiratory failure) Obstructive lung disease (Asthma) Restricted lung disease (Pulmonary edema ) Paralyzed patients (General anesthesia )  Criteria for Initiation of Ventilator Support Ventilation Parameter Normal range criteria Pulmonary function Respiratory rate (breath/min) >35 or < 10 12-20 Tidal volume (ml/ kg) 36°C and 20 beats /min. ❑Increase or decrease in bod pressure of > 20 mm Hg. ❑Increase in respiratory rate of > 10 above baseline or > 30. ❑Monitor for signs of weaning Intolerance ❑Tidal volumes of < 250 ml. ❑Diaphoresis ❑Decrease in LOC ❑Dyspnea ❑Restlessness ❑SaO2 < 90% ❑ PaO2 < 60 mmHg  Nursing role after weaning ❑Ensure that extubation criteria are met. ❑Decanulate or extubat the patient. ❑ Documentation for all patient parameters and response.  Care of the Ventilated Patient ❑Assess patient status and functioning of ventilator. ❑Promote optimal gas exchange. ❑Reduce mucus accumulation. ❑Prevent trauma. ❑Prevent infection. ❑Obtain optimal mobility. ❑Establish non-verbal communication