FTP 303 Mechanical Ventilation PDF
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University of Pretoria
N Mshunqane
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Summary
The document presents a detailed overview of mechanical ventilation, encompassing various aspects of the topic. It clarifies the different ventilation methods, their applications in intensive care units, and related considerations. The document includes essential details for medical professionals, such as intubation, suctioning, and weaning.
Full Transcript
THEME 2: Mechanical Ventilation FTP 303: ICU Prof. N Mshunqane Mechanical Ventilation Can be defined as the technique through which gas is moved towards and from the lungs through an external device connected directly to the patient. ...
THEME 2: Mechanical Ventilation FTP 303: ICU Prof. N Mshunqane Mechanical Ventilation Can be defined as the technique through which gas is moved towards and from the lungs through an external device connected directly to the patient. Mechanical Ventilation cont: Mechanical ventilation (MV) helps control gas exchange and acid base balance by manipulating the following: - Inspired oxygen (FIO2), provides different levels of FIO2 - Minute volume (VE) - Pressure - Volume - I:E ratio and - PEEP, ( A. Hough, 2014) It involves the application of tidal volumes to improve FRC. Allows for respiratory support in the presence of an increased ventilatory demand. Mechanical Ventilation cont: Goals: Decrease work of breathing (rest/relax respiratory muscles). Improve/Increase oxygenation. Improve Carbon dioxide clearance Maintain Arterial blood gases (ABG) values within normal range Improve distribution of inspired gases Mechanical Ventilation cont: Indications: Patients with increased work of breathing due to airway obstruction. Impending or existing respiratory failure. Acute head injuries who are sedated. Control ventilation in critically ill patients, e.g. Coma, GBS. Inspiratory muscle weakness. Hypercarbia, hypoxia, clinical deterioration. Post surgical conditions. Intubation Methods Patient can be connected to a ventilator via endotracheal tube or via tracheostomy tube. Endotracheal tube It is accomplished by placing a tube nasally or orally through the larynx into the trachea. Intubation Methods cont: Tracheostomy tube Tracheostomy tubes provide an airway directly into the level of the second or fourth tracheal rings. Shorter and more comfortable for patient, less resistance to air flow. Good for longer term ventilation. May be cuffed if the patient requires MV or if aspiration may be a problem. Uncuffed when patient has competent glottis function. Tracheostomy tube cont: Indications for Intubation To protect the airway from aspiration e.g. patients with loss of gag/cough reflex- GCS 95 % Decannulation of Tracheostomy The first step involves replacing the cuffed tracheostomy tube with an uncuffed tube. The tube can be removed when there is satisfactory cough effectiveness with minimal secretions. Once the tube is removed, the patient will be taught on how to hold the sterile dressing over the stoma when coughing. Weaning and Extubation A process of removing the endotracheal tube. Readiness for extubation involves the following: - Correction of the underlying condition for mechanical ventilation. - Optimum nutrition, fluid, metabolic and cardiovascular status. - Reversal of sedation and minimal pain. - Optimum arterial blood gases. - Elimination of unnecessary work of breathing, strong cough reflex. - Absence of abdominal paradox or rapid shallow breathing, a rapid shallow index of
