Mechanical Ventilation (MV) PDF

Mechanical ventilation L2  Introduction Definition Indications Ventilator Settings Modes of Ventilation Weaning Summary Objectives: Explain the function of the most commonly used mechanical ventilation settings. Outline the management of patients...

Mechanical ventilation L2  Introduction Definition Indications Ventilator Settings Modes of Ventilation Weaning Summary Objectives: Explain the function of the most commonly used mechanical ventilation settings. Outline the management of patients undergoing mechanical ventilation. Describe the issues of concern in regards to mechanical ventilation. Review how the interprofessional team plays a key role in the management of mechanically ventilated patients.  ‫اطﻼع‬ Introduction What is Mechanical Ventilation and how does it work? If you’re ready to learn the basic concepts of this topic, you’re in the right place. We should have titled this The lecture Mechanical Ventilation Made Easy because our goal is to break it down for you in a way that’s simple to learn and understand. Mechanical Ventilation is one of the most important topics in all of medical education — especially for doctors and Respiratory Therapists. With that being said, it’s one of the most difficult subjects to learn because of the complexity of the information. Not to worry, in this guide, we’re going to break it down for you in a way that’s much easier to understand. We’re going to cover all the important subtopics, including ventilator modes, settings, initiation, weaning, benefits, risks, and more. Not to mention, we’ve also included some helpful practice questions near the end as a bonus. So if you’re ready to get started, let’s go ahead and dive right in.  ‫داﺧﻞ‬ Definition Mechanical ventilation is a type of therapy that helps you breathe or breathes for you when you can’t breathe on your own. You might be on a ventilator during surgery or if your lungs aren’t working properly. Mechanical ventilation keeps your airways open, delivers oxygen, and removes carbon dioxide. What is Mechanical Ventilation? Mechanical Ventilation is a form of therapy that is used on patients who are unable to breathe on their own. A certain level of ventilation is required in order to maintain the proper levels of oxygen and carbon dioxide in the body. This process is referred to as Gas Exchange. A Mechanical Ventilator is a device that is used to provide positive pressure ventilation to help normalize a patient’s arterial blood gas levels to maintain an adequate acid-base balance.  ‫ﻓﻘﻂ ﺑﺎﻷزرق‬ Mechanical Ventilation is a form of life support that is indicated in critically ill patients in the Intensive Care Unit (ICU) for short-term or long-term use. It’s often used to treat patients with cardiopulmonary disorders but is also used on postoperative patients who are recovering from anesthesia and sedation. The ventilator can provide a full cycle of breathing during both inspiration and expiration so that the patient does not have to do any work while recovering from the underlying condition. In summary — whenever a patient is unable to ventilate or breathe on their own, this is where Mechanical Ventilation comes into play. What is a Mechanical Ventilator? As I mentioned, a Mechanical Ventilator is a machine that aids in a patient’s ability to ventilate. That’s where it gets its name. In other words, it helps the patient take in oxygen and remove carbon dioxide from the lungs.  Jackson-Rees system (for manual ventilation) Single Limb Breathing Circuits with Double Lumen While on a ventilator machine, a hollow tube, known as an Endotracheal Tube, connects the patient to the machine. The patient stays on a ventilator until he or she is able to achieve spontaneous breathing on their own. It’s important to keep in mind that the use of this machine does not completely heal the condition of the patient. Rather, it helps the patient achieve a stabilization while medications  ‫ﺣﻔﻆ‬ ‫ﻣﮭﻢ‬ The Y-piece is the connection between the tube and both ventilation hoses (inspiration and expiration hose). The Y-piece incl. both ventilation hoses is changed every 7 days. HME filter (heat moisture exchange) It is attached between the tube and the breathing hose. It absorbs the moisture during expiration, which is then taken up again during inspiration (passive humidification). It should be changed after 24 hours. HME filter (heat moisture exchange) We use the HME booster in addition to the HME filter as standard for ventilation duration longer than 24 hours. This is inserted between the HME filter and the breathing hose. It contains a ceramic plate (heating plate) that is heated by electricity (socket) to 70°C (relatively hot, therefore always put a towel underneath to protect the patient). Distilled water is passed onto the heating plate (60ml per 24h) and heated there so that water vapor is generated, which then enters the breathing hose through the Goretex membrane of the HME booster, which is only permeable to water vapor. The HME filter is changed every 24 hours, and the HME booster every 48 hours. Types MV ‫داﺧﻞ‬ home-ventilation device (e.g. BiPAP [bilevel positive airway pressure],. Legendair) emergency respirators (history: The first emergency respirator in Germany was developed in 1907 by the Dra- in Germany and was developed in 1907 by the Dräger company in Lübeck and was named "Pulmotor". It had to be driven by a hand crank and was especially. used for resuscitation due to gas poisoning [e.g. in miners].) intensive care respirators anesthesia respirators.home-ventilation device (e.g. Legendair) ‫ﻣﻦ اﺣﺪد اﻟﻤﻮد‬ ‫ادﺧﻞ ﻋﻠﻲ‬ Circt Emergency respirators (examples) Medumat (Weinmann) Oxylog, Oxylog 2000, 3000 (Dräger) Hamilton T1 (Heinen + Löwenstein) Var plus (Vartran) Medumat (Weinmann) - a common emergency respirator in (emergency) Oxylog 2000 (Dräger) ambulance Oxylog (Dräger Hamilton T1 (Heinen + Löwenstein) Intensive care ventilators (examples) Evita 2, Evita 4, Evita XL, Evita V300, Evita Infinity V500(Dräger) Servo i, Servo s, Servo Ventilator 300A, 900C, 900D (Siemens) Puritan Bennett NPB 760, 840 (Tyco Healthcare) Raphael Color, Galileo Gold (Hamilton Medical) Centiva (Datex-Ohmeda) ‫ﻓﻘﻂ اﺳﻤﺎﺋﮭﻢ‬ Evita V800 (Dräger) Evita Infinity V500 (Dräger) Servo i (Siemens) Engström Carestation Bennett 840 (Tyco Healthcare) Bennett 760 (Tyco Healthcare) Puritan Bennett 980 (Covidian) Hamilton C3 (Heinen + Löwenstein)  1.home-ventilation device (e.g. Legendair) legendair applications Home care ‫ﺣﻔﻆ‬ Adults and infants weighing ≥5 kg Pressure and volume ventilation Noninvasive and invasive ventilation ‫ﯾﺸﺘﻐﻞ إﯾﺴﺖ وﻛﻞ اﻟﻤﻮدات وﻛﻮﻧﺘﺮول‬ GENERAL PRECAUTIONS FOR USE It is essential to read, understand, and follow these instructions before using the LEGENDAIR® ventilator. The LEGENDAIR® ventilator was designed according to the standards of pulmonary ventilators intended for patients at home. This ventilator is recommended for Non-Invasive Ventilation (NIV) as well as Invasive Ventilation (IV) in temporary or continual use for adult patients or for pediatrics (children over 5 kg). For patients who are totally dependent, supplementary surveillance is recommended according to the patient's handicap, as well as a backup means of ventilation. In such a case, when running the device on its internal battery, the external battery must be readily available. EXTERNAL INTERFACES AND FUNCTIONAL APERTURES Front: "Patient" interfaces and User - Machine Interface Rear: Electrical interfaces and technical aperture When the apparatus is on stand-by (not in ventilation), the display contrast can be modified by pressing the key, and then by adjusting using the incrementation or decrementation keys. LABELS / IDENTIFICATION AND INSTRUCTION INFORMATION Several labels or specific indications are affixed to the ventilator. They indicate the precautions to be taken for The ventilation modes available are: - Pressure Support Ventilation (PSV S) or spontaneous ventilation - Pressure Support Ventilation with Back Up Rate (PSV BUR) - Pressure Controlled Ventilation (PCV) - Pressure Assisted Controlled Ventilation (PACV) ‫ﻧﺸﺮﺣﮭﻢ‬ - Controlled Volume (CV): ‫ﺑﺎﻟﺘﻔﺼﯿﻞ‬ - Assisted Controlled Volume (ACV): ‫ﺑﻤﺤﺎﺿﺮة ﺧﺎﺻﺔ‬ - Synchronous Intermittent Mandatory Ventilation (SIMV)  ‫اطﻼع‬ Benefits of Mechanical Ventilation There are many benefits for patients who are receiving Mechanical Ventilation. These include the following: It helps decrease the patient’s work of breathing which helps the respiratory muscles rest and recover. It helps the patient get adequate amounts of oxygen. It provides stability and allows medications to work while the patient heals. It helps the patient achieve adequate ventilation by removing carbon dioxide for effective gas exchange. There are many benefits of Mechanical Ventilation. These are just some of the most common examples. Mechanical ventilator is available in 1. I.C.U. 2. C.C.U. 3. O.R. ‫ﻓﯿﺪﯾﻮ‬  ‫اطﻼع‬ What is the double-branch patient circuit? A double-branch patient circuit, also known as a dual-limb circuit, is a type of ventilator circuit used in critical care. It consists of two separate tubes: one for delivering inspiratory gas to the patient and another for exhalation gas. Here are some key features: Inspiratory and expiratory pathways: These circuits have dedicated pathways for inhalation and exhalation, which helps minimize rebreathing of exhaled gases. Valves: The inspiratory and expiratory valves are typically located inside the ventilator. The expiratory valve closes during the inspiratory phase, and the inspiratory valve closes during the expiratory phase. Reduced dead space: By separating the inspiratory and expiratory gases, these circuits help reduce mechanical dead space, which can improve alveolar ventilation and reduce the partial arterial pressure of carbon dioxide (PaCO2).