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mechanical ventilation
- 2. BASICS……????? Respiration-Ventilation 3D Medical Animation.avi
- 3. Mechanics of Breathing - 1 2.avi
- 4. Intubation and Mechanical Ventilation.avi
- 5. MEANING A mechanical ventilator is a positive- or negative-pressure breathing device that can maintain ventilation and oxygen delivery for a prolonged period
- 6. INDICATIONS Protection of airway Respiratory arrest or rate < 8/min Tachypnoea > 35/min Inability to tolerate oxygen mask/CPAP/NIV, e.g. agitation,confusion Removal of secretions Hypoxaemia (Pa O2 < 8 kPa (< 60 mmHg); Sp O2 < 90%),despite CPAP with F iO2 > 0.6
- 7. Hypercapnia if conscious level impaired or risk of raised intracranial pressure Worsening respiratory acidosis Vital capacity falling below 1.2 L in patients with neuromuscular disease Removing the work of breathing in exhausted patients
- 8. CLINICAL CONDITIONS Post-operative • e.g. After major abdominal or cardiac surgery
- 9. Respiratory failure ARDS Acute severe asthma Pneumonia Aspiration COPD Smoke inhalation, burns
- 10. Circulatory failure Low cardiac output: cardiogenic shock Following cardiac arrest Pulmonary oedema
- 11. Neurological disease Coma of any cause Status epilepticus Drug overdose Respiratory muscle failure (e.g. Guillain– Barré syndrome, poliomyelitis, myasthenia gravis) Head injury: to avoid hypoxaemia and hypercapnia, and reduce intracranial pressure Bulbar abnormalities causing risk of aspiration (e.g. cerebrovascular accident, myasthenia gravis)
- 12. TERMINOLOGY TRIGGER TIDAL VOLUME RESPIRATORY RATE POSITIVE END EXPIRATORY PRESSURE FLOW RATE INSPIRATORY TIME EXPIRATION
- 14. NON INVASIVE +ve pressure via nasal or face mask NIPPV BiPAP -ve pressur e CURAS S TANK IRON LUNG
- 17. Intermittent positive pressure ventilation (IPPV)
- 21. Pressure support ventilation (PSV)/Assisted spontaneous breathing (ASB)
- 24. Continuous positive airways pressure (CPAP)
- 25. Bi-level positive airway pressure (BiPAP/BIPAP)
- 30. INITIAL VENTILATOR SETTINGS Assess the mode Tidal volume and rate Patient or time triggered MINUTE VENTILATION=RATE X TIDAL VOLUME IMV AND SIMV TOTAL MINUTE VENTILATION= MINUTE VOLUME MACHINE+ MINUTE VOLUME SPONTANEOUS
- 31. TOTAL MINUTEVOLUME= (MACHINE TIDAL VOLUME X MACHINE RATE )+ AVERAGE SPONATANEOUS TIDAL VOLUME X SPONATNEOUS RATE) INSPIRATORY FLOW RATE= SET MINUTE VENTILATION/PERCENTAGE INSPIRATORY TIME X 0.01 AIRWAY RESISTANCE = INCREASING PEAK PRESSURE- PLATEAU PRESSURE/ INSPIRATORY FLOW(L/S)
- 32. FIO2 REQUIRED = PaO2 DESIRED PaO2 /PAO2 PaCO2 X 12.5) 1 PB- PH2O
- 33. INITIAL PaO2/FiO2 = DESIRED PaO2/FiO2 Optimal peep DO2 = QT X CAO2 Alveolar ventilation VA =( VT – V D) F PaCO2 = 0.863X VCO2/ VA
- 34. INITIAL PaCO2 X VA= DESIRED PaCO2 X VA INITIAL PACO2 X F = DESIRED PaCO2 X F INITIAL PACO2 X VT = DESIRED PaCO2 X VT
- 37. COMPLICATIONS
- 38. MANAGEMENT
- 39. WEANING Vital capacity:10 to 15 mL/kg Maximum inspiratory pressure (MIP) at least –20 cm H2O Tidal volume: 7 to 9 mL/kg Minute ventilation: 6 L/min Rapid/shallow breathing index: below 100 breaths/minute/L; PaO2 _60 mm Hg with FiO2 less than 40%
- 42. NURSE WHAT YOU DO..???
- 43. REFERENCES Mason R.J, Braaddus V.C.Murray and Nadel`s :Textbook of Respiratory Medicine. 5th edn. Philadelphia:Saunders;2010. George R.B,Light R.W. Chestmedicine:Essentials of Pulmonary and Critical Care Medicine. 4th edn . Philadelphia:Lippincott;2000. Fauci AS, Braunwald E, Kasper DL, Hauser SL, Longo DL, Jameson JL, et al., editors. Harrison’s principles of internal medicine. 17th ed. New York: McGraw Hill; 2008 Johnson J.Y.Brunner anD Suddharth`s:Textbook of Medical Surgical Nursing. 11th edn. Philadelphia:Lippincott;2008. Black M.J, Hawks H.K. Medical Surgical Nursing. 7th edn. Missouri: Saunders;2005