1. 1 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use.

2. 2 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Chapter 25 Continuous Mechanical Ventilation

3. 3 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. What is Continuous Mechanical Ventilation? Continuous mechanical ventilation (CMV) is the support of a patient’s ventilatory needs by artificial means. –A patient may be ventilated mechanically until the disease state or underlying cause for respiratory failure has been resolved.

4. 4 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Volume Control and Pressure Control Ventilation Volume control ventilation –Allows for volume control by respiratory care practitioner Pressure control ventilation –Allows for pressure control by respiratory care practitioner

5. 5 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Respiratory Failure A syndrome in which the lungs are unable to exchange gases –A PaO 2 of 40 -59 mmHg while breathing room air –A PaCO 2 of greater than 50mmHg –Type I Respiratory Failure PaO 2 of less than 59 mmHg –Type II Respiratory Failure Hypercapnia which may be accompanied by hypoxemia

6. 6 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Indications For Mechanical Ventilation Apnea and impending respiratory failure Acute exacerbation of COPD Acute asthma Neuromuscular disease Acute hypoxemic failure Heart failure and cardiogenic shock

7. 7 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Non-Invasive Ventilation (NIV) and Invasive Positive Pressure Ventilation (IPPV) Invasive Positive Pressure Ventilation –Allows the utilization of more advanced modes of gas delivery, which are not possible via NIV Non-Invasive Ventilation (NIV) –Provides a means of ventilatory support without the need to place an artificial airway

8. 8 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Control Variable and Mode of Ventilation Control variable –Pressure, volume, flow, time Mode of ventilation –Mandatory, spontaneous

9. 9 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Ventilator Settings Volume Control Ventilation Volume Control/Assist-Control Ventilation Pressure Control/Assist-Control Volume Control and Volume Control/Assist-Control Ventilation Pressure Control and Pressure Control/Assist-control

10. 10 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Spontaneous Ventilation Modes The primary concern to the clinician is hypoventilation. Continuous Positive Airway Pressure (CPAP) Pressure Support

11. 11 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Patient Ventilator System Checks Assess the patient’s response to ventilation. Verify the correct operation of the ventilator. Verify the patient settings and alarms. Verify the correct F I O 2 and that the humidifier/HME is connected and functioning properly.

12. 12 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Ventilator Operational Verification Procedure Performance of a ventilator operation verification procedure must be completed and documented prior to using the ventilator on a patient. –Tests that microprocessor, control circuit, sensors (pressure, flow, and oxygen sensors) are functional –Leak testing of the circuit, humidifier or HME, and filters and measuring the circuit compliance

13. 13 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Establishing Ordered Ventilator Settings It is the responsibility of the respiratory care practitioner to establish the settings as ordered on the ventilator. –Type of ventilation or control variable Specified in physician’s order or ventilator protocol –Selection and adjustment of settings

14. 14 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Monitoring the Patient-Ventilator System Identify changes in the patient’s condition and to verify that the ventilator is operating properly and maintaining the ordered settings. –Patient Pulmonary Cardiac Neurological –Ventilator Verify proper operation

15. 15 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Documentation of Ventilator Settings Control variable Tidal volume or inspiratory pressure Frequency F I O 2 PEEP (continues)

16. 16 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Documentation of Ventilator Settings (continued) Flow Rate I:E ‑ Ratio Temperature Alarms

17. 17 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Documentation of Patient Values Pressures Volumes Compliance Resistance Rate (continues)

18. 18 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Documentation of Patient Values (continued) Arterial blood gases Breath sounds Oximetry Artificial airway type and placement Cuff pressures Status

19. 19 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Ventilator Disinfection and Preparation for Use Upon ventilator discontinuance, aseptic precautions to: –Remove and discard patient circuit (biohazard precautions) –Discard disposable parts of the circuit –Drain heated humidifier platen and discard –Wipe all surfaces of ventilator with approved disinfectant