Mechanical Ventilation, Positive Pressure: Class Notes

A mechanical ventilator moves air in and out of a patient’s lungs. Although the equipment serves to ventilate a patient, it doesn’t ensure adequate gas exchange. Mechanical ventilators may use either positive or negative ...

A mechanical ventilator moves air in and out of a patient’s lungs. Although the equipment serves to ventilate a patient, it doesn’t ensure adequate gas exchange. Mechanical ventilators may use either positive or negative pressure to ventilate patients. Equipment Oxygen source ▪ air source that can supply 50 psi ▪ mechanical ventilator ▪ humidifier ▪ ventilator circuit tubing, connectors, and adapters ▪ condensation collection trap ▪ spirometer, Mechanical Ventilation Glossary Assist-control mode: Continuous positive airway pressure (CPAP): Control mode Fraction of inspired oxygen (FIO2): Inspiratory-expiratory (I:E) ratio: Inspiratory flow rate (IFR): The Minute ventilation or minute volume (VE): Minute ventilation or minute volume (VE): Positive end-expiratory pressure (PEEP): Pressure support Respiratory rate: Sensitivity setting: Synchronized intermittent mandatory ventilation (SIMV): Tidal volume (VT): Preparation of Equipment Implementation • Verify the doctor’s order. • If the patient isn’t already intubated, prepare him for intubation. (See “Endotracheal intubation,” page 260.) Troubleshooting Responding to Ventilator Alarms • Tube disconnected from ventilator Complications Mechanical ventilation can cause tension pneumothorax, decreased cardiac output, oxygen toxicity, fluid volume excess (from humidification), infection, and such GI complications as distention or bleeding from stress ulcers. References 1 The Joint Commission. (2012). Standard NPSG.01.01.01. Comprehensive accreditation manual for hospitals: The official handbook. Oakbrook Terrace, IL: The Joint Commission. (Level I) 2 The Joint Commission. (2012). Standard NPSG.07.01.01. Comprehensive accreditation manual for hospitals: The official handbook. Oakbrook Terrace, IL: The Joint Commission. (Level I) 3 Centers for Disease Control and Prevention. (October 2002). Guideline for hand hygiene in health-care settings. Morbidity and Mortality Weekly Report, 51(RR-16), 1–45. (Level 1) 4 World Health Organization. (2009). WHO guidelines on hand hygiene in health care: First global patient safety challenge. Clean care is safer care. Geneva, Switzerland: World Health Organization. (Level I) 5 Association for Professional in Infection Control and Epidemiology. (2009). “Guide to the Elimination of Ventilator-Associated Pneumonia” [Online]. Accessed January 2012 via the Web at www.apic.org/Resource_/EliminationGuideForm/18e326ad-b484-471c-9c35-6822a53ee4a2/File/VAP_09.pdf 6 American Association for Respiratory Care. (1992). AARC clinical practice guideline: Humidification during mechanical ventilation. Respiratory Care, 36(8), 887–890. (Level I) 7 American Association for Respiratory Care. (2003). AARC evidence-based clinical practice guideline: Care of the ventilator circuit and its relation to ventilator-associated pneumonia. Respiratory Care, 48(9), 869–879. (Level I) 8 Coffin, S.E., et al. (2008). Strategies to prevent ventilator-associated pneumonia in acute care hospitals. Infection Control and Hospital Epidemiology, 29(1), S31–S40. 9 Institute for Healthcare Improvement. (2010). 5 million lives campaign getting started kit: Prevent ventilator-associated pneumonia. Cambridge, MA: Institute for Healthcare Improvement. (Level I) 10 The Joint Commission. (2012). Standard RC.01.03.01. Comprehensive accreditation manual for hospitals: The official handbook. Oakbrook Terrace, IL: The Joint Commission. (Level I) Additional References Lynn-McHale Wiegand, D. (Ed.). (2011). AACN procedure manual for critical care (6th ed.). Philadelphia, PA: Saunders. Nettina, S.M. (2010). Lippincott manual of nursing practice (9th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.