Mecanical ventilationMecanical ventilation

I. INTRODUCTIONI. INTRODUCTION MECHANICAL VENTILATION: BREATH MADE TO MECHANICAL VENTILATION: BREATH MADE TO

HELP PATIENTS TO ACHIEVE YOUR BREATH HELP PATIENTS TO ACHIEVE YOUR BREATH adequate.adequate.

TOOLS: TOOLS: 1. BREATHING CIRCUIT1. BREATHING CIRCUIT 2. Ventilator & BED SITE MONITOR2. Ventilator & BED SITE MONITOR 3. OXYGEN & DRUG3. OXYGEN & DRUG

BIG & FORMS HELP MY EVERY BREATH adapted BIG & FORMS HELP MY EVERY BREATH adapted PATIENT, EACH & CONDITIONS AT ANY TIME.PATIENT, EACH & CONDITIONS AT ANY TIME.

ROLE OF THE NURSE: FACILITATORS AND ROLE OF THE NURSE: FACILITATORS AND MONITOR THE PATIENT OR EQUIPMENT, MONITOR THE PATIENT OR EQUIPMENT, MAINTENANCE AND PERFORMANCE OF BREATH MAINTENANCE AND PERFORMANCE OF BREATH HELP.HELP.

II. VASILITATORII. VASILITATOR PREPARING EQUIPMENT & DRUGPREPARING EQUIPMENT & DRUG

1. PREPARATION intubation (ET SE-D1. PREPARATION intubation (ET SE-D

SUAI, sterile, TOOLSSUAI, sterile, TOOLS22 FUNCTIONING FUNCTIONING

GOOD MEDICINE IS READY)GOOD MEDICINE IS READY)

2. PREPARATION MACHINE Ventilator2. PREPARATION MACHINE Ventilator

- READY TOOL (MACHINERY AND CIRCUIT)- READY TOOL (MACHINERY AND CIRCUIT)

- READY TO FUNCTION (TESTS, CALIBRATION)- READY TO FUNCTION (TESTS, CALIBRATION)

3. READY TO JOINT DOCTOR maintain their3. READY TO JOINT DOCTOR maintain their

LA BREATH PATIENT.LA BREATH PATIENT.

PREPARING THE PLACE & TOOLSPREPARING THE PLACE & TOOLS - BED, BED MONITOR SITE, suc-- BED, BED MONITOR SITE, suc- Tion, sterile suction cannula DGTion, sterile suction cannula DG D TOTAL ENOUGH, HANDSCHOON,D TOTAL ENOUGH, HANDSCHOON, Bin & PLACE WASTE.Bin & PLACE WASTE. - CHECK SOURCE OF OXYGEN, compres-- CHECK SOURCE OF OXYGEN, compres- SOR, VACUUM, ELECTRICAL.SOR, VACUUM, ELECTRICAL. - D ENOUGH LIGHT SOURCE- D ENOUGH LIGHT SOURCE PATIENT conditioning (POSITION, PATIENT conditioning (POSITION, Cooperative, BLANKET, TERLIN-Cooperative, BLANKET, TERLIN- Protecting, ETC.Protecting, ETC.

III. MONITORINGIII. MONITORING

MONITORING EQUIPMENT (IN NORMAL AND MONITORING EQUIPMENT (IN NORMAL AND WORKING)WORKING)

MONITORING PERFORMANCE OF BREATHMONITORING PERFORMANCE OF BREATH PATIENT MONITORINGPATIENT MONITORING PREPARING chard FLOW MONITORPREPARING chard FLOW MONITOR NOTING & communicate to MEDICAL TEAMNOTING & communicate to MEDICAL TEAM TAKING THE SAMPLE AGD, NOTINGTAKING THE SAMPLE AGD, NOTING

& Communicate the results of AGD.& Communicate the results of AGD.

IV. MAINTENANCE ASSISTANCE IV. MAINTENANCE ASSISTANCE PERFORMANCE BREATHPERFORMANCE BREATH

ROAD MAINTENANCE BREATHROAD MAINTENANCE BREATH

(Suction, bronchial washing, freeing it from (Suction, bronchial washing, freeing it from kinking, plugging the DLL.kinking, plugging the DLL.

HELP THERAPY & REHABILITATIONHELP THERAPY & REHABILITATION

(Chest physiotherapy, EXERCISE COUGH, ETC)(Chest physiotherapy, EXERCISE COUGH, ETC) Conditioned PATIENT (PATIENT POSITION Conditioned PATIENT (PATIENT POSITION

SECURE & minimal DLL COMPLICATIONS SECURE & minimal DLL COMPLICATIONS SHG)SHG)

V. BREATH HELP V. BREATH HELP MECHANICALMECHANICAL

INDICATIONS:INDICATIONS:

1. Abnormalities VENTILATION: 1. Abnormalities VENTILATION:

- BREATH MUSCLE DYSFUNCTION:- BREATH MUSCLE DYSFUNCTION:

. BREATH MUSCLE FATIGUE. BREATH MUSCLE FATIGUE

. Abnormalities CHEST WALL. Abnormalities CHEST WALL

- Neuromuscular diseases- Neuromuscular diseases

- REDUCTION OF VENTILATORY DRIVE- REDUCTION OF VENTILATORY DRIVE

- IMPROVEMENT OF PRISONERS JL - IMPROVEMENT OF PRISONERS JL BREATH & / ObstructionBREATH & / Obstruction

CONTINUEDCONTINUED INDICATIONSINDICATIONS

2. Oxygenation abnormalities2. Oxygenation abnormalities . Refractory HYPOXEMIA. Refractory HYPOXEMIA . REQUIRE P E E P. REQUIRE P E E P . EXCESS WORK OF BREATH . EXCESS WORK OF BREATH 3. PURPOSE:3. PURPOSE: . REDUCING CONSUMPTION O2. REDUCING CONSUMPTION O2 . REDUCING T I K. REDUCING T I K . PREVENT atelectasis. PREVENT atelectasis . FACILITATE Sedation & MUSCLE RELAXAN. FACILITATE Sedation & MUSCLE RELAXAN

CLASSIFICATION OF MECHANICAL CLASSIFICATION OF MECHANICAL VENTILATIONVENTILATION

Volume-cycled ventilation:Volume-cycled ventilation: BREATH MACHINE GIVES SOME VOLUME (VT), IF BREATH MACHINE GIVES SOME VOLUME (VT), IF

THEN HAD ACHIEVABLE PHASE ENDED INSPIRATIONTHEN HAD ACHIEVABLE PHASE ENDED INSPIRATION TIME-cycled ventilation:TIME-cycled ventilation: MACHINE GIVE / CONTROL MACHINE GIVE / CONTROL - DURATION PHASES BREATH, - DURATION PHASES BREATH, - DECREASE IN FLOW AIR BREATH-INS- DECREASE IN FLOW AIR BREATH-INS PIRASI,PIRASI, - PRESSURE PEAK ROAD WHEN THE BREATH- PRESSURE PEAK ROAD WHEN THE BREATH INSPIRATIONINSPIRATION

• MODES OF MECHANICAL ventilationMODES OF MECHANICAL ventilation

Controlled Mechanical Ventilation Controlled Mechanical Ventilation (C M V)(C M V) ASSIST-CONTROL ventilation ASSIST-CONTROL ventilation (A C)(A C) Synchronized Intermittent Mandatory Synchronized Intermittent Mandatory

Ventilation Ventilation (S I M V)(S I M V) PRESSURE-SUPPORT ventilationPRESSURE-SUPPORT ventilation (P S V)(P S V) Controlled ventilation PRESSURE Controlled ventilation PRESSURE (P C V)(P C V) Continuous positive airway pressure Continuous positive airway pressure (C P A (C P A

P)P)

PRESSURE-TIME GRAPHPRESSURE-TIME GRAPHPD MECHANICAL VENTILATIONPD MECHANICAL VENTILATION

GETTING STARTED GUIDE MECHANICAL GETTING STARTED GUIDE MECHANICAL VENTILATIONVENTILATION

1.1. SELECT MODE, DG PRIMARY PURPOSE:SELECT MODE, DG PRIMARY PURPOSE:

. Oxygenation / Ventilation adequate,. Oxygenation / Ventilation adequate,

. REDUCING WORK BREATH,. REDUCING WORK BREATH,

. PATIENT-MACHINE SYNC. PATIENT-MACHINE SYNC

. AVOID PRESSURE D INSPIRATION. AVOID PRESSURE D INSPIRATION

HIGHHIGH

2. FiO2 1.0 EARLY, LOWER THE NEXT 2. FiO2 1.0 EARLY, LOWER THE NEXT TARGET IN titration DG SaO2 92-94% TARGET IN titration DG SaO2 92-94%

START UP GUIDE ...START UP GUIDE ...

3. VT EARLY: 8-10 mL / kg3. VT EARLY: 8-10 mL / kg

PD PENYK. Neuromuscular :10-12PD PENYK. Neuromuscular :10-12

ARDS: 5-8 mL / kg ARDS: 5-8 mL / kg

4. SET RR (respiratory rate) & 4. SET RR (respiratory rate) &

MV (minute volume), the target normal pHMV (minute volume), the target normal pH

5. USE PEEP, FiO2 LOWER5. USE PEEP, FiO2 LOWER

6. K / P D APPROPRIATE USE FLOW RATE6. K / P D APPROPRIATE USE FLOW RATE

7. K / P USE sedation, analgesia, & POSITION7. K / P USE sedation, analgesia, & POSITION

8. Consul INTENSIVIST8. Consul INTENSIVIST

Continuous maintenance MECHANICAL Continuous maintenance MECHANICAL VENTILATIONVENTILATION

O.K. Interdependence SYSTEMS IN THE O.K. Interdependence SYSTEMS IN THE BODY: BODY:

Critical CARE SUPPORT Consultative Critical CARE SUPPORT Consultative SHOUL BE OBTAINED.SHOUL BE OBTAINED.

PRESSURE inspiratory be adjusted (<35 PRESSURE inspiratory be adjusted (<35 mm Hg):mm Hg):

- Lower PEEP (decreased oxygenation)- Lower PEEP (decreased oxygenation) - Lower VT (hypercapnia)- Lower VT (hypercapnia) - Lower the Flow Rate (I long &- Lower the Flow Rate (I long & E Short, auto PEEPE Short, auto PEEP

Continued maintenance of continuous ...Continued maintenance of continuous ...

I: E RatioI: E Ratio Normal: 1: 2Normal: 1: 2 PPOM: OR 1:3 1:2,5PPOM: OR 1:3 1:2,5 FiO2FiO2 IMMEDIATE LOWER <0.5 IF POSSIBLEIMMEDIATE LOWER <0.5 IF POSSIBLE MINUTE Ventilation (ADJUSTING VT & MINUTE Ventilation (ADJUSTING VT &

RR to reach the alveolar ventilation RR to reach the alveolar ventilation and reduce auto PEEPand reduce auto PEEP

continued maintenance of continuous ...continued maintenance of continuous ...

K / P USE sedation, analgesia and K / P USE sedation, analgesia and paralytic MUSCLE.paralytic MUSCLE.

• MONITORING DURING MECHANICAL MONITORING DURING MECHANICAL VENTILATIONVENTILATION

Chest X-rayChest X-ray AGDAGD VITAL SIGN intermittent VITAL SIGN intermittent PULSE oximetryPULSE oximetry ALARM PD VentilatorALARM PD Ventilator PATIENT OBSERVATIONS OFTEN LANG-PATIENT OBSERVATIONS OFTEN LANG-

SUNGSUNG

VI. COMPLICATIONS VENTILATIONVI. COMPLICATIONS VENTILATION MECHANICAL MECHANICAL

1. Complications of mechanical 1. Complications of mechanical ventilationventilation

2. complications of chemical (gas ex-2. complications of chemical (gas ex-

change)change) 2. iatrogenic2. iatrogenic 3. Infection3. Infection

Complications of mechanical ventilation Complications of mechanical ventilation

Ventilator was not functioning Ventilator was not functioning hypoxia-diehypoxia-die Ventilator function does not fit:Ventilator function does not fit: - Pressure too high: - Pressure too high: cause barotrauma,cause barotrauma, lung alveoli rupture,lung alveoli rupture, pneumothorax, tension pneumothoraxpneumothorax, tension pneumothorax shock, died shock, died

- The volume is too large causes:- The volume is too large causes:

1. volutrauma, alveolar rupture and so on.1. volutrauma, alveolar rupture and so on.

2. hyperventilation and hypocapnia, 2. hyperventilation and hypocapnia,

- Vasoconstriction of blood vessels of - Vasoconstriction of blood vessels of the brain the brain

, Brain hypoxia, coma, death., Brain hypoxia, coma, death.

- Alkalosis, arrhythmias, cardiac arrest.- Alkalosis, arrhythmias, cardiac arrest.

- The pressure is too low or the volume of - The pressure is too low or the volume of breath is less cause:breath is less cause:

VT and MV less, hypoxia, deathVT and MV less, hypoxia, death

- Ventilators & patients out of sync:Ventilators & patients out of sync:- (Fighting):(Fighting):

- Cause: hypoventilation, hypoxia, death, - Cause: hypoventilation, hypoxia, death,

or when the collision, the pressure or when the collision, the pressure becomes high and cause barotrauma, becomes high and cause barotrauma, alveolar rupture, tension pneumothorax, alveolar rupture, tension pneumothorax, shock and the patient died.shock and the patient died.

- Causes - Causes trapping watertrapping water : :

patient became hypoxic & hypercarbia & patient became hypoxic & hypercarbia & acidosis, or barotrauma & volutrauma acidosis, or barotrauma & volutrauma occur locally, alveolar rupture. It all occur locally, alveolar rupture. It all resulted in the patient died.resulted in the patient died.

VVIIII. CLOSING. CLOSING

Outcome ASSISTANCE REQUIRED Outcome ASSISTANCE REQUIRED MECHANICAL VENTILATION FACTOR MECHANICAL VENTILATION FACTOR DISEASE, PATIENT, DISEASE, PATIENT, Ventilator (INCLUDING Ventilator (INCLUDING care of a government-TECH TOOLS), care of a government-TECH TOOLS), NURSES, OTHER TEAM D & ICU PHYSICIAN.NURSES, OTHER TEAM D & ICU PHYSICIAN.

MECHANICAL ASSISTANCE TO BREATH MECHANICAL ASSISTANCE TO BREATH VERY WELL lasted DG TGTVERY WELL lasted DG TGT PD PD FUNCTION FUNCTION VentilatorVentilator..

ONE KEY TO SUCCESS: COOPERATION ONE KEY TO SUCCESS: COOPERATION AND COMMUNICATION DG D ENTIRE TEAM AND COMMUNICATION DG D ENTIRE TEAM INVOLVED IN THE MANAGEMENT OF THE INVOLVED IN THE MANAGEMENT OF THE PATIENT.PATIENT.