Mechanical Ventilation.docx - Mechanical Ventilation...

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Mechanical Ventilation Definition o The process in which air or oxygen-rich air is moved into and out of the lungs mechanically. Not a curative process Supportive until patient recovers the ability to breathe independently o Allows Administration of up to 100% O2 and Control of breathing pattern for patient unable to ventilate on their own Indications o Extra pulmonary CNS-regulates respiration Neuromuscular-paralysis of respiratory muscles Musculoskeletal-interrupted of inhibited movement of the chest wall o Intrapulmonary Pulmonary- impaired gas exchange Cardiac – impaired gas exchange Goals o Improve ventilation o Improve oxygenation o Provide rest and pulmonary reconditioning (muscles) o Maintain ABG values within normal limits o Decrease the work of breathing Classification of Ventilators o Two classifications of ventilators Negative Pressure Ventilators Positive Pressure Ventilators o Positive or negative pressure breathing device to maintain ventilation or oxygenation. Types of Ventilators o Negative-pressure “Iron lung” Chest cuirass Body wrap o Positive-pressure Pressure-cycled Timed-cycled Volume-cycled Negative Pressure Ventilators o Definition- exerts negative pressure to chest to raise ribcageandlowerthediaphragmtocreate negative pressure within the lungs so air flows in o No artificial airway necessary o Indications: CNS disorders, neuromuscular disorders, fracture of spinal cord, severe COPD Positive Pressure Ventilators o Definition- ventilator inflate the lungs by exerting positive pressure into lungs forcing alveoli to expand during inspiration. Expiration occurs passively. o 3 types Volume cycled
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Pressure cycled Time cycled Volume Cycled o Preset volume of air is delivered with each inspiration is preset o Inspiration ends once volume is delivered and expiration occurs passively o Volume delivery remains constant despite lung resistance and compliance o Built in pressure-limiting valves to prevent excess pressure in lungs o Generally requires ETT, but can be applied via nasal mask for nocturnal use Pressure Cycled o Delivered flow of air to patient until it reaches a preset pressure and cycles off. Expiration occurs passively. o Pressure varies with patient’s airway resistance or compliance changes o Used for treatments, home therapy, short-term ventilation, patients without lung disease o Used with mask, mouthpiece or artificial airway Time Cycled o Control inspiration after a preset time. o Volume of air patient receives is regulated by length of inspiration. o Volume may vary from breath to breath o Used primarily for neonates and infants o Has built-in “fail-safe” pressure limits Settings o Definition-regulated rate, depth and other characteristics based on: ABG’s LOC Muscle strength Body weight Standard Settings o Fio2 Fraction of inspired oxygen; percent of oxygen delivered to the patient
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