Mechanical ventilation is the medical term for artificial ventilation where mechanical means is used to assist or replace spontaneous breathing.
BiPAP: Bi-Level Positive Airway Pressure, commonly known as BiPAP uses noninvasive ventilation support that combines positive support ventilation (PSV) and positive end expiratory pressure (PEEP). We use this to avoid intubation. It is also used in patients with sleep apnea.
CPAP: Continuous positive airway pressure is a spontaneous breathing mode on the ventilator. The application of continuous positive pressure decreases the work of breathing by decreasing resistance the patient experiences.
Now a patient with an endotracheal tube is for a more invasive ventilation type which is through a patient’s neck versus over their mouth and face.
A person can also receive mechanical ventilation through a tube being inserted into their mouth in the event they show signs of difficulty breathing.
DIFFERENT TYPES OF VENTILATION SETTINGS
There are different types of ventilation mode settings.
SYNCHRONIZED INTERMITTENT MANDATORY VENTILATION
A preset rate and tidal volume are set, but the machine allows the patient to initiate AND perform their own breaths as well. A positive pressure is applied to ASSIST with the breath, but it is the patient doing the breathing. The ventilator will synchronize the automated breaths with the patient’s own breaths.
CONTROLLED MANDATORY VENTILATION
With this setting, the ventilator does all the work. We set the rate and tidal volume that is delivered with each breath.
The biggest thing you want to remember about this type of ventilation is that there is no room or accommodation for patient the initiate their own breaths. Administered to patient who are paralyzed or heavily sedated. It “locks out” the patient’s breath.
A/C (ASSIST CONTROL): A type of positive pressure ventilator setting that delivers a preset volume of gas at a set rate. If the patient initiates a breath on their own, the ventilator will assist in delivering the preset volume. The ventilator will deliver a breath every time the patient breaths so if the patient has a lot of spontaneous breaths this setting might not be indicated since the patient can hyperventilate resulting in a decreased CO2 levels. This is the ventilator setting that has an increased risk of the patient getting respiratory alkalosis.
PRESSURE SUPPORT VENTILATION
Pressure support ventilation is just the way it sounds, it used to provide specific amount of pressure to help assist with the patients breathing.
It is designed to elevate the end-expiratory pressure to the above atmospheric pressure in order to increase lung volume and oxygenation. Each breath is triggered by the patient since there is no set respiratory rate and all the breaths of the patient are spontaneous.
It can be used with SIMV to decrease the number of spontaneous breaths the patient takes and improve their tolerance. It can also be used by itself for ventilatory support for weaning patients from the ventilator.
Pressure support is an additional pressure that is added to help spontaneous breathing. It helps to augment spontaneous breaths from the patient.
TYPES OF ALARMS
HIGH PRESSURE ALARM: High pressure limit is reached before volume is delivered.
WHAT IS WRONG: A kink in the ventilator tubing. Patient may be biting on the tubing.
WHAT YOU DO: Check for kinks or condensation in ventilator tubing. Use a bite block on the patient. Assess oxygenation status, vital signs, breath sounds and suction airway as needed. Administer bronchodilators.
Assess the patient for pain, anxiety and synchrony with the ventilator;
Consider giving the patient a sedative.
Notify respiratory therapist if you can not find the cause or the status of the patient deteriorates.
LOW PRESSURE ALARM: Not developing set pressure to deliver volume.
WHAT IS WRONG: A leak in the tubing.
WHAT YOU DO: Check for a disconnect or a leak in the tubing. Check the ETT for placement. Assess the patient for air leakage from the mouth or around the tube.
Notify the respiratory therapist if you can not troubleshoot the cause or if the patient’s status declines.
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