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Mechanical Ventilation
Acute Respiratory Failure
• Characterized by
– PaO2 < 60
– O2 Sat < 90
– PaCO2 > 50
– pH < 7.30
Types of Failure
• Ventilatory Failure
• Oxygenation Failure
• Combined Ventilatory/Oxygenation Failure
Ventilatory Failure
• V/Q • Caused by
• Adequate Perfusion – Mechanical
abnormality of lungs or
• Inadequate ventilation chest wall
– Insufficient air – Defect in respiratory
movement control center
↓ O2 to alveoli – Impaired function of
– CO2 retention respiratory muscles
Oxygenation Failure
• Adequate ventilation
• Decreased perfusion
• Inadequate oxygenation of pulmonary
blood
• Caused by
– Pulmonary Embolism
– Inadequate hemoglobin
Combined
Ventilatory/Oxygenation Failure
• Hypoventilation
• Inadequate gas exchange
• Occurs in clients with abnormal lungs
• Cardiac failure
– Cannot compensate for ↓ O2
Assessment
• Signs of Hypoxemia • Signs of Hypercapnia
• Decreased PO2 • Increased PCO2
– Dyspnea, tachypnea – Dyspnea → resp.
– Cyanosis depression
– Restlessness – Headache
– Apprehension – Tachycardia
– Confusion – Coma
– Tachycardia – Systemic vasodialation
– Dysrhythmias – Heart failure
– Metabolic acidosis – Respiratory acidosis
Interventions
• Correct underlying cause
• Support ventilation
∀ ↑ PO2 and ↓PCO2
– O2 therapy
– Positioning
↓ anxiety
– Energy conservation
– Bronchodialators
Mechanical Ventilation
• Unresponsive to interventions
• Hypoxemia
• Progressive alveolar hypoventilation with
respiratory acidosis
• Respiratory support after surgery
Endotracheal Intubation
• Short term (10-14 days)
• Maintain patent airway
∀ ↓ work of breathing
• Remove secretions
• Provide ventilation & O2
Types of Ventilators
• Negative Pressure (Mimic spontaneous breaths)
– Iron Lung
• Positive Pressure (Push air into lungs)
– Pressure cycled
• Air delivered until preset pressure reached
– Time cycled (Pediatrics/Neonates)
• Push air in with preset time
• Tidal volume & pressure variable
– Volume cycled
• Push air in until preset volume reached
• Constant tidal volume
• Variable pressure
Modes of ventilation
• Controlled ventilation
• Assist-control (A/C)
• Synchronized Intermittent Mandatory
Ventilation (SIMV)
Controlled ventilation
• Least used
• All breaths delivered at preset tidal
volume, pressure & rate
• Client with no spontaneous effort
– Severe ICP
– Brain death
– Voluntary paralysis of muscles
Assist-Control Ventilation
• Most commonly used
• Tidal volume & rate preset
• Client does not trigger breath, ventilator
will deliver breath
• Advantage- client controls rate of
breathing
• Disadvantage - ↑ respiratory rate →
hyperventilation → respiratory alkalosis
SIMV
• Similar to A/C ventilation
• Spontaneous breathing between ventilator
breaths at clients own rate & tidal volume
• Used as primary ventilator mode or
weaning mode
Ventilator Settings
• Tidal Volume (VT)
– Volume of air delivered each breath
– 7-10 cc/kg body wt.
• 75 kg = 750 cc
• Rate
– # of breath/minute
– 10-14 BPM