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Mechanical Ventilation PowerPoint Presentation

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Description : Check out this medical PowerPoint presentation titled "Mechanical Ventilation" by Dr. Abdul-Monim Batiha.

This medical PowerPoint presentation talks about mechanical ventilation, a medical treatment that involves using a machine to assist or replace a persons breathing. It is commonly used in intensive care units (ICUs) to support critically ill patients who are unable to breathe on their own or who have difficulty breathing.

There are two main types of mechanical ventilation: invasive and noninvasive. Invasive mechanical ventilation involves inserting a tube through the mouth or nose and into the airway, while noninvasive mechanical ventilation uses a mask or other device to deliver air to the lungs without inserting a tube.

Mechanical ventilation can be used for a variety of reasons, including to provide oxygen to the body, to remove carbon dioxide from the body, and to support the respiratory muscles. It is often used in patients with conditions such as acute respiratory distress syndrome (ARDS), pneumonia, or chronic obstructive pulmonary disease (COPD).

Mechanical ventilation carries risks and complications, including infection, lung injury, and damage to the vocal cords. Therefore, careful monitoring and management by trained healthcare professionals are essential to ensure the safety and effectiveness of the treatment.

Tags : mechanical ventilation, intensive care units, ICU, Invasive mechanical ventilation, noninvasive mechanical ventilation, critical care medicine, critical care medicine PowerPoint presentation

Published on : Mar 28, 2023 | Views : 2495 | Downloads : 6

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Slide 1-

Mechanical Ventilation Dr. Abdul-Monim Batiha Assistant Professor Critical Care Nursing
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Mechanical Ventilation is ventilation of the lungs by artificial means usually by a ventilator. A ventilator delivers gas to the lungs with either negative or positive pressure.
Slide 4-

Purposes: To maintain or improve ventilation, & tissue oxygenation. To decrease the work of breathing & improve patient’s comfort.
Slide 5-

Indications: 1- Acute respiratory failure due to: Mechanical failure, includes neuromuscular diseases as Myasthenia Gravis, Guillain-Barré Syndrome, and Poliomyelitis (failure of the normal respiratory neuromuscular system) Musculoskeletal abnormalities, such as chest wall trauma (flail chest) Infectious diseases of the lung such as pneumonia, tuberculosis.
Slide 6-

2- Abnormalities of pulmonary gas exchange as in: Obstructive lung disease in the form of asthma, chronic bronchitis or emphysema. Conditions such as pulmonary edema, atelectasis, pulmonary fibrosis. Patients who has received general anesthesia as well as post cardiac arrest patients often require ventilatory support until they have recovered from the effects of the anesthesia or the insult of an arrest.
Slide 7-

Criteria for institution of ventilatory support:
Slide 8-

Criteria for institution of ventilatory support:
Slide 9-

Types of Mechanical ventilators: Negative-pressure ventilators Positive-pressure ventilators.
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Negative-Pressure Ventilators Early negative-pressure ventilators were known as “iron lungs.” The patient’s body was encased in an iron cylinder and negative pressure was generated . The iron lung are still occasionally used today.
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Intermittent short-term negative-pressure ventilation is sometimes used in patients with chronic diseases. The use of negative-pressure ventilators is restricted in clinical practice, however, because they limit positioning and movement and they lack adaptability to large or small body torsos (chests) . Our focus will be on the positive-pressure ventilators.
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Positive-pressure ventilators Positive-pressure ventilators deliver gas to the patient under positive-pressure, during the inspiratory phase.
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Types of Positive-Pressure Ventilators 1- Volume Ventilators. 2- Pressure Ventilators 3- High-Frequency Ventilators
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The volume ventilator is commonly used in critical care settings. The basic principle of this ventilator is that a designated volume of air is delivered with each breath. The amount of pressure required to deliver the set volume depends on :- - Patient’s lung compliance - Patient–ventilator resistance factors. 1- Volume Ventilators
Slide 17-

Therefore, peak inspiratory pressure (PIP ) must be monitored in volume modes because it varies from breath to breath. With this mode of ventilation, a respiratory rate, inspiratory time, and tidal volume are selected for the mechanical breaths.
Slide 18-

The use of pressure ventilators is increasing in critical care units. A typical pressure mode delivers a selected gas pressure to the patient early in inspiration, and sustains the pressure throughout the inspiratory phase. By meeting the patient’s inspiratory flow demand throughout inspiration, patient effort is reduced and comfort increased. 2- Pressure Ventilators
Slide 19-

Although pressure is consistent with these modes, volume is not. Volume will change with changes in resistance or compliance, Therefore, exhaled tidal volume is the variable to monitor closely. With pressure modes, the pressure level to be delivered is selected, and with some mode options (i.e., pressure controlled [PC], described later), rate and inspiratory time are preset as well.
Slide 20-

3- High-Frequency Ventilators High-frequency ventilators use small tidal volumes (1 to 3 mL/kg) at frequencies greater than 100 breaths/minute. The high-frequency ventilator accomplishes oxygenation by the diffusion of oxygen and carbon dioxide from high to low gradients of concentration.
Slide 21-

This diffusion movement is increased if the kinetic energy of the gas molecules is increased. A high-frequency ventilator would be used to achieve lower peak ventilator pressures, thereby lowering the risk of barotrauma.
Slide 22-

Classification of positive-pressure ventilators: Ventilators are classified according to how the inspiratory phase ends. The factor which terminates the inspiratory cycle reflects the machine type. They are classified as: 1- Pressure cycled ventilator 2- Volume cycled ventilator 3- Time cycled ventilator
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1- Volume-cycled ventilator Inspiration is terminated after a preset tidal volume has been delivered by the ventilator. The ventilator delivers a preset tidal volume (VT), and inspiration stops when the preset tidal volume is achieved.
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2- Pressure-cycled ventilator In which inspiration is terminated when a specific airway pressure has been reached. The ventilator delivers a preset pressure; once this pressure is achieved, end inspiration occurs.
Slide 25-

3- Time-cycled ventilator In which inspiration is terminated when a preset inspiratory time, has elapsed. Time cycled machines are not used in adult critical care settings. They are used in pediatric intensive care areas.
Slide 26-

Ventilator mode The way the machine ventilates the patient How much the patient will participate in his own ventilatory pattern. Each mode is different in determining how much work of breathing the patient has to do.
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Modes of Mechanical Ventilation A- Volume Modes B- Pressure Modes
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A- Volume Modes 1- Assist-control (A/C) 2- Synchronized intermittent mandatory ventilation (SIMV)
Slide 29-

1- Assist Control Mode A/C The ventilator provides the patient with a pre-set tidal volume at a pre-set rate . The patient may initiate a breath on his own, but the ventilator assists by delivering a specified tidal volume to the patient. Client can initiate breaths that are delivered at the preset tidal volume. Client can breathe at a higher rate than the preset number of breaths/minute
Slide 30-

The total respiratory rate is determined by the number of spontaneous inspiration initiated by the patient plus the number of breaths set on the ventilator. In A/C mode, a mandatory (or “control”) rate is selected. If the patient wishes to breathe faster, he or she can trigger the ventilator and receive a full-volume breath.
Slide 31-

Often used as initial mode of ventilation When the patient is too weak to perform the work of breathing (e.g., when emerging from anesthesia). Disadvantages: Hyperventilation,
Slide 32-

2- Synchronized Intermittent Mandatory Ventilation (SIMV) The ventilator provides the patient with a pre-set number of breaths/minute at a specified tidal volume and FiO2. In between the ventilator-delivered breaths, the patient is able to breathe spontaneously at his own tidal volume and rate with no assistance from the ventilator. However, unlike the A/C mode, any breaths taken above the set rate are spontaneous breaths taken through the ventilator circuit.
Slide 33-

The tidal volume of these breaths can vary drastically from the tidal volume set on the ventilator, because the tidal volume is determined by the patient’s spontaneous effort. Adding pressure support during spontaneous breaths can minimize the risk of increased work of breathing. Ventilators breaths are synchronized with the patient spontaneous breathe. ( no fighting)
Slide 34-

Used to wean the patient from the mechanical ventilator. Weaning is accomplished by gradually lowering the set rate and allowing the patient to assume more work
Slide 35-

B- Pressure Modes 1- Pressure-controlled ventilation (PCV) 2- Pressure-support ventilation (PSV) 3- Continuous positive airway pressure (CPAP) 4- Positive end expiratory pressure (PEEP) 5- Noninvasive bilevel positive airway pressure ventilation (BiPAP)
Slide 36-

1- Control Mode (CM) Continuous Mandatory Ventilation ( CMV) Ventilation is completely provided by the mechanical ventilator with a preset tidal volume, respiratory rate and oxygen concentration Ventilator totally controls the patient’s ventilation i.e. the ventilator initiates and controls both the volume delivered and the frequency of breath. Client does not breathe spontaneously. Client can not initiate breathe
Slide 37-

2- Pressure-Controlled Ventilation Mode ( PCV) The PCV mode is used If compliance is decreased and the risk of barotrauma is high. It is used when the patient has persistent oxygenation problems despite a high FiO2 and high levels of PEEP. The inspiratory pressure level, respiratory rate, and inspiratory–expiratory (I:E) ratio must be selected.
Slide 38-

2- Pressure-Controlled Ventilation Mode ( PCV) In pressure controlled ventilation the breathing gas flows under constant pressure into the lungs during the selected inspiratory time. The flow is highest at the beginning of inspiration( i.e when the volume is lowest in the lungs). As the pressure is constant the flow is initially high and then decreases with increasing filling of the lungs.
Slide 39-

Like volume controlled ventilation PCV is time controlled.
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Advantages of pressure limitations are: 1- reduction of peak pressure and therefore the risk of barotruma and tracheal injury. 2- effective ventilation. Improve gas exchange
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Tidal volume varies with compliance and airway resistance and must be closely monitored. Sedation and the use of neuromuscular blocking agents are frequently indicated, because any patient–ventilator asynchrony usually results in profound drops in the SaO2. This is especially true when inverse ratios are used. The “unnatural” feeling of this mode often requires muscle relaxants to ensure patient–ventilator synchrony.
Slide 42-

Inverse ratio ventilation (IRV) mode reverses this ratio so that inspiratory time is equal to, or longer than, expiratory time (1:1 to 4:1). Inverse I:E ratios are used in conjunction with pressure control to improve oxygenation by expanding stiff alveoli by using longer distending times, thereby providing more opportunity for gas exchange and preventing alveolar collapse.
Slide 43-

As expiratory time is decreased, one must monitor for the development of hyperinflation or auto-PEEP. Regional alveolar overdistension and barotrauma may occur owing to excessive total PEEP. When the PCV mode is used, the mean airway and intrathoracic pressures rise, potentially resulting in a decrease in cardiac output and oxygen delivery. Therefore, the patient’s hemodynamic status must be monitored closely. Used to limit plateau pressures that can cause barotrauma & Severe ARDS
Slide 44-

3- Pressure Support Ventilation ( PSV) The patient breathes spontaneously while the ventilator applies a pre-determined amount of positive pressure to the airways upon inspiration. Pressure support ventilation augments patient’s spontaneous breaths with positive pressure boost during inspiration i.e. assisting each spontaneous inspiration. Helps to overcome airway resistance and reducing the work of breathing.
Slide 45-

Indicated for patients with small spontaneous tidal volume and difficult to wean patients. Patient must initiate all pressure support breaths. Pressure support ventilation may be combined with other modes such as SIMV or used alone for a spontaneously breathing patient.
Slide 46-

The patient’s effort determines the rate, inspiratory flow, and tidal volume. In PSV mode, the inspired tidal volume and respiratory rate must be monitored closely to detect changes in lung compliance. It is a mode used primarily for weaning from mechanical ventilation.
Slide 47-

Constant positive airway pressure during spontaneous breathing CPAP allows the nurse to observe the ability of the patient to breathe spontaneously while still on the ventilator. CPAP can be used for intubated and nonintubated patients. It may be used as a weaning mode and for nocturnal ventilation (nasal or mask CPAP) 4- Continuous Positive Airway Pressure (CPAP)
Slide 48-

5- Positive end expiratory pressure (PEEP) Positive pressure applied at the end of expiration during mandatory \ ventilator breath positive end-expiratory pressure with positive-pressure (machine) breaths.
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Uses of CPAP & PEEP Prevent atelactasis or collapse of alveoli Treat atelactasis or collapse of alveoli Improve gas exchange & oxygenation Treat hypoxemia refractory to oxygen therapy.(prevent oxygen toxicity Treat pulmonary edema ( pressure help expulsion of fluids from alveoli
Slide 50-

6- Noninvasive Bilateral Positive Airway Pressure Ventilation (BiPAP) BiPAP is a noninvasive form of mechanical ventilation provided by means of a nasal mask or nasal prongs, or a full-face mask. The system allows the clinician to select two levels of positive-pressure support: An inspiratory pressure support level (referred to as IPAP) An expiratory pressure called EPAP (PEEP/CPAP level).
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Common Ventilator Settings parameters/ controls Fraction of inspired oxygen (FIO2) Tidal Volume (VT) Peak Flow/ Flow Rate Respiratory Rate/ Breath Rate / Frequency ( F) Minute Volume (VE) I:E Ratio (Inspiration to Expiration Ratio) Sigh
Slide 52-

● Fraction of inspired oxygen (FIO2) The percent of oxygen concentration that the patient is receiving from the ventilator. (Between 21% & 100%) (room air has 21% oxygen content). Initially a patient is placed on a high level of FIO2 (60% or higher). Subsequent changes in FIO2 are based on ABGs and the SaO2.
Slide 53-

In adult patients the initial FiO2 may be set at 100% until arterial blood gases can document adequate oxygenation. An FiO2 of 100% for an extended period of time can be dangerous ( oxygen toxicity) but it can protect against hypoxemia For infants, and especially in premature infants, high levels of FiO2 (>60%) should be avoided. Usually the FIO2 is adjusted to maintain an SaO2 of greater than 90% (roughly equivalent to a PaO2 >60 mm Hg). Oxygen toxicity is a concern when an FIO2 of greater than 60% is required for more than 25 hours
Slide 54-

Signs and symptoms of oxygen toxicity :- 1- Flushed face 2- Dry cough 3- Dyspnea 4- Chest pain 5- Tightness of chest 6- Sore throat
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● Tidal Volume (VT) The volume of air delivered to a patient during a ventilator breath. The amount of air inspired and expired with each breath. Usual volume selected is between 5 to 15 ml/ kg body weight)
Slide 56-

In the volume ventilator, Tidal volumes of 10 to 15 mL/kg of body weight were traditionally used. the large tidal volumes may lead to (volutrauma) aggravate the damage inflicted on the lungs For this reason, lower tidal volume targets (6 to 8 mL/kg) are now recommended.
Slide 57-

● Peak Flow/ Flow Rate The speed of delivering air per unit of time, and is expressed in liters per minute. The higher the flow rate, the faster peak airway pressure is reached and the shorter the inspiration; The lower the flow rate, the longer the inspiration.
Slide 58-

● Respiratory Rate/ Breath Rate / Frequency ( F) The number of breaths the ventilator will deliver/minute (10-16 b/m). Total respiratory rate equals patient rate plus ventilator rate. The nurse double-checks the functioning of the ventilator by observing the patient’s respiratory rate.
Slide 59-

For adult patients and older children:- With COPD A reduced tidal volume A reduced respiratory rate For infants and younger children:- A small tidal volume Higher respiratory rate
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● Minute Volume (VE) The volume of expired air in one minute . Respiratory rate times tidal volume equals minute ventilation VE = (VT x F) In special cases, hypoventilation or hyperventilation is desired
Slide 61-

In a patient with head injury, Respiratory alkalosis may be required to promote cerebral vasoconstriction, with a resultant decrease in ICP. In this case, the tidal volume and respiratory rate are increased ( hyperventilation) to achieve the desired alkalotic pH by manipulating the PaCO2.
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In a patient with COPD Baseline ABGs reflect an elevated PaCO2 should not hyperventilated. Instead, the goal should be restoration of the baseline PaCO2. These patients usually have a large carbonic acid load, and lowering their carbon dioxide levels rapidly may result in seizures.
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● I:E Ratio (Inspiration to Expiration Ratio):- The ratio of inspiratory time to expiratory time during a breath (Usually = 1:2)
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● Sigh A deep breath. A breath that has a greater volume than the tidal volume. It provides hyperinflation and prevents atelectasis. Sigh volume :------------------Usual volume is 1.5 –2 times tidal volume. Sigh rate/ frequency :---------Usual rate is 4 to 8 times an hour.
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● Peak Airway Pressure:- In adults if the peak airway pressure is persistently above 45 cmH2O, the risk of barotrauma is increased and efforts should be made to try to reduce the peak airway pressure. In infants and children it is unclear what level of peak pressure may cause damage. In general, keeping peak pressures below 30 is desirable.
Slide 66-

● Pressure Limit On volume-cycled ventilators, the pressure limit dial limits the highest pressure allowed in the ventilator circuit. Once the high pressure limit is reached, inspiration is terminated. Therefore, if the pressure limit is being constantly reached, the designated tidal volume is not being delivered to the patient.
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● Sensitivity(trigger Sensitivity) The sensitivity function controls the amount of patient effort needed to initiate an inspiration Increasing the sensitivity (requiring less negative force) decreases the amount of work the patient must do to initiate a ventilator breath. Decreasing the sensitivity increases the amount of negative pressure that the patient needs to initiate inspiration and increases the work of breathing.
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The most common setting for pressure sensitivity are -1 to -2 cm H2O The more negative the number the harder it to breath.
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Ensuring humidification and thermoregulation All air delivered by the ventilator passes through the water in the humidifier, where it is warmed and saturated. Humidifier temperatures should be kept close to body temperature 35 ºC- 37ºC. In some rare instances (severe hypothermia), the air temperatures can be increased. The humidifier should be checked for adequate water levels
Slide 70-

An empty humidifier contributes to drying the airway, often with resultant dried secretions, mucus plugging and less ability to suction out secretions. Humidifier should not be overfilled as this may increase circuit resistance and interfere with spontaneous breathing. As air passes through the ventilator to the patient, water condenses in the corrugated tubing. This moisture is considered contaminated and must be drained into a receptacle and not back into the sterile humidifier.
Slide 71-

If the water is allowed to build up, resistance is developed in the circuit and PEEP is generated. In addition, if moisture accumulates near the endotracheal tube, the patient can aspirate the water. The nurse and respiratory therapist jointly are responsible for preventing this condensation buildup. The humidifier is an ideal medium for bacterial growth.
Slide 72-

Ventilator alarms:- Mechanical ventilators comprise audible and visual alarm systems, which act as immediate warning signals to altered ventilation. Alarm systems can be categorized according to volume and pressure (high and low). High-pressure alarms warn of rising pressures. Low-pressure alarms warn of disconnection of the patient from the ventilator or circuit leaks.
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Complications of Mechanical Ventilation:- I- Airway Complications, II- Mechanical complications, III- Physiological Complications, IV- Artificial Airway Complications.
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I- Airway Complications 1- Aspiration 2- Decreased clearance of secretions 3- Nosocomial or ventilator-acquired pneumonia
Slide 75-

II- Mechanical complications 1- Hypoventilation with atelectasis with respiratory acidosis or hypoxemia. 2- Hyperventilation with hypocapnia and respiratory alkalosis 3- Barotrauma a- Closed pneumothorax, b- Tension pneumothorax, c- Pneumomediastinum, d- Subcutaneous emphysema. 4- Alarm “turned off” 5- Failure of alarms or ventilator 6- Inadequate nebulization or humidification 7- Overheated inspired air, resulting in hyperthermia
Slide 76-

III- Physiological Complications 1- Fluid overload with humidified air and sodium chloride (NaCl) retention 2- Depressed cardiac function and hypotension 3- Stress ulcers 4- Paralytic ileus 5- Gastric distension 6- Starvation 7- Dyssynchronous breathing pattern
Slide 77-

IV- Artificial Airway ComplicationsA- Complications related to Endotracheal Tube:- 1- Tube kinked or plugged 2- Rupture of piriform sinus 3- Tracheal stenosis or tracheomalacia 4- Mainstem intubation with contralateral (located on or affecting the opposite side of the lung) lung atelectasis 5- Cuff failure 6- Sinusitis 7- Otitis media 8- Laryngeal edema
Slide 78-

B- Complications related to Tracheostomy tube:- 1- Acute hemorrhage at the site 2- Air embolism 3- Aspiration 4- Tracheal stenosis 5- Erosion into the innominate artery with exsanguination 6- Failure of the tracheostomy cuff 7- Laryngeal nerve damage 8- Obstruction of tracheostomy tube 9- Pneumothorax 10- Subcutaneous and mediastinal emphysema 11- Swallowing dysfunction 12- Tracheoesophageal fistula 13- Infection 14- Accidental decannulation with loss of airway
Slide 79-

Nursing care of patients on mechanical ventilation Assessment: 1- Assess the patient 2- Assess the artificial airway (tracheostomy or endotracheal tube) 3- Assess the ventilator
Slide 80-

Nursing Interventions 1-Maintain airway patency & oxygenation 2- Promote comfort 3- Maintain fluid & electrolytes balance 4- Maintain nutritional state 5- Maintain urinary & bowel elimination 6- Maintain eye , mouth and cleanliness and integrity:- 7- Maintain mobility/ musculoskeletal function:-
Slide 81-

Nursing Interventions 8- Maintain safety:- 9- Provide psychological support 10- Facilitate communication 11- Provide psychological support & information to family 12- Responding to ventilator alarms /Troublshooting ventilator alarms 13- Prevent nosocomial infection 14- Documentation
Slide 82-

Responding To Alarms If an alarm sounds, respond immediately because the problem could be serious. Assess the patient first, while you silence the alarm. If you can not quickly identify the problem, take the patient off the ventilator and ventilate him with a resuscitation bag connected to oxygen source until the physician arrives. A nurse or respiratory therapist must respond to every ventilator alarm.
Slide 83-

Alarms must never be ignored or disarmed. Ventilator malfunction is a potentially serious problem. Nursing or respiratory therapists perform ventilator checks every 2 to 4 hours, and recurrent alarms may alert the clinician to the possibility of an equipment-related issue.
Slide 84-

When device malfunction is suspected, a second person manually ventilates the patient while the nurse or therapist looks for the cause. If a problem cannot be promptly corrected by ventilator adjustment, a different machine is procured so the ventilator in question can be taken out of service for analysis and repair by technical staff.
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Causes of Ventilator Alarms High pressure alarm Increased secretions Kinked ventilator tubing or endotracheal tube (ETT) Patient biting the ETT Water in the ventilator tubing. ETT advanced into right mainstem bronchus.
Slide 86-

Low pressure alarm Disconnected tubing A cuff leak A hole in the tubing (ETT or ventilator tubing) A leak in the humidifier
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Oxygen alarm The oxygen supply is insufficient or is not properly connected.
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High respiratory rate alarm Episodes of tachypnea, Anxiety, Pain, Hypoxia, Fever. -
Slide 89-

Apnea alarm During weaning, indicates that the patient has a slow Respiratory rate and a period of apnea.
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Temperature alarm Overheating due to too low or no gas flow. Improper water levels
Slide 91-

Methods of Weaning 1- T-piece trial, 2- Continuous Positive Airway Pressure (CPAP) weaning, 3- Synchronized Intermittent Mandatory Ventilation (SIMV) weaning, 4- Pressure Support Ventilation (PSV) weaning.
Slide 92-

1- T-Piece trial It consists of removing the patient from the ventilator and having him / her breathe spontaneously on a T-tube connected to oxygen source. During T-piece weaning, periods of ventilator support are alternated with spontaneous breathing. The goal is to progressively increase the time spent off the ventilator.
Slide 93-

2-Synchronized Intermittent Mandatory Ventilation ( SIMV) Weaning SIMV is the most common method of weaning. It consists of gradually decreasing the number of breaths delivered by the ventilator to allow the patient to increase number of spontaneous breaths
Slide 94-

3-Continuous Positive Airway Pressure ( CPAP) Weaning When placed on CPAP, the patient does all the work of breathing without the aid of a back up rate or tidal volume. No mandatory (ventilator-initiated) breaths are delivered in this mode i.e. all ventilation is spontaneously initiated by the patient. Weaning by gradual decrease in pressure value
Slide 95-

4- Pressure Support Ventilation (PSV) Weaning The patient must initiate all pressure support breaths. During weaning using the PSV mode the level of pressure support is gradually decreased based on the patient maintaining an adequate tidal volume (8 to 12 mL/kg) and a respiratory rate of less than 25 breaths/minute. PSV weaning is indicated for :- - Difficult to wean patients - Small spontaneous tidal volume.
Slide 96-

Weaning readiness Criteria Awake and alert Hemodynamically stable, adequately resuscitated, and not requiring vasoactive support Arterial blood gases (ABGs) normalized or at patient’s baseline - PaCO2 acceptable - PH of 7.35 – 7.45 - PaO2 > 60 mm Hg , - SaO2 >92% - FIO2 ≤40%
Slide 97-

Positive end-expiratory pressure (PEEP) ≤5 cm H2O F < 25 / minute Vt 5 ml / kg VE 5- 10 L/m (f x Vt) VC > 10- 15 ml / kg PEP (positive expiratory pressure) > - 20 cm H2O ( indicates patient’s ability to take a deep breath & cough),
Slide 98-

Chest x-ray reviewed for correctable factors; treated as indicated, Major electrolytes within normal range, Hematocrit >25%, Core temperature >36°C and <39°C, Adequate management of pain/anxiety/agitation, Adequate analgesia/ sedation (record scores on flow sheet), No residual neuromuscular blockade.
Slide 99-

Role of nurse before weaning:- 1- Ensure that indications for the implementation of Mechanical ventilation have improved 2- Ensure that all factors that may interfere with successful weaning are corrected:- - Acid-base abnormalitie - Fluid imbalance - Electrolyte abnormalities - Infection - Fever - Anemia - Hyperglycemia - Protein - Sleep deprivation
Slide 100-

Role of nurse before weaning:- 3- Assess readiness for weaning 4- Ensure that the weaning criteria / parameters are met. 5- Explain the process of weaning to the patient and offer reassurance to the patient.
Slide 101-

6- Initiate weaning in the morning when the patient is rested. 7- Elevate the head of the bed & Place the patient upright 8- Ensure a patent airway and suction if necessary before a weaning trial, 9- Provide for rest period on ventilator for 15 – 20 minutes after suctioning.
Slide 102-

10- Ensure patient’s comfort & administer pharmacological agents for comfort, such as bronchodilators or sedatives as indicated. 11- Help the patient through some of the discomfort and apprehension. 12- Support and reassurance help the patient through the discomfort and apprehension as remains with the patient after initiation of the weaning process. 13- Evaluate and document the patient’s response to weaning.
Slide 103-

Role of nurse during weaning:- 1- Wean only during the day. 2- Remain with the patient during initiation of weaning. 3- Instruct the patient to relax and breathe normally. 4- Monitor the respiratory rate, vital signs, ABGs, diaphoresis and use of accessory muscles frequently. If signs of fatigue or respiratory distress develop. Discontinue weaning trials.
Slide 104-

Signs of Weaning Intolerance Criteria Diaphoresis Dyspnea & Labored respiratory pattern Increased anxiety ,Restlessness, Decrease in level of consciousness Dysrhythmia,Increase or decrease in heart rate of > 20 beats /min. or heart rate > 110b/m,Sustained heart rate >20% higher or lower than baseline
Slide 105-

Increase or decrease in blood pressure of > 20 mm Hg Systolic blood pressure >180 mm Hg or <90 mm Hg Increase in respiratory rate of > 10 above baseline or > 30 Sustained respiratory rate greater than 35 breaths/minute Tidal volume ≤5 mL/kg, Sustained minute ventilation <200 mL/kg/minute SaO2 < 90%, PaO2 < 60 mmHg, decrease in PH of < 7.35. Increase in PaCO2
Slide 106-

Role of nurse after weaning 1- Ensure that extubation criteria are met . 2- Decanulate or extubat 2- Documentation
Slide 107-

Good Luck