i have prepared this ppt. from various Books as a refrences as well as uses of web pages and explain and modify in simplify language which are easily understand by medical or para medical personnel..thank you..
5. “Mechanical ventilation is the use of a
ventilator to move room air or oxygen
enriched air into and out of the lungs
mechanically to maintain proper levels of
oxygen and carbon dioxide in the blood.”
6. Mechanical ventilation alone does not treat
or reverse the underlying pathology leading
to the need for ventilator support. Rather, it
is applied as one of the support systems
until the reversal of the pathological
condition, so that the patient may then
become weaned from mechanical
ventilation.
8. To maintain gas exchange in case of acute
and chronic respiratory failure.
To maintain ventilator support after CPR.
To reduce pulmonary vascular resistance.
To excrete increased CO2 production.
To give general anesthesia with muscle
relaxants.
9. Acute respiratory failure
Apnea or impending inability to breath
Severe Hypoxia/Hypoxemia
Respiratory muscle fatigue
Cardiac Insufficiency
Neurological problems
Therapeutic and prophylactic
10. Respiratory failure: An inability of the heart and
lungs to provide adequate tissue oxygenation or
removal of carbon dioxide.
Hypoxemic respiratory failure – lung failure
Hypercapnic respiratory failure – pump failure
Neuromuscular diseases : Myasthenia Gravis,
Guillain-Barre Syndrome, and Poliomyelitis
(failure of the normal respiratory neuromuscular
system)
Musculoskeletal abnormalities :Such as chest
wall trauma .
Infectious diseases of the lung such as
pneumonia, tuberculosis.
11. 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 requires ventilatory support until
they have recovered from the effects of the
anesthesia or out from a Danger.
15. Independent variables : “The parameters that
are set by clinician.”
Dependent variables : “The parameters
measured by the ventilators.”
Fraction of inspired oxygen (FiO2): “The
concentration of O2 in the inspired gas,
usually between 21% and 100% O2. The
lowest possible fraction of inspired oxygen
(FiO2) necessary to meet oxygenation goals
should be used. “
16. Tidal volume (TV): “The amount of air
delivered to the patient per breath. It is
expressed in milliliters.”
A starting point for the VT setting is 8 to
10ml/kg of ideal weight.
Respiratory rate/frequency (f): “The number
of breaths per minute. This can be from the
ventilator, the patient, or both. “
The RR is set as near to physiological rates
(14 to 20 breaths/min) as possible.
17. Minute ventilation (V E): “The product of V and
respiratory frequency (VT * f). It is usually
expressed in liters/minute.”
Exhaled Tidal Volume:(E TV): “It is the amount
of gas that comes out of the patients lungs on
exhalation.”
This is the most accurate measure of the
volume received by the patient
If the ETV deviates from the set TV by 50ml or
more, troubleshoot the system to identify the
source of gas loss.
18. Inspiratory to Expiratory ratio (I:E): “The I:E ratio
is usually set to mimic the pattern of
spontaneous ventilation.”
During spontaneous breathing, the normal I:E
ratio is 1:2, indicating that for normal patients
the exhalation time is about twice as long as
inhalation time.
If exhalation time is too short “breath stacking”
occurs resulting in an increase in end-
expiratory pressure also called auto-PEEP.
Depending on the disease process, such as in
ARDS, the I:E ratio can be changed to improve
ventilation.
19. Inverse Inspiratory to Expiratory ratio:
“I:E ratios such as 1:1,2:1 and 3:1 are called
inverse I:E ratios”
Inverse I:E ratio allows unstable alveoli time to
fill and also prevents collapse by shortened
expiratory phase.
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.
20. Positive end-expiratory pressure (PEEP): “The
amount of positive pressure that is maintained
at end-expiration.”
Typical settings for PEEP are 5 to 20 cm H2O
PEEP increases oxygenation by preventing
collapse of small airways
It increases the functional residual capacity of
the lungs
A typical initial applied PEEP is 5 cmH2O.
However, up to 20 cmH2O may be used in
patients undergoing low tidal volume
ventilation for acute respiratory distress
syndrome (ARDS)
21. Auto PEEP: “Auto PEEP is the spontaneous
development of PEEP caused by gas trapping
in the lung resulting from insufficient
expiratory time and incomplete exhalation.”
Causes of auto PEEP formation include rapid
RR, high VE demand, airflow obstruction and
inverse I:E ratio ventilation.
Auto PEEP = Total PEEP - Set PEEP
22. 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.
The most common setting for pressure sensitivity are
-1 to -2 cm H2O
The more negative the number the harder it to
breath.
23. Peak airway pressure (Paw): “The pressure
that is required to deliver the TV to the
patient. It has a unit of centimeters of water
(cm H2O).”
Plateau pressure (Pplat): “The pressure that is
needed to distend the lung. This pressure can
only be obtained by applying an end
inspiratory pause. It also has a unit of cm
H2O.”
24. Peak inspiratory Pressure (PIP): 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.
“Increasing PIP is also sign of Blockage of
airway and needed to suctioning or change Et
/TT.”
25. Mean airway pressure: “The time-weighted
average pressure during the respiratory cycle.
It is expressed in cm H2O.”
26.
27. (i) Invasive ventilation or conventional
mechanical ventilation (MV) &
(ii) non invasive ventilation (NIV).
OR
(i) Positive Pressure Ventilation &
(ii) Negative pressure ventilation.
28. Non Invasive Ventilation: “Ventilatory support
that is given without establishing endo-
tracheal intubation or tracheostomy is called
Non invasive mechanical ventilation.”
Invasive Ventilation: “Ventilatory support that
is given through endotracheal intubation or
tracheostomy is called as Invasive mechanical
ventilation.”
29. Negative pressure:
• Producing Neg. pressure
intermittently in the
pleural space/ around
the thoracic cage.
• e.g.: Iron Lung
Positive pressure:
• Delivering air/gas with
positive pressure to the
airway.
• e.g.: BIPAP & CPAP ( O2
mask , Nasal cannula
etc.
30. Elongated tank, which encases the patient up to
the neck. The neck is sealed with a rubber
gasket, the patient's face are exposed to the
room air.
These exert negative pressure on the external
chest decreasing the intra-thoracic pressure
during inspiration, allows air to flow into the
lungs, filling its volume.
The cessation of the negative pressure causes
the chest wall to fall and exhalation to occur.
31.
32. The patient’s body was encased in an iron
cylinder and negative pressure was generated
The iron lung are still occasionally used
today.
These are simple to use and do not require
intubations of the airway; consequently, they
are especially adaptable for home use.
It is used mainly in chronic respiratory failure
associated with neuromuscular conditions
such as poliomyelitis, muscular dystrophy
and myasthenia gravis.
33. 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).
34.
35. Positive pressure ventilation inflate the lungs by
exerting positive pressure on the airway forcing
the alveoli to expand during inspiration.
Expiration occurs passively.
Positive-pressure ventilators require an
artificial airway (Endotracheal or tracheostomy
tube) in invasive ventilation and in NIV includes
BiPAP Mask , O2 mask , Nasal mask/cannula ,
O2 high concentrated reservoir mask etc.
Inspiration can be triggered either by the
patient or the machine.
36.
37.
38.
39. Invasive mechanical ventilation is
implemented once a cuffed tube is inserted
into the trachea to allow conditioned gas
(warmed, oxygenated, and humidified) to be
delivered to the airways and lungs at
pressures above atmospheric pressure.
Ventilatory support that is given through
endotracheal intubation or tracheostomy is
called as Invasive mechanical ventilation
40. Positive invasive pressure ventilation deliver
gas to the patient under positive-pressure,
during the inspiratory phase.
41. A/C: Assist-Control Ventilation
V/C: Volume-Control Ventilation
T/C: Time-Control Ventilation
IMV: Intermittent Mandatory Ventilation
SIMV: Synchronized Intermittent Mandatory
Ventilation
BiPAP ( Bi-level/Biphasic ): Non-invesive
Pressure Ventilation with Pressure Support
(consists of 2 levels of pressure)
PRVC: Pressure Regulated Volume Control
43. Modes of mechanical ventilation are the
techniques that the ventilator and patient
work together to perform the respiratory
cycle.
(1) Pressure Cycled Modes
(2) Volume Cycled Modes
(3) Time Cycled Modes
45. CPAP is positive pressure applied throughout
the respiratory cycle to the spontaneously
breathing patient.
A continuous level of elevated pressure is
provided through the patient circuit to
maintain adequate oxygenation, decrease the
work of breathing.
CPAP may be used invasively through an
endotracheal tube or tracheostomy or
noninvasively with a face mask or nasal
prongs.
46. provides pressure at end expiration, which
prevents alveolar collapse and improves the
functional residual capacity and oxygenation.
CPAP allows the nurse to observe the ability
of the patient to breath spontaneously while
still on the ventilator.
It may used as a Weaning Mode.
47. The ventilator is used to deliver CPAP during
weaning the nurse can monitor the adequacy
of the patient’s TV.
Alarms should be set to detect ETV and apnea.
If a patient in this mode can maintain his own
respiratory effort without excess work, if the
ABG’s are good, and the patient has good
respiratory mechanics then extubation is at
hand.
48. The patient breaths 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.
49. 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.
50. 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.
5 – 10 cm H20 are generally used,
especially during weaning.
51. During P-A/C the nurse must be familiar with
all the ventilator settings: the level of
pressure, the set RR, the FiO2, and the level
of PEEP
The nurse monitors the total RR to evaluate
whether the patient is initiating spontaneous
breaths and ETV for adequacy of volume.
52. 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.
53. 1.reduction of peak pressure and therefore
the lower risk of barotrauma and tracheal
injury.
2.effective ventilation.
3.Improve gas exchange
4. PCV has traditionally been preferred for
patients with neuromuscular disease .
54. Careful attention must be given to the TV to
prevent unplanned hyperventilation and
hypoventilation.
Sedation and the use of neuromuscular
blocking agents are frequently indicated,
because any patient–ventilator asynchrony
usually results in profound drops in the
SaO2.
55. 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.
56. As expiratory time is decreased, one must
monitor for the development of hyperinflation
or auto-PEEP. Regional alveolar over
distension 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.
58. 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 breathe at a higher rate than the
preset number of breaths/minute
59. 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.
If the patient wishes to breathe faster, he or
she can trigger the ventilator and receive a
full-volume breath.
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)
60. The preset RR ensures that the patient
receives adequate ventilation, regardless of
spontaneous efforts.
The patient can breath faster than the
preset rate but not slower.
61. Respiratory alkalosis may develop if the
patient has a tendency to hyperventilate
because of anxiety, pain or neurological
factors.
Patient may rely on the ventilator and not
attempt to initiate spontaneous breathing if
ventilatory demands are met.
62. Total RR, to determine whether the patient is
initiating spontaneous breaths.
PIP, to determine whether it is increasing(
indicating a change in compliance or
resistance).
Patient’s sense of comfort and
synchronization with the ventilator and acid
base status.
63. A mode of mechanical ventilation in
which the patient is allowed to breath
independently except during certain
prescribed intervals, when a ventilator
delivers a breath either under positive
pressure or in a measured volume.
This mode is not use mostly in clinical
practice due to many new tech. Modes.
64. The SIMV mode of ventilation delivers a set
number of breaths of a set TV, and between
these mandatory breaths the patient may
initiate spontaneous breaths.
If the patient initiates a breath near the time a
mandatory breath is due, the delivery of the
mandatory breath is synchronized with the
patient’s spontaneous effort to prevent
patient ventilator dyssynchrony.
65. SIMV is indicated when it is desirable to allow
patients to breath at their own RR and thus
assist in maintaining a normal PaCo2,or when
hyperventilation has occurred in the A/C
mode.
SIMV mode helps to prevent respiratory
muscle weakness associated with mechanical
ventilation.
Self regulates the rate and volume of
spontaneous breath
It is used as a mode for weaning
66. In between the ventilator-delivered breaths ,
the patient is able to breath spontaneously at
his own tidal volume and rate with no
assistance from the ventilator.
Ventilators breaths are synchronized with the
patient spontaneous breath.
67. Monitor RR to determine whether the patient
is initiating spontaneous breaths, and the
patients ability to manage the WOB.
Assess PIP, patient’s sense of comfort and
synchronization with the ventilator and acid
base status.
If the total RR increases, the TV of the
spontaneous breaths is assessed for
adequacy. A rising total RR may indicate that
the patient is beginning to fatigue, resulting
in a more shallow and rapid respiratory
pattern and that may lead to atelectasis.
68.
69. “Ventilator Alarms defined as a Voice or
sound to alert Nurse/Doctor and caused by
any abnormal value of either in client or in
Ventilator.”
These Alarms have 4 main Types as below…
(i)Pressure alarms
(ii)Volume alarms
(iii)Apnea alarms
70.
71. They are triggered when there is increased
airway resistance or decreased lung
compliance.
Low pressure alarms and high pressure
alarms
72. Volume alarms are valuable for ensuring
adequate alveolar ventilation, particularly in
the patient receiving a pressure mode of
ventilation
73. This alarm is very important when the patient
is on a spontaneous breathing mode such as
PS or CPAP, and no mandatory breaths are
set.
74. High pressure alarms
Increased secretions in airway
Decreased A Way size due to wheezing or
bronchospasm
Displacement of ET tube
Obstructed ET tube – water/kink in tubing
Pt coughs gags, or bites the ET tube
Anxious pts – fights(Bucking) on Vent LOW
Pressure alarm
Disconnection /leak in the ventilator or airway
cuff
Pt stops spontaneous breathing
75. Hypotension caused by +ve pressure – which
increase intra thoracic pressure and inhibit blood
return to heart
Air leak
Airway obstruction
Respiratory complications…. pneumothorax,
subcutaneous emphysema due to +ve pressure
(Barotrauma ), resp failure
G.I alterations – stress ulcers bleeding
Malnutrition – if not supported
Infections
Muscular deconditioning
Ventilator dependence or inability to wean
76. An alarm should never be silenced until the
cause has been investigated and corrected.
If the source of the alarm cannot be
determined, disconnect the client from the
ventilator and use a hand-held resuscitation
bag for manual ventilation with 100% oxygen
until the problem can be resolved
77.
78. I Airway Complications
II Mechanical complications,
III Physiological Complications,
IV Artificial Airway Complications
79. Aspiration
Decreased clearance of secretions
Nosocomial or ventilator-acquired pneumonia
(VAP)
80. Hypoventilation with atelectasis with
respiratory acidosis or hypoxemia.
Hyperventilation with hypocapnia and
respiratory alkalosis
Barotrauma
- Closed pneumothorax,
- Tension pneumothorax,
- Subcutaneous emphysema.
Alarm “turned off”
Failure of alarms or ventilator
Inadequate nebulization or humidification
Overheated inspired air, resulting in
hyperthermia
81. Fluid overload with humidified air and
sodium chloride (NaCl) retention
Depressed cardiac function and
hypotension
Stress ulcers
Paralytic ileus
Gastric distension
Starvation
Dyssynchronous breathing pattern
82. (A) In Endotracheal Tube :
Tube kinked or plugged
Tracheal stenosis or tracheomalacia
Main stem intubation with contralateral (located
on or affecting the opposite side of the lung)
lung atelectasis
Cuff failure
Sinusitis
Otitis media
Laryngeal edema
83. (B) In Tracheostomy Tube :
Acute hemorrhage at the site
Air embolism
Aspiration
Tracheal stenosis
Failure of the tracheostomy cuff
Laryngeal nerve damage
Obstruction of tracheostomy tube
Pneumothorax
Subcutaneous and mediastina emphysema
Swallowing dysfunction
Tracheoesophageal fistula
Infection
Accidental decannulation with loss of airway
86. ◦ Alveolar hyperventilation
Due to hypoxemia, fear, pain, anxiety →
alkalosis
RX: sedate, analgesia, communication,
correct hypoxemia
Due to inappropriate ventilator settings
high tidal volume
High rate
◦ Pulmonary Infection
87. Neurological complications:
◦ Positive pressure ventilation → increased
intrathoracic pressure
◦ interferes with venous drainage; increased
ICP
GI:
◦ Stress ulcers and GI bleeds; Rx with H2
receptor blockers
Gastric and bowel dilation
88. Musculoskeletal:
Muscle atrophy r/t immobilization
Mobilize
ROM
Psychologic:
Stress
Communication very important
Sedate, explain, family visits, pain management
Facilitate expression of needs
89. Common problems
◦ High peak pressures
◦ Patient with COPD
◦ Ventilator synchrony
◦ ARDS
90. If peak pressures are increasing:
◦ Check plateau pressures by allowing for
an inspiratory pause (this gives you the
pressure in the lung itself without the
addition of resistance)
◦ If peak pressures are high and plateau
pressures are low then you have an
obstruction
◦ If both peak pressures and plateau
pressures are high then you have a lung
compliance issue
91.
92. High peak pressure differential:
High Peak Pressures
Low Plateau Pressures
High Peak Pressures
High Plateau Pressures
Mucus Plug ARDS
Bronchospasm Pulmonary Edema
ET tube blockage Pneumothorax
Biting ET tube migration to a
single bronchus
Effusion
93. If you have a patient with history of
COPD/asthma with worsening oxygen
saturation and increasing hypercapnia
differential includes:
◦ Given the nature of the disease process, patients have
difficultly with expiration (blowing off all the tidal volume)
◦ Must be concern with breath stacking or auto- PEEP
◦ Management options include:
Decrease respiratory rate Decrease tidal volume
Adjust flow rate for
quicker inspiratory rate
Increase sedation
Adjust I:E ratio
94. Increase in patient agitation and dis-
synchrony on the ventilator:
◦ Could be secondary to overall discomfort
Increase sedation
◦ Could be secondary to feelings of air hunger
Options include increasing tidal volume, increasing
flow rate, adjusting I:E ratio, increasing sedation
95. If you are concern for acute respiratory
distress syndrome (ARDS)
◦ Correlate clinically with HPI and radiologic findings
of diffuse patchy infiltrate on CXR
◦ Obtain a PaO2/FiO2 ratio (if < 200 likely ARDS)
◦ Begin ARDSnet protocol:
Low tidal volumes
Increase PEEP rather than FiO2
Consider increasing sedation to promote synchrony
with ventilator
96.
97.
98. Weaning is the process of withdrawing
mechanical ventilator support and transferring
the work of breathing from the ventilator to the
patient.
It is done only when patient is free from the
cause to be kept on mechanical ventilation.
“Weaning success is defined as effective
spontaneous breathing without any mechanical
ventilation for 24 hours or more.”
“The process of going OFF from ventilator
dependence to spontaneous breathing”
99. 3 stages………pt gradually weaned from ---
From Ventilator
From Tube
From Oxygen
Decision is made on the physiologic view
point by the physician considering his clinical
status.
It’s a joined effort of Physician – Resp
Therapist & Nurse
100. Tidal volume be above a given threshold
(greater than 5 ml/kg),
Respiratory frequency be below a given count
(less than 30 breaths/min),
Oxygen partial pressure be above a given
threshold (PaO2 greater than 60mm Hg) and
FIO2 <40%
Vital capacity 10 to 15 ml/kg.
101. When the above ventilator capacity is
adequate…Then CHECK Baseline
Measurements like following…
Vital Capacity
Insp . Force
Resp Rate
Resting TV
Minute Ventilation
ABG levels
FiO2
103. It consists of removing the patient from the
ventilator and having him / her breathe
spontaneously on a T-piece 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 of f the ventilator.
104. for signs & Symptoms of….
Hypoxia,
increasing fatigue,
Tachy cardia- Ischemic ECG changes
Restlessness
RR > 35/min
Use of accessory muscles for breathing
Paradoxical chest movement
105. If tolerating T –piece trial……….ABG – 20mts
after spont. breathing at a constant FiO2 (
Alveolar-Arterial equalization occur15-
20mins)
If ABG↓— hypoxia---→ back to vent
Wean on and off (Pt who had prolonged vent
support need gradual weaning process – even
weeks)
Primarily weaned during day time and placed
back on Vent during night
106. 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.
In pt’s who – satisfies all criteria for weaning
but cannot have spontaneous breathing for
long time.
107. Respiratory Rate
Minute Volume
Spont. /Machine Breaths
FiO2
ABG levels
No deterioration on parameters--- adequate
TV, vent resp gradually decreased-- then
weaning is complete
108. 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
109. 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 respirator y rate
of less than 25 breaths/minute.
PSV weaning is indicated for :-
- Difficult to wean patients
- Small spontaneous tidal volume.
110. ET/TT removed only if following criterion
met…
Spontaneous ventilation is adequate
Pharyngeal and laryngeal reflexes are active
Pt maintain adequate airway and can swallow,
move the jaw clench teeth , voluntary cough
is effective to bring out secretion
Before the tube is removed—a trail with
nose/mouth breathing is done – Deflating
cuff, using fenestrated tube etc
111. Diaphoresis
Dyspnea & Labored respirator y 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.
Tidal volume ≤5 mL/kg, Sustained minute
ventilation <200 mL/kg/minute
112. Increase or decrease in blood pressure of
> 20 mm Hg Systolic blood pressure >180
mm Hg or <90 mm Hg
Increase in respirator y rate of > 10 above
baseline or > 30 Sustained respirator y rate
greater than 35 breaths/minute
SaO2 < 90%, PaO2 < 60 mmHg, decrease in
PH of < 7.35.Increase in PaCO2
114. Pt successfully weaned---- and has adequate
respiratory function – weaned from O2
FIO2 is gradually reduced until SPO2 is in
range of 80-100 mmHg while breathing in
Room air
If R air SPO2 less than 70 supplementary O2
recommended
115. Ensure that extubation criteria are met .
Decanulate or extubat
Documentation
116. PHYSIOLOGICAL NEEDS:
comfort
activity
nutrition
elimination of wastes
Patients are often not able to fulfill these needs
by themselves, nursing function is then for
example seeing to comfort, determining intake
and output together with blood chemistry to
assess adequacy of intravenous nutrition, and so
on.
117. SAFETY NEEDS:
Threat of injury by person or machines
Medication must be checked. Machines must
be in best working condition.
NEED TO BELONG:
Security, means of communication
Staff must communicate with the patient and
patient must be allowed to respond. Patients
need constant reassurance.
118. NEED FOR RECOGNITION:
Esteem, dignity, respect Patients must be
treated with respect and addressed correctly.
NEED TO CREATE:
Expression of self, need to contribute Patients
must be involved in the choice and
implementation of their treatment.
119. NEED TO KNOW AND UNDERSTAND:
Need for knowledge and comprehension An
explanation of diagnosis and treatment on
the patient’s level.
SELF ACTUALIZATION:
Order, truth, privacy Patients should have as
much privacy as possible — pull screens or
close doors. The patient has the right to be
told the truth.
120. Ineffective breathing pattern
Potential for pulmonary infection
Impaired water and fluid regulation
Oral hygiene
Potential altered nutritional status: less than
body requirement related to NPO status
Potential for complications related to
immobility
121. Knowledge deficit related to intubation and
mechanical ventilation
Elimination care
Promoting coping ability
Preventing trauma and infections
Promoting rest and sleep
Safety and security needs.