Mechanical Ventilators

are design to monitor many components of patients respiratory status

used when patient is unable to breath adequately oh his or her own

Negative Pressure
-

The original ventilators used negative pressure to remove and

replace gas from the ventilator chamber.
The cessation of the negative pressure caused the chest wall to
fall and exhalation to occur.
No insertion of an artificial airway

Positive pressure
-

ventilators require an artificial airway

types
Volume-cycled ventilators - are designed to deliver a preset tidal volume
-

most commonly used in critical care environments

Pressure-cycled ventilators - deliver gases at preset pressure

allow passive expiration
decreased risk of lung damage from high inspiratory pressures.
may not receive the complete tidal volume
Flow-cycled ventilators - deliver a breath until a preset flow rate is
achieved during inspiration.
Ventilator Settings
Setting
Function
Respiratory Rate (RR)
Number of breaths
delivered by the ventilator
per minute
Tidal Volume (VT)
Volume of gas delivered
during each ventilator
breath
Fractional Inspired
Amount of oxygen
Oxygen (FIO2)
delivered by ventilator to
patient
Inspiratory:Expiratory (I:E) Length of inspiration
Ratio
compared to length of

Usual Parameters
Usually 4-20 breaths per
minute
Usually 5-15 cc/kg

21% to 100%; usually set to

keep PaO2 > 60 mmHg or
SaO2 > 90%
Usually 1:2 or 1:1.5 unless
inverse ratio ventilation is

expiration
Pressure Limit

Mode

required

Maximum amount of
10-20 cm H2O above peak
pressure the ventilator can inspiratory pressure;
use to deliver breath
maximum is 35 cm H2O
Ventilator Modes
Function

Clinical Use

Delivers preset volume or

Usually used for patients
Control Ventilation (CV) pressure regardless of patients who are apneic
own inspiratory efforts
Assist-Control
Ventilation (A/C)

Delivers breath in response to Usually used for

patient effort and if patient fails spontaneously breathing
to do so within preset amount patients with weakened
of time
respiratory muscles
Pressure Support
Preset pressure that augments Often used with SIMV
Ventilation (PSV)
the patients inspiratory effort during weaning
and decreases the work of
breathing
Positive End Expiratory Positive pressure applied at the Used with CV, A/C, and
Pressure (PEEP)
end of expiration
SIMV to improve
oxygenation by opening
collapsed alveoli
Constant Positive
Similar to PEEP but used only Maintains constant positive
Airway Pressure (CPAP) with spontaneously breathing pressure in airways so
patients
resistance is decreased

Advantages

Disadvantages

Combitube
LMA
Easy to insert quickly.
Easy to insert quickly.
Dont have to worry
Allows ETT intubation
about accidentally
through it, while
intubating esophagus.
maintaining an open
Balloon prevents
airway.
aspiration.
Can only be used for a
Does not prevent
few hours.
aspiration.
Can only be used short
term until another airway
is established.

Advantages

Disadvantages

Advantages

Disadvantages

Oropharyngeal
Prevents tongue from
obstructing pharynx.
May prevent the need for
intubation in patients who are
temporarily unable to maintain
their airway (i.e., drug
overdose).

Causes conscious patients to

gag, thus can only be used in
unconscious patients with a
diminished gag reflex.

Endotracheal Tube
Can be used for up to three
weeks.
Provides route for sterile
suctioning of airway.
Some emergency
medications can be given via
the ETT (NAVEL= Narcan,
atropine, Versed,
epinephrine, lidocaine)
Can be inserted either
nasally or orally (oral route
generally preferred unless
patient had jaw trauma or
surgery).
Patients may need sedation
and/or wrist restraints to
prevent accidental removal.
Patients may feel like theyre
breathing through a straw.
Patients not able to speak.

Nasopharyngeal
Same as
oropharyngeal.
Tolerated by conscious
patients with an intact
gag reflex.
Can be left in place for
a few days.
Provides route for
sterile suctioning of
airway.
Nares must be closely
monitored for skin
breakdown if used for a
few days.

Tracheostomy
Can be used long-term;
up to years.
More comfortable for
patient.
Allows speaking and
eating if respiratory status
is stable.
Patients can be taught
how to care for their
tracheostomy at home.
Stoma can be plugged,
but kept patent if needed.

Requires surgical
procedure to insert.
Long-term use can cause
fistulas between trachea
and skin, esophagus, or
innominate artery.

Indication

Acute lung injury

Apnea with respiratory arrest
Chronic obstructive pulmonary disease (COPD)
Acute respiratory acidosis with partial pressure of carbon dioxide (pCO2) >
50 mmHg and pH < 7.25,
Tachypnea (respiratory rate >30cpm)
Hypoxemia with arterial partial pressure of oxygen (PaO2) with
supplemental fraction of inspired oxygen (FiO2) < 55 mm Hg
Hypotension including sepsis, shock, congestive heart failure
Neurological diseases
Clinical deterioration
Vital capacity > 15ml/kg
Minute ventilation >10L/min
Respiratory muscle fatigue
coma

Equipment
Various sizes of ETT tubes (6 to
8.5)
Tape or device to secure ETT tube
Bite block
Sterile gloves
Suction sterile and Yankauer
Saline
Stethoscope
CO2 detector to confirm placement
Cardiac monitor/pulse oximeter
Nurses responsibility
Constantly present in the bedside to monitor patients respiratory status
Responsible to notify the respiratory therapist when mechanical problems
occur with the ventilator
Responsible for documenting frequent respiratory assessment

document ventilator setting

spontaneous respiratory parameters per hour
full respiratory assessment
lung sound

Performs suctioning and provides oral and site care around the artificial
airway