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Mechanlcal venLllaLlon
Mechanlcal venLllaLlon ls a
meLhod Lo mechanlcally asslsL
or replace sponLaneous
breaLhlng
means of lnserLlng arLlflclal
alrways
rLlflclal lrways
are lnserLed Lo malnLaln a paLenL passage Lo cllenL whose
alrway become obsLrucLed
ssessmenL for upper lrway CbsLrucLlon
lnspecLlon ls Lhe paLlenL consclous? ls Lhere any lnsplraLory efforL?
uoes Lhe chesL rlse symmeLrlcally? ls Lhere use or reLracLlon of
accessory muscles? WhaL ls Lhe skln color? re Lhere any obvlous
slgns of deformlLy or obsLrucLlon (Lrauma food LeeLh or vomlLus)? ls
Lhe Lrachea mldllne?
alpaLlon do boLh sldes of Lhe chesL rlse equally wlLh lnsplraLlon?
re Lhere any speclflc areas of Lenderness fracLure or subcuLaneous
emphysema (creplLus?)
usculLaLlon ls Lhere any audlble alr movemenL sLrldor (lnsplraLory
sound) or wheezlng (explraLory sound)? re breaLh sounds bllaLerally
ln all lobes?
ommon Lypes of lnLubaLlon
oroparyngeal
lnLubaLlon
done frequenLly
wlLh who has
general
anesLhesla
lnserLed lnLo Lhe
mouLh Lo Lhe
pharynx
nasoparyngeal
lnLubaLlon
Lube LhaL ls deslgned
Lo be lnserLed lnLo
Lhe nasal passageway
Lo secure an open
alrway
lnserLed lnLo Lhe
nosLrll Lo Lhe pharynx
endoLracheal lnLubaLlon
ls a procedure by whlch a
Lube ls lnserLed Lhrough
Lhe mouLh down lnLo Lhe
Lrachea (Lhe large alrway
from Lhe mouLh Lo Lhe
lungs) 8efore surgery Lhls
ls ofLen done under deep
sedaLlon ln emergency
slLuaLlons Lhe paLlenL ls
ofLen unconsclous aL Lhe
Llme of Lhls procedure
general anesLhesla
semlconsclous/unconsclous
LracheosLomy
surglcal procedure
whlch an openlng ls
made lnLo Lhe Lrachea
ls used Lo bypass an
upper alrway Lo permlL
Lhe long Lerm use of
mechanlcal
venLllaLlon
Mechanlcal venLllaLlon
W 1hls may lnvolve a machlne called a venLllaLor
or Lhe breaLhlng may be asslsLed by a
physlclan or oLher sulLable person
compresslng a bag or seL of bellows
1radlLlonally dlvlded lnLo negaLlve pressure
venLllaLlon where alr ls essenLlally sucked lnLo
Lhe lungs or poslLlve pressure venLllaLlon
where alr (or anoLher gas mlx) ls pushed lnLo
Lhe Lrachea
-egaLlveressure venLllaLors
-egaLlvepressure venLllaLors exerL a negaLlve
pressure on Lhe exLernal chesL uecreaslng Lhe lnLraLhoraclc pressure
durlng lnsplraLlon allows alr Lo flow lnLo Lhe lung fllllngs lL volume
hyslologlcally Lhls Lype of asslsLed venLllaLlon ls slmllar Lo
sponLaneous venLllaLlon
1hls ls used malnly ln chronlc resplraLory fallure assoclaLed
wlLh neuromuscular condlLlons such as
ollomyellLls
Muscular dysLrophy
myoLrophlc laLeral sclerosls
MyesLhenla gravls
-egaLlvepressure venLllaLors are slmple Lo use and do
noL requlre lnLubaLlon of Lhe alrway consequenLly Lhey are especlally
adapLable for home use
1ypes of -v
lron Lung (urlnker 8esplraLory 1ank)
ls a -v chamber used for venLllaLlon lL was used
exLenslvely durlng pollo epldemlcs ln Lhe pasL and currenLly
used by pollo survlvors and paLlenLs wlLh oLher
neuromuscular dlsorders
8ody Wrap (neumowrap) and hess ulrass (1orLolse Shell)
boLh of Lhese porLable devlces requlre a rlgld cage or shell
Lo creaLe a negaLlvepressure chamber around Lhe Lhorax and
abdomen 8ecause of Lhe problems wlLh Lhe proper flL and
sysLem leaks Lhese Lypes of venLllaLors are used only wlLh
carefully selecLed paLlenLs
oslLlveressure venLllaLors
oslLlvevenLllaLors lnflaLe Lhe lungs
by exerLlng poslLlve pressure on Lhe
alrway slmllar Lo bellows mechanlsm
forclng Lhe alveoll Lo expand durlng
lnsplraLlon LxplraLlon occurs passlvely
LndoLracheal lnLubaLlon or LracheosLomy
ls necessary ln mosL cases
1ypes of v
ressureycled venLllaLors
ends ln lnsplraLlon when a preseL pressure has been reached ln oLher
words Lhe venLllaLor cycles on dellvers a flow of alr unLll lL reaches a
predeLermlned pressure Lhe cycles off
1lmeycled venLllaLors
LermlnaLe or conLrol lnsplraLlon afLer a preseL Llme 1he volume of alr Lhe
paLlenL recelves ls regulaLed by Lhe lengLh of lnsplraLlon and Lhe flow of
Lhe alr
volumeycled venLllaLors
are far Lhe mosL commonly used v venLllaLors Loday 1he volume of alr
Lo be dellvered wlLh each lnsplraLlon ls preseL Cnce Lhls preseL volume ls
dellvered Lo Lhe paLlenL Lhe venLllaLors cycles off and exhalaLlon occurs
passlvely lrom breaLh Lo breaLh Lhe volume of alr dellvered by Lhe
venLllaLor ls relaLlvely consLanL ensurlng conslsLenL adequaLe breaLhs
desplLe varylng alrway pressure
-onlnvaslve oslLlveressure venLllaLors
v can be glven vla facemasks LhaL cover Lhe nose and mouLh nasal
masks or oLher nasal devlces
LllmlnaLes Lhe need for endoLracheal lnLubaLlon or LracheosLomy
uecreases Lhe rlsk of nosocomlal lnfecLlons such as pneumonla
aLlenLs who are candldaLe for nonlnvaslve v
Who have acuLe or chronlc resplraLory fallure
cuLe pulmonary edema
Cu
hronlc hearL fallure wlLh sleep relaLed breaLhlng dlsorders
onLralndlcaLed ln paLlenLs wlLh
who have experlenced resplraLory arresL
serlous dysryLhmlas
cognlLlve lmpalrmenL
head or faclal Lrauma
W lL can be used as a shorL Lerm measure for
example durlng an operaLlon or crlLlcal lllness
(ofLen ln Lhe seLLlng of an lnLenslve care unlL)
lL may be used aL home or ln a nurslng or
rehablllLaLlon lnsLlLuLlon lf paLlenLs have
chronlc lllnesses LhaL requlre longLerm
venLllaLory asslsLance
Mechanlcal venLllaLlon may be requlred
for varleLy of reasons lncludlng Lhe need Lo
conLrol Lhe paLlenL's resplraLory durlng
surgery or durlng LreaLmenL of severe head
ln[ury Lo oxygenaLe Lhe blood when Lhe
paLlenL's venLllaLory efforLs are lnadequaLe
and Lo resplraLory muscles
lndlcaLlon for Mechanlcal venLllaLlon
lf Lhe paLlenL has a conLlnuous decrease ln oxygenaLlon
an lncrease ln arLerlal carbon dloxlde levels
perslsLenL acldosls (decreased ln pP)
condlLlons such as
1horaclc or abdomlnal surgery
urug overdose
-euromuscular dlsorders
lnhalaLlon ln[ury
Cu
MulLlple Lrauma
Shock
MulLlsysLem fallure
oma
W 1ypes of venLllaLors
W venLllaLlon can be dellvered vla
W PandconLrolled venLllaLlon such as
8ag valve mask
onLlnuousflow or naesLhesla (or 1plece) bag
1ypes of mechanlcal venLllaLors lnclude
1ransporL venLllaLors 1hese venLllaLors are small more rugged
and can be powered pneumaLlcally or vla or u power
sources
lu venLllaLors 1hese venLllaLors are larger and usually run on
power (Lhough vlrLually all conLaln a baLLery Lo faclllLaLe
lnLrafaclllLy LransporL and as a backup ln Lhe evenL of a power
fallure) 1hls sLyle of venLllaLor ofLen provldes greaLer conLrol of
a wlde varleLy of venLllaLlon parameLers (such as lnsplraLory rlse
Llme) Many lu venLllaLors also lncorporaLe graphlcs Lo provlde
vlsual feedback of each breaLh
W -lu venLllaLors ueslgned wlLh Lhe preLerm neonaLe ln mlnd Lhese
are a speclallzed subseL of lu venLllaLors whlch are deslgned Lo
dellver Lhe smaller more preclse volumes and pressures requlred Lo
venLllaLe Lhese paLlenLs
venLllaLors Lhese venLllaLors are speclflcally deslgned for
nonlnvaslve venLllaLlon 1hls lncludes venLllaLors for use aL
home ln order Lo LreaL sleep apnea
-urslng rocess 1he aLlenL on
venLllaLor
ssessmenL
1he nurse has a vlLal roles ln assesslng Lhe pL's sLaLus
and Lhe funcLlonlng of Lhe venLllaLor
LvaluaLes Lhe paLlenL's physlologlc sLaLus and how he
or she coplng wlLh mechanlcal venLllaLlon
SysLemaLlc assessmenL of all body sysLems
8esplraLory assessmenL lncludes
vlLals slgns especlally resplraLory raLe and paLLern
breaLh sounds
evaluaLlon of sponLaneous venLllaLory efforL
poLenLlal evldence of hypoxla
-urslng ulagnoses
W lmpalred Cas Lxchange
W lneffecLlve lrway learance
W 8lsk for 1rauma and lnfecLlon
W lmpalred hyslcal MoblllLy
W lmpalred verbal ommunlcaLlon
W uefenslve oplng Mechanlsm and
owerlessness
oLenLlal ompllcaLlons
W lLeraLlon ln cardlac funcLlon
W voluLrauma (baroLrauma) and pneumoLhorax
W ulmonary lnfecLlon
W Sepsls
lannlng and Coals
1he ma[or goals for Lhe paLlenL may lnclude
achlevemenL of opLlmal gas exchange malnLenance of
a paLenL alrway absence of Lrauma or lnfecLlon
aLLalnmenL of opLlmal moblllLy ad[usLmenL Lo non
verbal meLhods of communlcaLlon acqulslLlon of
successful coplng measures and absence of
compllcaLlon
-urslng lnLervenLlons
W Lnhance Cas Lxchange
W romoLe LffecLlve lrway learance
W revenL 1rauma or lnfecLlon
W romoLe CpLlmal Level of mobllLy
W romoLe opLlmal communlcaLlon
W romoLe oplng blllLy
W MonlLor and manage poLenLlal compllcaLlons
-urslng ManagemenL for aLlenL wlLh
Mechanlcal venLllaLors
W losely monlLor Lhe paLlenL wlLh mechanlcal venLllaLors
W 8esplraLory raLe and oxygenaLlon sLaLus conLlnually
assessed Lo ensure Lhe paLlenL ls LoleraLlng venLllaLlon
W onLlnued pulse oxymeLry wlLh a seL alarm parameLer
ls lnlLlaLed
W 1he key Lo ensurlng adequaLe venLllaLory supporL ls a
properly flLLed mask
W 1he paLlenL ls poslLlon wlLh Lhe head of bed elevaLed aL
43 degrees Lo prevenL asplraLlon and faclllLaLe
breaLhlng