This ppt is about just overview of mechanical ventilation and related nursing care.

2. Mechanical ventilation
Presented By
Miss Pallavi Rai
M.Sc. Nursing
KGMU Institute
of Nursing

3. Objectives of the session
• Define mechanical ventilation.
• Identify clinical situations in which mechanical ventilation
is used.
• Review and understand ventilator definitions and
terminology
• Describe types and modes of ventilation
• State the major components of ventilation
• Understand ventilator parameters
• PEEP Therapy
• Recognize common causes of alarms
• State complications from mechanical ventilation
• Review the weaning process
• Explain the nursing responsibility

4. Mechanical Ventilation & ventilator
• Mechanical Ventilation is
ventilation of the lungs by
artificial means.
• A mechanical ventilator control or
assist patient breathing by delivering a
predetermined percentage of oxygen to
the lungs.

5. Goals for MECHANICAL VENTILATION
• Achieve and maintain adequate
pulmonary gas exchange
• Minimize the risk of lung injury
• Reverse respiratory muscle fatigue
• Reduce patient work of breathing
• Optimize patient comfort
• To normalize blood gases and provide
comfortable breathing

6. INDICATIONS
Mechanical ventilation is indicated when the patient cannot
maintain spontaneous ventilation to provide adequate
oxygenation or carbon dioxide removal.
INDICATION EXAMPLES
1.Acute ventilatory
failure
pH<7.3,PaCO2>50mmHg
2.Severe hypoxemia PaO2<40mmHg,SaO2<75%
3.Impending ventilatory
failure
Progressive acidosis and hypoventilation to
pH<7.3,PaCO2>50mmHg
4.Prophylactic ventilatory
support
Post anaesthesia recovery

7. INDICATIONS FOR PROPHYLACTIC
VENTILATORY SUPPORT
INDICATION EXAMPLES
Reduced risk of pulmonary complications Prolonged shock
Head injury
Smoke inhalation
Reduced hypoxia of major body organs Hypoxic brain
Hypoxia of heart muscles
Reduced cardiopulmonary stress Prolonged shock
Coronary artery bypass surgery
Other thoracic or abdominal surgeries

8. Contraindications
of Mechanical Ventilation
• Contraindications
– Untreated pneumothorax
• Relative Contraindications
– Patient’s informed consent
– Medical futility
– Reduction or termination of patient pain
and suffering
8

9. Types of Mechanical ventilators
• Negative pressure
ventilators
• Positive pressure
ventilators
Mechanical
ventilator

10. Negative-Pressure Ventilators
• The patient’s body was
encased in an iron cylinder
and negative pressure was
generated.
• The use of negative-pressure
ventilators is restricted in
clinical practice,, because
they limit positioning and
movement and they lack
adaptability to large or small
body torsos (chests) .
• This is not used nowadays .

11. Mechanism of negative pressure
ventilators
It is similar to the spontaneous breathing
& Expiration occurs passively
Allows the air to flows in the lungs
Decrease the intrathoracic pressure during inspiration
Exert negative pressure on the external chest as compared to
atmospheric pressure

12. Positive-pressure ventilators
• Positive-pressure
ventilators deliver gas
to the patient under
positive-pressure,
during the inspiratory
phase.

13. Mechanism Of Positive Ventilators
& Expiration occurs passively
Allows the air to flows in the lungs
Forcing the alveoli to expand during the inspiration
Inflate the lungs by exerting positive pressure on the
airway as compared to atmospheric pressure

14. Types Of MECHANICAL Ventilation
1.INVASIVE
2. NON INVASIVE

15. Invasive ventilation
• Mechanical ventilation
via artificial airways
which can either be
endotracheal intubation
or tracheostmy tube.

16. Non invasive ventilation
• It refers to the delivery of
mechanical ventilation to
the lungs using
techniques that do not
require an invasive
artificial airway(ETT, TT)
• It provide breathing
support through
CPAP,BiPAP.

17. 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:
 Volume cycled ventilators
 Pressure cycled ventilators
 Time cycled ventilators

18. 1- Volume-cycled ventilator
• The ventilator delivers a
preset tidal volume
(VT), and inspiration
stops when the preset
tidal volume is
achieved.
• Most commonly used in
adult.

19. 2- Pressure-cycled ventilator
• In which
inspiration is
terminated when
a specific airway
pressure has been
reached.

20. 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.

21. Ventilator mode
The way the
machine will
ventilate the
patient in
relation to the
patient’s own
respiratory
efforts.

22. Various modes of mechanical ventilators
 Controlled mandatory ventilation
(CMV)
 Assist/control (AC)
 Intermittent mandatory ventilation
(IMV)
 Synchronized intermittent mandatory
ventilation (SIMV)
 Positive end-expiratory pressure
(PEEP)
 Continuous positive airway pressure
(CPAP)
 Bilevel positive airway pressure
(BiPAP)
 Pressure support ventilation (PSV)
 Volume ventilation plus (VV1)
 Pressure-controlled ventilation
(PCV)
 Airway pressure release
ventilation (APRV)
 Inverse ratio ventilation (IRV)
 High-frequency oscillatory
Ventilation (HFOV)
 Proportional assist ventilation
(PAV)
 Pressure-regulated volume
control (PRVC)

23. 1.Controlled Mandatory Ventilation
• Delivers a set tidal volume and respiratory
rate. The ventilator does ALL the work.
• Patient needs to be sedated or paralyzed.

24. Pros Cons Nursing responsibility
• It is primary
ventilator
mode in
patients who
are apnic.
•Doesn't permit
normal
spontaneous
breathing, and can
cause respiratory
muscles to atrophy.
•Used in a
patient unable to
initiate a breath
•Spontaneously
breathing patient
must be sedated
and/or paralyzed.
•Frequent ABGs
monitoring .

25. 2. Synchronizedintermittent mandatory ventilation
(SIMV)
• Synchronized intermittent mandatory ventilation
(SIMV) delivers a preset tidal volume and number of
breaths per minute.
• Between ventilator-delivered breaths, the patient can
breathe spontaneously with no assistance from the
ventilator on those extra breaths.
• As the patient’s ability to breathe spontaneously
increases, the preset number of ventilator breaths is
decreased and the patient does more of the work of
breathing.

26. Pros Cons Clinical
applicability
•Patient can
exercise
respiratory
muscles. May
improve cardiac
output.
•that it may
increase the
work of
breathing and
respiratory
muscle fatigue
•Used as
weaning mode
•Patient who
require partial
ventilatory
support.

27. 3. Pressure Support Ventilation (PSV)
• Pressure support ventilation , is a
spontaneous mode of ventilation. The patient
initiates every breath and the ventilator delivers
support with the preset pressure value. With
support from the ventilator, the patient also
regulates his own respiratory rate and tidal
volume.
• PSV is used for patients with a stable respiratory
status and is often used with SIMV to overcome
the resistance of breathing through ventilator
circuits and tubing.

28. ADVANTAGES OF PS Ventilation
• Supports the patient's spontaneous tidal volume
• Decrease in work of breathing
• Facilitates weaning
• May be applied in any mode that allows spontaneous
breathing
• Improves patient comfort and reduces need for
sedation

29. Indications
• Spontaneously
breathing patients
who require
additional ventilatory
support to
help overcome:
↑ WOB or
respiratory muscle
weakness
• Weaning
Contraindications
• Requires consistent
spontaneous breathing
• Fatigue and
tachypnea if PS level is
set too low

30. PEEP(Positive end expiratory
pressure)
• It is A method of ventilation in which airway pressure
is maintained above atmospheric pressure at the end
of exhalation,which increases the functional
residual capacity (volume in lungs at the end of
exhalation)
•This is NOT a specific mode, but is rather an
adjunct to any of the vent modes.
• The application of positive pressure to the airways
during expiration may keep alveoli open and
prevent closure.
• Most patients are set on 5 of peep as a standard.

31. Indications to PEEP Contraindications to PEEP
•ARDS
•COPD
•Asthma
•Pulmonary edema
Tension Pneumothorax - it will
get worse
Hypovolemic shock – cardiac
output will decrease
Bronchopleural fistula - it wont
heal
High intracranial pressure - it
will get higher
Right ventricular failure - the
failing right ventricle may fail more
with the addition of increased
afterload

32. ADVANTAGES DISADVANTAGES
Increasing the functional
residual capacity
• Re-inflating atelectatic lung
areas and recruitment of
collapsed alveoli
• Optimizing the ventilation/
perfusion ratio
• Reducing the right-to-left
shunt
Reducing the cardiac output
by reducing venous return
• Reducing renal, hepatic and
splanchnic circulation
• Over-distending alveoli and
alveolar rupture
• Increasing intracranial
pressure

33. MODE FUNCTIONS CLINICAL
USE
Control Ventilation
(CV)
Delivers preset volume
or pressure regardless
of patient’s own
Inspiratory efforts
Usually used for
patients who are
apneic.
Assist-Control
Ventilation (A/C)
Delivers breath in
response to patient
effort and if patient
fails to do so within
preset amount of time
Usually used for
spontaneously
breathing patients
with weakened
respiratory muscles
Synchronous
Intermittent
Mandatory Ventilation
(SIMV)
Ventilator breaths are
synchronized with
patient’s respiratory
effort
Usually used to wean
patients from
mechanical ventilation

34. MODE FUNCTIONS CLINICAL
USE
Pressure
Support
Ventilation
(PSV)
Preset pressure that augments
the patient’s Inspiratory effort
and decreases the work of
breathing Often used with
SIMV during weaning
Often used with
SIMV during weaning
Constant
Positive
Airway
Pressure
(CPAP)
Used only with spontaneously
breathing patients Maintains
constant positive pressure in
airways so resistance is
decreased
Maintains constant
positive pressure in
airways so resistance
is decreased

35. Parts of ventilator

36. Ventilator
monitor
Ventilator
circuit
Ports

37. Central oxygen and air supply to the ventilator

39. Bacteria
filter and
HME Unit
Water trap

42. Settings of Mechanical
Ventilation
• Mechanical Ventilator Settings
regulates the rate, depth and other
characteristics of ventilation.
• Settings are based on the patient’s
status (ABGs, Body weight, level of
consciousness and muscle strength)

43. Setting of ventilator
PARAMETERS
• Mode of ventilation
• Respiratory rate
• Tidal volume
• PEEP level
• Fraction of inspired O2 conc.(FiO2)
• I:E ratio

44. Setting Functions Usual parameters
Mode how the machine will
ventilate the patient in
relation to the patient’s
own respiratory efforts
Depends upon the
clinical conditions of
the patients.
Respiratory rat e Number of breaths
delivered by the ventilator
per minute.
Usually 8-12 breaths
per minute
Fractional Inspired
Oxygen (FIO2)
Amount of oxygen
delivered by ventilator to
patient
21-100%
Tidal volume Volume of gas delivered
during each ventilator
breath
Usually 8 ml/kg.
PEEP amount of pressure left in
the alveoli at the end of
exhalation .
Usually 5 cm of
H2o(5-10cm of H20)

45. Complications
of Mechanical Ventilation:-
I- Airway Complications
II- Mechanical complications
III- Physiological Complications
IV- Artificial Airway Complications

46. Airway
Complication
1- Aspiration
2- Decreased
clearance of
secretions
3- Nosocomial or
ventilator-acquired
pneumonia
Mechanical
complications
1- Hypoventilation
2- Hyperventilation
3- Barotrauma
4- Alarm “turned off”
5- Failure of alarms or
ventilator
6- Inadequate nebulization
or humidification
7- Overheated inspired air,
resulting in hyperthermia

47. 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
Artificial Airway
Complications
• Complications
related to
Endotracheal Tube
• Complications
related to
Tracheostmy Tube

48. NONINVASIVE
FORMS
OF
MECHANICAL
VENTILATION

49. 2.NONINVASIVE FORMS OF MECHANICAL
VENTILATION
• Modality that supports breathing with out the
need for invasive artificial airway.
• 2 types of NIPPV are commonly used
1. CPAP (continuous positive airway pressure )
2.BiPAP(Bilevel positive airway pressure )

50. Indications of nippv
• Obstructive sleep
apnoea syndrome
• COPD with
exacerbation
• Bilateral pneumonia
• Acute congestive heart
failure with pulmonary
oedema
• Neuromuscular
disorder
• Acute lung injury
• Method of weaning

51. Contraindications
• Patient’s inability to maintain his or her own
airway.
• Unstable facial fractures ,or facial lacerations
• Laryngeal trauma
• Basal skull fracture
• Patient with recent GI surgery or at risk of GIT
bleeds/ileus
• Vomiting/ and or high aspiration risk
• Uncooperative or unmotivated patients.
• Cardiac or respiratory arrest
• Severe encephalopathy
• Coma

52. Advantages of NPPV
• Avoids potential trauma secondary to
endotracheal intubation
• Avoids need for sedation
• Allows patient to maintain ability to
communicate, eat and drink.
• Avoids risk of ventilator associated
pneumonia.
• Increases functional residual capacity.

53. Disadvantages of NIPPV
• Patient must be alert.
• have spontaneous respirations
• tight mask fit (no facial hair)
• feeling of claustrophobia
• Increased Thoracic Pressure (ITP) can reduce
Cardiac Output (CO)

54. Equipment
• BiPAP machine
• BiPAP disposable circuit with disposable
proximal pressure line and exhalation port
(flushes exhaled gas from the circuit)
• Low resistance bacterial filter
• BiPAP Total Face Mask, Full Face Mask or Nasal
Mask plus head strap.
• Disposable Humidifier
• Distilled water

56. Interfaces

57. Parts of facemask
One way exhalation
port
Head gear straps

58. CPAP (Continuous Positive
Airway Pressure)
• CPAP is spontaneous
breathing at a positive end-
expiratory pressure.
• CPAP delivers a single,
constant pressure during
both inhalation and
exhalation.
• Requires only a source of
oxygen and a face mask with
an expiratory valve that
maintains a PEEP.
• Usually set at 5-10cm H2O.
• In neonates, nasal CPAP is
the method of choice.

59. BiPAP (Bi-level Positive Airway Pressure)
• It delivers two
pressures. It provides
a combination of both
IPAP and EPAP.
• High pressure level is
inspiratory positive
airway pressure
(IPAP) and low
pressure level is
expiratory positive
airway pressure
(EPAP).

60. Nursing Responsibilities: NIPPV
• Check ventilator setting.
• Hrly observations, HR, RR, BP,SPO2 ,lungs sounds
• Maintain adequate face/mask seal .
•
• Observe patients level of consciousness, chest wall
movement, co-ordination of patient respiratory effort
with the ventilator, work of breathing.
• Pressure areas on the skin beneath the mask

61. • Change tubing and device check every 7 days
• Maintain patient comfort, oral, nasal and eye
hygiene.
• Reassure the patient that they may experience
feelings of suffocation, their mouth will be dry and
the mask does smell &they can feel very nauseous
due to the high flow of oxygen.

62. ALARMS OF VENTILATOR

63. High Pressure Alarm Low pressure alarm
•Secretions in ETT/airway or
•Kinking in tubing
•Patient biting on ETT
•Patient coughing, gagging, or
trying to talk
•Increased airway pressure from
bronchospasm or pneumothorax
•Vent tubing not connected
•Displaced ETT or trach tube
High Respiratory Rate Low Exhaled Volume
•Patient anxiety or pain
•Secretions in ETT/airway
•Hypoxia
•Hypercapnia
•Vent tubing not connected
• Leak in cuff or inadequate cuff seal
Occurrence of another alarm
preventing full delivery of breath

64. Responding to alarm
• Check client
• check circuit
• check ventilator setting and alarms limits
• Replace filter
• Remove water from tubing and check
humidifier setting (i.e., relative humidity )
• Check cuff pressure
• Consider more ventilatory support for client

65. Complications
• Infection
Because of placement of artificial airways and
invasive lines
• Ulcerations
may be because of pressure from tubing's and
prolonged immobility

66. Complications of MV
• Ventilator Associated Pneumonia (VAP)
– Ventilator Associated Pneumonia is an infection of
the lungs occurring more than 48 hours after
intubation.

67. Complications
• Accidental Extubation/ Displacement
– can occur if the patient pulls the ET Tube out, or when
it becomes dislodged during routine care.
• Tracheal and Laryngeal Damage
– can occur when the patient is unintentionally
extubated while the cuff is still inflated.
– Other causes are laryngoedema from extubation,
and cranial nerve damage.

68. Prevention is Key!
• Accidental Extubations/ Displacement
– Ensure you have enough slack in the circuit before
moving the patient
– Monitor sedation. If the patient is grabbing at the
ventilator you may need an order for more sedation or
light wrist restraints as a reminder to keep their hands
away from the vent.
– Placement at the lips
– No movement in the epigastric area

69. Prevention is Key!
• Tracheal and Laryngeal Trauma
– Prevent accidental extubations
– Ensure the cuff is fully deflated before extubation
• VAP
– Head of bed up to at least 30 degrees
– Mouth care including chlorhexidine, suctioning, and
brushing teeth
– Check and secure the tubes
– Change the circuit per protocol

70. Prevention is Key!
• Volutrauma and Barotrauma
– Low Tidal Volumes with a higher rate
– Ideally PEEP should be kept at 5
– Monitor pressures (Inspiratory, Plateau,
Expiratory)
• Ulcerations and infections
– Mouth care
– switch side of mouth (angle change )
– Suctioning of secretions

71. Prevention is Key!
• Sedation levels must be closely observed
during the weaning period.
• Patients may need to be occasionally
stimulated during weaning but if excessive
stimulation is needed to maintain adequate
rate, the patient is not ready to wean.

72. Prevention is Key!
• The number one way to prevent complications
related to ventilators is to wean as early as
possible. Get your patient off the vent!

73. Weaning from
mechanical ventilator
Weaning is the word used to describe the
process of gradually removing the
patient from ventilator and restoring
spontaneous breathing after a period
of mechanical ventilator.

74. EVALUATING A PATIENT FOR
WEANING
A daily routine follow up should be done in every patient
receiving mechanical ventilation and exploring the following
condition
 Resolution/improvement of the underlying disease
 Stop sedation
 Core temperature below 38 ºC
 Stable haemodynamics
 Adequate haemoglobin ( Hb > 8 g/dL)
 Adequate mentation ( arousable, GCS > 13)
 No major metabolic and/or electrolyte disturbances

75. Criteria for Weaning
• Careful assessment is required to determine
whether the patient is ready to be removed
from mechanical ventilation.

76. Respiratory criteria Other criteria
•Minute
ventilation<15/L
•Respiratory rate <38
breaths /mint
•Tidal volume > 325 ml
•Maximum inspiratory
pressure < -15cm of
H2O
•Improvement, correction, or
stabilization of the active disease
process
•Nutritional and fluid status sufficien
to maintain the increased metabolic
needs and demands of spontaneous
respiration
•Adequate physical strength and
mental alertness
•Afebrile status (any infections
controlled)
•Stable cardiovascular ,renal and
cerebral status

77. Other criteria
• 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.

78. WEANING PRECEDURE
• Rapid ventilator discontinuation
• Spontaneous breathing trials
• Pressure support ventilation (PSV)
• SIMV
• Other Modes used for weaning

79. RAPID VENTILATOR
DISCONTINUATION
• Considered in patients with no underlying cardiovascular,
pulmonary, neurologic, or neuromuscular disorders and patients
receiving ventilatory support for short periods e.g. post-op
patients.
• SBTs are superior to both SIMV and PS in both duration of weaning
and the likelihood of success after weaning.
Patient on ventilator
for < 72 hrs
SBT for 30 to 120 min.
EXTUBATE if no other
limiting factor
Good spont RR,
MV, MIP, f/Vt

80. 2. SPONTANEOUS BREATHING
TRIAL
SBT can be in the form of or
SIMV
 PSV of 5-10 cm H2O
T – tube trial
 CPAP 5-7 cmH2O.

81. WEANING WITH SIMV
• Mandatory breaths are synchronized with patient’s own
efforts
ADVANTAGES
•Gradual transition
•Easy to use
•Alarm system may be used
•Should be used in comb.
with PSV/CPAP
DISADVANTAGES
•Prolongs weaning
•May worsen fatigue

82. PROTOCOL OF SIMV
WEANING
Monitor
patient’s
appearance,
respiratory
rate, SpO2, BP,
obtain ABG
sample
Start with SIMV rate at
80% of full support
Decrease 2 – 4 breaths
twice daily
If the patient tolerates an
SIMV rate of 2-4 breaths
for> 2 hrs
Consider extubation
If
deterioration→
↑ SIMV rate
Allow pt’s resp
msls to rest at
night by ↑ing
SIMV rate

83. WEANING WITH PSV
• Pressure support is given with each spontaneous
breath to ensure an adequate TV.
ADVANTAGES
•Gradual transition
•Prevents fatigue
•Increased pt comfort
•Weans faster than SIMV alone
•Pt can control cycle length, rate
and inspiratory flow.
•Overcomes resistive WOB d/t
ET tube and circuit.
DISADVANTAGES
•TV not guaranteed

84. Continuous Positive Airway Pressure ( CPAP)
Weaning
• When placed on CPAP, the patient does all the work
of breathing without the assistance form ventilator
• 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.

85. 3. Weaning trials using a T-piece
• Weaning trials using a T-
piece or tracheostomy
mask are normally
conducted with the patient
disconnected from the
ventilator, receiving
humidified oxygen only,
and performing all work
of breathing.
• The goal is to
progressively increase
the time spent off the
ventilator.

86. T-Tube trial: allows spontaneous breathing
interspersed with periods of full ventilatory support
• ADVANTAGES
• Tests pt’s spontaneous
• breathing ability
• Allows periods of work and
• rest
• Weans faster than SIMV
• DISADVANTAGES
• Abrupt transition difficult for
some pts
• No alarms, unless attached
to ventilator
• Requires careful observation.

87. WEANING PROTOCOL FOR SBT WITH A T-
TUBE
Prepare for T-Tube trial
3 min. screening trial
Measure TV,RR
Measure MIP thrice
selecting the best
. Formal SBT for 30 – 120 min
MIP < -20 cm H20
TV spon. > 5 ml/kg
RR spon. < 35/min.
no signs of intolerance
If signs of intolerance
are present
Put the patient
back on previous
ventilator
settings
Repeat next trial
after 24 hrs
extubate
Optimize the
patient’s medical
condition suction,
adequate
humidification,
bronchodilator
therapy, good
nutrition, optimal
position,
psychological
counseling,
adequate staff,
equipment, no
sedatives

88. NURSING ASSESSMENTS
• While on the T-piece, the patient should be observed
for signs and symptoms of hypoxia, increasing
respiratory muscle fatigue, or systemic fatigue.
• Observe respiratory rate, work of breathing etc.
• use of accessory muscles, tachycardia and paradoxical
chest movement (asynchronous breathing, chest
contraction during inspiration and expansion during
expiration).

89. 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 abnormality
- Fluid imbalance
- Electrolyte abnormalities
- Infection
- Fever
- Anemia
- Hyperglycemia
- Protein
- Sleep deprivation

90. 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.
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

91. 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.

92. 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 and put the patient on
ventilatory support.

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

94. Nursing care in Mechanical ventilation
• Assessment
• Check ventilator settings
and modes
• Prevent respiratory
function.
• Monitor for complications
• Prevent infections.
• Provide adequate
nutrition.
• Monitor GI bleeding.

95. Nursing Assessment
• All ventilator settings should be recorded at least every
hour.
• parameters including HR, BP, Sp02 and respiration should
be recorded every 30 minutes. Temperature should be
checked every 4 hours..
• Assess for the airway patency & securing of tubes
• Listen to air movement ,chest rise and fall.
• Observe for breathing rate rhythm,TV,Fio2 etc.
• Check for circulation and level of consciousness
• Check for GCS,ability to communicate and sedation level.
• Monitor ABG analysis and pulse oximetry
• Check for adequacy of humidification .

96. Nursing assessment
• Check temp,BP,Heart rate and other
hemodynamic parameters .
• Observe for presence of pressure ulcers
• Monitor urine output ,serum electrolytes,
blood glucose level .
• Check frequency of bowel movements
• Physical strength and body weight
• Observe for signs of DVT

97. respiratory care
• Measure tidal volume and vital capacity
• Auscultate lungs frequently to assess for
abnormal sounds.
• Arterial blood gas analysis and Spo2
monitoring
• Heat and moisture exchangers (HMEs) must
be changed every 24 hours.
• Suction as needed..
• Turn and reposition every 2 hours.

98. • Secure ETT properly. Observe for tube
misplacement
• Prevent accidental extubation by taping tube
securely, checking q.2h.; restraining/sedating
as needed.
• Monitor ABG value and sPO2.

99. 2. PREVENT INFECTION
• Maintain sterile technique when suctioning.
• Monitor color, amount and consistency of
sputum.
• ensure ventilator tubing changed q. 7 days, in-
line suction changed q. 24 h.; ambu bags
changes between patients and whenever
become soiled
• Regular oral care with an antibacterial solution
and to suction the pharynx.

100. • Lines, drains and tubes – IV catheters, central
catheters, arterial catheters, urinary catheters
and any other form of tube/drain should be
checked at least twice daily for signs of
complications.
• Central lines should be managed aseptically.
Feeding tube should be cleaned daily.
• Intravenous catheters should be rewrapped daily
and veins evaluated for signs of phlebitis or
infection.

101. • Eye care and Ophthalmic ointment should be
applied at least every 2 hours to protect against
corneal drying and ulceration.
• Body position should be changed every 4 hours
and passive range of motion exercises
performed.

102. provide adequate nutrition
• Begin tube feeding as soon as POSSIBLE.
• Provide nutrition as ordered, e.g. TPN, lipids or
parental feedings.
• Weigh daily.
• Monitor I&O .

103. • Assess for GI problems. Preventative
measures include relieving anxiety, antacids
or H2 receptor antagonist therapy, adequate
sleep cycles.
• Regular palpation of the colon is advised, and
enemas should be administered as needed.
• Auscultate bowel sounds.

104. • Explain purpose/mode/and all treatments
• encourage patient to relax and breath with
the ventilator
• explain alarms; teach importance of deep
breathing
• provide alternate method of
communication; keep informed of results of
studies/progress;

105. Responding To Alarms
• If an alarm sounds, respond immediately because
the problem could be serious.
• Assess the patient first, while you silence the alarm.
• Alarms must never be ignored or disarmed.
• Alarms setting should be checked every 2-4 hours

106. Patient Comfort
Carefully explain all procedures
to the
patient, prior to their
commencement;
At all times, the nurse should attempt to:
Orientate the patient to their
environment and events;
Provide a suitable
means of
ommunication for the patient.
Involve the patient and their
family in the planning and
implementation of nursing care;
Facilitate a proper day /
night
rhythm for the patient;

107. DOCUMENT ALL NURSING ACTIONS

108. Suctioning
MM J
Oral care and eye care
Respiratory auscultation
Securing of tubing
What we shouldnot forget

109. words of comfort
,skillfully
administered ,are
the oldest therapy
known to man