it is an brief summary with diagrammatic presentation for NURSES regarding Mechanical ventilator, uses, complications, types, important terms,common modes, NIV, uses, NURING ROLES & RESPONSIBILITIES for handling INTUBATED patients...

1. MECHANICAL VENTILATOR,
PARAMETERS,
COMMON MODES,
INDICATIONS, COMPLICATIONS
, NIV USE,AND NURSING
RESPONSIBILITIES.
PREPARED BY
MURUGESH HJ RN
ICU 02 (HAYATH) KFCH HOSPITAL JIZAN
SAUDI ARABIA

2. INTRODUCTION……….
MECHANICAL VENTILATOR….
Mechanical ventilation is a form of life support. A mechanical ventilator is a machine that takes
over the work of breathing when a person is not able to breathe enough on their own. The
mechanical ventilator is also called a ventilator, respirator, or breathing machine. There are many
reasons why a patient may need a ventilator, but low oxygen levels or severe shortness of breath
from an infection such as pneumonia are the most common reasons….
Benefits of mechanical ventilation are improved gas exchange and decreased work of
breathing…

3. AIRWAYS…
Endotracheal Tube (ETT)….
An endotracheal tube is a “flexible plastic tube that is placed through the
mouth into the trachea (windpipe) to help a patient breathe. The
endotracheal tube is then connected to a ventilator, which delivers oxygen to
the lungs. The process of inserting the tube is called “endotracheal intubation”

4. AIRWAYS…
TRACHIOSTOMY….
Tracheostomy is an operative procedure that creates a surgical airway in the
trachea. It is most often performed in patients who have had difficulty weaning off
ventilator, followed by those who have suffered trauma or a catastrophic
insult. Infectious and neoplastic processes are less common in diseases that
a surgical airway…
The outer diameter of the tracheostomy tube should be about ⅔ to ¾ of the
tracheal diameter. As a general rule, most adult females can accommodate a tube
with an outer diameter of 10mm, whilst an outer diameter of 11mm is suitable for
most adult males.
BASED ON INCISION 2 TYPES---
1.SURGICAL TRACHIOSTOMY 2.PERCUTANEOUS TRACHIOSTOMY

5. INDICATIONS….
Why are ventilators used?
■ To deliver high concentrations of oxygen into the lungs.
■ To help get rid of carbon dioxide.
■ To decrease the amount of energy a patient uses on
breathing so their body can concentrate on fighting
infection or recovering.
■ To breathe for a person who is not breathing because of
injury to the nervous system, like the brain or spinal cord, or
who has very weak muscles.Eg; myasthenia gravis, stroke etc…
■ To breathe for a patient who is unconscious because of a
severe infection, build up of toxins, or drug overdose.

6. INDICATION FOR VENTILATION:
Poor ventilation:
CNS disease e.g. Guillain-Barré Syndrome, Myasthenia Gravis, Spinal cord
injury
***Drug over dose, Sedation
***Neuromuscular blockade
***General anesthesia
***Poor gas exchange:
***PaO2 < 50mmHg or PaCO2 > 55mmHg
***pH < 7.25
***Acute lung injury (Including ARDS, trauma)
***Apnea with respiratory arrest, including cases from intoxication
Poor circulation–Shock, Severe anaemia
***Prophylaxis (e.g. for multi trauma patients and upper GI hemorrhage)
***Raised ICP

7. COMPLICATIONS OF VENTILATOR…..
COMPLICATIONS:
*** Infection
*** Aspiration:
*** Tracheal stenosis, laryngeal edema
*** Barotrauma
*** Decreased cardiac output, especially with PEEP
*** Fluid retention
*** Inadequate nutrition
*** Ensure that Written informed consent is taken and procedure explained
to patient/relatives.
****Verbalize the rationale for the placement of NG/OGT in intubated /
ventilated patients – To prevent vomiting & aspiration.

8. VENTILATOR PARAMETERS…
Ventilator Settings/Parameters….
** Tidal Volume
** PEEP
** Mode (type of assist given by vent)
** Rate (Breaths per minute.Adjusted based on
patient’s
own respiratory rate)
** FiO2 (amount of O2 being delivered)
** PIP
** Ppeak
**PLATEU Pressure….

9. VENTILATOR PARAMETERS…
 Fraction of inspired oxygen (FiO2)
 ***Concentration of oxygen in the inspired air
 ***Use the lowest FiO2 that achieves the targeted oxygenation
 ***Avoid prolonged FiO2 > 0.60, as this may cause oxygen toxicity
 Frequency (f) or respiratory rate (RR) (10-20 breaths/min)
 *** Set number of ventilator breaths per minute
 *** Actual RR includes the spontaneous breaths taken by the patient
 ***Hypoventilation may cause respiratory acidosis; hyperventilation may
cause respiratory alkalosis

10. VENTILATOR PARAMETERS…
Inspiratory: expiratory (I:E) ratio -
Normal: longer expiratory phase than inspiratory phase (1:2, 1:3)
** Inverse ratios provide a longer inspiratory phase (1:1, 2:1, 3:1, 4:1) **Reduced
I:E allows more time for exhalation and reduces breath stacking; used for
patients who have obstructive airway disease with acute respiratory acidosis
Minute ventilation (VE) (5-10 L/minute)-
Volume of gas exchanged per minute, normally 5-10L/min
Minute ventilation caluculation formula ; VE = RR X VT
Example- RR IS 20B/MIN, TV IS 400ML, then Minute ventilation (Ve) is
Ve=20b/min x 400ml
Ve=8000ml/minute

11. VENTILATOR PARAMETERS…
Peak flow rate -
• Maximum flow delivered by the ventilator during inspiration
Peak inspiratory pressure(PIP)-
• Highest proximal airway pressure reached during inspiration
• Target PIP is < 35 cm H2O
• Low PIP may result in hypoventilation; high PIP may cause lung
damage

12. VENTILATOR PARAMETERS
Tidal volume (VT)
Normally;6-8 mL/kg of ideal bodyweight [IBW] to preventbarotrauma)
VT means- Volume of gas exchanged with each breath
• A lower VT is indicated in patients with stiff, non-compliant
lungs
• Higher VT may cause tachycardia, decreased blood pressure
and lung injury
LOW TIDAL VOLUME VENTILATION
Trigger
Breaths can be triggered by:
Timer (ventilator-initiated breaths); occur at the set
respiratory rate or frequency
Patient effort (patient-initiated breaths); occur when the
patient causes sufficient change in either the pressure or
flow in the circuit

13. VENTILATOR PARAMETERS….
Plateau pressure (Pplat)
Reflects pulmonary compliance and is measured by applying a brief inspiratory
pause after ventilation
Assess Pplat with peak inspiratory pressure (PIP):
A high PIP with normal Pplat = increased resistance to flow (i.e.,
endotracheal tube obstruction or bronchospasm)
A High PIP and high Pplat = decreased lung compliance (i.e., interstitial
pulmonary fibrosis, pneumonia, ARDS, pulmonary edema)
Positive end-expiratory pressure (PEEP) (3-10 cm H2O)
Pressure remaining in the lungs at end expiration
*** Used to keep alveoli open and “recruit” more alveoli to improve oxygenation
for patients
*** High levels may cause barotrauma, increased intracranial pressure, and
decreased cardiac output
*** For Severe ARDS requires more PEEP 8-14cm H2O

14. VENTILATOR PARAMETERS….
Pressure support (PS)(8-20 cm H2O)--
*** Provides additional pressure during inspiration to ensure a
larger Vt with minimal patient effort
***Used to help overcome the work of breathing through
ventilator tubing
Target --
Flow of air into the lung can target a predetermined flow rate
(i.e. peak inspiratory flow rate) or pressure limit

15. MODES OF VENTILATOR…
There are six conventional modes:
1. volume assist/control (VCV)
2. pressure assist/control ( PCV)
3. pressure support ventilation ( PS /CPAP)
4. volume synchronized intermittent mandatory ventilation
(SIMV)
5. pressure SIMV
6. Airway Pressure Release Ventilation (APRV)

16. MODES OF VENTILATOR…
01.Controlled Ventilation
• Vent initiates all breaths at a pre-set rate and tidal
volume
• Vent will block any spontaneous breaths
• Used mainly in the OR for paralyzed and sedated
patients.
2.Assist Control (A/C)
• Vent will allow a patient to initiate a breath and then vent
will deliver a pre-set tidal volume
• Machine set at a minimum rate so apnea will not occur if
the patient does not initiate a breath
• Disadvantages:
• Hyperventilation if patient has increased respiratory rate (can
lead to respiratory alkalosis)
• Vent dysynchrony, breath-stacking

17. MODES OF VENTILATOR….
3.Synchronized Intermittent Ventilation (SIMV)
• Similar to A/C, but patients can take own breaths with
their own TV between mechanically assisted breaths
• Can be used as a primary mode or a weaning mode
• May lead to a low respiratory rate in a patient who does
not initiate breaths if set rate is low..
4.Pressure Support Ventilation (PSV)
• Also called “spontaneous mode”
• Pt initiates breath & vent delivers a pre-set inspiratory
pressure to help overcome airway resistance and keeps
airways open
• Patient controls the rate, tidal volume, and minute ventilation
• Tidal volume is variable
• Can be used in conjunction with SIMV or CPAP settings

18. MODES OF VENTILATOR….
5.Continuous Positive Airway Pressure (PS/CPAP)
• Positive airway pressure provided during both inspiration and
expiration
• Vent provides O2 and alarms, but no respirations
• Improves gas exchange and oxygenation in patients able to
breathe on their own
• Can also be used non-invasively via a face or nasal mask for
patients with sleep apnea
6. Airway Pressure ReleaseVentilation (APRV)
• Differs from conventional vent
• Elevation of airway pressures with brief intermittent releases
of airway pressure
• Facilitates oxygenation and CO2 clearance
• May be an improved way to treat ALI/ ARDS

19. MOST COMMONLY USING MODE- PRVC
MODE……
Pressure-regulated volume control (PRVC) ventilation is a mode of
mechanical ventilation that combines volume and pressure control ventilation.
PRVC is an appropriate mode of ventilation for patients who require a specific tidal
volume (VT) with the lowest effective pressure, such as those with acute respiratory
distress syndrome (ARDS).
In the PRVC mode, the ventilator delivers a volume-controlled breath. Using the
plateau pressure from the previous delivered breath, the ventilator delivers the next
breath. This allows the lowest delivery pressure, which is the target VT. PRVC is an
adaptive control form of ventilation that allows automatic adjustment of targets
(pressure versus volume) over several breaths to maintain a selected target; in this
case, volume is targeted. In this manner, the PRVC mode may help prevent
volutrauma and barotrauma by limiting the delivery pressure to 5 cm H2O below
the set upper pressure limit alarm.

20. PRVC MODE OUTCOMES…..
EXPECTED OUTCOMES or ADVANTAGES
• Risk of barotrauma is reduced.
• Ventilator alarms when pressure limit is reached.
• Patient’s ventilation and oxygenation status are improved as evidenced by ABG
values,
decreased FIO2, decreased work of breathing, and improved vital signs.
UNEXPECTED OUTCOMES OR DISADVANTAGES
• Infection
• Hemodynamic compromise
• Complications associated with artificial airways (e.g., leaks, cuff rupture,
obstruction of endotracheal [ET] tube, pressure necrosis)
• Patient-ventilator asynchrony (e.g., auto-PEEP
, hyperventilation or
hypoventilation,
increased work of breathing, hyperoxygenation or hypo-oxygenation)
• High pressure reached before volume is delivered and set volume not delivered
to patient

21. PCV MODE….
Pressure-controlled ventilation is a modality utilized in
patients with an indwelling endotracheal tube or tracheostomy tube that affords
the practitioner the ability to ventilate a patient with a maximal peak pressure. In
contrast to volume-controlled ventilation, pressure-control involves the selection
of an inspiratory pressure instead of a tidal volume target. The setting of an
inspiratory pressure, as well as an associated positive end-expiratory pressure
(PEEP), will allow a provider to control the peak pressure, thereby protecting
from barotrauma.
ADVANTAGES….
****Most convenient for mode to use for ARDS
**PROTECTS from lung injury
DISADVANTAGES….
***Infection or VAP
***rare conditions barotrauma or volutrauma

22. ARTICLES & EQUIPMENTS PREPARATION OF
VENTILATOR……..
Articles & Equipment for
preparation of ventilator:
**Disposable ventilator tubing’s
**Disposable Heat and Moist Exchange Filter (H.M.E).
**Humidifier heater wires.
***Test Lung.
**Sterile surgical gloves
**Disposable gown.
**Servo filters OR BACTRIFILTERS
**Catheter mount
***Water for irrigation
**Under pad
**Closed sucton set or suction catheter

23. NURSES ROLE DURING INTUBATION OR
CONNECTING TO VENTILATOR…..
**Demonstrate proper connection of bacterial filter and breathing tube.
Keep an Emergency equipment on bedside for Ventilated patient:
***Ambu bag must be available & functional
***Yankeur catheter, suction catheters and functioning suction unit, airways and
masks should be available
***Keep bedside tracheostomy kit and intubation tray
****Crash trolley with defibrillator
***Demonstrate the knowledge about how to connect disposable ventilator
circuit to ventilator as per Nursing Practice Guidelines for ICU.
***Check that the ventilator is working by attaching test lung to circuit and
double checking by biomedical.
***Performs appropriate procedures for correctly identifying the patient. (by full
name and hospital number )
***Verbalize the knowledge about the things to be checked while receiving
Ventilator patients. (e.g. Ventilator settings/parameters/tubing, emergency
equipments, alarm limits)

24. NON INVASIVE VENTILATION….
Non-Invasive Ventilation (NIV)
Non-invasive ventilation (NIV) refers to the provision of ventilatory support through
the patient's upper airway using a mask or similar device.
INDICATIONS FOR NIV
***Chronic obstructive pulmonary disease (COPD): Long-term diseases like chronic
bronchitis and emphysema in which there is excessive coughing, increase in
respiratory rate and difficulty in breathing
***Cardiogenic pulmonary edema: Fluid build-up in the lungs due to cardiac
disease
***Respiratory muscle weakness
**Ventilator-associated pneumonia
***Sleep apnea (cessation of your breathing in sleep)
***COVID-19: Only those patients with the most severe symptoms of COVID-19
need noninvasive ventilation.

25. NON INVASIVE VENTILATION….TYPES
There are two types of noninvasive ventilation:
01.Positive-pressure ventilation:
It pushes the air into the lungs.
Two types of positive pressure ventilation are used in sleep apnea—Continuous
Positive Airway Pressure (CPAP) and Bi level Positive Pressure(BiPAP).
Pulmonologist will decide which one is suitable …..
02.Negative-pressure ventilation:
It sucks the air into the lungs by expanding and contracting the chest through a
device that wraps the chest.
This method of ventilation is hardly used nowadays.

26. TYPES OF NIV POSITIVE AIRWAY PRESSURE…
01. Bi-Level Airway pressure (BiPAP)
*** Delivered by mask, not through an airway
*** Similar to CPAP
, but can be set at one pressure for inhalation and another for
exhalation.
*** Used in sleep apnea, but also has been found to be useful in patients with CHF
and respiratory failure to avoid intubation….
02.Continuous positive air way pressure( CPAP)
*** delivered by mask,less expensive,in home with proper training patient can use
***mainly used for COPD, OSA Cases….

27. ADVANTAGES & COMPLICATIONS OF NIV…
Use of noninvasive ventilation offers the following
advantages:
*** Reduces the work pressure on longs
*** Eliminates the need for endotracheal intubation or a tracheotomy,
*** avoiding their complications
*** Reduces the chances of infections
*** Improves the chances of survival
*** Reduces hospital stay
Most complications are mild and happen with long-term use.
These include:
== Ulcers at the attachment of the face mask
== Eye irritation and pain
== Congestion of the nasal sinuses
Other complications include:
*** Bloating of stomach
*** Aspiration (sucking of food into the lung)
*** Hypotension (low blood pressure)

28. NURSISNG RESPONSIBILITIES…
NURSING CARE :
1. Promote respiratory function.
2. Monitor for complications
3. Prevent infections.
4. Provide adequate nutrition.
5. Monitor GI bleeding.
PROMOTE RESPIRATORY FUNCTION:
1. Auscultate lungs frequently to assess for abnormal sounds.
2. Suction as needed.
3. Turn and reposition every 2 hours.
4. Secure ETT properly.
5. Monitor ABG value and pulse oximetry.
b.Suction of an Artificial Airway:
1. To maintain a patent airway
2. To improve gas exchange.
3. To obtain tracheal aspirate specimen.
4. To prevent effect of retained secretions. ( Its important to OXYGENATE
and after suctioning)

29. NURSISNG RESPONSIBILITES
MONITOR FOR COMPLICATIONS :
1. Assess for possible early complications Rapid electrolyte changes. Severe alkalosis.
Hypotension secondary to change in Cardiac output.
2. Monitor for signs of respiratory distress: Restlessness Apprehension Irritability and
increase HR.
3. Assess for signs and symptoms of barotrauma(rupture of the lungs) Increasing
dyspnea Agitation Decrease or absent breath sounds. Tracheal deviation away from
affected side. Decreasing PaO2 level . 1. Assess for cardiovascular depression:
Hypotension Tachy. and Bradycardia Dysrhythmias
PREVENT INFECTION
1.Maintain sterile technique when suctioning.
2. Monitor color, amount and consistency of sputum.
PROVIDE ADEQUATE NUTRITION :
1. Begin tube feeding as soon as it is evident the patient will remain on the ventilator
for a long time.
2. Weigh daily. 3. Monitor I&O .
MONITOR FOR GI BLEEDING:
1. Monitor bowel sounds. 2. Monitor gastric PH and hematest gastric secretions
shift.

30. REFERANCES
***Grossbach, I., Chlan, L., & Tracy, M. F. (2011). Overview of mechanical ventilatory support and
management of patient- and ventilator-related responses. Critical Care Nurse, 31(3), 30–44.
https://doi.org/10.4037/ccn2011595 Hyzy, R. & MsSparron, J. (2020, April 5).
*** Overview of mechanical ventilation. UpToDate. https://www.uptodate.com/contents/overview-
initiating-invasive-mechanical-ventilation-in-adults-in-the-intensive-careunit Hyzy, R. (2019, May
**** Modes of mechanical ventilation. UpToDate. https://www.uptodate.com/contents/modes-
ofmechanical- ventilation
***American Thoracic Society www.thoracic.org/patients
***National Heart Lung & Blood Institutehttps://www.nhlbi.nih.gov/health/health-
**erme, C., & Chandraskekar, R.K. (2008). Managing the patient on mechanical ventilation in ICU:
mobility and walking program. Acute Care Prospectives,Vol 17(1).
*** Sadowsky, H.S. Monitoring and life support equipment. In E.A. Hillegass and H.S. Sadowsky,
Essentials of cardiopulmonary physical therapy. (pp. 509-533). 2001; Philadelphia: Saunders. •
S.P., Goval, M., & Sarani, B. (2009, Jul-Aug).
**Frequency oscillatory ventilation (HFOV) and airway pressure release ventilation (APRV): a
guide. J Intensive Care Med, 24(4):215-29. Epub 2009 Jul 17.

31. THANK
YOU
ALL…….