Intensive Care Nursing/Mechanical Ventilator Management

Objectives
By end of reading, learner will be able to
 * 1) List different modes of mechanical ventilation
 * 2) Recognize methods of troubleshooting based on alarms
 * 3) Remember normal pressure ranges
 * 4) Recognize critical lab values
 * 5) Calculate minute ventilation volumes

Ventilator Modes
Ventilator modes (table) and settings should be chosen based on the needs of the ventilated patient. Nomenclature of mechanical ventilation may vary based on device and location of care, however modes are typically classified as pressure controlled (i.e. PC-CMV, CPAP, etc.) and volume controlled (i.e. VC-CMV, IMV, etc.). Pressure-controlled modes will deliver air up to a set pressure limit with variable volumes being delivered, whereas volume-controlled modes will provide a set volume of air but allows for variable airway pressure. Ventilator weaning is generally done with a spontaneous breathing trial (SBT) and ventilator setting are adjusted to approximate breathing without the Ventilator and/or artificial airway (i.e. PSV, CPAP, etc.).

Common Alarms
Being aware of the ventilator being utilized settings, alarms, and functionality as it is crucial to being able to troubleshoot alarms as they come up. The first task to perform is to assess the patient, to ensure their safety throughout the time determining and correcting the abnormality with the ventilated patient and/or ventilator. Common alarms are listed with common solutions to correct the abnormality with the patient/ventilator, the wording which appears on the ventilator during alarms may vary from the verbiage listed below. Alarms are grouped together based on similar causes

Elevated pressure / high airway pressure / high PIP / high Ppeak: Patient biting on tube, mucous (plug) in tube, patient coughing/hiccupping, kinked tubing, bronchospasm, patient attempting to speak

Apnea / ventilator disconnect / low minute volume / low pressure: Disconnected/loose circuit connection with air leak, patient not breathing (while on patient driven ventilator modes), patient over sedated, self-extubation

High minute volume (high MV, etc.) / High respiratory rate (high rate, frequency high, etc.) / Tidal volume elevated (Tv high, Vt high, etc.): Patient anxiety, air leak, patient agitation, increased lung compliance

Arterial Blood Gas Basics
Reading and interpreting an arterial blood gas (ABG) after sample collection is crucial to being able to manipulate ventilator settings appropriately for your patient to have adequate ventilation. See table below for normal ranges for arterial blood gas values which are frequently reported.

Activities

 * 1) /ICU Nurse Ventilator Management Worksheet/
 * 2) /ICU Nurse Ventilator Management Quiz/