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Ventilator Initiation CHAPTER © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION 6NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOTVentilator FOR SALE OR DISTRIBUTION InitiationNOT FOR SALE OR DISTRIBUTION David C. Shelledy and Jay I. Peters © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © Thep © Thep Urai/Shutterstock © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION OUTLINE 6. Define the term trigger variable and compare time-triggered ventilation to patient-triggered ventilation. Introduction © Jones & Bartlett Learning, LLC7. Explain each of the following© terms Jones related &to theBartlett trigger Learning, LLC Goals of Mechanical VentilationNOT FOR SALE OR DISTRIBUTIONvariable: flow trigger, pressureNOT trigger, FOR and autotrigger. SALE OR DISTRIBUTION Methods of Ventilation 8. Define each of the following commonly used terms:assist Negative-Pressure Ventilation breath, control breath, assist-control, and controlled Positive-Pressure Ventilation ventilation in terms of the trigger variable associated with Establishment of the Airway each term. Endotracheal Intubation 9. Explain how each of the following cycle variables terminates Tracheostomy© Jones & Bartlett Learning, LLC the inspiratory© Jones phase: & volume Bartlett cycled, pressureLearning, cycled, LLCtime ChoiceNOT of a VentilatorFOR SALE OR DISTRIBUTION cycled,NOT and flow FOR cycled. SALE OR DISTRIBUTION Choice of Mode 10. Compare volume-control (VC) and pressure-control More on Nomenclature ventilation (PC). Full and Partial Ventilatory Support 11. Compare pressure-support ventilation (PSV) and pressure- Major Modes of Ventilation control ventilation (PCV). Other Modes of Ventilation 12. Define each of the following: continuous mandatory © Jones & InitialBartlett Ventilator Learning, Settings LLC © Jones ventilation& Bartlett (CMV), Learning,intermittent mandatory LLC ventilation (IMV), Mode and continuous spontaneous ventilation (CSV). NOT FOR SALETidal Volume OR and DISTRIBUTION Rate NOT 13.FOR Explain SALE the indications, OR DISTRIBUTION contraindications, advantages, and Breath Trigger disadvantages of noninvasive ventilation (NIV). Inspiratory Phase, Expiratory Phase, and I:E Ratio 14. Describe initial ventilator settings for NIV. PEEP and CPAP 15. Describe methods and steps to establish the airway for Alarms and Limits invasive mechanical ventilation. Humidification © Jones & Bartlett Learning, LLC16. Contrast endotracheal intubation© Jones and tracheostomy & Bartlett when Learning, LLC Patient Assessment used to provide invasive mechanical ventilation. Management of Specific NOTDisease FORStates andSALE Conditions OR DISTRIBUTION17. Summarize the factors that shouldNOT be FOR considered SALE when OR DISTRIBUTION Asthma choosing a mechanical ventilator. Acute Exacerbation of COPD 18. Explain each of the following terms used to define the mode Severe Pneumonia of ventilation employed: control variable, breath sequence, Acute Respiratory Distress Syndrome and targeting scheme. Neuromuscular Disease 19. Explain methods for providing full and partial ventilatory Summary© Jones & Bartlett Learning, LLC suppor©t and Jones contrast & advantages Bartlett and Learning, disadvantages ofLLC NOT FOR SALE OR DISTRIBUTION each. NOT FOR SALE OR DISTRIBUTION OBJECTIVES 20. Define each of the five major modes of ventilation and explain the advantages and disadvantages of each. 1. Describe the primary function of a mechanical ventilator. 21. Explain the use of other modes of ventilation to include 2. Identify the four major indications for mechanical ventilation. adaptive pressure control (APC), mandatory minute 3. Describe the major goals of mechanical ventilation. ventilation (MMV), adaptive support ventilation (ASV), © Jones & Bartlett4. Overview Learning, the historical development LLC of negative-pressure © Jones airway& Bartlett pressure-release Learning, ventilation LLC (APRV), proportional NOT FOR SALEventilation. OR DISTRIBUTION NOT FORassist SALE ventilation OR (PAV), DISTRIBUTION automode, neutrally adjusted 5. Explain the advantages and disadvantages of negative- ventilatory assist (NAVA), and high-frequency pressure ventilation. ventilation (HFV). 311 © Jones & Bartlett Learning LLC, an Ascend Learning Company. NOT FOR SALE OR DISTRIBUTION. 9781284139860_CH06_311_366.indd 311 22/02/19 12:04 PM 312 CHAPTER 6 Ventilator Initiation 22. Describe initial ventilator setup for adult patients to include expiratory time and I:E ratio, oxygen concentration, © Jones & Bartlettmode, tidalLearning, volume, rate, LLC inspiratory pressure, breath © Jones PEEP/& Bartlett CPAP, alarms Learning, and limits, and LLC humidification. NOT FOR SALEtrigger, OR pressure DISTRIBUTION rise time or slope, inspiratory time, NOT FOR SALE OR DISTRIBUTION KEY TERMS adaptive pressure high-frequency positive end-expiratory secondary breaths control (APC) © Jones &positive-pressure Bartlett Learning, LLCpressure (PEEP) ©servo Jones targeting & Bartlett (r) Learning, LLC adaptive support ventilation (HFPPV) positive-pressure ventilation set-point targeting (s) ventilation (ASV) NOT FORhigh-frequency SALE OR DISTRIBUTIONpressure control-continuous NOTspontaneous FOR SALEbreaths OR DISTRIBUTION adaptive targeting (a) ventilation (HFV) mandatory ventilation synchronized intermittent airway pressure-release imposed work of (PC-CMV) mandatory ventilation (APRV) breathing (WOBI) pressure control-continuous ventilation (SIMV) assist-control volume intelligent targeting (i) spontaneous targeting scheme ventilation intermittent mandatory ventilation (PC-CSV) time cycled autotriggering© Jones & Bartlett Learning,ventilation LLC(IMV) pressure control© Jones & Bartletttime-triggered Learning, breaths LLC automodeNOT FOR SALE OR invasiveDISTRIBUTION ventilation intermittentNOT mandatory FOR SALEvolume OR control-continuous DISTRIBUTION biovariable targeting (b) lung-protective ventilation (PC-IMV) mandatory ventilation continuous positive airway ventilatory strategy pressure-control (VC-CMV) pressure (CPAP) mandatory breaths ventilation (PCV) volume control controlled ventilation mandatory minute pressure cycled intermittent mandatory dual targeting (d) ventilation (MMV) pressure-regulated volume ventilation (VC-IMV) © Jones & flowBartlett cycled Learning, LLCnegative-pressure © Jonescontrol & Bartlett(PRVC) Learning,volume LLC control (VC) NOT FOR SALEfull ventilatory OR DISTRIBUTION support ventilation NOTpressure-support FOR SALE OR DISTRIBUTIONvolume cycled high-frequency jet neurally adjusted ventilation (PSV) volume support (VS) ventilation (HFJV) ventilatory assist (NAVA) primary breaths work of breathing (WOB) high-frequency oscillatory noninvasive ventilation (NIV) proportional assist ventilation (HFOV) optimal targeting (o) ventilation (PAV) high-frequency percussive partial ventilatory support rapid sequence ventilation (HFPV) © Jonespatient-triggered & Bartlett Learning,breaths LLCintubation (RSI) © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Introduction The decision to initiate mechanical ventilatory support The primary function of a mechanical ventilator is to aug- must also consider contraindications to mechanical venti- ment© Jonesor replace & Bartlettnormal ventilation. Learning, Thus, LLC mechanical lation, and possible© Jones complications & Bartlett and hazards.Learning, Hazards LLC of ventilationNOT FOR may be SALE required OR when DISTRIBUTION spontaneous breathing mechanical NOTventilation FOR include SALE ventilator-associated OR DISTRIBUTION lung is insufficient or absent. The decision to initiate mechani- injury (VALI), ventilator-associated pneumonia (VAP), cal ventilatory support should be based on a thorough and increased work of breathing (WOB) and ventilatory patient assessment, sound clinical judgment, and an un- muscle dysfunction due to inappropriate ventilator set- Positive-pressure ventilation derstanding of the indications, contraindications, compli- tings. may result in reduced © Jones & cations,Bartlett and Learning, hazards of mechanical LLC ventilation. The most© Jonesvenous & return Bartlett to the rightLearning, heart, decreased LLC cardiac out- put, and hypotension. Other possible adverse effects of NOT FOR SALEcommon OR reason DISTRIBUTION for initiation of mechanical ventilatoryNOT FOR SALE OR DISTRIBUTION support is acute respiratory failure. Other common diag- mechanical ventilation include the development of baro- noses associated with the need for mechanical ventilatory trauma (e.g., pneumothorax, pneumomediastinum), air- support include acute exacerbation of chronic obstruc- way problems (e.g., accidental bronchial intubation, airway tive pulmonary disease (COPD), coma, multiple trauma, occlusion), and ventilator system failure. Chapter 2 reviews and neuromuscular disease.© Jones The &respiratory Bartlett care Learning, clinician LLCrespiratory failure, while Chapter© Jones5 provides & a Bartlettdiscussion Learning, LLC of the indications for mechanical ventilation. should be aware of predisposingNOT FOR factors SALE for OR the developDISTRIBUTION- NOT FOR SALE OR DISTRIBUTION ment of acute respiratory failure, the clinical manifesta- Once the decision has been made to institute me- tions of acute respiratory failure, and the indications chanical ventilatory support, a number of choices
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