As a nursing student, understanding how to use and maintain ventilators is extremely important. In many situations, ventilator support can be the difference between life and death, so learning about them should be taken seriously.
This post will discuss the basics of ventilators—what they are used for, how they work technically, why healthcare professionals need to care for them properly—and more. Regardless of your expertise with these devices, you’re sure to learn something new here today that will prepare you even better when working with patients requiring ventilator support.
Table of Contents
What is a Ventilator?
A ventilator is a machine that assists in breathing by providing controlled breaths to patients who cannot breathe independently. The device aims to supply oxygen-enriched air and remove carbon dioxide from the lungs, artificially assisting in respiration.
Ventilators use complex algorithms and settings to deliver air with the right amount of pressure, volume, and oxygen concentration. A ventilator monitors a patient’s vital signs to ensure proper oxygenation and ventilation.
A ventilator purpose:
- It provides oxygen to your lungs.
- It removes carbon dioxide from your lungs.
- Monitors your crucial signs.
- Adjusts the pressure, volume, and oxygen concentration of the air delivered to ensure optimal ventilation.
What is Mechanical Ventilation?
Mechanical ventilation is a medical intervention that helps improve oxygenation and ventilation for patients by delivering breaths through an artificial airway. This is usually done using a ventilator, which can be used in the hospital setting and at home.
The goal of mechanical ventilation is to provide adequate amounts of oxygen to the tissues while providing enough ventilation to remove carbon dioxide and other metabolic waste. Depending on the patient’s needs, mechanical ventilators can be used for short-term and long-term conditions.
What are the Types of Mechanical Ventilation?
There are two main types of mechanical ventilation: invasive and noninvasive.
Invasive Mechanical Ventilation: Invasive mechanical ventilation involves inserting a tube through the patient’s mouth or nose into the lungs. This allows for more precise control over oxygenation and ventilation, making it an effective therapy for patients with severe respiratory issues.
Noninvasive Mechanical Ventilation: Noninvasive mechanical ventilation involves delivering oxygen to the patient through a mask, nasal cannula, or other interface. This type of ventilation is less invasive and requires fewer settings to be adjusted. In some instances, noninvasive mechanical ventilation can also be used for short-term respiratory support.
Need of Ventilator Setting Nursing Management
Mechanical ventilation nursing management includes:
- Monitoring the patient’s vital signs
- Adjusting ventilator settings to ensure proper oxygenation and ventilation,
- Educating the patient and family about the ventilator and its use.
Ventilator Settings for nurses include:
Pressure settings. This sets the amount of pressure used to push air into the lungs.
Flow rate. This determines how much air is delivered to the patient.
Oxygen concentration. This sets the amount of oxygen in the air delivered to the patient.
Breathing frequency. This sets the number of breaths per minute the ventilator delivers to the patient.
Fundamental Setting of Mechanical Ventilator
A mechanical ventilator has many settings.
Understand the Meaning of Fio2
Fio2, also known as Fraction of Inspired Oxygen, is an essential term in the medical field. It refers to the amount of oxygen delivered to a patient in a medical setting. Understanding fio2 is crucial for doctors and nurses as it helps them monitor a patient’s respiratory status and adjust their treatment plan accordingly.
For medical patients experiencing difficulty breathing, oxygen-enriched air can be a lifesaver. When breathing becomes difficult, healthcare providers can supply patients with high oxygen levels through a face mask or other delivery device.
This oxygen-enriched air has a higher-than-normal FIO2, or “fraction of inspired oxygen,” representing the percentage of oxygen participating in gas exchange. While natural air contains about 21% oxygen (or a FIO2 of 0.21), oxygen-enriched air can contain up to 100% oxygen (a FIO2 of 1.00).
While it’s essential to maintain the FIO2 at safe levels to avoid oxygen toxicity, sometimes higher levels are necessary for specific medical conditions.
Even if the barometric pressure changes, the FIO2 level can remain constant. Understanding and managing FIO2 levels is crucial for providing patients with the best possible care.
It’s important to note that administering too little or too much oxygen can harm a patient’s health. Therefore, maintaining the right balance of fio2 is crucial to ensure a patient’s proper oxygenation and overall health.
Issues of Concern
To understand FiO2, it is crucial to understand a few other terms:
- Hypoxemia: Is defined as a decrease in the partial pressure of oxygen in the blood, resulting in inadequate oxygenation of the tissues.
- Hyperoxemia: Is defined as an increase in the partial pressure of oxygen in the blood, which can lead to breathing difficulties and even death.
- PaO2: Partial pressure of oxygen of arterial as measured by an arterial blood gas sample.
- PAO2: Partial pressure of oxygen of the alveoli, a calculated value.
- Hypoventilation: Refers to a decrease in breathing rate or a reduction in the amount of air inhaled per minute
- Hyperventilation: Refers to an increase in breathing rate or volume per minute.
PEEP, or Positive End-Expiratory Pressure, is a setting on a mechanical ventilator to prevent alveolar collapse. It maintains a certain pressure in the respiratory system and helps keep the airways open, allowing for better ventilation of the lungs and improved oxygenation. PEEP also enhances patient comfort by reducing the work of breathing.
PEEP is usually adjusted to maintain a certain blood oxygenation level based on the patient’s needs and the underlying medical condition. It can also help reduce lung injury by decreasing the pressure gradient between alveoli during exhalation.
Overall, PEEP helps maximize ventilation efficiency and oxygen delivery to the patient. It is essential to adjust PEEP correctly for each patient, as too much or too little pressure can cause complications.
The respiratory rate, or breathing rate, is an essential vital sign to monitor a patient’s respiratory status. It is calculated by counting the number of breaths taken in one minute. Respiratory rates can vary depending on age, activity level, and medical condition.
Generally, average adult respiratory rates range from 12 to 20 breaths per minute. A higher respiratory rate may indicate a medical condition or illness, and the medical team should assess the patient to determine if supplemental oxygen is necessary.
In addition to monitoring the respiratory rate, healthcare providers also monitor other vital signs, such as oxygen saturation and end-tidal carbon dioxide levels, using pulse oximetry and capnography. Monitoring these vital signs can help the medical team recognize changes in the patient’s condition early and intervene accordingly.
Mechanical Ventilation Modes
Mechanical ventilation is the process of delivering oxygen-enriched air to a patient through a mechanical ventilator. Various modes of mechanical ventilation can be used depending on the type and severity of the patient’s condition.
Some of the most common types of mechanical ventilation include:
Assist Control Ventilation (AC): This mode provides positive pressure ventilation and can be adjusted according to the patient’s needs. In this mode, the ventilator supports a certain amount of each breath taken by the patient and provides additional air when needed.
Pressure Support Ventilation (PSV): This mode helps maintain a certain airway pressure level while the patient takes spontaneous breaths. It reduces the work of breathing and helps improve oxygenation and ventilation for the patient.
Synchronized Intermittent Mandatory Ventilation (SIMV): This mode uses both mandatory breaths from the ventilator and spontaneous breaths by the patient. The ventilator will provide a set number of compulsory breaths alongside the patient’s spontaneous breaths.
Airway Pressure Release Ventilation (APRV): This mode helps keep the airway open longer than other modes. It also provides higher levels of positive pressure during exhalation, allowing for better oxygen delivery to the patient.
Continuous Positive Airway Pressure (CPAP): This mode helps keep the airways open by providing the patient with oxygen-enriched air. It is commonly used to treat sleep apnea and other respiratory conditions.
High-Frequency Ventilation (HFV): This mode helps to deliver a high frequency of tiny breaths at frequent intervals. It is used in cases where the patient’s condition is severe, and oxygen needs are high.
Volume-Controlled Ventilation (VCV): This mode helps to maintain a specific volume of air with each breath delivered by the ventilator. It can be adjusted depending on the patient’s needs and is often used in cases with high levels of carbon dioxide retention.
Neurally Adjusted Ventilatory Assist (NAVA): This mode uses electrical signals to detect changes in the patient’s respiratory effort and adjusts ventilator assistance accordingly. It is used in cases where the patient has difficulty triggering breaths from the ventilator.
The mechanical ventilator has two types of alarms: low-pressure and high-pressure.
The high-pressure ventilator alarm can be a jarring sound, causing anyone nearby to take notice. The alarm is meant to alert medical staff of a potential issue with a patient’s breathing and can indicate that the ventilator is pushing too much air into the lungs. It’s a scary sound for patients and their families but also a crucial warning for medical professionals. Reacting quickly to the alarm can mean the difference between life and death. While the sound may be alarming, it is essential in keeping patients safe.
The low-pressure ventilator alarm indicates that the ventilator delivers insufficient air to the patient’s lungs. This can be due to a problem with the machine itself, or it could suggest the patient is not taking in enough oxygen. Low-pressure alarms are usually accompanied by other warning signs – such as a decrease in oxygen saturation levels or an increase in carbon dioxide levels – which are monitored by the medical team. If left unchecked, this lack of adequate air delivery can cause severe complications for the patient.
It is essential to recognize and respond quickly to any alarms that sound during mechanical ventilation, as they may signify a critical problem with the patient’s ventilation. The medical team should evaluate the patient and adjust the settings on the ventilator accordingly.
Mechanical ventilation is a critical tool for providing oxygen and air to patients who cannot breathe independently. It can be lifesaving in many cases, but it must be used properly and monitored closely.
Ventilator settings nursing must be regularly monitored and adjusted to ensure that the patient is receiving adequate oxygenation while minimizing discomfort, fatigue, and respiratory distress. It is also essential to recognize and react quickly to any alarms that sound during mechanical ventilation.
Mrs. Marie Brown has been a registered nurse for over 25 years. She began her nursing career at a Level I Trauma Center in downtown Chicago, Illinois. There she worked in the Emergency Department and on the Surgical Intensive Care Unit. After several years, she moved to the Midwest and continued her nursing career in a critical care setting. For the last 10 years of her nursing career, Mrs. Brown worked as a flight nurse with an air ambulance service. During this time, she cared for patients throughout the United States.