Monitoring Mechanical Ventilation

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As a practicing Respiratory Therapist, it will be important for you to understand that research is constantly going on behind the scenes to advance the science of mechanical ventilation. Whenever there is a disease or condition that is not well addressed by our current ventilatory technology, you can bet that researchers are at work to find a better way to ventilate patients with that disease or condition. That is part of what makes respiratory care so fascinating. It never stays the same for very long, constantly changing, constantly advancing. 

This week you are learning about several special ventilatory techniques that have come along as advancements in the science of ventilation. Among these are airway pressure release ventilation (APRV), high-frequency oscillatory ventilation (HFOV), neutrally adjusted ventilatory assist (NAVA), and Heliox therapy. You will learn about how these special modes actually function, and protocols for their application to patients. You will learn when you should recommend these modes for patients.

This week you will also learn about the rapid recognition of a patient in sudden respiratory distress and the key steps that therapists must take to identify the cause of distress and take quick action to correct it. 

This is an important assignment, both in terms of care for your patients, and because the National Board for Respiratory Care wants you to know about the latest special modes of ventilation before you can pass the Therapist Multiple Choice Exam.

Identifying the patient Sudden Respiratory Distress

An absolutely essential skill for any respiratory therapist is identifying the patient in sudden respiratory distress. Physicians cannot always be at the bedside observing their patients, so we become their eyes and ears at the bedside, observing for distress and taking immediate action on the patient’s behalf.

Clinical Manifestations of Sudden Respiratory Distress

The manifestations of sudden respiratory distress include:

– Patient use of accessory breathing muscles

– Pursed-lip breathing

– Minimal or absent cough

– Leaning forward to breathe

– Barrel chest

– Digital clubbing

– Dyspnea

Patient-Related Causes of Sudden Respiratory Distress in Ventilator Patients

Any of the following can be patient-related causes of sudden respiratory distress in mechanical ventilation patients. These causes must be addressed immediately:

– Artificial airway problems

– Severe bronchospasm

– Excessive secretions

– Pulmonary edema

– Dynamic hyperinflation

– Abnormal respiratory drive

– Alteration in body position

– Drug-induced problems

– Abdominal distension

– Pneumothorax

– Anxiety

Ventilator-Related Causes of Sudden Respiratory Distress in Ventilator Patients

System leaks

Circuit malfunction or disconnect

– Inadequate FIO2

-Patient-ventilator asynchrony, including inappropriate mode, trigger sensitivity, flow setting, cycle variable, or PEEP

– Problems with closed-loop ventilation

Seven Key Steps for Managing Sudden Respiratory Distress

One of the most important things that you will learn in this course is the sequence of Seven Key Steps to protect and treat your patient who is experiencing sudden respiratory distress on the ventilator. Once sudden respiratory distress is identified, the following steps must be completed quickly and efficiently:

  1. Disconnect the patient from the ventilator. Whatever is going wrong, we need to make sure that the patient is being ventilated, and that is best done manually
  2. Begin manual ventilation at 80-100% oxygen, and use a PEEP attachment if the patient has been receiving PEEP on the ventilator.
  3. Manually evaluate compliance and resistance via bag ventilation. Is the patient difficult to bag? Is there a delay in exhalation?
  4. Perform a rapid physical examination, including observation, palpation, percussion, and auscultation.
  5. Pass a suction catheter through the airway to determine patency.
  6. If death appears imminent, treat the most likely causes, which are pneumothorax and airway obstruction.
  7. Once the patient’s condition has stabilized, perform a more detailed assessment, and provide any additional treatment which is required.

Following these seven key steps saves lives, no doubt of that. Things go wrong with our patient-ventilator system on a regular basis. The actions of the Respiratory Therapist often make the difference in whether the patient does or does not survive such an event.

Prompt

Select any one of the special modes of ventilation and explain (1) how the special mode of ventilation actually works, i.e. how it functions to ventilate your patient (2) the protocols for use of this special mode (3) and the clinical indications for the special mode, meaning clinical conditions or situations in which you would recommend it for your patient.Note: Special ventilatory techniques include:               Airway pressure release ventilation (APRV),               High-frequency oscillatory ventilation (HFOV),               Neurally adjusted ventilatory assist (NAVA) and               Heliox therapy.

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