Ventilation: Basic Principles
Jamie Ranse
Registered Nurse
Emergency Department
The Canberra Hospital
Overview
• Introduction to Ventilation Principles
• Respiratory Anatomy and Physiology
• Indications for Ventilation
• Modes of Ventilation
• Patient Management
• Complications
• Questions
Introduction
• Ventilation is the movement of air into and out of the alveoli.
Mechanics of Ventilation:
• Elasticity
• Compliance
• Resistance
• Pressure
• Gravity
Anatomy and Physiology
• Respiratory Structures
• Respiratory Zones
• Partitioning of Respiratory Pressures
• Boyles Law
Air flows from a region of higher pressure to a region of lower pressure.
To initiate a breath, airflow into the lungs must be precipitated by a drop in alveolar pressures.
• Respiratory Volumes and Capacity
• Ventilation and Perfusion
Indications for Ventilation
• Airway Compromise (potential)
• Respiratory Failure
– pH: <7.25
– PaCO2: >50 mmHg
– PaO2: <50 mmHg
• Increased Work of Breathing
• Head Injury Management
Objective of Ventilation
• Support though illness
• Reversal of hypoxemia
• Reversal of acute respiratory acidosis
• Relief of respiratory distress
• Resting of the ventilatory muscles
• Decrease in oxygen consumption
• Reduction in intracranial pressures
• Stabilisation of the chest wall
Modes of Ventilation
• Controlled
– Pressure Control (PC)
– Volume Control (VC)
• Supported
– Continuous Positive Airway Pressure (CPAP)
– Pressure Support (PS)
• Combined
– SIMV (PC) + PS
– SIMV (VC) + PS
Modes of Ventilation:Control
Controlled Mechanical Ventilation:
• The Minute Volume is determined by the ventilator
• The patient has no option to override the ventilator
Pressure Control:
• A preset peak inspiratory pressure is delivered to the patient at a preset
respiratory rate
• Volume is not preset and is determined by the mechanics of ventilation.
(elasticity, compliance, resistance, pressure,gravity)
Volume Control:
• A preset tidal volume is delivered at a present respiratory rate
• 7 – 10 mls/kg
50kg = 350 – 500mls
70kg = 490 – 700mls
90kg = 630 – 900mls
Modes of Ventilation: Support
Continuous Positive Airway Pressure:
• A spontaneous breathing mode, where the patient generates their own breath
• The ventilator maintains a constant positive pressure on expiration (PEEP)
• Aims to increase Functional Residual Capacity
Pressure Support:
• A spontaneous breathing mode
• Need for additional support to achieve optimal tidal volumes
• Ventilator delivers a constant preset pressure on inspiration
CPAP + PS = BiPAP
Modes of Ventilation:Combined
Synchronised Intermitted Mandatory Ventilation:
• Similar to IMV
• If the patient initiates a breath and the ventilator synchronises so the ventilator doesn’t deliver a
breath at the same time
SIMV (PC) + PS:
• Pressure controlled ventilation with pressure support on spontaneous breaths
SIMV (VC) + PS:
• Volume controlled ventilation with pressure support on spontaneous breaths
Patient Management
• Monitoring
• Suctioning
• Other
– Sedation
– Positioning
– Oral and Eye Care
Monitoring
• ECG
• SpO2
• ETCO2
• Alarm limits
• Air Entry / Work of Breathing
• Ventilator observations and alarm limits
• Full assessment
Suctioning
• PRN
– Increasing airway pressures
– Decreasing SpO2
– Increased work of breathing
• Pre-oxygenate (100% oxygen)
• Less than 15 Seconds
Other
• Sedation
– Propofol, Morphine and Midazolam
• Positioning
– 2/24
• Oral and eye care
– 2/24
Complications
• Airway
– Aspiration, decreased clearance of secretions, predisposition to infection
• Endotracheal Tube
– Tube kinking, sputum plug, right main bronchus intubation, tube migration, cuff failure,
laryngeal oedema
• Mechanical
– Ventilator malfunction, hypoventilation, hyperventilation, barotrauma, pneumothorax