Even though the consequence of saline instillation on a ventilator patient in the acute care setting is pneumonia or the patient may become hemodynamically unstable, this practice remain contentious, the practice of this procedure will also decrease the oxygenation. (Ayhan, et al., 2015),
Due to the mechanical ventilator, it is able to assist in oxygen perfusion to all of her tissue. Thus, the lungs will be able to expand appropriately.
Stretch-induced lung injury may not occur if lung compliance is not greatly reduced. However, the benefit of ventilation with a lower tidal volume was independent of the static compliance of the respiratory system at base line, suggesting that the lower tidal volume was advantageous regardless of lung compliance. Variations in chest-wall compliance, which contributes to compliance of the respiratory system and is reduced in many patients with acute lung injury and the acute respiratory distress syndrome,39 may have obscured a true interaction between tidal volume and base-line lung compliance.
ation that I will be discussing is Airway Pressure Release Ventilation (APRV). I have not had an opportunity to use this mode, so I thought I would research it for this assignment. “The degree of ventilator support with APRV is determined by the duration of the two CPAP levels and the mechanically delivered tidal volume. Depends mainly on respiratory compliance and the difference between the CPAP levels. By design, changes in ventilatory demand do not alter the level of mechanical support during APRV. When spontaneous breathing is absent, APRV is not different from conventional pressure-controlled, time-cycled mechanical ventilation”( Putensen, C. )APRV is a form of improved pressure ventilation allowing unrestricted spontaneous breath at an
Consequently, there are numerous benefits of Neurally Adjusted Ventilation Assist (NAVA) for patients meeting the qualifications to both the patient and the medical team. First of all, the EdiCatheter can be used as an assessment tool for the patient. If you were to drop the catheter down a patient’s esophagus you could assess the diaphragm’s muscle strength which would determine if there was a possible neuromuscular problem occurring. (Kylie- KC Children’s) A patient placed on NAVA will also require less sedation to maintain comfortability, as a result this will let the patient’s respiratory muscles work while still being supported. NAVA will also help the nurses and doctors determine the appropriate level of sedation based upon the ventilator
To assess the appropriateness of the ventilator settings, I would first assess the patient by listening to breath sounds, monitoring heart rate, respiratory
Lung protective ventilation strategies are interventions to decrease potentials of lung injuries that could be acquired from the ventilator. The ventilator setting should be checked once an hour to make sure the patient is still on the correct mode and the correct settings selected; frequent checks will minimize any errors and way of assessing the patient’s tolerance to the current settings. Maintaining a low tidal volume is one strategy to reduce barotrauma. The ideal tidal volume should be 6ml/kg; Mary’s current weight is 81 kg thus the ideal tidal volume is 486 or lower and she is currently on 450 which is good. A second intervention to minimize lung injury is decreasing FiO2, the current ventilator setting is FiO2 1.0 which can cause
Another weaning test is performed without disconnecting the patient from the ventilator by using a low level of pressure sup- port (PS) with or
Providing anesthesia for lung transplantation (LT) is considered by many to be a major feat in cardiothoracic anesthesia. Some say it involves the most complex manipulation of cardiothoracic physiology, especially when cardiopulmonary bypass (CPB) is not used. There are many indications for end-stage pulmonary disease, from obstructive lung disease to pulmonary vascular disease. Traditionally, ventilation strategies for this population included tidal volumes of 8-12ml/kg to prevent atelectasis and zero PEEP to prevent a shunt of blood flow (Slinger, 2012). This strategy proved to cause harm during the periorperative period. Research now indicates that a reduction in tidal volume with added PEEP not only decreases atelectasis, but it also reduces pulmonary inflammatory response (Coppola, Froio, & Chuimello 2014). These patients already have a decreased respiratory reserve, therefore inducing an inflammatory mediated response with ventilation settings can be detrimental and should be avoided at all costs by the nurse anesthetist. It is imperative for the nurse anesthetist understand the necessity of lung protective ventilation strategies in LT.
The goal of management is to provide immediate intensive care and early ventilation support. 
The inspiratory reserve volume where 3,100 ml of air is additionally inhaled after the inspiratory of a regular tidal volume.
The lungs are attached at the Left atrial cannula were a slight flow of air is introduced to de-air through the pulmonary artery cannula. Once de-aired, the pulmonary artery cannula was then connected as well and a flow of around 130 mL/min of perfusate, which is essentially a solution with an enhanced colloid osmotic pressure that was created for EVLP. The ventilation of the perfusate is gradually increased. An estimation of the donor’s cardiac output is then made and around 50% of estimated cardiac output is maintained for the flow rate to perfuse both lungs. The ventilation using a tidal volume of around 6mL/kg (donors body weight) is maintained at 7 breaths per minute. The oxygenated perfusate is then deoxygenated by the use of CO2 gas and a heat exchanger and the resulting perfusate is then pumped back into the lungs to the pulmonary artery. The electrolytes, glucose, pCO2 and pH levels were maintained at physiologic levels in the perfusate to best reconstruct real ventilation. Just like the ex vivo heart perfusion machine (EVHP), the EVLP monitors just about every important aspect that the transplant patient will require to be able to maintain a healthy lung once transplantation is finished. These monitored values include the Left Atrial cannula pressure, the mechanical tidal volume ventilations based on donors ideal body weight, the
The first ventilator the patient was placed on was the volume control and the second ventilator is the pressure control. Volume control ventilator is set up so the end of the inspiration meets the set tidal volume; this mode gurantees a specific amount of volume in the lungs. Some advantages are offering safety of having pre-set tidal volume. However, some disadvantages include causing the patient to have rapid breathing thus leading to hyperinflation and respiratory alkalosis eventually increasing the risk of barotrauma.
Mechanically ventilated patients are increasingly at the risk of acquiring Ventilator-associated pneumonia (VAP) which is the leading infectious complication, affecting from 8% to 28% of patients admitted in the intensive care units. Morbidity and mortality associated with the development of VAP is high, with mortality rates ranging from 20 to 41%.Development of VAP increases ventilator days, critical care and hospital lengths of stay. Essential airway management is one of the important interventions to prevent ventilator associated pneumonia. Manual Hyperinflation (MH) enhances clearance of airway secretions and thereby improved lung compliance, reduced inspiratory resistance, improved V/Q matching, cleared airway and re-expanding the collapsed alveoli. MH could resemble a forceful cough, with which, sputum could propagate from distal to more proximal areas that is, from the smaller airways toward the larger airways, where it can be easily removed through endotracheal suctioning. Hence MH followed by suctioning is considered to be a suitable intervention to prevent VAP among intubated and mechanically ventilated patients.
Before a client can be totally independent from ventilators, they need to undergo weaning or SBT(spontaneous breathing trial). The nurse must prepare the client before the weaning procedure. Weaning is done by plugging the opening of the tube for 5-20 minutes and can be repeated up to 4xaday. Depending on the client’s respiratory status, the length of weaning can be gradually increased. Do not plug the tube for over