The Use of Home Mechanical Ventilation to Manage Chronic Ventilatory Failure

The prevention of VAP through standardized care can reduce mortality rates, reduce mechanical ventilation days, and decrease costs and improve patient outcome.

BiPAP is a form of noninvasive mechanical ventilation used on patients that have acute respiratory failure. Many of these patients go on noninvasive ventilation due to COPD exacerbations that are infectious, with congestive heart failure, and ventilator parameters based on their clinical assessment and changes in arterial blood gases. Two different studies were conducted on COPD patients, using a BiPAP machine to improve exacerbations and their activities of daily living. There are many positive outcomes for using these noninvasive ventilators however when used incorrectly, negative outcomes or not changes at all are always possible.

Respiratory therapy refers to both a subject area within clinical medicine and to a distinct health care profession. During the 20th century, there were many health care fundamental transformations. Here are 10 possible predictions of what may occur in the future of respiratory care: (1) Less focus on raising PaO2 as a primary goal in managing patients with acute hypoxemic respiratory failure. (2) More attention to

38. American Journal of Respiratory care and critical care Medicine, Volume 175, issue 7, pages 698 – 704

Mr. Joseph is a 56-year-old has 30 smoking pack years. He was diagnosed 10 years ago with asthma/chronic bronchitis, arthritis of the knees, and congestive heart failure (CHF). Mr. Joseph weighs 350 pounds with a height of 6 feet, making his body mass index (BMI) of 47.5, much more than the recommended 25, and in fact his BMI places him in the morbid obesity classification. He takes medicines for his pulmonary conditions, along with a diuretic.

Airway pressure release ventilation (APRV) is a fairly new mode of ventilation, just becoming available in the U.S. in the mid-1990’s. APRV is “inverse ratio, pressure controlled, intermittent mandatory ventilation with unrestricted spontaneous breathing and it is based on the principle of open lung approach”. (Daoud, Farag, & Chatburn, 2012) The open lung approach is “concept of maximizing and maintaining alveolar recruitment throughout the ventilatory cycle by potentially ventilating the lung on the steep portion of the pressure-volume curve, thus avoiding over-distention on inspiration and alveolar collapse on exhalation”. (2012) APRV “was first used and described in 1987 as CPAP with an intermittent pressure release phase. Continuous airway pressure is applied to maintain adequate lung volume and improve alveolar recruitment. It is a pressure-limited, time-cycled, volume-variable mode of ventilation.” (2012)

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

The nature of the study recommended in the paper was to assess the effects of protocolized weaning from mechanical ventilation on the total duration of mechanical ventilation for critically ill adults and ascertain differences between protocolized and non-protocolized weaning in terms of adverse events, mortality, quality of life, weaning duration, intensive care unit (ICU) and hospital length of stay (LOS) and explore the variation in outcomes by the type of ICU, type of protocol and approach to delivering the protocol.

One of the most common causes of an airway obstruction in unconscious patient's is their tongue. This problem can be overcome by the use of an oropharyngeal airway (OPA) or nasopharyngeal airway (NPA). These airway adjuncts are inserted into the patient's mouth or nostril, and are designed to hold the tongue in a position that prevents it from occluding the airway. Another skill authorized for BLS providers is the use of a bag-valve-mask (BVM). This tool allows EMS personnel to deliver positive pressure ventilations to a patient who is not breathing sufficiently on their own. However, this skill is commonly performed improperly. When using a BVM, an EMS provider must make certain that his patient's airway is patent, and that his head is positioned properly. Furthermore, it is critical that an EMS provider ensures that the mask is maintaining a complete seal around his patient's nose and mouth. Otherwise, pressure needed to force air into the lungs escapes through the unsealed portion of the mask, reducing the effectiveness of the ventilation. Another, more advanced skill used by EMS providers is the performance of an endotracheal

During mechanical ventilation, patients are at risk of injuries to their lungs caused by improper settings on ventilators. Mechanical ventilator induced lung injury (VILI) can affect the lung in several ways. Some of the ways the lung become affected is by excessive pressure, excessive volume, and not enough volume. When the lungs are affected by excessive pressure its termed pulmonary barotrauma. On the other hand, if the lungs receive too much volume it’s called volutrauma. However, when the lungs don’t receive enough volume its termed atelectrauma. This paper describes how pulmonary barotrauma, pulmonary volutrauma, and pulmonary atelectrauma affects the lungs during mechanical ventilation and ways to prevent them from happening.

This truly is a problem that more professional health care providers need to be acutely aware of so that they can engage in more efficient methods of adequately preventing this condition. For many patients, receiving ventilation is not an option; it's a life-saving necessity. However, clinicians need to work harder to lower the rates of corresponding pneumonia associated with ventilation, so that it isn't such a "give-in" or overwhelming risk factor of receiving ventilation. Generally VAP occurs at a rate of just over 20 percent in clients who are put on mechanical ventilation (Augustyn, 2007). Mechanical ventilation bolsters the danger of acquiring pneumonia from a rate of three-fold, tripling it to ten-fold (Augustyn, 2007). These numbers reflect a lack of capability and deficit in high quality of care among members of the clinical staff. While certain hospital borne infections are unavoidable, and while

Negative pressure ventilation relies on the ability to move the chest wall. Negative pressure ventilation (NPV) has also been used in treatment in CCHS patients, however it has been linked to upper airway obstruction during sleeping. Nasal mask ventilation has also been proven in children who are older than 7 years of age with a dependency on nocturnal ventilation. This is the preferred mode of ventilatory support by parents and patients.[32]

Ventilator-associated pneumonia is the leading cause of death out of all hospital-acquired infections. Pneumonia that is acquired 48 hours or longer after at patient has been mechanically ventilated is considered hospital acquired. Endotracheal tubes provide pathogenic microorganisms’ with a direct access to the lungs where they can easily set up shop and cause deathly consequences for patients’ in the acute care setting. For example, the mortality rate of patients who have ventilator-associated pneumonia is 46% whereas unaffected intubated patients mortality rate is 32%. When ventilator-associated pneumonia (VAP) occurs in a patient(s), it often increases the amount of days a patient is on the ventilator and increases their overall hospital stay (Safe Care). The big problem with this is that VAP is costing hospitals

Oronasal mask was used with all subjects to start NIV. Manually and/or Mechanically Assisted Cough - manually assisted cough was employed to provide optimal insufflations. Portable ventilator was used to deliver deep insufflations. Both assisted coughs were administered for the first 3 days of the home care practical by a respiratory care therapist, who visited the patients every morning. They trained them for 3 days how to use NIV. The pulmonology also visited the subjects for the first three days. The nurses visited the patients mornings and afternoons until recover them not to getting worst.

Nurses are responsible for promoting and enhancing client health by implementing interventions that prevent illnesses and minimize deterioration (Watson, 2008). In order to assist Mr. X with ventilation, I implemented several interventions that assisted with the accomplishment of this human need. This comprised of the usage of comfort measures to assist with ventilation which included repositioning my client into a semi-fowler position by elevating the head of the bed 45 degrees with the arms supported by pillows. This allows the diaphragm to expand with some ease while stabilizing the chest and reducing breathing efforts. Also, I encouraged breathing techniques, such as pursed-lips, which assisted in reducing respirations while improving the laminar flow of the expired air (Loring et al., 2009).