Care of Neonate in Ventilator PDF

CARE OF NEONATE IN
VENTILATOR
Definitions:
A) Ventilator: A ventilator is a machine that provides mechanical

ventilation by moving breathable air into and out of the lungs, to
deliver breaths to a patient who is physically unable to breathe, or
breathing insufficiently.
B) Assisted Ventilation: Movement of gas in and out of lungs by
external source connected directly to the patient
Terminologies used in Neonatal Ventilation:
TERM DEFINITION
Breath Pattern The method by which the ventilator coordinates
the breath sequence
The 4 general patterns used in neonatal
ventilation are
− IMV
− SIMV
− ACV
− PSV
Control How a ventilator coordinates how a breath is to
be delivered is termed Control
Generally breath modes are
− Volume controlled
− Pressure controlled
− Dual controlled
TERMS DEFINITION
Cycling Sequence of switching from inspiration to
expiration (delivering a breath)
Cycling includes
− Time cycled breaths
− Flow cycled breaths
− Volume cycled breaths
Expiratory time The time spent during the expiratory phase of
ventilation
Flow Net movement of respiratory gases within a
confined tubing or space. Flow refers to the
measurement of volume over an amount of
time.
Frequency/Rate Number of breaths per minute
Inspiratory time Time spent during the inspiratory phase of
ventilation
Fraction of inspired Percent of oxygen delivered to the patient
Oxygen (FiO2) Changes in fiO2 alter alveolar oxygen pressure
and thus oxygenation
Mean Airway Average airway pressure delivered throughout
Pressure(MAP) the respiratory cycle.
×
MAP= ×( − )+
Peak Inspiratory Peak pressure at the end of inspiration
Pressure(PIP) Adequate PIP is manifested by a gentle chest
rise with a delivered breath
Positive End- The constant distending pressure delivered at
expiratory pressure end expiration.
(PEEP) Increases in PEEP generally improve oxygenation
Tidal Volume(Vt) The volume of air inhaled and exhaled at each
breath
Triggering It is the method by which the ventilator switches
from expiration to inspiration
TERMS DEFINITION
Set breath Ventilator breath which is set by the clinician
(ventilator initiated)
Spontaneous breath Patient’s own inherent breath
(patient initiated)
Inspiratory Time (It) Time taken for inspiration in one respiratory
cycle.
Expiratory Time (Et) Time taken for expiration in one respiratory
cycle.
I:E Ratio The ratio of inspiration time to expiration time
Minute Volume The volume of gas entering the lungs in more
(Vmin) than one minute. Expressed in lit/min
Flow It is the flow of gas delivered measured in lit/min
Leak Flow that is lost from the respiratory circuit
Functional Residual The volume of gas present in the lung alveoli at

Capacity (FRC) the end of passive expiration
Compliance The elasticity or distensibility of the respiratory
system including the lungs and the chest
Resistance The capability of the airways and endotracheal
tube to oppose airflow
Resistance=
Modes of Ventilation:
VENTILATOR MODE DEFINITION

Intermittent Mandatory Delivers breath at a set rate per minute
Ventilation (IMV) regardless of patient effort
Synchronized Intermittent Synchronizes breaths basing the timing on
Mandatory Ventilation the patient’s inspiratory effort
(SIMV)
VENTILATOR MODE DEFINITION
Assisted Control Similar to SIMV in that the breaths are
Ventilation (ACV) synchronized but every patient breath is
supported. A backup breath rate is used in
the event of apnea.
Pressure Support Provides pressure support (above PEEP)
Ventilation (PSV) with variable flow to assist in spontaneous
breaths.
Pressure Control Pressure limited, but flow is variable so
Ventilation (PCV) that the PIP can be earlier in the
inspiratory phase and held at a plateau
pressure
Pressure Regulated Uses assisted control breaths to deliver a
Volume (PRV) unique decelerating flow waveform.
Volume controlled but breath terminates
when a set pressure is met
Volume Guaranteed A variation of PSV In which volume, not
Ventilation (VGV) pressure guides the delivery of the
augmented breath
Nursing Care of the baby on ventilator:
The nursing care of baby on ventilator includes
1. Nursing Assessment
Assessment includes
a) Temperature-Normothermic, hypo or hyperthermic
b) Color-pink, blue, yellow or mottled
c) Respiratory –rate, quality of breathing, intercostal recession,
restlessness, oxygen saturation
d) Cardiovascular –Heart rate, peripheral and central pulses,
perfusion and blood pressure
e) Neurobehavioral and developmental status- pain,
discomfort, restlessness
f) Daily weight
g) Intake and output
2. Ventilator Support assessment
It includes checking and assessing
• The patency and functioning of intravascular devices
• ET tube patency and security
• Placement of invasive tubes like chest tubes
• Functions of all respiratory equipments
• Monitoring devices
• Infusion pumps
• Thermoregulatory devices
• Emergency equipments, humidifier, etc.
3. Respiratory Care
• Assisting in initiation of ventilation
• Administration of surfactant
• Airway security
• Suctioning
• Chest physiotherapy
4. Thermoregulation
• Premature babies have immature skin so babies kept on
assisted ventilation requires close monitoring and should
not be kept naked
• Oil bath can be implemented to prevent heat loss
• Thermoneutral environment should be maintained
5. Skin care
6. Development care
• Nose and Light Stimuli control
7. Positioning
8. Family centered care
Ventilator Weaning:
The goal is to wean the infant from the ventilator as soon as possible
because of the potential for damage and complications with longer
mechanical ventilation exposure.
• An infant who is considered who is considered medically

stable, has spontaneous respirations, and has normal or
near normal blood gases can be considered for weaning
• The method of weaning is dependent upon the stage of the
infant’s illness
• In general factors that are most toxic to the lungs are
weaned off first
• Changes to the ventilator settings at a time is made by
evaluating tolerance to decrease in different parameters
• Evaluation of blood gases is done after most changes and
before making additional changes.
Complications:
1. Plugged ET tube or airway obstruction

2. Mal[positioned ET tube
3. Accidental extubation
4. Pneumothorax
5. Pneumomediastinum
6. Pneumopericardium
7. Malfunctioning equipment
8. Pneumonia
9. Pulmonary hemorrhage

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What are the different modes of ventilation discussed?

What are the components of nursing assessment of a baby on ventilator?

CARE OF NEONATE IN

A) Ventilator: A ventilator is a machine that provides mechanical

Terminologies used in Neonatal Ventilation:

Functional Residual The volume of gas present in the lung alveoli at

VENTILATOR MODE DEFINITION

Nursing Care of the baby on ventilator:

The nursing care of baby on ventilator includes

• An infant who is considered who is considered medically

1. Plugged ET tube or airway obstruction

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