SAN LORENZO RUIZ COLLEGE OF ORMOC, INC.

Brgy. San Pablo, Ormoc City

COLLEGE OF NURSING

NCM 118 (RLE REPORT)

MECHANICAL VENTILATION

Submitted by:

BRIONES, PRECILLA MAE

DUMAGSA, DHANA MAE
FERRER, PAULINE
QUILISADIO, AERON JN
RAGAS, STIFFEI XEENA
ROCHE, LOVELY JANE
SORIA, TRICIA MAY
YUNTING, JAN PHILIP

September 2022
 Mechanical Ventilation
At the end of the 5- hours lecture discussion, the level IV nursing students will be able to :
1. Define the following terms:
1.1. Hypoxemia
1.2. Mechanical Ventilation
1.3. Hypoventilation
1.4. Hyperventilation
1.5. Respiratory Acidosis
1.6. Respiratory Alkalosis
2. Enumerate Indication for Mechanical Ventilation
3. Understand Significance of Mechanical Ventilation
4. Identify Different Modes of Ventilation
4.1. Conventional Ventilation
4.1.1. Breath Termination
4.1.1.1. Volume Ventilation
4.1.1.2. Pressure Ventilation
4.1.2. Breath Initiation
4.1.2.1. Assist Control (AC)
4.1.2.2. Synchronized Intermittent Mandatory Ventilation (SIMV)
4.1.2.3. Controlled Mechanical Ventilation (CMV)
4.1.2.4. Continuous Positive Airway Pressure (CPAP)
4.1.2.5. Positive End - Expiratory Pressure (PEEP)
4.2 APRV (Airway Pressure Release Ventilation)
4.3. High Frequent Ventilation
5. General guidelines in the different initial ventilator setting
6. Various procedures and mechanical devices
7. Complications of mechanical ventilation
8. Nursing responsibilities
1. DEFINITION OF TERMS
Mechanical Ventilator
 a positive- or negative-pressure breathing device that supports ventilation and
oxygenation.
 is a machine that helps a patient breathe when they are having surgery or cannot breathe
on their own due to a critical illness.

Hypoxemia
 decrease in arterial oxygen tension in the blood.
 reduced oxygen in the blood.

Hypoventilation
 is breathing that is too shallow or too slow to meet the needs of the body.
 is the abnormal retention of carbon dioxide in the blood due to the poor exchange of
carbon dioxide and oxygen within the lungs.

Hyperventilation
 is rapid or deep breathing, usually caused by anxiety or panic. This overbreathing, as it is
sometimes called, may actually leave you feeling breathless.
  is a condition in which you start to breathe very fast.

Respiratory Acidosis
 is a condition that occurs when the lungs cannot remove all of the carbon dioxide the
body produces.
 is a clinical disorder in which the pH is less than 7.35 and the PaCO2 is greater than 42
mmHg and a compensatory increase in the plasma HCO3 occurs.

Respiratory Alkalosis
 is the most common finding in patients with an ongoing asthma exacerbation and is due
to hyperventilation.
 is a clinical condition in which the arterial pH is greater than 7.45 and the PaCO2 is less
than 38 mmHg.

2. INDICATIONS OF MECHANICAL VENTILATION

•Patients with apnea
Sleep apnea is a condition in which people stop breathing during sleep. These patients
may use a form of ventilation only while sleeping called CPAP or BiPAP.

•Patients with acute respiratory failure

The patient does not have to work as hard to breathe – their respiratory muscles rest.
The patient's as allowed time to recover in hopes that breathing becomes normal
again. Helps the patient get adequate oxygen and clears carbon dioxide.

•Patients with COPD

Mechanical ventilation is also suggested in 26%–74% of patients with COPD so that
the respiratory muscle load may be alleviated to reduce dyspnea and respiratory rate
and improve arterial oxygenation, partial pressure of carbon dioxide in arterial blood
(PaCO2), and pH.
 •Patients with ARDS
To maintain oxygenation, this involves maintaining oxygen saturation in the range of
85-90%, with the aim of reducing the fraction of inspired oxygen (FiO2) to less than
65% within the first 24-48 hours.

•Comatose Patient
The current results indicate that treating comatose patients resulting from
inoperative acute ICH may be futile. In particular, treating these patients with a
ventilator only has the effect of prolonging unresponsive life, and the treatment may
be criticized from the perspective of the appropriate use of public medical resources.

•Patients with ischaemic stroke

Mechanical ventilation is frequently performed in these patients due to swallowing
dysfunction and airway or respiratory system compromise.

•Brain and Spinal Cord Injury

An injury or disease to the brain can interfere with the signals that control breathing.
Damage to the spinal cord can block the brain’s signals from reaching the breathing
muscles.

3. SIGNIFICANCE OF MECHANICAL VENTILATION

 To maintain ventilation when patient cannot breathe well
 To improve gas exchange
 To decrease the work of breathing until the cause of respiratory failure can be identified
and corrected
 To decrease the amount of energy a patient uses on breathing
 To deliver high concentrations of oxygen into the lungs or have adequate oxygenation
 To help get rid of carbon dioxide
 To breathe for a patient who is unconscious

4. DIFFERENT MODES OF VENTILATION

The mode of ventilation is the aggregate of the mechanisms for initiation, limitation, and cycling
of the ventilator
Conventional Ventilation
- The conventional modes of mechanical ventilation are volume-preset techniques
that offer full or partial ventilatory support to the patient with respiratory
insufficiency.

Breath Termination
Volume Ventilation
- Also known as volume-controlled ventilation
- Offers the safety of a pre-set tidal volume and minute ventilation
but requires the clinician to appropriately set the inspiration flow,
flow waveform, and inspiratory time.
- Airway pressure increases in response to reduced compliance,
increased resistance, or active exhalation may increase the risk of
ventilator-induced lung injury
Pressure Ventilation
- Also known as pressure-controlled ventilation
- The clinician should titrate the inspiratory pressure to the
measured tidal volume, but the inspiratory flow and flow
waveform are determined by the ventilator as it attempts to
maintain a square inspiratory pressure profile
- Limits the maximum airway pressure delivered to the lung, but may
result in variable tidal and minute volume
Breath Initiation
Assist Control (AC)
- Commonly known as continuous mandatory ventilation
- The ventilator delivers a preset tidal volume or pressure at a preset
rate of respirations
- If the patient initiates a breath between the machine breaths, the
ventilator delivers at the preset volume or pressure (assisted
breath), therefore, every breath is the preset volume or pressure,
regardless whether it is initiated by the patient or the ventilator.

Synchronized Intermittent Mandatory Ventilation (SIMV)

- Also delivers a preset tidal volume and number of breaths per
minute
 - Between ventilator-delivered breaths, the patient can breathe
spontaneously without assistance from the ventilator
- As the patient’s ability to breathe spontaneously increases, the
preset number of ventilator breaths is decreased and the patient
does more of the work of breathing.
Controlled Mechanical Ventilation (CMV)
- Provides full ventilator support by delivering a preset tidal volume
and respiratory rate
- Indicated for patients who are apneic

Continuous Positive Airway Pressure (CPAP)

- Spontaneous breathing at a positive end-expiratory pressure
- Delivers a single, constant pressure during both inhalation and
exhalation
- No ventilator breaths are delivered, but the ventilator delivers
oxygen and provides monitoring and an alarm system
- The respiratory pattern is determined by the client’s efforts
Positive End - Expiratory Pressure (PEEP)
- Airway pressure is maintained above atmospheric pressure at the
end of exhalation, which increases the functional residual capacity
- Application of positive pressure to the airways during expiration
may keep the alveoli open and prevent closure
APRV (Airway Pressure Release Ventilation)
- a time-triggered, pressure-limited, time-cycled mode of mechanical ventilation
that allows unrestricted, spontaneous breathing throughout the ventilator cycle
- breaths may be initiated spontaneously as well as by the ventilator
- allows alveolar gas to be expelled through the lungs’ natural recoil
- cause less ventilator-induced lung injury and fewer adverse effects on the
cardiocirculatory function and being associated with lower need for sedation and
neuromuscular blockade
High Frequent Ventilation
- type of ventilation that is utilized when conventional ventilation fails
- a technique where the set respiratory rate greatly exceeds the normal breathing
rate
- In this rescue strategy, the tidal volume delivered is significantly less and can also
be less than dead space ventilation
- Reduces risk of volutrauma and thus helps prevent ventilator-induced lung injury
5. GENERAL GUIDELINES IN THE DIFFERENT INITIAL VENTILATOR SETTING
LUNG CAPACITIES
Initial Ventilator Premature
Neonate Infant/child Adolescent
Settings neonate
Volume control
Mode Pressure control Pressure control with pressure Volume control
support
Rate 40-50 30-40 20-30 12-15
PEEP (cm) 3 -6/7 3–6 3-5 3-5
Inspiratory
0.3-0.4 0.3-0.4 0.5-0.6 0.7-0.9
time(cm)
16-18(in
increased ICP); 18-25;35(in
PIP 18-22(if HMD) 18 – 20
18- 25(if low severe ARDS)
compliance)

a) Choose the Mode - Control every breath if plan for heavy sedation and muscle relaxation.
Use SIMV when patient likely to breathe spontaneously. Whenever a breath is supported by
the ventilator, regardless of the mode, the limit of the support is determined by:

• Volume limited: -preset tidal volume;

• Pressure limited: - preset PIP.

b) Fi02 - start at 100% and quickly wean down to a level < or 60% (to avoid O2 toxicity)
depending on O2 requirement. 60% may be a starting point.

c) I:E ratio – normally set at 1:2-1:3. Higher inspiratory times may be needed to improve
oxygenation in difficult situations (inverse ratio ventilation), increasing the risk of air leak.
Lower rate and higher expiratory time-1:3-1:4 may be needed in asthma to allow proper
expiration due to expiratory obstruction.

d) Trigger Sensitivity - set at 0 to -2. Setting above zero is too sensitive; triggered breath
from ventilator will be too frequent while too negative a setting will increase work for
patient to trigger a ventilator breath.

e) Volume Limited - Tidal Volume - 8-10ml/kg with a goal to get to 6-8ml/kg. If leak present
around ET tube, set initial tidal volume to 10-12ml/kg. These lung-protective strategies
recruit atelectatic areas while preventing over distention of normal lung parenchyma.
Steps in Operating a Mechanical Ventilator:
1. Set the machine to deliver the tidal volume required (6-10 mL/kg) or (4-8 mL/kg for
patient with ARDS).
2. Adjust the machine to deliver the lowest concentration of oxygen to maintain normal
PaO2 (greater than 60 mmHg) or an SpO2 level greater than 92%. This setting maybe high
initially but will gradually be reduced based on arterial blood gas (ABG) results.
3. Record speak inspiratory pressure.
4. Set mode (continuous mandatory ventilation [also known as assist- control] or
synchronized intermittent mandatory ventilation) and rate as prescribed by the primary
provider. Set positive and- expiratory pressure (PEEPP) and pressure support if
prescribed.
5. Set sigh setting (usually set at 1.5 times the tidal volume and ranging from 1 to 3 per hour)
if applicable.
6. Adjust sensitivity so that the patient can trigger the ventilator with a minimal effort
(usually 2 mmHg negative inspiratory force)
7. Record minute volume and obtain ABGs to measure carbon dioxide partial pressure
(PaC02) pH1 and PaO2 after 20 minutes of continuous mechanical ventilation.
8. Adjust setting (Fi02 and rate) according to results of ABG analysis to provide normal values
or those set by the primary provider.
9. If there is poor coordination between the breathing rhythms of the patient and the
ventilator (example: if the patient is “fighting” or “bucking the ventilator”), assess for
hypoxia and manually ventilate on 100% oxygen with the resuscitation bag.

6. VARIOUS PROCEDURES AND MECHANICAL DEVICES

MECHANICAL DEVICES
 Mechanical ventilators were traditionally classified according to the method by
which they support ventilation.
 The two major categories are
a. Negative-pressure ventilators –are older modes of ventilator support that are
rarely utilized today
b. Positive-pressure ventilators – inflate the lungs by exerting positive pressure
on the airway , pushing air in, similar to a bellows mechanism, and forcing the
alveoli to expand during inspiration.
NEGATIVE PRESSURE VENTILATORS
1. Iron lung
- An iron lung is a type of negative
pressure ventilator, a mechanical
respirator which encloses most of a
person's body, and varies the air
pressure in the enclosed space, to
stimulate breathing.
- It assists breathing when muscle
control is lost, or the work of
breathing exceeds the person's ability

2. Chest Cuirass
- A chest cuirass is a molded shell that
fits tightly around a person's thorax.
Its tight fit makes possible a good
degree of negative-pressure
ventilation, that is, negative pressure
within the shell causes expansion of
the chest wall with resultant inspiration.

3. Jacket Ventilator/ Pulmo-wrap

- Also known as pulmo-wrap or poncho-
wrap
- This ventilator is a windproof, water-
permeable nylon parka suspended over
a rigid grid that includes the rib cage and
abdomen. It allows the application of
negative pressure over the anterior
portion of the chest wall. Airtight seals
around the neck, arms, and hips are
required to prevent air leakage.
POSITIVE PRESSURE VENTILATORS
1. AVEA Ventilator
- Can be used to both ventilate and monitor
neonatal, pediatric, and adult patients.
- It can also deliver noninvasive ventilation with
heliox to adult and pediatric patients.

2. Puritan-Bennett 840 Ventilator System

- Has volume, pressure, and mixed modes
designed for adult, pediatric, and infant
ventilation.

TYPES OF BREATHING CIRCUITS

(A) Single limb circuit with a leak port

- In this configuration, the leak port is
always open to atmosphere. Pressure is
generated as the result of flow in the circuit
and resistance through the leak port. Thus,
with higher pressure, the ventilator must
deliver more flow into the circuit.
- This circuit type is commonly used in
ventilators designed for noninvasive
ventilation.
 - It is also the typical design for positive airway pressure devices used for the
treatment of obstructive sleep apnea.

(B) Single limb circuit with active exhalation valve

- Single limb circuit with active exhalation
valve near the patient. This circuit type is
typically used with portable ventilators, such
as those used for transport or in the home.
During inspiration, the exhalation valve is
closed via the pressurization line from the
ventilator.

(C) Dual limb circuit

- Dual limb ventilator circuit commonly
used with critical care ventilators.
- The valves are within the ventilator.

NEBULIZING & SUCTIONING A PATIENT THAT IS ATTACHED TO A MECHANICAL VENTILATOR

1. Using a Nebulizer
Gather the supplies:
 Nebulizer machine
 Power source
 Medicine
 Aerosol tubing, T-connector, medicine cup (nebulizer)
Set it up:
 Insert the proper dose of medicine into the medicine cup.
 Place the lid on the cup.
 Attach the T-connector to the lid.
 Attach the tubing to the nebulizer machine.
  Disconnect the ventilator at the connection between the vent filter and the
person's trach tubing.
 Connect the nebulizer T-connector to the vent filter and then connect the other
end to the person's trach tube.
Start the treatment:
 Turn the nebulizer machine on.
 The medicine in the cup will begin to turn into a fine mist. The person will breathe
in the mist as the ventilator gives the usual amount of breaths.
 Watch the medicine cup to see when all of the mist is gone. When the mist is
gone, the treatment is finished.
Stop the treatment:
 Turn off the nebulizer machine (not the ventilator).
 Remove the nebulizer from between the vent filter and the trach tubing.
 Re-attach the regular vent tubing back to the filter and back on to the person's
trach tube.The ventilator will continue to give breaths as usual.
 Sometimes a person may need to be suctioned after a treatment.

2. Suctioning
After disconnection of the ET or tracheostomy tube from any ventilatory circuit or oxygen
sources, a sterile single-use suction catheter is inserted into the open end of the tube.
 Perform hand hygiene and don gloves. Don additional PPE based on the patient’s need
for isolation precautions or risk of exposure to bodily fluids. Handle all nonsterile items
with the nondominant hand.
 Open the sterile catheter package on a clean surface, using the inside of the wrapping
as a sterile field.
 Pick up the suction catheter, being careful to avoid touching nonsterile surfaces. With
the nondominant hand, pick up the connecting tubing. Secure the suction catheter to
the connecting tubing.
 Check equipment for proper functioning by suctioning a small amount of sterile
solution from the container.
 Administer 100% oxygen to the patient for 30 to 60 seconds. (Rationale: The
administration of 100% oxygen helps prevent a decrease in arterial oxygen levels
during the suctioning procedure.)
  Disconnect the ventilator circuit or gas-delivery tubing from the end of the ET or
tracheostomy tube and attach the MRB (manual resuscitation bag) to the tube with
the nondominant hand. Verify also that the MRB has a reservoir to deliver the highest
level of oxygen possible.
 Remove the ventilator circuit or MRB with the nondominant hand
 With the control vent of the suction catheter open, gently but quickly insert the
catheter with the dominant hand into the artificial airway.
 Advance the catheter to the predetermined depth
 In select patient populations (those with a lung transplant or pulmonary surgery), the
depth of suctioning may be restricted. Advance the catheter to the identified depth
using the markings on the catheter.
 In a patient at high risk for suction-related complications, insert the catheter into the
ET or tracheostomy tube until it emerges out of the end of the airway. In a patient, not
at risk for suction-related complications, insert the catheter into the ET or
tracheostomy tube until resistance is met and then pull back 1 to 2 cm.
 Place the nondominant thumb over the control vent of the suction catheter to apply
continuous suction.
 Administer 100% oxygen again for 1 minute.
 Remove sterile glove(s) and dispose of catheter after completion of upper-airway
suctioning.
 Turn off the suction device.Discard suction collection tubing and canisters when
completely full. Suction collection tubing and canisters may remain in use for multiple
suctioning episodes.
 Discard supplies, remove PPE, and perform hand hygiene.
 Document the procedure in the patient’s record.

WHAT IS A T-PIECE?
T-piece is an instrument used in weaning of a patient
from ventilator during spontaneous breath trials, and is
widely used to identify patients who are ready for
extubation.

HOW TO WEAN A PATIENT FROM THE MECHANICAL VENTILATOR

Respiratory Weaning – the process of withdrawing the patient from dependence on the
ventilator, takes place in three stages:
Ventilator Endotracheal/Tracheostomy Tube Oxygen

 CRITERIA FOR WEANING

- Vital capacity: 10-15 ml/kg
- Maximum inspiratory pressure (MIP) at least -20 cm H2O
- Tidal volume: 7 – 9 ml/kg
- Minute ventilation: 6 L/min
- Rapid/shallow breathing index: Below 100 breaths/min/L;PaO2 >60mmhg with FiO2
<40%

 METHODS OF WEANING
1. Pressure Support Ventilation (PSV)
- Pressure support ventilation (PSV) is a spontaneous mode of ventilation
in which each breath is initiated by the patient but is supported by constant pressure
inflation.
- This method has been shown to increase the efficiency of inspiration and
decrease the work of breathing.
2. Synchronized Intermittent Mandatory Ventilation (SIMV)
- is a type of volume control mode of ventilation.
- With this mode, the ventilator will deliver a mandatory (set) number of
breaths with a set volume while at the same time allowing spontaneous breaths.
- the rate is slowly decreased to 1 to 3 breaths until the patient is fully
breathing on their own
3. Spontaneous Breathing Trial (SBT)
- assesses the patient's ability to breathe while receiving minimal or no
ventilator support.
- this method uses the T-piece trial and is used only if patient is awake and
alert, is breathing without difficulty, has good gag and cough reflexes and is
hemodynamically stable
- are conducted with the patient disconnected from the ventilator,
receiving humidified oxygen only and performing all the works of breathing
  WEANING FROM THE OXYGEN
The patient who has successfully weaned from the ventilator cuff and tube and
has adequate respiratory function is then weaned oxygen.
- The FiO2 is gradually reduced until the paO2 is in the range of 70 to 100 mmHg while
the patient is breathing the air.
- If the PaO2 is less than 70 mmHg on room air, supplemental oxygen is
recommended.

HOW TO ATTACH A MECHANICAL VENTILATOR TO A TRACHEOSTOMY:

1. Position patient in an upright position
2. Observe baseline vital signs
3. Perform tracheostomy care
4. Attach the T-piece to the tracheostomy tube
5. Attach aerosol tubing to the T-piece to provide ventilation
6. Monitor for any signs of complications

7. COMPLICATIONS OF MECHANICAL VENTILATION

MONITORING AND MANAGING POTENTIAL COMPLICATIONS.

PATIENT PROBLEMS
• Alterations in Cardiac Function
Alterations in cardiac output may occur as a result of positive-pressure
ventilation. The positive intrathoracic pressure during inspiration compresses
the heart and great vessels, thereby reducing venous return and cardiac output.
This is usually corrected during exhalation when the positive pressure is off. The
patient may have decreased cardiac output and resultant decreased tissue
perfusion and oxygenation.

To evaluate cardiac function, the nurse first observes for signs and
symptoms of hypoxia (restlessness, apprehension, confusion, tachycardia,
tachypnea, pallor progressing to cyanosis, diaphoresis, transient hypertension,
and decreased urine output). If a pulmonary artery catheter is in place, cardiac
output, cardiac index, and other hemodynamic values can be used to assess the
patient's status.
 • Barotrauma and Pneumothorax.
Excessive positive pressure can cause lung damage, or barotrauma, which
may result in a spontaneous pneumothorax, which may quickly develop into a
tension pneumothorax, further compromising venous return, cardiac output, and
blood pressure. The nurse considers any sudden changes in oxygen saturation or
the onset of respiratory distress to be a life-threatening emergency requiring
immediate action.

• Pulmonary Infection.
The patient is at high risk for infection, as described earlier. The nurse
reports fever or a change in the color or odor of sputum to the primary provider
for. follow-up. Subglottic secretions may increase the patients' risk for the
development of VAP. Patients expected to be intubated for longer than 72 hours
may benefit from the use of an endotracheal tube with a subglottic suction port.
This extra port that is connected to continuous suction (20 to 30 cm H,O) allows
for the removal of the secretions above the cuff.

• Delirium.
Patients who are critically ill are at risk for delirium. The Awakening and
Breathing Coordination, Delirium monitoring and management, Early mobility
bundle (ABCDE) proposes an interdisciplinary process using evidence based
practice to manage delirium and weakness in the critically ill patient. The goal of
this bundle is to (1) improve communication among members of the healthcare
team, (2) standardize care related to the assessment and use of sedation, (3)
provide non-pharmacologic interventions in the management of delirium, and (4)
provide early exercise and ambulation.

VENTILATOR PROBLEMS:
• Increase in peak airway pressure
- Peak airway pressure increase is a late warning sign of partial
endotracheal tube obstruction whereas change in expiratory flow is an
early warning sign.
• Decrease in pressure or loss of volume
 - Low pressure: Indicates that the pressure in the ventilator circuit has
dropped. Low pressure alarms are usually caused by a leak or disconnect.
Start at the patient and work your way towards the vent checking for
loose connections.

MECHANICAL VENTILATOR ALARMS:

 High Pressure Alarm
Possible causes: What to do:
- Kinks in the ventilator  Straighten the ventilator
tubing tubing if it is kinked
- Mucus plugs or secretions  Suction to remove secretions
- Coughing, swallowing or
hiccupping
- Too much water in the  Empty water from ventilator
ventilator tubing tubing
- Changes in respiratory  Contact the physician
status
- Incorrect alarm settings  Correct the alarm settings
- Exhalation valve not  Check the exhalation valve
functioning

 Low Pressure
Possible causes: What to do:
- Leaks in the ventilator  Check for leaks
circuit
- Water in the pressure link  Drain the water
- Ventilator circuit has  Reconnect the tracheostomy
become disconnected from to the ventilator
the tracheostomy
- Incorrect alarm settings  Correct the alarm setting
- Change in medical status  Evaluate the client
- Incorrect circuit assembly  Check and test the circuit
assembly

 Low minute volume

Possible causes: What to do:
- Leaks in the ventilator  Check for leaks
circuit
- Ventilator circuit has  Reconnect the tracheostomy
become disconnected from to the ventilator
the tracheostomy
 - Incorrect alarm settings  Correct the alarm setting
- Change in medical status  Evaluate the client

 Power Switch Over

Possible causes: What to do:
- Power source has changed  Make sure the ventilator is
from AC to an internal or plugged into an AC power
external (e.g. battery) due outlet
to power outage  Make sure the external
battery is prepared in case
there is a long-term power
outage

 Low Power
Possible causes: What to do:
- Internal battery is used up  Plug the ventilator into an AC
power outlet

 Ventilator failure
Possible causes: What to do:
- Ventilator has  Switch the patient to the
malfunctioned back-up ventilator and call
for replacement

8. NURSING RESPONSIBILITIES
Before:
 Observe for changes in the level of consciousness.
 Assess the client’s respiratory rate, depth, and pattern, including the use of
accessory muscles.
 Assess the client’s heart rate and blood pressure.
 Auscultate the lung for normal or adventitious breath sounds.
 Assess the skin color, examine the lips and nail beds for cyanosis.
 Monitor oxygen saturation using pulse oximetry.
 Monitor arterial blood gases (ABGs) as indicated
During:
 Assess for correct endotracheal (ET) tube placement through:
- observation on of a symmetrical rise of both chest sides.
- auscultation of bilateral breath sounds
 - x-ray confirmation
 Assess for client’s comfort and the ability to cooperate while on mechanical
ventilation.
 Assess the ventilator settings and alarm system every hour.
 Assess the level of water in the humidifier and the temperature in the
humidification system.
 Ensure the alarms are set.
 If cause for an alarm cannot be determined, ventilate the client manually
 Empty the ventilator tubing when moisture collects
 Turn the client at least every 2 hours
 Have resuscitation equipment available at the bedside.
 Provide call bell to the patient.
 Provide note and pen to the patient.
After:
 Monitor for complications
 Encourage patient to take deep breaths, cough, reposition themselves and make
use of an incentive spirometer.

Video:
https://www.youtube.com/watch?v=bV6MShlhO_s
https://www.youtube.com/watch?v=3w_MGwAlSko

SOURCE:
1. Principles and Practice of Mechanical Ventilation, 3rd edition, Chapter 16, Martin J. Tobin
2. Brunner & Siddhartha’s Textbook of Medical-Surgical Nursing,14th edition, Janice L. Hinkle
& Kerry H. Cheever
3. Mechanical Ventilator for Nurses, Johny Wilbert
4. Overview of Mechanical Ventilation and Nursing Care, Pallavi Rai
5. Basics of Mechanical Ventilation, Parveen Kumar Chadha