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    1.basic Troubleshooting of Ventilator

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    Jek Arellano

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    1.basic Troubleshooting of Ventilator

    Uploaded by

    Jek Arellano
    3 views38 pages

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    1.Basic Troubleshooting of Ventilator

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    3 views38 pages

    1.basic Troubleshooting of Ventilator

    Uploaded by

    Jek Arellano

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
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    Basic Mechanical

    Ventilator Set
    -up/Troubleshooting
    LECTURER: AGERICO ZACHARCY RAMOS ARELLANO RRT, MMHoA
    PORTABLE VENTILATORS
    MECHANICAL VENTILATOR

    • HOME VENTILATORS SERVE THE SAME PURPOSE AS HOSPITAL


    VERSIONS USED IN LONG CARE FACILITY.
    • THEY BOTH HAVE A MODE THAT DELIVERS A PRESET VOLUME OF AIR
    AT A SET INTERVAL
    • THEY BOTH HAVE MODE THAT DELIVERS A PRESET PRESSURE AT A SET
    INTERVAL
    INDICATION FOR MECHANICAL
    VENTILATION IN HOMECARE SET-UP

    • OBSTRUCTIVE SLEEP APNEA – (APNEA DUE TO NEUROMUSCULAR CAUSES ,


    PROGRESSIVE HYPOVENTILATION, FATIGUE OF RESPIRATORY MUSCLE ,FACIAL
    TRAUMA
    • CHRONIC OBSTRUCTIVE PULMONARY DISEASE
    • OBESITY
    • NEUROLOGICAL DYSFUNCTION (FOR INVASIVE VENTILATION)
    Bronchiectasis
    Bronchiectasis is a long-term
    condition where the airways of the
    lungs become widened, leading to a
    build-up of excess mucus that can
    make the lungs more vulnerable to
    infection. The most common symptoms
    of bronchiectasis include: a persistent
    cough that usually brings up phlegm
    (sputum) shortness of breath.
    Treatment for Bronchiectasis
    1. Inhaled Tobramycin therapy was effective in reducing
    Pseudomonas. aeruginosa microbial density in the sputum of patients
    with bronchiectasis. Several studies demonstrated favourable impacts
    on hospitalizations, number and severity of exacerbations, and
    symptoms.

    2. The treatment of bronchiectasis involves promoting sputum clearance,


    using positional physiotherapy, and early and aggressive treatment of
    pulmonary infections

    *Physiotherapy has a very valuable role in aiding with symptoms of


    bronchiectasis. Since mucocilliary clearance is reduced to about 15% of normal,
    patients tend to cough more. Physiotherapy treatments are aimed at aiding
    secretion clearance, managing fatigue induced by the effort of ineffective
    clearance and increased coughing.
    Management of Severe but not Life - threatening exacerbations

    • Assess the severity of symptom


    Administration of supplemental oxygen therapy ( monitoring of sp02)

    • Bronchodilator
    Increase doses/ or frequency of short acting bronchodilator
    Combine short acting and anticholinergic medication
    Consider of Long-acting beta agonists

    • Consider oral corticosteroid

    • Consider Noninvasive ventilation

    • At all time
    *monitor fluid balance
    * Identify and treat associated conditions ( e.g., Heart failure, Arrhythmias, Pulmonary embolism etc..
    COMMON MODES IN HOMECARE
    SETTINGS

    • NON- INVASIVE MODE:


    1. BILEVEL POSITIVE AIRWAY PRESSURE ( BIPAP)
    2.CONTINUOUS POSITIVE AIRWAY PRESSURE ( CPAP)
    BILEVEL POSITIVE AIRWAY PRESSURE ( BIPAP)

    • TWO DIFFERENT TYPE OF PRESSURE


    1. IPAP – INSPIRATORY POSITIVE AIRWAY PRESSURE
    INITIAL SETTINGS : 8 cmH20 titrate as appropriate
    2. EPAP – EXPIRATORY POSITIVE AIRWAY PREUSSURE
    INITIAL SETTINGS : 4 cmH20 titrate as appropriate
    • IPAP – CORRECTION OF VENTILATION AND OPTIMIZATION OF VT

    • EPAP – CORRECTION OF OXYGENATION NEEDED FOR ALVEOLAR


    RECRUIMENT
    • PROVIDES MECHANICAL BREATHS IN LOWER RATES
    COMMON CRITERIA : ACUTE RESPIRATORY FAILURE OR ACUTE HYPERCAPNIC
    EXACERBATION OF COPD

    PH – 7.35
    PCO2 - >50 mmHg
    PAO2 – <50mmHg
    • ACUTE RESPIRATORY FAILURE TYPE 1
    > OXYGENATION - HYPOXEMIA

    • ACUTE RESPIRATORY FAILURE TYPE 2


    > OXYGENATION AND VENTILATION
    • No respiratory failure: Respiratory rate: 20-30 breaths per minute; no use of accessory respiratory
    muscles; no changes in mental status; hypoxemia improved with supplemental oxygen given via
    Venturi mask 28-35% inspired

    • Acute respiratory failure – non-life-threatening: Respiratory rate: > 30 breaths per minute; using
    accessory respiratory muscles; no change in mental status; hypoxemia improved with
    supplemental oxygen via Venturi mask 25-30% FiO2; hypercarbia i.e., PaCO2 increased compared
    with baseline or elevated 50-60 mmHg

    • Acute respiratory failure – life-threatening: Respiratory rate: > 30 breaths per minute; using
    accessory respiratory muscles; acute changes in mental status; hypoxemia not improved with
    supplemental oxygen via Venturi mask or requiring FiO2 > 40%; hypercarbia i.e., PaCO2 increased
    compared with baseline or elevated > 60 mmHg or the presence of acidosis (pH ≤ 7.25).
    INDICATION AND CONTRAINDICATION
    INDICATION:

    • REDUCTION OF RESPIRATORY WORKLOAD IN OBESITY


    • ACUTE RESPIRATORY FAILURE
    • ACUTE HYPERCAPNIC EXACERBATIONS OF COPD
    CONTRAINDICATION:
    • APNEA
    • UNABLE TO HANDLE SECRETIONS
    • FACIAL TRAUMA
    • CLAUTROPHOBIA
    NIV- CONTINUOUS POSITIVE AIRWAY PRESSURE ( CPAP)

    ALSO KNOWN AS “PEEP”


    INITIAL SETTINGS : 4cmH20
    - PROVIDES POSITIVE PRESSURE DURING SPONTANEOUS BREATHS AND
    DOES NOT PROVIDE MECHANICAL BREATHS
    - OR SAME SET OF IPAP AND EPAP IS KNOWN TO BE CPAP”
    • INDICATION:

    • OBSTRUCTIVE SLEEP APNEA - DIAGNOSED BY


    NOCTURNAL POLYSOMNOGRAPHY AND SEVERITY
    BY APNEA AND DESATURATION INDEX

    • APNEA-HYPONEA INDEX – REFERS AVERAGE


    NUMBER OF APNEA OR HYPONEA
    • Why need CPAP in patient with OSA?
    - IF UNTREATED OSA MAY CAUSE THE FF:
    • 1. HYPERTENSION
    • 2. LEFT AND RIGHT VENTRICULAR HYPERTTROPHY
    • 3.SUDDEN CARDIAC ARREST
    • 4.INCREASE BRAIN INFRACTION
    TYPES OF NON-INVASIVE MASK
    OBESITY
    BASIC TROUBLESHOOTING
    1. Ensure proper sizing or best type of mask to be used.
    2. Check for disconnection in tubing’s
    3. Ensure proper fit in patients face before initiation of machine
    4. Ensure proper explanation to patient before initiation
    5. If poor synchronization occurs, check for leaks or alter IPAP maximum time
    to improve synchronization
    6. Do not increase IPAP or EPAP level beyond patient tolerance
    ALARMS

    • 1. LOW PRESSURE ALARMS – CHECK FOR LEAKS , DISCONNECTIONS OF


    TUBINGS AND IMPROPER FITTING OF MASK
    • 2.HIGH PRESSURE ALARMS – PATIENT IS FIGHTING THE VENTILATOR,
    INCREASE SECRETIONS, COUGHING
    • LOW VTE – CHECK FOR LEAKS, RESPIRATORY RATE
    • HIGH VTE – RESPIRATROY RATE, COUGHING, TOO MUCH PRESSURE SET
    PARTS OF PORTABLE VENTILATOR

    • 1. Portable ventilator check for power cable and power supply make sure to
    connect in a stable outlet to prevent unwanted disconnections.
    • 2. Corrugated tubing's single limb or Double Limb
    • 3. Humidifier Chamber/ Heat and Moisture Exchange Filter
    • 4.Bacterial Filter
    • 5. Mask/ Nasal with Strap
    • 6. oxygen outler ( some ventilators)
    CORRUGATED TUBINGS
    PORTABLE VENTILATOR WITH CHAMBER
    mask/nasal pillow
    HEAT MOISTURE EXCHANGE / BACTERIAL
    FILTER
    END OF LECTURE

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