1. HOSPITAL SUPPORT SERVICES VENTILATOR MACHINE TRAINING By: Armando Darino Ngojo Senior Biomedical Engr. 2. Outlines Aims and Objectives What is Mechanical Ventilator or Respiratory Support Machine What is the process of Respiration What are the parameters used in Mechanical Ventilation Basic troubleshooting techniques 15 July 2014 Armando Darino Ngojo 2 3. Aims To provide basic understanding on the use of Mechanical Ventilation To perform and understand the basic users troubleshooting steps 15 July 2014 Armando Darino Ngojo 3 4. Objectives - as a result of completing this module, the user should be able to: identify and be familiar with the mechanical ventilator and its effect during patient respiration understand the usage of the mechanical ventilator including the parameters used perform and identify basic problems, errors and basic troubleshooting solutions during alarms 15 July 2014 Armando Darino Ngojo 4 5. VENTILATOR or RESPIRATORY SUPPORT MACHINE 15 July 2014 5Armando Darino Ngojo 6. VENTILATION TRANSPORT OF AIR/OXYGEN IN AND OUT OF THE LUNGS 15 July 2014 6Armando Darino Ngojo 7. MECHANICAL VENTILATOR WHAT IS MECHANICAL VENTILATOR? A mechanical ventilator is a machine that makes it easier for patients to breathe until they are able to breathe completely on their own. It gives breath in various modes in order to maintain the level of Oxygen in the blood 15 July 2014 7Armando Darino Ngojo 8. RESPIRATORY SYSTEM DIVIDED INTO THREE PARTS 1.UPPER RESPIRATORY OR AIRWAY - NASAL CAVITY FUNCTIONS * TO CLEAN, WARM AND HUMIDIFY THE INHALED AIR - PHARYNX {THROAT} * CONTROLS THE FLOW OF FOOD/LIQUID AND AIR TO NASAL CAVITY 2.LOWER RESPIRATORY OR AIRWAY - THE LARYNX, THE TRACHEA AND THE BRONCHIAL TREE 3.LUNGS WHERE THE GAS EXCHANGE TAKES PLACE 15 July 2014 8Armando Darino Ngojo 9. 15 July 2014 Armando Darino Ngojo 9 Upper Respiratory tract Lower Respiratory tract Lungs THE RESPIRATORY TRACT 10. RESPIRATION Is A PROCESS of taking in OXYGEN and AIR and the ELIMINATION OF CO2 { CARBON DIOXIDE} through the LUNGS 15 July 2014 10Armando Darino Ngojo 11. 15 July 2014 Armando Darino Ngojo 11 12. BREATHING The frequency of breathing is based on the impulses in the respiratory center which is situated in the brain stem OR in other words, the partial pressure of CO2 in {Pa CO2} in the blood The higher PaCO2 gives low pH value of blood which effect respiratory center in the lung and stimulate breathing. 15 July 2014 12Armando Darino Ngojo 13. REGULATION OF BREATHING Also Tidal volume and frequency increases to remove excess CO2 from blood Other receptors which respond to low O2 cause an increase in tidal volume 15 July 2014 13Armando Darino Ngojo 14. 15 July 2014 Armando Darino Ngojo 14 PICTURE OF THE LUNGS 15. PARAMETERS USED IN THE VENTILATOR INSPIRATION EXPIRATION LUNG/TIDAL VOLUME BREATH RATE MINUTE VOLUME AIR WAY AIRWAY PRESSURE PEAK AIR WAY PRESSURE COMPLIANCE INSPIRATORY PEAK FLOW I:E RATIO INSPIRATORY TIME PAUSE TIME EXPIRATORY TIME 15 July 2014 15Armando Darino Ngojo 16. 15 July 2014 Armando Darino Ngojo 16 Ventilator Parameter Settings: 17. PARAMETERS USED IN VENTILATORS SENSITIVITY {TRIGGERING} FiO2, OXYGEN PERCENTAGE PEEP {POSITIVE END EXPIRATORY PRESSURE} SIGH BREATH 15 July 2014 17Armando Darino Ngojo 18. 15 July 2014 Armando Darino Ngojo 18 Ventilator Parameter Settings: 19. INSPIRATION Is an active movement The diaphragm moves downwards The outside air goes into lungs 15 July 2014 19Armando Darino Ngojo Cont Parameters 20. EXPIRATION Is a passive movement Return of the diaphragm to normal Air {more CO2} goes out from lung 15 July 2014 20Armando Darino Ngojo Cont Parameters 21. TIDAL VOLUME / LUNG VOLUME The Volume of air/O2 for one breath Unit ml 15 July 2014 21Armando Darino Ngojo Cont Parameters 22. BREATH RATE Number of breaths for one minute unit BPM 15 July 2014 22Armando Darino Ngojo Cont Parameters 23. MINUTE VOLUME Number of breaths in one minute multiplied by tidal volume Unit is in ml/min 15 July 2014 23Armando Darino Ngojo Cont Parameters 24. AIRWAY PRESSURE The pressure in the airway, i.e. In the tube Peak airway pressure is the maximum pressure during inspiration 15 July 2014 24Armando Darino Ngojo Cont Parameters 25. INSPIRATORY PEAK FLOW The maximum flow of air/O2 during inspiration 15 July 2014 25Armando Darino Ngojo Cont Parameters 26. I:E RATIO The ratio between inspiration and expiration 15 July 2014 26Armando Darino Ngojo Cont Parameters 27. SENSIVITY The amount of effort; cm of H20 to trigger the ventilator to get a breath by the patient 15 July 2014 27Armando Darino Ngojo Cont Parameters 28. % OF OXYGEN [O2] The oxygen concentration [FiO2 %] in the air during inspiration 15 July 2014 28Armando Darino Ngojo Cont Parameters 29. COMPLIANCE Measurement of the elasticity of the lungs and chest wall 15 July 2014 29Armando Darino Ngojo Cont Parameters 30. PEEP Positive End Expiratory Pressure I.e. the pressure maintained in the airway / lung even after the expiration 15 July 2014 30Armando Darino Ngojo Cont Parameters 31. Equipment checks are performed at regular intervals to ensure patient safety and delivery of the prescribed therapy. Both nurses and respiratory therapists can perform equipment checks. These are the lists of essential components to checks. Ventilator tubing is free of water Ventilator tubing is kink free Ventilator tubing free i.e. not pulling on ETT, not caught in side-rails Connections are secure 15 July 2014 Armando Darino Ngojo 31 Equipment Check 32. Verify that ventilator alarms are on and set appropriately for the patient. Monitor pressure readings [inspiratory force, peak inspiratory pressure (PIP) tidal volume, minute ventilation, airway pressure, respiratory rate (total patient and machine breaths) and FiO2]. Monitor effectiveness of ventilator changes (if any) associating them with the patients response 15 July 2014 Armando Darino Ngojo 32 Continuation: Equipment Check 33. BLOCK DIAGRAM OF VENTILATOR Gas/Air mixture Pressure regulator Flow sensor Inspiration pressure sensor Bacteria filter Airway filter Airway tubing Humidifier Water chamber Expiration flow sensor Expiration pressure sensor 15 July 2014 33Armando Darino Ngojo 34. 15 July 2014 Armando Darino Ngojo 34 35. VENTILATOR BLOCK DIAGRAM Gas mixture / Regulator Control valve Flow sensor pressure sensor Humidifier or HME filter Patient Exhalation Flow sensor Expiratory Pressure sensor Expiration Value Expired gas 15 July 2014 35Armando Darino Ngojo 36. Troubleshooting the Ventilator Anytime that the ventilator is malfunctioning and cannot be corrected immediately, manually ventilate the patient!! One person needs to manually ventilate the patient, while another troubleshoots the ventilator. The bag- valve-mask device must be readily available. 15 July 2014 Armando Darino Ngojo 36 37. The goal of the ventilator alarm system is to warn of events. The alarms are individualized for each patient. Events are categorized into mechanical/technical and patient generated events. They are categorized according to levels of priority. 15 July 2014 Armando Darino Ngojo 37 38. Level 1 Ventilator malfunction (life threatening) No gas delivery to patient Excessive gas delivery to patient Exhalation valve failure Loss of electric power 15 July 2014 Armando Darino Ngojo 38 39. Level 2 Ventilator malfunction (not immediately life threatening) Blender failure Loss of PEEP or excessive PEEP Autocycling 15 July 2014 Armando Darino Ngojo 39 Circuit leak Circuit partially occluded Inappropriate I:E ration Inappropriate heater/humidifier function 40. Level 3 Patient event affecting ventilator- patient interface Change in ventilatory drive (CNS, peripheral nerves or muscle function) Change in compliance/resistance (air trapping, barotrauma) Auto PEEP 15 July 2014 Armando Darino Ngojo 40 41. Level 4 Patient event not affecting ventilator- patient interface Change is gas exchange (Capnograph, oximeter, ) Change in respiratory system impedance Change in muscle function Change in cardiovascular function 15 July 2014 Armando Darino Ngojo 41 42. 15 July 2014 Armando Darino Ngojo 42 43. Summary Mechanical ventilation is a complex supportive therapy for patients with respiratory failure. Optimal outcomes for these patients are achieved through the skilled delivery of care by a multidisciplinary team. Essential components of care include management of the airway and ventilator, physical care, emotional support, pain and anxiety control, and prevention of complications. 15 July 2014 Armando Darino Ngojo 43 44. Questions!!! 15 July 2014 Armando Darino Ngojo 44 45. THANK YOU Special thanks to tutorvista.com for the respiration video. 15 July 2014 Armando Darino Ngojo 45