Ventilation:

Basic Principles
Jamie Ranse
Registered Nurse
Emergency Department
The Canberra Hospital

Overview

Introduction to Ventilation Principles

Respiratory Anatomy and Physiology
Indications for Ventilation
Modes of Ventilation
Patient Management
Complications
Questions

Introduction
Ventilation is the movement of air into and
out of the alveoli.

Hudak, et al, 1997, Critical Care Nursing: A Holistic Approach (7th Edn), Lippincott, Philadelphia, USA

Introduction
Mechanics of Ventilation:
Elasticity
Compliance
Resistance
Pressure
Gravity

Hudak, et al, 1997, Critical Care Nursing: A Holistic Approach (7th Edn), Lippincott, Philadelphia, USA

Anatomy and Physiology

Respiratory Structures
Respiratory Zones
Partitioning of Respiratory Pressures
Boyles Law
Respiratory Volumes and Capacity
Ventilation and Perfusion

Anatomy and Physiology

Respiratory Structures

Porth CM, 1998, Pathophysiology (5th Edn), Lippincott, Philadelphia, USA

Anatomy and Physiology

Respiratory Zones

Porth CM, 1998, Pathophysiology (5th Edn), Lippincott, Philadelphia, USA

Anatomy and Physiology

Partitioning of Respiratory Pressures

Porth CM, 1998, Pathophysiology (5th Edn), Lippincott, Philadelphia, USA

Anatomy and Physiology

Boyles Law
Increase V =
Decreased P
Decreased V =
Increased P

Porth CM, 1998, Pathophysiology (5th Edn), Lippincott, Philadelphia, USA

Anatomy and Physiology

Boyles Law
Air flows from a region of higher pressure
to a region of lower pressure.
To initiate a breath, airflow into the lungs
must be precipitated by a drop in alveolar
pressures.

Porth CM, 1998, Pathophysiology (5th Edn), Lippincott, Philadelphia, USA

Anatomy and Physiology

Respiratory Volumes and Capacity

Porth CM, 1998, Pathophysiology (5th Edn), Lippincott, Philadelphia, USA

Anatomy and Physiology

perfusion without
ventilation = shunt

normal ventilation
and perfusion

Porth CM, 1998, Pathophysiology (5th Edn), Lippincott, Philadelphia, USA

airway

Ventilation
and
Perfusion

venous blood

arterial blood

ventilation without
perfusion = dead space

Indications for Ventilation

Airway Compromise (potential)
Respiratory Failure
pH: <7.25
PaCO2: >50 mmHg
PaO2: <50 mmHg

Increased Work of Breathing

Head Injury Management

Hudak, et al, 1997, Critical Care Nursing: A Holistic Approach (7th Edn), Lippincott, Philadelphia, USA

Objective of Ventilation

Support though illness

Reversal of hypoxemia
Reversal of acute respiratory acidosis
Relief of respiratory distress
Resting of the ventilatory muscles
Decrease in oxygen consumption
Reduction in intracranial pressures
Stabilisation of the chest wall

Hudak, et al, 1997, Critical Care Nursing: A Holistic Approach (7th Edn), Lippincott, Philadelphia, USA

Modes of Ventilation
freq
Vt
MV
I:E ratio
Trigger
Ramp

Pmax
Paw
fspn
MVspn

PEEP

Diepenbrock NH, 1999, Quick Reference to Critical Care, Lippincott, Philadelphia, USA: P166.

Modes of Ventilation
Controlled
Pressure Control (PC)
Volume Control (VC)

Supported
Continuous Positive Airway Pressure (CPAP)
Pressure Support (PS)

Combined
SIMV (PC) + PS
SIMV (VC) + PS
Diepenbrock NH, 1999, Quick Reference to Critical Care, Lippincott, Philadelphia, USA: P166.

Modes of Ventilation:
Control
Controlled Mechanical Ventilation:
The Minute Volume is determined by the
ventilator
The patient has no option to override the
ventilator

Modes of Ventilation:
Control
Pressure Control:
A preset peak inspiratory pressure is
delivered to the patient at a preset
respiratory rate
Volume is not preset and is determined by
the mechanics of ventilation.
(elasticity, compliance, resistance, pressure,
gravity)

Modes of Ventilation:
Control
Volume Control:
A preset tidal volume is delivered at a
present respiratory rate
7 10 mls/kg
50kg = 350 500mls
70kg = 490 700mls
90kg = 630 900mls

Modes of Ventilation:
Support
Continuous Positive Airway Pressure:
A spontaneous breathing mode, where the
patient generates their own breath
The ventilator maintains a constant
positive pressure on expiration (PEEP)
Aims to increase Functional Residual
Capacity

Modes of Ventilation:
Support
Pressure Support:
A spontaneous breathing mode
Need for additional support to achieve
optimal tidal volumes
Ventilator delivers a constant preset
pressure on inspiration
CPAP + PS = BiPAP

Modes of Ventilation:
Combined
Synchronised Intermitted Mandatory
Ventilation:
Similar to IMV
If the patient initiates a breath and the
ventilator synchronises so the ventilator
doesnt deliver a breath at the same time

Modes of Ventilation:
Combined
SIMV (PC) + PS:
Pressure controlled ventilation with
pressure support on spontaneous breaths
SIMV (VC) + PS:
Volume controlled ventilation with
pressure support on spontaneous breaths

SIMV (VC)
+ PS
Freq: 10
Vt: 500
(MV = 5.0)
PEEP: 5
PS: 10

Patient Management
Monitoring
Suctioning
Other
Sedation
Positioning
Oral and Eye Care

Patient Management:
Monitoring

ECG
SpO2
ETCO2
Alarm limits
Air Entry / Work of Breathing
Ventilator observations and alarm limits
Full assessment

Patient Management:
Suctioning
PRN
Increasing airway pressures
Decreasing SpO2
Increased work of breathing

Pre-oxygenate (100% oxygen)

Less than 15 Seconds

Patient Management:
Other
Sedation
Propofol, Morphine and Midazolam

Positioning
2/24

Oral and eye care

2/24

Complications
Airway
Aspiration, decreased clearance of secretions,
predisposition to infection

Endotracheal Tube
Tube kinking, sputum plug, right main bronchus
intubation, tube migration, cuff failure, laryngeal
oedema

Mechanical
Ventilator malfunction, hypoventilation,
hyperventilation, barotrauma, pneumothorax

Questions

Ventilation:
Basic Principles
Jamie Ranse
Registered Nurse
Emergency Department
The Canberra Hospital