Endotracheal Intubation and Mechanical Ventilation Endotracheal Intubation • Components of the endotracheal tube • Preparation for intubation • Verifying tube placement • Stabilizing the tube • Nursing care Mechanical Ventilation • Types of ventilators: – Negative-pressure ventilators – Positive-pressure ventilators • Pressure-cycled ventilators • Time-cycled ventilators • Volume cycled • Microprocessor ventilators Modes of Ventilation • The ways in which the client receives breath from the ventilator include: – Assist-control ventilation (AC) – Synchronized intermittent mandatory ventilation (SIMV) – Bi-level positive airway pressure (BiPAP) and others Ventilator Controls and Settings • Tidal volume • Rate: breaths per minute • Fraction of inspired oxygen • Sighs • Peak airway (inspiratory) pressure • Continuous positive airway pressure • Positive end-expiratory pressure Mechanical Ventilation with PEEP • Sedation • Neuromuscular blocking agents • Reassure patient that paralysis is temporary • Closely monitor Nursing Management • First concern is for the client; second for the ventilator. • Monitor and evaluate response to the ventilator. • Manage the ventilator system safely. • Prevent complications. Complications • Complications can include: – Lung – Cardiac – Gastrointestinal and nutritional • Infection • Muscular complications • Ventilator dependence Weaning • Methods: – Conventional – Intermittent Mandatory Ventilation (IMV) How will you know that weaning is successful and the ETT can be removed?
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