Troubleshooting the Ventilator

Troubleshooting the Ventilator

1. Is the Patient haemodynamically unstable?

   • Yes - Disconnect and use BVM - can you BMV?
     • Yes - Circulation/ventilator problem
       • Causes of hypotension
         • Hypovolaemia
         • Drug Induced (e.g.Sedatives)
         • Raised intrathoracic pressure from dynamic hyperinflation
         • Tension Pneumothorax
     • No -
       • ETT problem
         • Manual Obstruction
           • Sputum plugging, kinking of ETT, Positioning of ETT, Patient biting
             • Suction ETT and reposition
         • Bronchospasm
       • Bronchospasm/Dynamic Hyperinflation
       • Pneumothorax

2. Is there sudden desaturation?

   • Assess the patient
     • Check rise and fall of chest
     • Auscultate for equal air entry
     • Check O2 sats
     • Check CXR/perform USS
     • Check connections
       • ETT Cuff & pressure
       • ETT Placement
       • Circuit to ETT
       • Circuit to ventilator
     • Causes of desaturation
       • Endobronchial intubation - check ETT position
       • Accidental extubation - check ETT position
       • Pneumothorax - decompress
       • Pulmonary Embolus
       • Shunting - e.g. ARDS, collapse, cardiac failure/APO
       • Ventilator malfunction
         • Circuit connection, O2 supply,
         • Ventilator flow connections
         • Kinking of circuit
         • Fluid in circuit
         • Fluid in filter

3. Is there high PIP alarms?

   • Check Pplat - Inspiratory hold gives estimate of Palveolar
     • Paw High, Pplat High
       • Reduced Lung Complicance
         • Endobronchial Intubation - check position
         • Sputum plugging - suction tube
         • Chest wall stiffness - paralyse
         • Abdominal distension - NGT
         • Pneumothorax - CXR/USS & decompress
         • Collapse/Consolidation/Oedema -> Increase PEEP, small Vt
       • Patient/Ventilator dysynchonry
         • Assess, treat these and paralyse
         • Mode - SIMV if not paralysed
         • Gas Trapping - dynamic hyperinflation
         • Pain
         • Under sedation/Pt coughing
         • Other causes
           • Cardiac ischaemia
           • Abdominal distension
           • Neurological deterioration (chest wall/diaphram)
     • Paw High, Pplat Low/Normal
       • Anaphylaxis
       • Kinked ETT
       • Mucous plugging
       • Bronchospasm/Dynamic Hyperinflation
         • Reduce RR
         • Reduce I:E time
         • Increase Inspiratory flow
         • Sedate adequately
         • Treat bronchospasm
         • Disconnect the ventilator