Troubleshooting the Ventilator

Is the Patient haemodynamically unstable?
1. Yes - Disconnect and use BVM - can you BMV?
  1. Yes - Circulation/ventilator problem
    1. Causes of hypotension
      1. Hypovolaemia
      2. Drug Induced (e.g.Sedatives)
      3. Raised intrathoracic pressure from dynamic hyperinflation
      4. Tension Pneumothorax
  2. No -
    1. ETT problem
      1. Manual Obstruction
        Sputum plugging, kinking of ETT, Positioning of ETT, Patient biting
        Suction ETT and reposition
      2. Bronchospasm
    2. Bronchospasm/Dynamic Hyperinflation
    3. Pneumothorax
Is there sudden desaturation?
1. Assess the patient
  1. Check rise and fall of chest
  2. Auscultate for equal air entry
  3. Check O2 sats
  4. Check CXR/perform USS
  5. Check connections
    1. ETT Cuff & pressure
    2. ETT Placement
    3. Circuit to ETT
    4. Circuit to ventilator
  6. Causes of desaturation
    1. Endobronchial intubation - check ETT position
    2. Accidental extubation - check ETT position
    3. Pneumothorax - decompress
    4. Pulmonary Embolus
    5. Shunting - e.g. ARDS, collapse, cardiac failure/APO
    6. Ventilator malfunction
      1. Circuit connection, O2 supply,
      2. Ventilator flow connections
      3. Kinking of circuit
      4. Fluid in circuit
      5. Fluid in filter
Is there high PIP alarms?
1. Check Pplat - Inspiratory hold gives estimate of Palveolar
  1. Paw High, Pplat High
    1. Reduced Lung Complicance
      1. Endobronchial Intubation - check position
      2. Sputum plugging - suction tube
      3. Chest wall stiffness - paralyse
      4. Abdominal distension - NGT
      5. Pneumothorax - CXR/USS & decompress
      6. Collapse/Consolidation/Oedema -> Increase PEEP, small Vt
    2. Patient/Ventilator dysynchonry
      Annotations:
      - Assess, treat these and paralyse
      1. Mode - SIMV if not paralysed
      2. Gas Trapping - dynamic hyperinflation
      3. Pain
      4. Under sedation/Pt coughing
      5. Other causes
        Cardiac ischaemia
        Abdominal distension
        Neurological deterioration (chest wall/diaphram)
  2. Paw High, Pplat Low/Normal
    1. Anaphylaxis
    2. Kinked ETT
    3. Mucous plugging
    4. Bronchospasm/Dynamic Hyperinflation
      1. Reduce RR
      2. Reduce I:E time
      3. Increase Inspiratory flow
      4. Sedate adequately
      5. Treat bronchospasm
      6. Disconnect the ventilator

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Troubleshooting the Ventilator

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	Created by Kesh K about 9 years ago