Ventilator Modes
AC (every breath supported), SIMV (set rate, patient breathes between), PSV (pressure support), CPAP. Settings: tidal volume 6-8 mL/kg, rate 10-12, FiO2 titrate to SpO2 >92%, PEEP 5 cmH2O.
Nursing Care
Assess breath sounds, SpO2, ABGs, settings, alarms. Prevent VAP: HOB 30-45°, oral care q4h with CHG, subglottic suctioning, daily sedation interruption, assess readiness to extubate daily.
Weaning
Readiness: stable, minimal secretions, awake, cough, FiO2 <=40%, PEEP <=5. SBT: minimal support 30-120 min. Monitor for failure: RR >35, SpO2 <90%, anxiety, diaphoresis. If successful, extubate.
Important Notes
- Ventilator alarms must be addressed immediately — potential disconnection or asynchrony.
- Always have a bag-valve-mask at bedside — ventilator failure requires immediate manual ventilation.
Clinical Tips
- Daily spontaneous breathing trials reduce ventilator days by 2-3 days on average.
- Elevate HOB 30-45° and oral care every 4 hours to prevent VAP.
Summary
Mechanical ventilation management requires monitoring settings/ABGs, VAP prevention bundle, daily weaning assessment, and emergency preparedness.
