How to nurse the intensive care unit ventilator patient

01 March 2013

9 mins read

02 March 2013

Volume 4 · Issue 2

ISSN (print): 2044-0065

ISSN (online): 2052-2959

Abstract

Mechanical ventilators are an integral part of any intensive care unit. There are a variety of patients that may benefit from mechanical ventilation such as patients that are hypoxaemic (Pa0₂ <60mmHg) in spite of oxygen therapy, hypercapnic (PaC0₂>60mmHg) or at risk of impending respiratory failure. Mechanical ventilation is expensive and requires a dedicated nurse to care for the patient. This nurse must have an understanding of respiratory physiology, principles of mechanical ventilation, terminology, setting up the ventilator, troubleshooting problems, providing nursing care to meet the individual patient requirements and recognising signs of complications. Such cases require thorough clinical records and communication between staff members. They are labour intensive cases but can be extremely rewarding to nurse.

There are a variety of circumstances in which a decision may be made to ventilate a patient. These reasons generally fall into four categories (Clare and Hopper, 2005a).

Hypoxaemia is defined as a PaO2 (partial pressure of oxygen in arterial blood) <80 mmHg. A PaO2 of <60 mmHg indicates severe hypoxaemia and the necessity to act immediately. The most common causes of hypoxaemia are hypoventilation, severe ventilation perfusion mismatch and more rarely diffusion impairment.

Hypercapnia is defined as a PaO2 >60 mmHg. Elevated partial pressure of carbon dioxide in arterial blood (PaCO2) causes respiratory acidosis which may lead to acidaemia, an increased level of hydrogen ions within the blood. The most common cause of hypercapnia is hypoventilation.

Impending respiratory failure due to pulmonary or non-pulmonary diseases. Increases in respiratory effort lead to an increase in oxygen demand further exacerbating hypoxaemia. Animals can quickly become fatigued causing hypoventilation and hypercapnia.

Increased intracranial pressure (ICP). Increases in PaCO2 can trigger cerebral vasodilation resulting in an increased blood flow to the brain, therefore worsening ICP. Such patients may be ventilated in order to maintain a lower PaCO2.

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