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Mechanical VentilatorPatient Monitoring
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Monitoring is important because pt.'s clinical condition may change rapidly and unpredictably ... Physiological data are useful in managing patients on ... – PowerPoint PPT presentation
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Title: Mechanical VentilatorPatient Monitoring
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Mechanical Ventilator/Patient Monitoring
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Introduction
- Monitoring is important because pt.s clinical
condition may change rapidly and unpredictably - Four reasons for monitoring continuously -
baseline measurements can be used to establish
initial treatment plan and as a reference for
future measurements - a trend can be established
to document the progress or regression of a
patient
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Intro. (cont.)
- Four reasons (cont.) - treatment plans can
be added, altered or discontinued according to
the measurements obtained - high-limit and
low-limit alarms can be set on most vents. to
safequard a patient
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Vital Signs
- During mech. vent. changes in vital signs often
indicate changes in the pt.s cardiopulmonary
status - T, P, R, BP
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Chest Inspection and Auscultation
- Chest movement should be symmetrical - may see
asymmetry with bronchial intubation,
atelectasis, pneumothorax - if dysynchronous
motion of chest and abdomen, pt. needs to be
evaluated for diaphragmatic fatique or
underlying pathology
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Chest Inspect. and Auscult. (cont.)
- Auscultation should be performed each vent. check
- Diminished or absent breath sounds - airway
obstruction - pl.effusion - atelectasis -
pneumothorax - main-stem intubation - Wheezes - airway narrowing
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Auscultation
- Inspiratory crackles - lung
consolidation - pulmonary edema - Rhonchi or coarse crackles - excessive
secretions - Cuff leak can be evaluated
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Fluid Balance
- Positive press. vent. reduces cardiac output and
renal perfusion, increases ADH - Oliguria - may see after bleeding,
diarrhea, renal failure, shock, drug poisoning,
deep coma, hypertrophy of prostate - normal
output is 50-60 ml/hr - below 20-30 ml/hr is
imbalance
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ABGs
- Essential monitoring tool for pt. on vent.
- PaCO2 monitors ventilatory status - prolonged
WOB may lead to resp. muscle fatigue and resp.
failure - Oxygenation status is assessed by - PaO2 - A-a
gradient (N. lt4/10yr. of age)
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O2 Saturation Monitoring by Pulse Oximetry
- Pulse Ox. is most frequent method used for
monitoring oxygenation (SpO2) - If the heart rate varies from that shown on the
pulse ox., need to question accuracy - Factors affecting accuracy of pulse ox. -
sunlight - nail polish - fluorescent -
dyshemoglobins -low perfusion
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End-Tidal CO2 Monitoring
- End tidal CO2 monitor is attached to end of E.T.
tube - Establishing a good correlation between PaCO2 and
PetCO2 can reduce of ABGs - P(a-et)CO2 gradient is usually 2 mmHg in normal
patients and 5 mmHg in critical patients is
normal - Disposable ETCO2 detectors
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ETCO2 Monitoring (cont.)
- Increase in P(a-et)CO2 can be caused by -
increased deadspace ventilation - changes in
mechanical volume and modality -
decreased C.O. - cardiac arrest - decreased
pulmonary perfusion - pulmonary embolism -
hyperthermia - hypothermia - 35-43 torr (4.6-5.6) is normal
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Transcutaneous Blood Gas Monitoring
- Involves placement of a miniature Clark and/or a
Severinghaus electrode on the skin via a
double-sided adhesive disk - In neonates PtcO2 closely approximates the PaO2,
in adults the PtcO2 measures lower than PaO2 due
to thicker skin - See good correlation with C.O., see fall in PtcO2
with a need for suctioning, E.T. tube misplaced,
pneumo., or other hypoxemia
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Transcutaneous Monitoring (cont.)
- Accuracy of PtcO2 electrode is affected by - skin
edema-hypothermia- capillary perfusion status - Is a better predictor of PaO2 when PaO2 is lt80
mmHg - When C.O. decreases, a disproportionate fall in
PtcO2 occurs
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Tanscutaneous Monitoring (cont.)
- PtcCO2 monitoring is done to provide a means of
cont. ventilatory assessment - Measured by heating skin to 44ºC (40-42 in
neonates) - Correlation between PaCO2 and PtcCO2 is good in
neonates as long as perfusion is good - PtcCO2 is usually higher than PaCO2
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Clinical Laboratory Data
- CBC (complete blood count)
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Clinical Lab Data (contd)
- Blood Chemistry Tests
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Chest Radiographs
- Portable A-P radiographs are used to
evaluate - ET tube placement 4 to 6
cm above carina is correct - proper
aeration - pathological changes such as
hyperinflation, atelectasis, consolidation,
pneumothorax, or pleural effusion
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Nutrition Monitoring
- Oxygen consumption and CO2 production are
affected by the intake and metabolism of
carbohydrates, proteins, and fats - RQ for CHO 1.0, Fat 0.7, Protein0.8
- Evaluation should be done by a clinical dietitian
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Physiological Monitoring
- Physiological data are useful in managing
patients on ventilatory support in respect to
oxygenation, ventilation, ventilatory mechanics,
and hemodynamics - Refer to Table 41.4, pg. 927 (Egans)
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