Trouble Shooting (Mechanical Ventilation)

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Trouble Shooting (Mechanical Ventilation)

• Arthur Sadhanandham
• Medical ICU, CMC.

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• WHEN NOAH BUILT THE ARK
• IT WAS NOT RAINING

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Precautions that would reduce troubles

• I. Power
• Plug into a grounded AC power with
  correct voltage receptacle.
• Secure the power cord properly.
• Battery Back up
• Check the battery level before connecting.
• Charging should be carried out regularly.
• Remember it is for short term use.

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II. Gas Source

• Preferable to have centralised supply.
• If cylinders used, should be full
• Spare cylinders should be available.
• Gas hoses should be in good condition.
• Hoses not contaminated with grease or oil
  (combustible)
• Availability of compressors should be ensured.
• Gases should remain dry and clean.

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III. Personnel

• Properly trained personnel should only use.
• Familiarising staff with operators manuel before
  using on a patient.
• (One manufacturers manual may not exactly match
  with other brands).
• Appropriate monitoring the functioning state of
  the ventilator while in use.

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Contd

• Familiarizing staff with alarm system.
• Do not place ventilators in a combustible or
  explosive environment.
• Do not use with flammable anaesthetic agents such
  as nitrous oxide and ether.

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IV Servicing and Testing

• Qualified personnel should undertake servicing.
• Ventilator housing should not be opened while it
  is still connected with power.
• Follow the specifications mentioned in the
  service manual.
• Use replacement parts supplied by the
  manufacturer only.

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Contd.

• General servicing at regular intervals should be
  done.
• Run the prescribed tests and calibrations before
  using the ventilator on a patient.
• Ensure that the ventilators pass all the tests
  before putting them in to clinical use.

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ALARMS

• All ventilators are equipped with visual and
  audible alarms which notify the user problems.

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Points to remember

• Never ignore an alarm.
• Never mute the alarm on regular basis.
• Find out for yourself what alarm is on.
• Check the patient.
• Silence the alarm.

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Act Swiftly

• Depending upon the patients status and nature of
  the alarm, act appropriately.
• This includes disconnecting the ventilator and
  connecting another means of ventilation to
  patient Bains/ Ambu.

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Do not forget

• The use of an alarm monitoring system does not
  give absolute assurance of warning for every form
  of trouble that may occur with the ventilator.

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Do not be like this !
But hear the alarm and respond See the problem
and Ask if you do not know what to do
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Common Troubles and Shooting

• Ensure Alarm knobs / switches are turned on and
  functional.

Alarm Cause Shooting
Apnoea No breath was delivered for the operator set apnoea time in spont, SIMV, AC, CMV NIV modes Because spontaneous Ventilation is too high or patient effort is too minimal Trigger level set improperly. Check the patient- Arouse if needed Activate back up facility if it was not done already. Consider switching over to any mandatory mode Or go up on rate Set trigger level appropriately
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Low SpO2 Air / O2 Blender continuous alarm Delivery of O2 FiO2, PEEP High resistance due to various clinical reasons Supply pressures are inadequate. Disconnect patient from ventilator Manually bag with Bains and Ambu. Insert the gas hose fittings (air O2) correctly into the wall outlets. Ensure wall outlets has adequate pressure
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Low pressure or Low min.Vent Or Low exhaled volume or Disconnection The measured PIP is lesser than the set minimum level because of cuff leak. Leak in the circuit Connections may be loose ET tube displacement Disconnection Inadequate flow Evaluate cuff pressure at regular intervals. Reinflate if leak / ruptured is noticed change ET tube. Check circuits, junctions- tighten or replace. Check water traps Check ET tube placement. Position it properly. Reconnect ventilator. Patient may require higher flow.


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High Pressure Alarm The measured peak inspiratory pressure is great than set level because of ?Secretions in airway Partial block (ETt) Kinking of tube Biting the tube Water in the tube Cuff herniation Deep Rt. sided intubation Fighting the ventilator Suctioning, Irrigation Release tubings Bite block insertion Empty the tubings and water traps Deflate reinflate cuff 3-4 times Reposition the ET tube Reposition the patient Re assurance Sedation medication (pain)
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High pressure alarm Cough Increased airway resistance or decreased compliance because of Bronchospasm Atelectasis Fluid overload Pneumothorax Medication Bronchodilators Adjust the settings VT ? Rate Adjust the settings VT ? Rate, ? PEEP (Peak pressure to be monitored) Immediate intervention
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Auto Cycling High Tidal Volume Leak Improper trigger setting Patient trying to take more volume of air Secure all tubings tight Set proper trigger level Increase flow rate or Increase tidal volume
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Trouble shooting!
THANK YOU FOR YOUR PATIENT HEARING. . . . .