Mechanical ventilation is a life-saving intervention used in critical care settings to support patients with respiratory failure or insufficient breathing. At SHIFAA PAN African Hospitals, our dedicated Intensive Care Unit (ICU) teams and Respiratory Therapists employ advanced mechanical ventilation techniques and personalized care to optimize respiratory function and improve patient outcomes.

Overview of Mechanical Ventilation:

Indications for Mechanical Ventilation:

• Respiratory Failure: Including acute respiratory distress syndrome (ARDS), pneumonia, COPD exacerbation, and post-operative respiratory insufficiency.
• Neuromuscular Disorders: Such as Guillain-Barré syndrome, myasthenia gravis, and spinal cord injuries affecting respiratory muscle function.
• Airway Protection: In cases of coma, drug overdose, or neurological impairment impairing protective airway reflexes.

Types of Mechanical Ventilation:

• Invasive Ventilation: Utilizing an endotracheal tube or tracheostomy for direct airway access, commonly used in acute respiratory failure or surgery.
• Non-Invasive Ventilation (NIV): Including Continuous Positive Airway Pressure (CPAP) or Bi-level Positive Airway Pressure (BiPAP) masks, suitable for selected patients with milder respiratory support needs or obstructive sleep apnea.

Mechanical Ventilation Process:

Patient Assessment and Monitoring:

• Comprehensive assessment of respiratory status, oxygenation levels, lung mechanics, and underlying conditions guides ventilator settings and therapy decisions.
• Continuous monitoring of vital signs, arterial blood gases (ABGs), ventilator parameters, and sedation levels ensures optimal ventilatory support and patient comfort.

Ventilator Settings and Modes:

• Ventilator Parameters: Including tidal volume, respiratory rate, inspiratory and expiratory pressures, FiO2 (fraction of inspired oxygen), and positive end-expiratory pressure (PEEP) tailored to individual patient needs.
• Ventilation Modes: Such as Assist-Control (AC), Pressure Support (PS), Synchronized Intermittent Mandatory Ventilation (SIMV), and Adaptive Support Ventilation (ASV) based on respiratory mechanics and patient-ventilator synchrony.

Key Points on Mechanical Ventilation:

Ventilator Management and Optimization:

• Regular assessment and adjustments of ventilator settings, oxygenation strategies, and sedation levels to maintain adequate oxygenation, ventilation, and lung protection.
• Lung-protective ventilation strategies, including low tidal volumes, appropriate PEEP, and permissive hypercapnia, reduce ventilator-associated lung injury (VALI).

Complications and Monitoring:

• Potential complications such as ventilator-associated pneumonia (VAP), barotrauma, oxygen toxicity, and ventilator-induced lung injury (VILI) necessitate diligent monitoring, infection control measures, and early detection of complications.
• Multidisciplinary team collaboration involving intensivists, respiratory therapists, nurses, and pharmacists ensures comprehensive care and timely interventions.

Post-ventilation Care and Liberation:

Weaning and Extubation:

• Gradual reduction of ventilator support (weaning) based on clinical parameters, spontaneous breathing trials (SBT), and readiness assessments.
• Successful weaning criteria include adequate oxygenation, stable respiratory mechanics, minimal ventilator support, and patient cooperation.

Rehabilitation and Follow-up:

• Post-ventilation rehabilitation programs, chest physiotherapy, early mobilization, and respiratory exercises promote lung recovery and prevent complications like muscle weakness and deconditioning.
• Long-term follow-up and respiratory care plans address post-ICU sequelae, pulmonary rehabilitation, and optimizing respiratory function for enhanced quality of life.

 

What is Mechanical Ventilation, and when is it used?

Mechanical ventilation is a supportive therapy used in respiratory failure, neuromuscular disorders, and airway protection to assist or control breathing in critically ill patients.

 

What are the types of Mechanical Ventilation, and how do they differ?

Invasive ventilation uses an endotracheal tube or tracheostomy, while non-invasive ventilation (NIV) delivers support through masks, providing varying levels of respiratory assistance.

 

How are ventilator settings and modes determined for patients on Mechanical Ventilation?

Ventilator parameters and modes are tailored to individual patient needs, respiratory mechanics, oxygenation requirements, and the underlying cause of respiratory failure.

 

What are the potential complications of Mechanical Ventilation, and how are they managed?

Complications may include VAP, barotrauma, oxygen toxicity, and VILI. Close monitoring, infection control measures, lung-protective strategies, and multidisciplinary care help manage and prevent complications.

 

What is the process of weaning from Mechanical Ventilation, and when is extubation considered?

Weaning involves gradual reduction of ventilator support based on clinical criteria and SBTs. Extubation is considered when patients demonstrate stable respiratory function, minimal ventilator support needs, and readiness for spontaneous breathing.

 

Are there alternatives to invasive Mechanical Ventilation?

Non-invasive ventilation (NIV) methods like CPAP and BiPAP offer respiratory support without invasive intubation, suitable for selected patients with certain respiratory conditions or during weaning phases.

 

What post-ventilation care and rehabilitation are necessary for patients?

Post-ventilation care includes rehabilitation programs, chest physiotherapy, early mobilization, and respiratory exercises to prevent complications, promote lung recovery, and optimize long-term respiratory function.