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Troubleshooting Problems During Ventilatory Support

The document provides a comprehensive guide for troubleshooting issues encountered during mechanical ventilatory support, emphasizing the importance of alarm settings and patient safety. It outlines steps to take when a patient is in distress, including checking for airway obstruction and assessing ventilator alarms for low tidal volume, high airway pressure, and low oxygen pressure. The guide also details potential causes and solutions for various alarm conditions to ensure effective patient management during ventilation.

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Mahmoud Ashraf
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2 views18 pages

Troubleshooting Problems During Ventilatory Support

The document provides a comprehensive guide for troubleshooting issues encountered during mechanical ventilatory support, emphasizing the importance of alarm settings and patient safety. It outlines steps to take when a patient is in distress, including checking for airway obstruction and assessing ventilator alarms for low tidal volume, high airway pressure, and low oxygen pressure. The guide also details potential causes and solutions for various alarm conditions to ensure effective patient management during ventilation.

Uploaded by

Mahmoud Ashraf
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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TROUBLESHOOTING PROBLEMS DURING

VENTILATORY SUPPORT

MR. SHEBIN LATHEEF C

SENIOR RESPIRATORY THERAPIST


PRS HOSPITAL, TRIVANDRUM
Mechanical ventilator alarms are used to warn of changes in patient or ventilator status.
All alarms should be set according to the patient’s condition and the manufacturer’s
instructions for the device. For patient safety, alarms should never be disabled.
PATIENT IN DISTRESS / COMPROMISE ON VENTILATOR

Disconnect and bag the patient with 100% oxygen

1. Relief 2. No relief

Machine problem
2. No relief with bag ventilation

Is the airway obstructed ?


Difficult to inflate
Unable to advance suction catheter

Yes No
Go to 3
Tube kinking - Correct head position
Tube biting - Insert bite block / Consider muscle relaxant
Mucus plug - Suction the patient

If unable to relieve obstruction – change the tube


(with appropriate sedation, paralysis, skills and equipment)
3. No significant airway obstruction

Ausultate chest
5- point over axilla, chest and epigastrium

Air entry reduced on one side Air entry over epigastrium

Check tube tie level


Get quick history of recent tube manipulation/re-tie
Laryngoscopy / change tube if needed
Tube in bronchus ?
Check tube marking
Chest X-ray

Percussion
Percussion

Tympanic
Dull

Stable patient Unstable patient


Lung collapse

Suction
Bronchoscopy ?
Chest x –ray Needle thoracotomy
possible

Pneumothorax confirmed Effusion


Intercostal drainage tube
(Needle thoracotomy/ ICD)
tapping

Post procedure
Chest x –ray
PATIENT IS NOT IN DISTRESS ON THE VENTILATOR

1. LOW TIDAL VOLUME ALARM

Low tidal volume alarm

Check for airway pressure

Low airway pressure High airway pressure


Low airway pressure

Indicates leak within the system

Disconnect patient from ventilator and ventilate


bag with 100% oxygen

Minimum resistance to bag ventilation Normal resistance to bag ventilation


Neck auscultation reveals leak
Hand placed over mouth confirms leak

Look for leak in ventilator circuits


This indicates major “LEAK’ in ET tube Check tidal volume settings
(cuff leak)
2. HIGH AIRWAY PRESSURE ALARM (In volume control mode)

• Intermittent rise in peak airway pressure may be due to carinal stimulation, secretions in tube or
high cuff pressure

• Persistent rise in peak airway pressure indicates problem with the lung compliance or airway
resistance

Persistent rise in peak airway pressure ( Paw)

Check plateau pressure (P plt)

Normal
High

• Normal lung compliance


• Decrease lung compliance
• Increase airway resistance
• Normal airway resistance
Peak Pressure
Increased Airway Resistance

Decreased compliance
Plateau Pressure

Peak Pressure

Plateau Pressure
Pressure

0
Time
PIP vs Pplat

Normal
PIP High Raw
PIP
Paw (cm H2O)

PPlat PPlat

Low Compliance
PIP PIP
High Flow
PPlat

PPlat

Time (sec)
Normal plateau pressure High plateau pressure
= =
Increased airway resistance Decreased lung compliance

• Kink in the ventilatory circuit


• Pneumothorax
• kink in the tube
• Atlectasis/collapse
• Water in the tube
• ET in main stem bronchus
• Clogging of filter
• ARDS
• Bitting the tube
• Consolidation
• Herniation of cuff
• LVF
• Bronchospasm
3. HIGH EXHALED TIDAL VOLUME or MINUTE VOLUME ALARM

Causes;
• Increased respiratory rate

(Anxiety, pain, hypoxia, metabolic acidosis, neurogenic hyperventilation, improvement in lung


function)

• Inappropriate or in compatible ventilator setting


( too high tidal volume/ minute ventilation respiratory rate or alarm parameters not set appropriate for
prescribed setting VT/VE)

• Ventilator “ auto-cycling” because of incorrectly set trigger sensitivity

• Excessive noise
- water in the tubing
4. LOW OXYGEN PRESSURE ALARM

The low oxygen alarm warns of inadequate pressure in oxygen line suppling the ventilator

Causes;

• Loss of O2 source

• Loss of adequate pressure in O2 source

• Accidental disconnection of O2 line


5. LOW AIR PRESSURE ALARM

• Low air pressure alar warns of inadequate pressure in the compressed air supply line to ventilator.
• If the source is lost most ventilator will provide 100% O2 in an attempt to maintain adequate flow of
gas to the patient
6. FiO2 alarm

Set above and below prescribed fio2.


Alarm will sound if delivered fio2 deviates from prescribed setting’

• If set fio2 inadvertently changed

• Intentional change in fio2 before suction

• O2 anlayzer error

• O2 sorce failure
REFERENCE

• ACKNOWLEDGEMENT :

Modified from the basic ventilator workshop workbook ;

ISCCM , pune branch; s. Prayag, s.Dixit, s.Kantak( editors) : 2005

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