Introduction
Many patients in the course of their care require a period of mechanical ventilator support. The specific reasons that patients require mechanical ventilator support vary widely but the need for this kind of support is primarily due to failure of the patient’s respiratory system to ventilate or exchange gases. While daily maintenance of the patient’s mechanical ventilator is one of the primary jobs of the respiratory therapist in patient care, the therapist is also responsible for the weaning and discontinuing of the ventilatory support system for patients.
The ventilator discontinuance process is one of the most important components of overall management of ventilator patients. In these cases, the clinician must balance between the patient’s capabilities and the patient’s demands. When the demands of the patient outweigh the capabilities of the patient, mechanical ventilation needs to be sustained and when the capabilities of the patient outweigh the demands of the patient, discontinuation of mechanical ventilation is possible. The role of the respiratory therapist in this decision to discontinue ventilator support is very important as many complications can be incurred if the patient is removed from ventilator support before the patient is ready or if the patient is left on the ventilator longer than necessary. These complications, along with the guidelines for ventilator discontinuance and protocol, will be discussed in this paper.
Complications
“As the conditions that warranted placing the patient on the ventilator stabilize and begin to resolve, attention should be placed on removing the ventilator as quickly as possible.” (MacIntyre, 375-396) This statement is true because the rate of complication...
... middle of paper ...
...specializing in the care of permanently ventilator dependent patients. The last recommendation says that these long-term ventilator dependent patients should still try to be weaned at a slow paced and gradually lengthening self-breathing trials.
Conclusions
In conclusion, the ventilator discontinuance process involves careful consideration, clinical assessments, and decisions by all members of the medical staff. When ventilator discontinuance is not executed at the optimal time for the patient many complications can occur. In order to decrease the incurrence of these complications medical professionals should follow the guidelines stated above. This will be clinically significant to me personally as a respiratory therapist because I will be responsible for at least part of the ventilator discontinuance process for my patients on mechanical ventilator support
Many interventions are already in place to improve patient outcomes while on a ventilator. For example, elevating the head of the bed to 30 degrees, preventing venous thrombus via sequential compression devices or anticoagulant drugs, initiating early mobilization and practicing good hand hygiene were among the interventions listed by Fields, L.B., 2008. However, oral care was n...
Additionally, the clinical staff has shown very low level of confidence in the RR documentation on observation chart. Lack of time, laziness, lack of training and knowledge and unawareness of the importance of the respiratory assessment are main reasons to neglect this important aspect of nursing as stated in this study (Philip, Richardson, & Cohen,
Introduction BiPAP is a form of noninvasive mechanical ventilation used in patients with acute respiratory failure. Many of these patients go on noninvasive ventilation due to COPD exacerbations that are infectious, with congestive heart failure, and ventilator parameters based on their clinical assessment and changes in arterial blood gases. Two different studies were conducted on COPD patients, using a BiPAP machine to improve exacerbations and their activities of daily living. There are many positive outcomes for using these noninvasive ventilators, however when used incorrectly, negative outcomes or no changes at all are always possible. Positive Use for COPD Exacerbations
Recognition, response and treatment of deteriorating patients are essential elements of improving patient outcomes and reducing unanticipated inpatient hospital deaths (Fuhrmann et al 2009; Mitchell et al 2010) appropriate management of the deteriorating patient is often insufficient when not managed in a timely fashion (Fuhrmann et al 2009; Naeem et al 2005; Goldhill 2001). Detection of these clinical changes, coupled with early accurate intervention may avoid adverse outcomes, including cardiac arrest and deaths (Subbe et al. 2003).
Fluid volume overload within the intervascular space can cause shortness of breath, fluid within the lungs, engorged neck veins, increased blood pressure and heart rate with a bounding pulse. As blood volume increases so will blood pressure and heart rate. Impaired gas exchange related to pulmonary congestion causes crackles within the lung fields. If oxygen saturation is low the nurse should supply supplemental oxygen. The nurse would raise head of the bed at least thirty degrees or higher to promote breathing and reduce cardiac pressure. Having the patient cough and breath deep can pop open alveoli to clear lung passages. Once the patient is comfortable and in safe position the nurse can call the doctor. The nurse should anticipate another dose of diuretics, such as furosemide. This treatment will decrease respiratory rate and blood pressure by reducing the amount of sodium and fluid within the body. Breath sounds will improve as crackles decrease. Maintaining appropriate fluid volume stabilizes blood pressure, cellular metabolism and proper nutrition gained or wastes lost. Supplemental oxygen if oxygen saturation is low and the nurse has already supplied the patient with oxygen. (Ignatavicius & Workman,
HENDERSON, Y (1998) A practical approach to breathing control in primary care. Nursing Standard (JULY) 22 (44) p41
The most important elements of the guidelines are organized into two “bundles” of care (Angus, 2013). The first “bundle” is for within the first 3 hours sepsis is suspected. The first thing you would do is measure the lactate level. The second thing is obtaining blood cultures prior to administration of prescribed antibiotics. You administer broad spectrum antibiotics in patients with septic shock. The risk of dying increases by approximately 10% for every hour of delay in receiving antibiotics. The last thing you would do for the 3 hr “bundle” is fluid resuscitation: administer 30 mL/kg crystalloid for hypotension or lactate ≥ 4mmol/L (Subtle Signs of Sepsis, 2017). The second “bundle” is for within the first 6 hours sepsis is suspected. The nurse would do the same protocol for suspected sepsis within 3 hours and continue for more advanced treatment. The next thing you would do is administer vasopressors (for hypotension that does not respond to initial fluid resuscitation) to maintain a MAP ≥ 65 mmHg. For persistent arterial hypotension despite volume resuscitation (septic shock) or initial lactate ≥ 4 mmol/L (36 mg/dL), reassess volume status and tissue perfusion and document findings. After initial fluid resuscitation, repeat focused exam, including pulse, capillary refills, vital signs, cardiopulmonary assessment, and skin (Subtle Signs of Sepsis,
Turnock, C. (1994). Technology in Critical Care Nursing. In B. Millar, and P. Burnard. (Eds.) (1994). Critical Care Nursing. Caring for the Critically Ill Adult. London: Baillière Tindall.
Medical technology today has achieved remarkable feats in prolonging the lives of human beings. Respirators can support a patient's failin...
There are many responsibilities in being a Respiratory Therapist. Which include, performing diagnostic and therapeutic procedures. Diagnostic procedures are the arterial blood gas analysis, pulmonary function studies, sleep studies, and more. Therapeutic procedures a...
A do not resuscitate order for patients who have emergency surgery is an “independent risk factor for poor surgical outcome and postoperative mortality” (Kelley , 2014 pg 1 para 3) and the probability of returning patients to their previous level of functioning is higher for CPR performed during the peri-operative period (Kelley , 2014).
Hess Dean R., M. N. (2012). Respiratory Care: Principles and Practice 12th Edition. Sudbury, MA: Jones and Bartlett Learning.
Hinkle, Janice, and Kerry Cheever. “Management of Patients with Chronic Pulmonary Disease." Textbook of Medical-Surgical Nursing, 13th Ed. Philadelphia: Lisa McAllister, 2013. 619-630. Print.
It is usually just a matter of days or may be minutes when a ventilator or a cardiopulmonary resuscitation is removed that a patient will die” (ConnectUS). Sometimes there is some hope to life support. The extended time frame that the life-sustaining treatment provides allows the family to have hope, come to terms with the traumatic event, accept the situation, and have more time to grieve. This also gives doctors a chance to continue to evaluate the patient and provide newly discovered treatment if, there is any. There have been cases that a patient fully recovers, after being put on life support, but the percentage of this happening is not that high.
We always look for a way to clean and freshen the air inside our home, but air fresheners aren’t just enough and doesn’t last long. Air purifier is a device which can remove air contaminants in a room, could reduce second-hand tobacco smoke, dust, pollen, mold spores, and dust mites, and other allergy triggering particles are reduced or terminated with air purifiers, as well as smoke particles, volatile organic compounds that can cause health risks. There are air purifiers nowadays that has advanced technology that captures and eradicate great number of bacterial, virus and harmful particles, this air purifier reduces accumulation of airborne impurities that cause unpleasant odor, and health risks, such as allergies. There are factors that can cause allergies and asthma, pet dander and dust are serious allergen that could promote allergies anytime, a pet can also carry pollen inside the house during high pollen season, so one should educate himself about allergies and how to prevent, and you can start by choosing and having the right air purifier.