101-1 Basic Ventilatory Care Concepts

Mechanical Ventilation is an interim life support procedure that in itself is not therapeutic. Its purpose is to maintain a patient’s ventilation and give the physician time to provide medical treatment with drugs, surgery and other procedures. A plan for weaning the patient from the ventilator should be developed and implemented as soon as the patient begins spontaneous breathing. The respiratory care practitioner must be an expert in operating all types of ventilators in all modes of delivery. This is not easy for there are over 32 different types of ventilators and each have as many as 22 different control functions. With the advent of continuous elevated baseline pressures and IMV in the late 1960’s, the physician and respiratory practitioner have a greater range of choices for controlling a patient’s arterial blood gases.

It is the practitioner’s role to select and administer mechanical ventilation based on the patient’s needs and available equipment. To do this safely and effectively, you must understand inherent physiological/mechanical concepts, such as pressure wave forms, pulmonary and mechanical compliance, pulmonary elasticity, airway resistance, I:E breathing ratio, arterial blood gases and the influence of various components of the blood, such as electrolytes and hemoglobin on gas exchange, and cardiac function. You must be able to monitor all aspects of the mechanical operation of the ventilator and learn to assess the patient. You must not become so involved with making equipment checks that you fail to recognize a deterioration or improvement in the condition of the patient. An important role is to serve as the physician’s assistant by constantly monitoring and reassuring the ventilator patient. This requires clinical experience and knowledge of visual signs and cardiopulmonary complications and measurements, such as cardiac output, pulmonary wedge pressure and possible lethal arrhythmias. These are all sophisticated concepts that only a few years ago would have been the exclusive role of medical pulmonary specialists.

Patients receiving continuous mechanical ventilation should be located in a special care unit with a staff capable of providing critical care. This includes the respiratory care practitioner whose responsibilities are rapidly increasing because of medical equipment knowledge.