Mechanical Ventilation

Download as PDF
Class
RSPT 2414

The study of mechanical ventilation with emphasis on ventilator classification, methods, principles, and operational characteristics. (3-4-0)

Course Learning Objectives

Describe procedures for mechanical ventilation as related to spontaneous and artificial ventilation with emphasis on ventilator classification, methods, principles, and operational characteristics; explain indications, complications, and physiologic effects/principles of mechanical ventilation; and apply initiation, management, and weaning of ventilator support.

End of Course Outcomes

I. Identify indications and contraindications of mechanical ventilation (F1,F3, F8, C18,
C19, C20)
A. Define respiratory failure and distinguish between its two primary types
2
B. Compare and contrast acute and chronic respiratory failure
C. Identify causes of respiratory failure
D. Justify ventilatory support in special circumstances
II. Demonstrate proficiency in initiating mechanical ventilation (F1, F5, F8, F10, C18,
C19, C20)
A. Differentiate between physician ordered and therapist controlled parameters
B. Differentiate between pressure ventilation and volume ventilation
C. Establish an appropriate minute volume for initial ventilator settings
D. Establish appropriate FiO2 setting for initial mechanical ventilation
E. Explain the relationship between flow, inspiratory time, and expiratory time
III. Differentiate between common modes of mechanical ventilation
A. Define the terms trigger, limit, and cycle as they pertain to modes of mechanical
ventilation
B. Differentiate between ventilator breaths and spontaneous breaths as they
relate to modes of mechanical ventilation
C. Produce graphic representations of different modes of mechanical ventilation
D. Describe controlled mandatory ventilation (CMV)
E. Describe assist control ventilation
F. Differentiate between intermittent mandatory ventilation and synchronized
intermittent mandatory ventilation
G. Differentiate between pressure control and volume control ventilation
H. Describe pressure support mode (PSV)
I. Describe continuous positive airway pressure (CPAP) mode of ventilation
J. Differentiate between PSV and CPAP
IV. Describe the difference between PEEP, CPAP, and PS
A. Define positive end expiratory pressure
B. Explain indications for PEEP
C. Determine optimal PEEP
D. Describe hazards of PEEP
E. List contraindications for PEEP
F. Define CPAP
G. Explain indications for CPAP
H. Define pressure support
I. Explain indications for pressure support
V. Define and discuss the relationship between inspiratory time, expiratory time, I:E
ratio, rate, minute volume, and inspiratory flow rate
A. Discuss the relationships between tidal volume, flow, and I:E ratio
B. Calculate all components needed to establish appropriate I:E ratio
C. Differentiate between various flow waveforms
D. Describe the correct setting of the sigh mechanism
E. List indications for initiating the sigh mechanism
VI. Explain the importance of proper alarm settings (F1, F3, F8, C18, C19, C20)
A. Differentiate between input and output alarms
B. Identify the need for each alarm and state the normal ranges for each.
C. Troubleshoot activated alarms
VII. Describe hazards and complications of mechanical ventilation (F1, F3, F5, F9)
A. Identify hazards related to positive pressure ventilation
B. Explain alteration of V/Q ratio by mechanical ventilation
3
C. Explain decreased venous return as it relates to central venous pressure
D. Identify pressures that may induce barotrauma
E. Identify hazards related to the patient’s condition
F. Identify hazards related to the ventilator and artificial airway
G. Identify hazards related to medical professionals
VIII. Differentiate between compliance and resistance (F1, F2, F3, F5, F6, F8, F9, F12)
A. Define compliance
B. Describe how compliance will affect volume changes in the lung
C. Differentiate between static and dynamic compliance
D. Calculate dynamic and static compliance
E. List factors influencing compliance
F. Identify disease processes in comparison to compliance changes.
G. Define and describe resistance
H. Calculate airway resistance
I. List factors influencing airway resistance
J. Identify disease processes in comparison to resistance changes.
IX. Student will utilize a systematic review of ventilator waveforms and their use in
ventilator management and troubleshooting.(F10, F12, C18, C19, C20)
A. Identify all phases of a pressure-time waveform
B. Identify five breath types that can be viewed with pressure-time waveform
C. Assess plateau pressure, patient triggering and peak flow rate using
pressure-time waveform
D. Identify all phases of a flow-time waveform
E. Determine the presence of Auto peep with the flow-time waveform
F. Evaluate I time with flow-time curves
G. Identify flow waveform shapes.
H. Detect leaks with volume-time waveforms
I. Identify mandatory and spontaneous breaths with pressure-volume loops
J. Assess patient’s work to trigger, changes in compliance and resistance, lung
over-distention, and inflection points with pressure-volume loop
K. Evaluate the effect of bronchodilators using flow-volume loops
L. Determine the presence of secretions in the airway or water in the circuit
using flow-volume loops.
X. Manage the patient-ventilator system by gathering data from physiologic
measurements and general patient assessment(F1, F2, F3, F5, F6, F8, F9, F12)
A. Recommend appropriate adjustments in ventilatory support settings, given
ABG parameters
B. Describe when and how to conduct a comprehensive patient-ventilator
system check
C. Interpret the meaning of common flow, volume, and pressure waveforms
seen during mechanical ventilation
D. Given specific clues regarding abnormal patient ventilator function, identify
the possible causes and potential corrective actions.
E. Outline the steps to be taken in managing sudden distress in a patient
receiving ventilatory support
XI. Demonstrate competence, care, and diligence in managing and monitoring the
critical care patient (F1, F2, F3, F5, F6, F8, F9, F12)
4
A. Identify and define the three essential components in the management
process for the critically ill patient.
B. Differentiate among the various aspects of general patient assessment and
their relevance to managing patient receiving ventilatory support.
C. Specify the common parameters used to assess patient oxygenation,
ventilation, mechanics and capacity, laboratory results; and their threshold
values and use in bedside decision making.
XII. Demonstrate an understanding of the science of weaning and be able to identify
different weaning techniques(F1, F2, F3, F5, F6, F8, F9, F12)
A. Identify factors contributing to ventilator dependence.
B. Differentiate among preweaning, weaning, and extubation phases of
ventilator withdrawal
C. Identify physiologic and psychological prerequisites for successful weaning
and methods to achieve them
D. Identify criteria useful in determining when to extubate a patient after
withdrawal of ventilatory support
XIII. Identify, initiate, manage and evaluate noninvasive ventilation. (F1,F3, F5, C18, C19,
C20
A. List and describe terms and acronyms associated with noninvasive
ventilation.
B. List and describe types, goals, indications and criteria for selection and
exclusion for noninvasive ventilation
C. Describe clinical applications for noninvasive ventilation
D. Describe advantages and disadvantages of noninvasive ventilation
E. Describe the troubleshooting associated with noninvasive ventilation and
interfaces.

Required Textbooks

Clinical Application of Mechanical Ventilation, 4 th ed. David W. Chang, Delmar

Egan’s Fundamentals of Respiratory Care, 11 th ed., Craig Scanlan, Mosby

Mosby’s Respiratory Care Equipment, 9 th ed., J.M. Cairo, Susan P. Pilbeam, Mosby

Evaluation Standards

5 Major Exams 60%
• Exam 1 (Course Objective I,II)
• Exam 2 (Course Objective III)
• Exam 3 (Course Objective IV, V)
• Exam 4 (Course Objective VI, VII)
• Exam 5 (Course Objective VII, IX)
• Exam 6 (X, XI)


Laboratory exercises and competencies: 20%
• Weaning Parameters
• Compliance & Resistance Lab (Course Objective VII)
• Ventilator Waveform Lab (Course Objective VIII)
• BiPAP competency (Course Objective VI)
• Adult Mechanical Ventilation Initiation (Course Objectives VIII & XII))


Final Exam (Course Objective I-XIII) 20%

Absences

Your attendance is the biggest predictor of your success. Attendance at every class is expected. The student will be allowed to miss 4 class days (exception test days) without it adversely affecting their grade and 2 lab days (exception check-off days) without it adversely affecting their grade. Every one absence over the allotted days will result in the student’s final grade being reduced by 10%. If the student is more than 15 minutes late to lecture or lab, this will constitute an absence. 3 tardies count as 1 day absent

All students must achieve a minimum of 75% or higher to pass this course

Grading Standards

▪ A 90-100%
▪ B 80-89%
▪ C 75-79%
▪ F <75%

Required Institutional Core Learning Outcomes

A student shall retain all rights to original work created as part of instruction or using College District technology resources

Disabilities

ADA Statement:

Any student with a documented disability (e.g. learning, psychiatric, vision, hearing, etc.) may contact the Office on the Weatherford College Weatherford Campus to request reasonable accommodations. Phone: 817-598-6350 Office Location: Office Number 118 in the Student Services Building, upper floor. Physical Address: Weatherford College 225 College Park Drive Weatherford, TX.

Academic Integrity
Academic Integrity is fundamental to the educational mission of Weatherford College, and the College expects its students to maintain high standards of personal and scholarly conduct. Academic dishonesty of any kind will not be tolerated. Academic dishonesty includes, but is not limited to, cheating on an examination or other academic work, plagiarism, collusion, and the abuse of resource materials including unauthorized use of Generative AI. Departments may adopt discipline specific guidelines on Generative AI usage approved by the instructional dean. Any student who is demonstrated to have engaged in any of these activities will be subject to immediate disciplinary action in accordance with institutional procedures.
Hope Statement
Any student who faces challenges securing basic resources such as food, clothing, or housing and believes this may affect their performance in their course of study is urged to contact the Director of Student Resources, Dr. Deborah Cregger, for support at (817) 598-6444. Her office is on the first floor of Student Services. If the student prefers, they may contact their instructor, who can reach out on their behalf. Weatherford College also provides the Coyote Pantry. The Pantry maintains boxed and canned foods for students in need. The location of the Coyote Pantry is two blocks west of the Weatherford campus at the Baptist Student Ministry (118 E. Park Ave., Weatherford). Pantry hours are Mon-Thurs. 8:30 am-4:30 pm and Fri. 8.30 am-12:00 pm (817-599-6586).
SCANS

The Secretary’s Commission on Achieving Necessary Skills (SCANS) identified Competencies in the area of Resources, Interpersonal, Information, Systems, and Technology; and foundation skills in the areas of Basic Skills, Thinking Skills, and Personal Qualities. This course is part of a program in which each of these Competencies and skills are integrated. The specific SCANS Competencies that are recognized throughout this course are noted at the end of the appropriate Competencies or task listed.