Ten Precautions That Should Be Taken When a Patient Is On Ventilator
There is a reason why ventilators are termed life-saving devices. After all, breathing remains the core function of a living being and without it, there would be no life. And if a person can't breathe on his own, it is the ventilator that comes to his aid. However, given the complex and sophisticated nature of a ventilator, a number of precautions must be exercised in the course of using a ventilator for a patient. A few of those important precautions are as follows.
1- A patient on a ventilator is often attended by an assortment of medical staff including a critical care specialist, primary care physician, pulmonologist, respiratory therapist, and nurse, among others. This means that the lines of communication between different professionals taking care of a patient must be open at all times, ensuring timely coordination, especially with regard to the changing of the settings of the ventilator. The less number of people are allowed to change settings, the better it is for a patient. Preferably, the respiratory therapist must be in charge of the machine and its settings with the pulmonologist overseeing the change from time to time.
2- The medical staff attending the patient must be thoroughly familiar with basic modes of ventilation such as volume control, pressure control, dual control (both volume and pressure), pressure support, and synchronized intermittent mandatory ventilation (SIMV). And needless to say, they must not only be able to set the mode but also change it if needed.
3- The position of the endotracheal tube must be monitored at all times. Sometimes, the endotracheal tube may get disconnected from the mechanical ventilator impinging on patient safety. And if the alarm has also failed or not made the requisite loud sound audible to the people in the surroundings due to someone having reduced the volume, it can spell trouble for the patient. So, it is important to monitor any premature extubation by the patient himself or another professional attending to him without the knowledge of the others. In addition, the cuff pressure of the endotracheal tube must be periodically checked.
4- A bag valve and mask must be placed nearby for an unintended extubation emergency situation. And it should be regularly checked whether it is in working condition. Until a patient is duly reintubated, a bag valve mask can be used to manually oxygenate the patient. In fact, attendants must practice sufficiently in using a bag valve and mask.
5- The alarm systems constitute a significant part of ventilator management. As such, alarms not only have to be set appropriately for different desired indicators, but they also need to be set at suitable decibel levels so that the attendants in the vicinity can clearly hear them. In fact, the attendants must understand manufacturer-set alarm settings and familiarize themselves with the latter beforehand since not all ventilators have similar alarm systems. Attendants must also know exactly what to do if an alarm sets off such as looking for any visible respiratory distress in the patient, adjusting settings if needed, and informing the respiratory therapist and the intensivist immediately. Importantly, alarm systems should be adjusted only when it is clinically critical to do so.
6-The respiratory therapist or the specialist must keep a constant watch on the following indicators such as respiratory rate per minute, a fraction of inspired oxygen (FiO2), tidal volume, peak inspiratory pressure, and positive end-expiratory pressure (PEEP).
7-Remember that continued ventilation has its own downsides. It can lead to infections such as pneumonia which can even worsen the condition of the patient. So, besides ensuring that the patient's oral cavity hygiene is regularly taken care of, the patient's position must also be changed from time to time to prevent muscle disuse and pressure sores.
8- There is a need to carry out suctioning of the patient from time to time. However, it should be only done when needed which can be ascertained by closely looking at the patient and listening to the chest. If it can be determined that any secretions are blocking the airways and leading to respiratory distress for the patient, suctioning must be carried out. This can ensure better gas exchange, sufficient oxygenation, and alveolar ventilation.
9- At the time of weaning a patient off a ventilator, the blood pressure and the heart rate must be normal and stable.
10- And finally, there must be a backup plan in terms of power should there be a power failure due to human factors or a natural disaster. If a patient is on a ventilator at home and the machine develops a snag or fails completely, another ventilator must be kept on standby at all times.
Disclaimer: The views expressed in this article are of the author and not of the Medical Dialogues. The Editorial/Content team at Medical Dialogues has not contributed to the writing/editing/packaging of this article.
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