Trouble Shooting (Mechanical Ventilation) Arthur Sadhanandham Medical ICU, CMC.

‘WHEN NOAH BUILT THE ARK IT WAS NOT RAINING’

Precautions that would reduce troubles I. Power: Plug into a grounded AC power with correct voltage receptacle. Secure the power cord properly. Battery Back up: Check the battery level before connecting. Charging should be carried out regularly. Remember it is for short term use.

II. Gas Source Preferable to have centralised supply. If cylinders used, should be full Spare cylinders should be available. Gas hoses should be in good condition. Hoses – not contaminated with grease or oil (combustible) Availability of compressors should be ensured. Gases should remain dry and clean.

III. Personnel Properly trained personnel should only use. Familiarising staff with operator’s manuel before using on a patient. (One manufacturer’s manual may not exactly match with other brands). Appropriate monitoring the functioning state of the ventilator while in use.

Contd… Familiarizing staff with alarm system. Do not place ventilators in a combustible or explosive environment. Do not use with flammable anaesthetic agents such as nitrous oxide and ether.

IV Servicing and Testing Qualified personnel should undertake servicing. Ventilator housing should not be opened while it is still connected with power. Follow the specifications mentioned in the service manual. Use replacement parts supplied by the manufacturer only.

Contd…. General servicing at regular intervals should be done. Run the prescribed tests and calibrations before using the ventilator on a patient. Ensure that the ventilators pass all the tests before putting them in to clinical use.

ALARMS All ventilators are equipped with visual and audible alarms which notify the user problems.

Points to remember Never ignore an alarm. Never mute the alarm on regular basis. Find out for yourself what alarm is on. Check the patient. Silence the alarm.

Act Swiftly Depending upon the patient’s status and nature of the alarm, act appropriately. This includes disconnecting the ventilator and connecting another means of ventilation to patient – Bain’s/ Ambu.

Do not forget The use of an alarm monitoring system does not give absolute assurance of warning for every form of trouble that may occur with the ventilator.

Do not be like this ! But hear the alarm and respond See the problem and Ask if you do not know what to do

Common Troubles and Shooting Ensure Alarm knobs / switches are turned on and functional. Alarm Cause Shooting Apnoea No breath was delivered for the operator set apnoea time in spont, SIMV, AC, CMV & NIV modes Because spontaneous Ventilation is too high or patient effort is too minimal Trigger level set improperly. Check the patient- Arouse if needed Activate back up facility if it was not done already. Consider switching over to any mandatory mode Or go up on rate Set trigger level appropriately

Low SpO2 Air / O2 Blender continuous alarm Delivery of O2 : FiO2, PEEP High resistance due to various clinical reasons Supply pressures are inadequate. Disconnect patient from ventilator Manually bag with Bain’s and Ambu. Insert the gas hose fittings (air & O2) correctly into the wall outlets. Ensure wall outlets has adequate pressure

The measured PIP is lesser than the set minimum level because of Low pressure or Low min.Vent Or Low exhaled volume or Disconnection The measured PIP is lesser than the set minimum level because of cuff leak. Leak in the circuit Connections may be loose ET tube displacement Inadequate flow Evaluate cuff pressure at regular intervals. Reinflate if leak / ruptured is noticed – change ET tube. Check circuits, junctions- tighten or replace. Check water traps Check ET tube placement. Position it properly. Reconnect ventilator. Patient may require higher flow.

High Pressure Alarm The measured peak inspiratory pressure is great than set level because of Secretions in airway Partial block – (ETt) Kinking of tube Biting the tube Water in the tube Cuff herniation Deep Rt. sided intubation Fighting the ventilator Suctioning, Irrigation Release tubings Bite block insertion Empty the tubings and water traps Deflate & reinflate cuff 3-4 times Reposition the ET tube Reposition the patient Re assurance Sedation & medication (pain)

High pressure alarm Cough Increased airway resistance or decreased compliance because of Bronchospasm Atelectasis Fluid overload Pneumothorax Medication Bronchodilators Adjust the settings VT &  Rate VT  Rate,  PEEP (Peak pressure to be monitored) Immediate intervention

Auto Cycling High Tidal Volume Leak & Improper trigger setting Patient trying to take more volume of air Secure all tubings tight Set proper trigger level Increase flow rate or Increase tidal volume

Trouble shooting! THANK YOU FOR YOUR PATIENT HEARING. . . . .