Mechanical ventilation may be required for a variety of reasons, including the need to control the patient’s respirations during surgery or during treatment of severe head injury, to oxygenate the blood when the patient’s ventilatory efforts are inadequate, and to rest the respiratory muscles. Many patients placed on a ventilator can breathe spontaneously, but the effort needed to do so may be exhausting.
A mechanical ventilator is a positive- or negative-pressure breathing device that can maintain ventilation and oxygen deliv-ery for a prolonged period. Caring for a patient on mechanical ventilation has become an integral part of nursing care in critical care or general medical-surgical units, extended care facilities, and the home. Nurses, physicians, and respiratory therapists must un-derstand each patient’s specific pulmonary needs and work to-gether to set realistic goals. Positive patient outcomes depend on an understanding of the principles of mechanical ventilation and the patient’s care needs as well as open communication among members of the health care team about the goals of therapy, weaning plans, and the patient’s tolerance of changes in ventila-tor settings.
If a patient has a continuous decrease in oxygenation (PaO2), an increase in arterial carbon dioxide levels (PaCO2), and a persistent acidosis (decreased pH), mechanical ventilation may be neces-sary. Conditions such as thoracic or abdominal surgery, drug overdose, neuromuscular disorders, inhalation injury, COPD, multiple trauma, shock, multisystem failure, and coma all may lead to respiratory failure and the need for mechanical ventila-tion. The criteria for mechanical ventilation (Chart 25-11) guide the decision to place a patient on a ventilator. A patient with apnea that is not readily reversible also is a candidate for me-chanical ventilation.
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