Help! I don't "get" vents!!!

[Penelope_Pitstop]

Hey everyone!

Very recently I left MedSurg after 7 years for critical care. Thank goodness I have years of experience and knowledge of what "normal" assessments are. So far things are going very well. Titrating pressors, measuring CVP, working with A-lines, etc. are still very foreign to me but I understand what I'm doing and just need practice.

However...

I don't understand vent settings. I feel like when people try to explain them to me, they are speaking Bulgarian. I feel like a total moron because all I comprehend is FiO2. I write down the settings and pass them along, but I don't know what they mean!

Disclaimer...I've only had seven days in the unit and I'm still with a preceptor, of course, so I don't want anyone to think I'm caring for these patients on my own.

I just need someone to explain to me, in layman's terms even, what the heck the different vent settings mean. (AC? PSV? PEEP? PIP? IDK my BFF Jill?)

Thanks!

[mlbluvr]

Anybody- please offer your opinions as to why, really, so many thousands of people in this country are being kept alive by ventilators. And please, by all means - cut my head OFF before you ever contemplate giving ME a tracheotomy. IMO it's a fate far worse than death. It makes me squeam to think about. It's just too gross for normal conversation. And I've had more than one trach disgorge an unholy amount of secretions onto me, my uniform, my hands, and etc. Eegads.

[wooh, BSN, RN]

I keep seeing this on the side under "Liked Nursing Topics" and can't understand why someone doesn't understand vents. It's just ranting for goodness sake! What is there to understand??

[JeanettePNP, MSN, RN, NP]

I keep seeing this on the side under "Liked Nursing Topics" and can't understand why someone doesn't understand vents. It's just ranting for goodness sake! What is there to understand??

What? You mean nurses VENT? Don't they even care about their patients? If you need to vent why did you ever go into nursing in the first place? Don't you know there are a million new grads who'd kill for your job???

[LadyFree28, BSN, LPN, RN]

at the last 2 posts!

vanilla bean, Esme and NRS and PPs gave some great advice and links...helped me out a TON as a refresher when learning about vents in a critical care.

When I started out, part of my orientation was shadowing a RT...it REALLY help put it all together. Hope you get a chance to grab one!

[MattNurse, MSN, RN]

[KenH]

Here are the Basics

Ventilation is just like understanding I&O's, to much or not enough will cause problems

Normally we breath by negitive pressure, when a person is intubated the cuff/balloon on the tube seals the airway so you can ventilate them with positive pressure.

When a patient is on a vent you are managing there breathing, sedation your friend

Vt= how big a breath, both to little and to much will cause problems, how big a breath depends on the disease process.

Rate, to fast and to slow hyper & hypo ventilation

AC = all the time, every breath the patients gets is what the vent is setup for

too slow= hypo ventilation increased Co2, to fast = hyper ventilation

Simv= sometimes, part of the breaths are AC (see above)and part of them are

spontaneous, how big of a breath depends on Pressure support = helping taking a

breath, to small, not enough support = hypo ventilation, to much help/ support =

hyperventilation.

Peep = 5 of peep changes your base line end pressure from 0 to +5, peep is use for

oxygenation, recruitment of alveoli , to much peep can cause decreased cardiac

output

Cpap/Peep + PS pressure support, every breath is spontaneous, totally patient driven.

To high of a Respiratory Rate and or to much Pressure Support = hyper ventilation

To Low of a Respiratory Rate and or not enough Pressure Support = hypo

ventilation

Lung compliance, low lung compliance = stiff lungs, hard to ventilate, higher peak

pressures. High lung compliance = soft lungs, easy to ventilate, lower peak

pressures. High Peak Pressure = lung injury

ABGs on the ventilation side PH and Co2 have an inverse action to each other

High Co2 = Low PH, hypo ventilation, Low Co2 = High PH, hyper ventilation

On the metabolic side you have Bicarb = buffering system, you can tell a lot about

respiratory status base on the bicarb, acute, partly compensated, not

compensated

[KenH]

Anybody- please offer your opinions as to why, really, so many thousands of people in this country are being kept alive by ventilators. And please, by all means - cut my head OFF before you ever contemplate giving ME a tracheotomy. IMO it's a fate far worse than death. It makes me squeam to think about. It's just too gross for normal conversation. And I've had more than one trach disgorge an unholy amount of secretions onto me, my uniform, my hands, and etc. Eegads.

Rule # 1 NEVER stand at the foot of the bed, if you do you are just asking to be sprayed

Rule # 2 Treat every trach as if they are Dirty, MRSA and mmmmmmm the smell of pseudomonas.

why, sometimes it a personal choice, ease of weaning off the ventilator, people can have normal lives and have a trach. Most of the time family cant let there love one go, some will call it selfish of them or loving, some time it just torture.

[Bortaz, MSN, RN]

I suggest you learn Bulgarian. :)

[Dodongo, APRN, NP]

Do you work in a teaching ICU with residents? At the beginning of every month the pulmonologist/intensivist will go over every aspect of the vent during rounds with the new interns. The experienced ICU nurses and residents gloss over during this time but the new nurses and interns love it and learn a ton. Once you get the basics down there is a lot you can do on the vent for your patients. Also, if you have RTs they can be a great resource for you.

[Penelope_Pitstop, BSN, RN]

I keep seeing this on the side under "Liked Nursing Topics" and can't understand why someone doesn't understand vents. It's just ranting for goodness sake! What is there to understand??

You are wrong. Dead wrong!

I don't understand that there are slits in the wall and floor that blow cold air out in the summer, then warm air in the winter! HOW DOES THAT WORK? How can they change their minds?

[Penelope_Pitstop, BSN, RN]

You all have given me so many great resources and information. I am going to dig into this stuff very soon - for now I have to study for a final (I'm in grad school as well - my brain's fixin' to explode!).

I did shadow respiratory for four hours and got a good explanation of everything but a few emergencies popped up and we kind of ended up running around! Thankfully respiratory and the residents are always on hand and willing to explain stuff.

Thanks again everyone. Keep the resources coming!

[wooh, BSN, RN]

You are wrong. Dead wrong!

I don't understand that there are slits in the wall and floor that blow cold air out in the summer, then warm air in the winter! HOW DOES THAT WORK? How can they change their minds?

You must work in a magnet hospital. My hospital's slits seems to always have cold air blowing out in the winter and warm air in the summer....