vent not working

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Today a collegue of mine had a patient on the vent who started biting the tube and being restless in general. So the nurse gave him dilaudid. Well, the patient's mv started going down and he was not moving any air. They had just given blood so they gave him lasix iv and bagged him for a bit. He got better and the put him back on the vent. He quit moving air again so the bagged him. At this point he is tachy and bp is dropping. So we took a look at the vent and it wasn't blowing any air. It wasn't alarming either. The HME was clogged up somehow and the vent wasn't letting anyone know about it. We changed the HME and it started working fine. The patient may or may not be okay I am not sure. Have you ever seen anything like this?

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How absolutely terrifying! I hope this isn't a common occurence, I don't work with anyone on vents but I remember my ICU clinical, and what you've described sounds like it should never happen... what did your supervisor say regarding the incident?

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I'm curious as to the type of vent.

I've seen that happen in home care with older LP6 and LP10 vents using a specific brand of HME. But I don't remember the darn brand. It is made of clear plastic, has a ball like shape that measures about 1" in across the diameter and the moisture trapping material is foam rubber.

The "solution" was to immediately pull the vent from use, send it for servicing and switch to something like the ThermoFlo (ARC Medical Inc) or the Humid-Vent (Hudson RBC).

I hate to say it but this is one of those situations of over reliance on the vent alarms. Caregivers of long term vent users are taught to always assume a vent failure in that type of situation.

If the patient never lost consiousness and returned to baseline within a few minutes of the problem being solved he will probably be OK.

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Specializes in ICU, Education.

i am also curoius about the typ of vent. I have seen vents occlude (ususally the filter) but it ALWAYS alarms.

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I agree this is very scary. As someone else said, we should always look at the patient, and not rely on alarms. But, as we all know in the real world, you can't stay in the patients room your entire shift. You have to go asses your other patient, give meds, call lab/pharmacy, and all the other 100 things we do in a shift. Your alarms on the vent are a backup safety measure for you and your patient. I've never seen that type of situation happen, but I like to think if the vent wasn't moving air the first time and his MV is dropping, I wouldn't have wanted to put him back on that vent, I would be checking my ETT since he'd been biting on it to see if the cuff and ETT are still viable. I would have definitely written it up an an incident report because if he suffered an anoxic brain injury from it, it's a lawsuit waiting to happen. Although it sounds like you starting bagging soon, with the bp and the hr, he was compensating for being hypoxic and a patient in the ICU with who knows how many multiple underlying medical issues can't take a hit like that to the lungs and bounce back as easily as you'd think.

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Let me clarify and say I'm not saying the nurse did anything wrong, I would do an incident report simply to CYA. If the vent wasn't work, that's not the nurses fault, you can't help equipment failure. The problem is, if the alarm wasn't working, how long was the patient not getting air before the nurse went in to look at the patient? That's why I'd do an incident report and make sure the respiratory department followed on the vent malfunction so it doesn't happen again.

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In the nurse's defense, it was thought to be a fluid overload from the blood he had just gotten. They thought the extra fluid (he sounded full of fluid) was making him antzy and causing resp difficulty so they gave the dilaudid to calm him down. He then dozed off. Problem started to be more obvious when the lasix did not help at all. They were on top of him the whole time. There was an orientee and an RN who both had no other patient. His sat never dropped. When he started to appear not to be moving air they took him off the vent, bagged him, checked the vent which appeared to be working, and put him back on just for a second before they realized it was the vent. Sorry if I left details out last night (and I still may be) but I had a bad headache. What made this more difficult to see was the patient had been having some tachycardia on and off and also had just come off of dopamine so the pressure dropping didn't really stick out. The mv followed by the crappy lungs sounds finally gave it away b/c the sat never dropped (that I saw).

I do not remember what vent it was b/c I haven't worked ICU in a while and was floated from the flex pool. It was a newer model with a very sleek look to it. The HME was as described by someone else. A clear ball with foam in the middle. You twisted it in half to open it up. I just can't believe the vent didn't alarm high pressure. But even then they might have thought mucous plug.

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By the way, if you held your hand up to the vent it was blowing air. When the hme came off however, it blew a lot more air and then became obvious that it wasn't working.

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In the nurse's defense, it was thought to be a fluid overload from the blood he had just gotten. They thought the extra fluid (he sounded full of fluid) was making him antzy and causing resp difficulty so they gave the dilaudid to calm him down. He then dozed off. Problem started to be more obvious when the lasix did not help at all. They were on top of him the whole time. There was an orientee and an RN who both had no other patient. His sat never dropped. When he started to appear not to be moving air they took him off the vent, bagged him, checked the vent which appeared to be working, and put him back on just for a second before they realized it was the vent. Sorry if I left details out last night (and I still may be) but I had a bad headache. What made this more difficult to see was the patient had been having some tachycardia on and off and also had just come off of dopamine so the pressure dropping didn't really stick out. The mv followed by the crappy lungs sounds finally gave it away b/c the sat never dropped (that I saw).

Hmmm...that is a tough scenario. It's trial and error problem solving to figure out what's causing the problem. I thought you meant the tachycardia and the hypotension were new events, so I was thinking that should have been a clue to hypoxia. It makes you pause and think how depedent we are on machines, even though we know we need them, we can't have blind faith that they always work.

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Specializes in Respiratory Therapy, Polysomnography.

I'm also really curious as to what type of vent you were using. I haven't seen any of the modern vents just "stop pushing air" when encountering an obstruction such as a clogged HME or plugged trach/ETT. Usually they'll continue to up the applied pressure until reaching the set high pressure limit then you of course get an alarm or alarms if the vent measures exhaled Vt breath by breath. Then after a minute or so you should get your low minute volume alarms. It definitely sounds like a mechanical issue for your biomed engineering dept to go over. I would think the vent would continue attempting to deliver breaths; a complete stoppage when encountering an obstruction sounds totally bizarre.

John M. B.S.^2, RRT

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Hey Y'all!!!

I've had HME's get soggy and cause high-pressure problems but always had the alarms go off appropriately. And in the situation described here, the Nurses seem to have done well enough. By that I mean--they recognized that they had a problem and their steps to solve the problem worked.

There are some numbers that the Vents display that give advance notice that this kind of thing is developing, however, that could have started the 'nursing process' earlier in this event.

The "Peak Airway Pressure" is monitored on vents. It is the force required to push air thru the circuit and into the Pt. In this case--that number would have gone very high. (It's the alarm that didn't go off.) Sometimes this is called "Peak Inspiratory Pressure" or 'PIP'. It is the alarm that we hear when the Pt is coughing or 'fighting the vent'.

Another number displayed on the Vent is the Tidal Volume; this is the volume of the Pt's breath measured on the 'expiratory' side of the circuit.

In this case there would likely have been a clear trend toward smaller and smaller volumes.

It is true--I always emphasize to my 'baby nurses'--that when you recognize a problem you should always LOOK FIRST AT THE PATIENT. Which these nurses did. So good on 'em!!!

But we need to know what the machines have to tell us about our Patents. So 'reading' the Vent is something Critical Care Nurses have to figure out.

This requires more than just reponding to alarms.

(Hint: Most Resp Rx folks are flattered to have a Nurse take them as 'consultants' and happily explain the Vents to ya.)

Papaw John

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I'm a little perplexed as to why with a HME that was clogged no alarms on the vent went off. As Papaw alluded to you would expect a high pressure alarm because the vent was unable to deliver the amount of volume programmed in and the second alarm is if the forced pressure was not coming from the vent due to a clogged HME than the patient could not have been making adequate tidal volumes and that should've alarmed.

The only thing that I can think of is that the alarms on the vent were not set correctly for upper and lower limits or the volume for the alarms to go off was turned down or even turned off?

Nonetheless you guys did the right thing by treating the patient!

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