Ventilator alarms

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I'm a new grad working in the NICU and just finished my level III orientation. Ventilators still kind of freak me out and when they alarm, I don't feel like I always know what to do/why they are alarming. I would love it if someone has good explanations for the different kinds of vent alarms (high volume, low volume, etc) the common reasons for the alarms, and what interventions should be done. During my orientation I didn't have an unstable vented kid, intubations, or extubations so I'm constantly afraid that a kid will extubate or alarms will be going off and I won't know what to do! Please help!

Thanks for your input. Unfortunately I have never worked in a NICU that has been able to accurately monitor EtCO2 levels off a vent circuit.

What do you mean by "accurately"? Do you mean the PaCO2 does not match the ETCO2? It more than likely will not even in some adults or pediatrics who have cardiopulmonary disease processes. This is known as the PaCO2 - ETCO2 gradient. It shows the ventilation-perfusion relationship and should be used along with the a/AO2 ratio.

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Great thoughts GreyGull; however, I'm assuming that He means that the ventilator flows are so low, combined with such small exhaled Vt's makes it extremely difficult for EtCO2 monitors to sample from the patient. For all intents and purposes, the monitors are accurate because what they sample is what they display. However, in this case, it's what they're unable to sample.

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Great thoughts GreyGull; however, I'm assuming that He means that the ventilator flows are so low, combined with such small exhaled Vt's makes it extremely difficult for EtCO2 monitors to sample from the patient. For all intents and purposes, the monitors are accurate because what they sample is what they display. However, in this case, it's what they're unable to sample.

I have learned some things about assuming through the years when it unfortunately lead to bad consequences for the patient. One example was assuming a CCT team knew to check the last ABG or ask for another for confirmation on their ventilator and that they knew about V/Q mismatching and gradients. When their ETCO2 read 20 they took it as the patient was being hyperventilated. They did their own correcting during transport to "normalize" the ETCO2. The patient arrived at the other hospital with a pH of 6.9 and very unstable.

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