Introduction
The article emphasizes the need for nurses to embrace evidence-based knowledge of how the various modes of ventilators operate, on strategies for managing patient responses to mechanical ventilator support, and causes of patient-ventilator dyssynchrony. This will enable them to provide quality healthcare to the patients. Timely identification of potential threats to health by nurses goes a long way in containing respiratory challenges. In their article, Grossbach, Chlan, and Tracy (2011) offer a general discussion of the areas that nurses need to be highly informed about. The paper critically analyzes the content of the article by either supporting or dismissing claims made by the authors using reliable and valid evidence.
Grossbach et al. note that critically ill adults who are admitted in the intensive care unit (ICU) are the most common group of patients that would always require mechanical ventilator support (2005). This is echoed by the findings of a study to establish the characteristics and results of cancer patients in need of mechanical ventilator support for more than 24 hours (Soares, Salluh, Spector, & Rocco, 2005). They found that acuteness of the affected organ, status of cancer, and aging were some of the main factors affecting mortality in the ICU. The ventilator support is also used routinely in other settings where long-term and sub-acute care is provided. The use of this crucial information helps in enhancing the chances of survival of patients admitted in the intensive care unit. When using the mechanical ventilator support, the nurse is usually in charge of every detail and should be able to address all challenges that may arise.
Modes of Mechanical Ventilator Support
Although the parameters of ventilators may differ with the manufacturing company, there are those which are found on all ventilators. These include the percentage of oxygen, tidal volume or minute ventilation, the rate of respiration, flow/inspiration rate, and alarm settings scale. Tehrani and Roum (2008) discuss a new computerized system for mechanical ventilation. Instead of a rule-based system, Flex is designed to work with the status of the patient being treated and hence can be used in several modes of ventilation. It can also regulate weaning to fit the conditions of the patient. Advanced types of ventilators incorporate newer settings and nurses should always be updated on ventilator operation for quality healthcare.
How the mechanical ventilator provides inspiratory support determines the mode of ventilation under use. Usually, a clinician relies on past experiences in choosing the mode of ventilation. The institution also has its preference when choosing the mode of ventilation. In their peer reviewed article, however, Branson and Johannigman (2004) observe that there is no evidence to show that new modes of ventilator support are superior to the existing ones. Just the same way that Flex functions, the authors of the article note that different modes operate differently especially in volume or pressure regulation. According to Burns (2009), the mode of ventilation to be used depends greatly on the ability of the patient to respond positively to it. The article captures other modes of mechanical ventilator support.
Strategies for Managing Patient Responses to Mechanical Ventilator Support
Despite the availability of different modes of mechanical ventilator support, some patients have been found to encounter major problems when using these services. Usually, the patient who is incompatible with a given ventilator support will appear distressed and struggle to breath. It is important to understand why this situation may arise. Since the ventilation is mechanical or computerized, it may in some cases be “out of synch” with the natural breathing rhythm. Simonds (2006) agree that almost all the mechanical ventilators are not free from malfunction. Worse still, those patients receiving home-based ventilator care are at greater risk due to higher chances of interruption and less timely response. The other risk factor for patient-ventilator problems is lack of skill in managing the operation of the mechanical ventilators especially among the homecare providers. Any delay to assess the cause of alarm will have dire consequences.
Sometimes, it gets even more serious when the patient is sedated or is unconscious because the alarm will not ring. This will only cause more ventilation problems. Barely half of the hospitals which encourage home based ventilation do follow up visits to determine the progress of the patient (Simonds, 2006). Through the entire process of mechanical ventilator support, the patient is the sole center of attention. This is aimed at ensuring that optimal outcomes of treatment are realized. The authors of the article discuss other factors that can affect the pressure and volume delivery targets of a mechanical ventilator as well as dyspnea.
Assessments and Causes of Patient-Ventilator Dyssynchrony
Dyssynchrony occurs when there is a mismatch between the patient’s breath and the mechanical ventilator-assisted breaths. This particular phenomenon is one of the most serious factors affecting the outcome of treatment and may warrant prolonged stay in hospital or ventilator-assisted respiration. One of the most common causes of this situation is the failure of initial inspiration by the patient to trigger or match with the breath from the ventilator. It has been established that lack of sufficient breath leads to several symptoms like restlessness, anxiety, hypertension, and nasal flaring. Mechanical problems in the ventilator may also cause dyssynchrony. Other important causes of this problem are pointed out in the article; autotrigerring, insufficient inspiratory flow delivery, double-triggering, and exhalation phase dyssynchrony.
Conclusion
The paper has captured very critical areas discussed by Grossbach et al. (2011) on the overview of mechanical ventilator support and management of patient and ventilator-related responses. Nurses have to be thoroughly trained on how the various ventilator modes function as well as their limitations. They should also be aware of the causes of respiratory dyssynchrony with the mechanical ventilator support. Healthcare providers, therefore, should share their experiences with the use of ventilators to enhance the quality of care provided to patients and avoid any foreseeable problems when using mechanical ventilation support.
References
Branson, R. D., & Johannigman, J. A. (2004). What is the evidence base for the newer ventilation modes? Respiratory Care, 49(7), 742–760.
Burns, M. S. (2009). Understanding mechanical ventilation support and weaning. Critical Care Nurse, 27(5), 469–492.
Grossbach, I., Chlan, L., & Tracy, F. M. (2011). Overview of mechanical ventilator support and management of patient and ventilator-related responses. Critical Care Nurse, 31(3), 30-44
Simonds, A. K. (2006). Risk management of the home ventilator dependent patient. THORAX, 61(5), 369-371
Soares, M., Salluh, J. F., Spector, N., & Rocco, J. (2005). Characteristics and outcomes of cancer patients requiring mechanical ventilator support for > 24 hours. Critical Care Nurse, 33(3), 520-526
Tehrani, F. T., & Roum, J. H. (2008). Flex: a new computerized system for mechanical ventilation. Journal of Clinical Monitoring and Computing, 22(2), 121-130