Protect the Patient
A ventilator alarm activates. What is the clinician’s first priority?
Ensure the patient is being adequately ventilated and oxygenated.
Unilateral absent breath sounds, uneven chest movement, and increased work of breathing should make you suspect what problem?
Pneumothorax.
Low pressure, low volume, and low minute-volume alarms commonly indicate what general problem?
A leak or disconnection.
How is the low-pressure alarm commonly set in relation to PIP?
About 5–10 cm H₂O below PIP.
On a ventilator graphic, expiratory volume does not return to zero. What does this suggest?
A leak is present in the system.
A ventilated patient suddenly develops severe distress. What should you do with the ventilator?
Disconnect the patient from the ventilator and begin manual ventilation with a self-inflating resuscitation bag.
Wheezing with an increased PIP but relatively unchanged plateau pressure suggests an increase in what?
Airway resistance (Raw), such as with bronchospasm.
You suspect an endotracheal tube cuff leak. What should you do after reinflating the cuff?
Recheck cuff pressure.
How is the high-pressure alarm commonly set in relation to PIP?
About 10 cm H₂O above PIP.
Which graphics can help identify ventilator leaks?
Volume-time scalars, pressure-volume loops, and flow-volume loops.
During manual ventilation, what two mechanical properties can you quickly evaluate by how the bag feels?
Compliance and airway resistance.
Thin, frothy, white-to-pink secretions are associated with what condition?
Cardiogenic pulmonary edema.
A patient is trying to inhale but the ventilator is not responding. Name one possible ventilator-related cause.
Incorrect sensitivity setting, low flow, poorly responsive demand valve, water in the inspiratory line, or auto-PEEP.
Name three airway-related causes of a high-pressure alarm.
coughing, secretions, biting/kinking the ETT, tube on the carina/trachea, or cuff herniation.
A volume tracing drops below zero. What equipment-related issue may this indicate?
The equipment may need to be recalibrated.
A patient was receiving a PEEP of 12 cm H₂O before being disconnected for manual ventilation. What should be added to the resuscitation bag?
A PEEP attachment/valve because the patient was on high PEEP (≥10 cm H₂O).
Expiratory flow does not return to baseline before the next breath. What problem should you suspect?
Dynamic hyperinflation / intrinsic PEEP (auto-PEEP).
A patient appears air hungry because inspiratory flow is inadequate. Give one ventilator adjustment that may help.
Increase the flow, change the flow pattern, or change the mode of ventilation.
coughing, secretions, biting/kinking the ETT, tube on the carina/trachea, or cuff herniation.
Circuit leak, strong patient inspiratory effort, inadequate sensitivity, or a demand valve that does not respond quickly enough.
What waveform finding is a classic clue for auto-PEEP?
Expiratory flow fails to return to baseline before the next breath begins.
After beginning manual ventilation in a suddenly distressed patient, how can you rapidly check airway patency?
Attempt to pass a suction catheter through the airway.
A ventilated patient suddenly becomes hypoxemic but has bilateral breath sounds. Manual ventilation does not relieve the distress, and ETCO₂ drops from 55 to 24. What should you suspect?
Pulmonary embolism.
A patient with COPD on PSV begins actively exhaling before inspiration cycles off, producing a pressure rise at the end of the breath. What ventilator feature may help?
Adjustable flow-cycling / Flow Cycle %.
A patient on PSV appears to be breathing, but the ventilator repeatedly activates the apnea alarm. What hidden problem can make patient triggering impossible?
Auto-PEEP (intrinsic PEEP).
A pressure overshoot or spike occurs at the beginning of inspiration. What does this indicate about ventilator delivery?
Flow and pressure delivery are very high at the beginning of the breath.