RTH 241 - Application of Mechanical Venilation

1. Recognize special airways for ventilation.
2. Describe indications for initiation of mechanical ventilation.
3. Explain weaning parameters and methods of liberation from mechanical ventilation.
4. Interpret, apply, and manage advanced modes of mechanical ventilation.
5. Describe mechanical ventilation in the nontraditional setting.
6. Identify characteristics of ventilator waveforms.

1. Special Airways for Management
   1. Oropharyngeal and nasopharyngeal
   2. Esophageal obturators
   3. Laryngeal mask airway
   4. Esophageal-tracheal combitube
   5. Double-lumen endobronchial tube
2. Airway Management in Mechanical Ventilation
   1. Indications for intubation
   2. Characteristics of endotracheal and tracheostomy tubes
   3. Management of endotracheal and tracheostomy tubes
   4. Management of cuff pressures
   5. Speaking valves
   6. Predictors and procedures for planned and unplanned extubation
3. Initiation of Mechanical Ventilation
   1. Goals of mechanical ventilation
   2. Primary indicators for mechanical ventilation
   3. Contraindications for mechanical ventilation
   4. Initial ventilator settings
   5. Initial ventilator alarm settings
   6. Hazards and complications of mechanical ventilation
4. Weaning from Mechanical Ventilation
   1. Weaning success, in progress, and failure
   2. Weaning criteria for assessing ventilation, oxygenation, and pulmonary measurements
   3. Rapid shallow breathing index
   4. Weaning procedures
   5. Indicators and causes of weaning failure
   6. Withholding and withdrawing mechanical ventilation
5. Management of Mechanical Ventilation
   1. Strategies to improve ventilation
   2. Strategies to improve oxygenation
   3. Interpreting arterial blood gases
   4. Troubleshooting ventilator alarms and events
   5. Caring for the ventilator circuit and artificial airway
   6. Fluid, electrolyte balance, and nutrition
   7. Adjunctive management strategies
6. Operating Modes of Mechanical Ventilation
   1. Review of assist/control and synchronized intermittent mandatory ventilation
   2. Mandatory minute ventilation and pressure support ventilation
   3. Adaptive support ventilation and proportional assist ventilation
   4. Volume assured pressure support and pressure-regulated volume control
   5. Adaptive pressure control, volume ventilation plus, and pressure-controlled ventilation
   6. Airway pressure release ventilation, biphasic positive airway pressure, and inverse ration ventilation
   7. Neutrally adjusted ventilator assist and high-frequency oscillatory ventilation
7. Mechanical Ventilation in Nontraditional Settings
   1. Indications, contraindications, and equipment selection for mechanical ventilation at home
   2. Mechanical ventilation in a mass casualty setting
   3. Mechanical ventilation in hyperbaric and hypobaric conditions
   4. Portable ventilators at high altitudes
8. Ventilator Waveform Analysis
   1. Waveform characteristics of flow-time, pressure-time, and controlled mandatory ventilation
   2. Waveform characteristics of spontaneous breathing during mechanical ventilation
   3. Effects of flow, circuit and lung characteristics on pressure-time waveform
   4. Waveform characteristics of pressure-controlled ventilation (PCV) vs. volume-controlled ventilation
   5. Waveform characteristics of pressure-supported ventilation
   6. Changing lung characteristics on PCV waveforms
   7. Identifying patient-ventilator dyssynchrony, increased airway resistance, loss of elastic recoil, decreased lung compliance, gas trapping, and circuit leaks
   8. Pressure-volume and flow-volume loops