Mechanical ventilation is a life-saving intervention used when patients cannot breathe adequately on their own. It delivers breaths using a machine in positive pressure ventilation (PPV) mode — much like an air pump inflating a tire, it pushes oxygen-rich air into the lungs.
When Mechanical Ventilation is Needed
- Severe respiratory failure (hypoxemia, hypercapnia)
- Post-surgical recovery in high-risk patients
- Neuromuscular disorders impairing breathing
- Severe trauma or head injury
- During anesthesia for major surgery
Suctioning in Ventilated Patients
Purpose: To remove airway secretions, maintain oxygenation, and prevent infection.
5 Key Points:
- Suction OUT, never IN – insert catheter gently before suctioning.
- Limit suction time to 10 seconds or less.
- Provide 100% oxygen 30 seconds before suctioning.
- Avoid suctioning before an arterial blood gas (ABG) draw.
- Do not suction routinely — only when needed to prevent lung injury.
NCLEX Tip: Never apply suction while inserting the catheter into the airway.
Oral Care and Ventilator-Associated Pneumonia (VAP) Prevention
VAP is a common and dangerous complication in intubated patients.
Prevention Measures:
- Reposition patient every 2 hours
- Oral care with chlorhexidine every 2 hours
- Elevate head of bed to 30–45 degrees
- Implement daily sedation and weaning protocols
- Practice strict hand hygiene
Best Indicators of VAP:
- Positive sputum culture
- Fever (>38°C / 100.4°F)
- Chest X-ray showing new infiltrates
Complications of Mechanical Ventilation
1. Dropping O₂ Saturation
- Causes: Secretions, tube displacement, poor oxygen delivery
- Action: Auscultate lung sounds, manually ventilate if needed, have a resuscitation bag ready.
2. Pneumothorax
- Caused by barotrauma from high PEEP (positive end-expiratory pressure)
- Monitor for sudden respiratory distress and decreased breath sounds.
- Positive pressure reduces venous return, lowering cardiac output.
Extubation: Steps and Risks
Care after extubation:
- Use warm humidified oxygen via facemask
- Maintain oral care with oral sponges
- Keep patient NPO initially
- Position in High Fowler’s
Deadly Risks After Extubation:
- Atelectasis & Pneumonia – Prevent with incentive spirometry every hour and TCDB (Turn, Cough, Deep Breathe)
- Stridor – A high-pitched squeaky sound indicating airway swelling; report immediately
Tracheostomy Care
New tracheostomy priority:
- Check tightness of ties (should fit 1 finger underneath)
- Monitor for bleeding, swelling, or dislodgement
Mature tracheostomy (≥7 days old):
- Insert new tracheostomy tube using a curved Kelly clamp if needed
- Cover stoma with occlusive dressing
- Secure lungs with a bag-valve mask if respiratory distress occurs
NG Tube Feeding and GI Ulcer Prevention
- Avoid bolus feeding in ventilated patients — risk of aspiration.
- Monitor for stress ulcers in prolonged ventilation cases.
Quick Reference Table: Mechanical Ventilation Care
| Area | Key Points |
|---|---|
| Suctioning | Limit to ≤10 sec, oxygenate before, never suction in |
| VAP Prevention | Oral care q2h, elevate HOB, reposition q2h |
| Complications | Hypoxia, pneumothorax, hypotension |
| Extubation Risks | Atelectasis, pneumonia, stridor |
| Tracheostomy Priority | Secure ties, check tightness, monitor airway |
Frequently Asked Questions (FAQs)
1. How long can a patient stay on mechanical ventilation?
Some stay for hours to days, while critically ill patients may require weeks — prolonged use increases complication risk.
2. Why is high PEEP dangerous?
It can cause barotrauma, leading to pneumothorax.
3. What’s the first action if O₂ saturation drops suddenly in a ventilated patient?
Check for secretions and tube placement, and be ready to ventilate manually.
4. When is a tracheostomy considered?
Usually after 7–10 days of intubation to reduce airway trauma.
5. How is VAP different from community-acquired pneumonia?
VAP occurs ≥48 hours after intubation and is caused by hospital-acquired pathogens.
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