Page 404 - ACCCN's Critical Care Nursing

Ventilation and Oxygenation
Management 15

Louise Rose
Gabrielle Hanlon

ventilation is complex, ranging from simple interven-
Learning objectives tions, such as nasal cannulae through to invasive mechan-
ical ventilation and extracorporeal support. Additionally,
After reading this chapter, you should be able to: the meaning of ventilator terminology is often unclear
● describe oxygen therapy, including low-flow and high flow and terms may be used interchangeably. Critical care
devices, complications associated with oxygen therapy, and nurses must have a strong knowledge of the underlying
management priorities principles of oxygenation and ventilation that will facili-
● state nursing priorities for airway management strategies tate an understanding of respiratory support devices,
including laryngeal masks, endotracheal tubes and associated monitoring priorities and risks.
tracheostomy tubes
● summarise current knowledge on the physiological OXYGEN THERAPY
benefits, indications for use, associated monitoring Oxygen is required for aerobic cellular metabolism and
priorities, complications, modes, settings and interfaces for ultimately for human survival, with some cells, such as
non-invasive ventilation those in the brain, being more sensitive to hypoxia than
● state the indications for use, associated monitoring others. Refer to Chapter 13 for discussion of oxygen deliv-
priorities, complications, classification framework, modes ery and consumption, the oxyhaemoglobin dissociation
and settings for invasive mechanical ventilation curve, hypoxaemia and tissue hypoxia; this material
● outline the weaning continuum and current evidence for provides rationales for clinical decisions regarding the
optimising safe and efficient weaning from mechanical administration of oxygen therapy or ventilation strate-
ventilation gies. Oxygen therapy should be considered for patients
● discuss ventilation management strategies for refractory with a significant reduction in arterial oxygen levels, irre-
hypoxaemia spective of diagnosis and especially if the patient is
● discuss ventilation management strategies for severe drowsy or unconscious.
airflow limitation
INDICATIONS
Indications for oxygen therapy include:

● cardiac and respiratory arrest
Key words ● type I respiratory failure
● type II respiratory failure
artificial airway ● chest pain, cardiac failure, myocardial infarction
oxygen therapy ● low blood pressure, cardiac output
mechanical ventilation ● increased metabolic demands
non-invasive ventilation ● carbon monoxide poisoning
weaning
COMPLICATIONS
Administration of oxygen, regardless of the delivery
device, has potential adverse effects. High concentrations
INTRODUCTION of oxygen cause nitrogen washout, resulting in absorp-
tion atelectasis.
Supporting oxygenation and ventilation are two of the
most common interventions in intensive care; in 2007–
2008, approximately 41% of patients in Australian and Hypoventilation and CO 2 Narcosis
New Zealand ICUs received invasive mechanical ventila- High-dose oxygen therapy may lead to hypoventilation,
1
tion and 8% received non-invasive ventilation (NIV). worsening hypercapnia and CO 2 narcosis due to inhibi-
The technology available for supporting oxygenation and tion of the hypoxic drive in a small proportion of patients 381