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So Alarming!!

Ventilators are often a source of anxiety and stress for new graduates or those new to critical care, ER or ICU, but in fact once you understand how they work, the modes and how easy they actually are to troubleshoot you'll learn to love your vented patients.

First off, remember that as long as you have a BVM within reach, IT IS NO BIG DEAL if your ventilator tubing connection (called a circuit) is lost. Just like you can hold your breath for a few seconds, so can a patient and although it isn't ideal, they aren't going to die if they miss a few respirations. In fact in many hospitals, patients on ventilators are transferred from ER to ICU via BVM and then placed back on the vent since pushing a large circuit around is nothing short of cumbersome.

If the connection is lost...stay calm, and either reconnect the circuit, or grab your BVM, attach, and squeeze every 5 seconds until you can correct the problem...or RT saves your butt.

A Portable Ventilator (The Newport HT70) and a BVM

The second source of anxiety are the alarms a vent produces. There are many but most can be categorized into two types, high and low pressure alarms.

It is important to know the causes of these alarms so you can troubleshoot the problem and fix the vent or your patient.

High pressure alarms arise from the vent struggling to overcome some resistance and thus inhibit adequate oxygen delivery to the patient. Common causes include (in order of most common to not): patient coughing, a kink in the circuit, a gunky patient (suction!!), stepping on the circuit, patient biting the ET tube, increased airway resistance, & reduced lung compliance (ARDS & Pneumothorax)!

Low pressure alarms indicate there is little to no resistance in within the circuit, which should be physiologically impossible in the case of a fully sealed set-up and chest cavity. Common causes include: patient disconnected from the ventilator (commonly at the site of the tube), leaky circuit, airway leaks (check balloon inflation!), chest tube leaks or dislodgement, and hypovolemia.

A good mnemonic for identifying ventilator alarm causes that I learned when starting critical care was D.O.P.E (Dislodgement ie. low pressure, Obstruction ie. high pressure, Pneumothorax ie. high pressure, Equipment ie. malfunction, poor parameter settings, low battery)!