What is Ventilator Management?

Ventilator management is the initiating, monitoring, and adjusting of a mechanical ventilator according to the patient’s response and medical condition. Ventilator management may include selecting the appropriate ventilator mode, and ventilator settings. Often, a respiratory therapist will provide ventilator management in a hospital.

Therapists work under the direction of a doctor and may have protocols that allow them to make adjustments and changes as needed. It is necessary for the therapist to work together with nurses to provide the best care for the patient. Proper administration of medication for pain, sedation, and comfort by the nurse are crucial for effective ventilator management.

The first step in ventilator management is for the doctor and therapist to decide what ventilator mode would be the most beneficial to the patient, and what settings are appropriate. Ventilator settings can include a volume of air delivered to the lungs or a level of pressure delivered to the lungs. The respiratory rate will be set along with oxygen levels and a ventilator alarm.

After an initial mode and settings are started, a patient on a ventilator needs to be monitored often to gauge his response to the mode of ventilation and ventilator levels. Part of ventilator management is making adjustments as needed. Therapists managing a ventilator will need to listen to a patient's lung sounds, watch for signs the patient is fighting the ventilator, and monitor oxygen saturation levels. Arterial blood gases are often drawn to measure the patient’s carbon dioxide and acidity of the blood, which are affected by the ventilator settings.

Side effects can develop as a result of being on a ventilator. Barotrauma can occur, which is an injury to the lung and can be caused by too much pressure or too large a volume being delivered into the lungs. Cardiovascular side effects may include a decrease in blood pressure and cardiac output. Ventilator management includes recognizing side effects and making adjustments to the ventilator mode and ventilator levels as needed.

Weaning a patient off a ventilator is often the goal for most patients and a large part of ventilator management. Assessing when a person is ready to start weaning from the ventilator and conducting tests are the first steps in getting a patient off the ventilator. Respiratory therapists will assess a person’s level of consciousness and ability to breath on his own. They will determine if the patient can protect his airway by coughing. Therapists may change modes to one that provides the patient with less assistance to determine if the patient is ready to come off the ventilator.