STUDENT COURSE INFORMATION

Transcription

1 STUDENT COURSE INFORMATION FANSHAWE COLLEGE OF APPLIED ARTS AND TECHNOLOGY HEALTH SCIENCES JANUARY 2010 RESP MECHANICAL VENTILATION 2 Duration: 60 total course hours Credit Units: 4.00 *NOTE: The hours may vary. This course is a prerequisite for: RESP-5009 CLINICAL PRACTICUM 1 RESP-5014 CLINICAL THEORY 1 Prerequisite(s) for this course: RESP-3002 MECHANICAL VENTILATION 1 Co-requisite(s) for this course: NO COURSES Course Description: Building upon mechanical ventilation fundamentals from semester one, this course starts by exploring facets of neonatal and pediatric ventilation with respect to equipment and techniques. The second unit of study focuses on new ventilator modes and adjunctive techniques as well as the initial set up parameters needed for all patients. This unit also addresses the psychological aspects of mechanically ventilated patients. Block III will address alternate and related ventilatory strategies as well as home care ventilation. Vocational Learning Outcomes: Upon successful completion of this course, the student will be able to: 1. explain the differences in equipment and ventilation strategies between neonatal, pediatric and adult mechanical ventilation 2. explain the most common ventilatory adjuncts and modes found on the modern day ventilator 3. explain the difference between invasive and non-invasive ventilation 4. discuss clinical applications of non-invasive ventilation 5. discuss the psychological impact on mechanically ventilated patients as well as their families. 6. describe criteria and techniques for weaning patients from mechanical ventilators 7. discuss other related factors and strategies as they relate to mechanically ventilated patient 8. explain the need and technique for nitric oxide therapy 9. explain the need and technique for extracorporeal membrane oxygenation (ECMO) 10. discuss the mechanically ventilated patient in the house Essential Employability Skills Learning Outcomes:

2 Essential Employability Skills Learning Outcomes Taught Reinforced Assessed or evaluated Communicate clearly, concisely and correctly in the written, spoken and visual form that fulfills the purpose and meets the needs of the audience. Respond to written, spoken or visual messages in a manner that ensures effective communication. Execute mathematical operations accurately. Apply a systematic approach to solving problems. Use a variety of thinking skills to anticipate and solve problems. Locate, select, organize and document information using appropriate technology and information systems. Analyze, evaluate and apply relevant information from a variety of sources. Show respect for the diverse opinions, values, belief systems and contributions of others. Interact with others in groups or teams in ways that contribute to effective working relationships and the achievement of goals. Manage the use of time and other resources to complete projects. Take responsibility for one's own actions, decisions and consequences. Detailed Content: Section One - NEONATAL AND PAEDIATRIC MECHANICAL VENTILATION Unit I - Neonatal / Paediatric Ventilators Upon completion of this section, the student will: 1. describe characteristics of the IDEAL infant ventilator 2. analyse the modes of ventilation and ventilatory adjuncts during the inspiratory and expiratory phase according to the functional specification template. Unit II - Physiological Aspects

3 1. define the normal lung volumes and breathing rates for infants and children 2. recognize the early signs of respiratory distress / failure in infants and children 3. differentiate between periodic breathing and apnea 4. list four indications for mechanical ventilation support in the newborn Unit III - Neonatal Ventilation 1. state indications for mechanical ventilatory support of the neonatal patient 2. discuss the following neonatal ventilator parameters: a. peak inspiratory pressure b. inspiratory time c. flow rate d. mean airway pressure e. frequency f. I:E Ratio g. positive end expiratory pressure h. fraction of inspired oxygen 3. describe pressure-limited time-cycled ventilation, including factors that determine the tidal volume delivered to the patient 4. describe the limitations of pressure-limited ventilation 5. describe the manipulation of mean airway pressure 6. describe weaning a neonate from mechanical ventilation 7. describe different types of high-frequency ventilation a. high frequency jet ventilation b. high frequency oscillation

4 8. describe the ventilator circuits commonly found with neonatal ventilators Unit IV - Surfactant Replacement Therapy 1. state the role of surfactant 2. describe the clinical use or surfactant 3. describe the different types of endogenous and exogenous surfactants 4. discuss the administration of surfactant Unit V - Pediatric Mechanical Ventilation 1. state indications for mechanical ventilation in pediatric patients 2. describe the following pediatric ventilator parameters: a. tidal volume b. inspiration time c. flow rate d. fraction of inspired oxygen e. frequency f. I:E Ratio g. positive end expiratory pressure 3. describe the application of negative pressure ventilation 4. describe pressure support as a mode of supported ventilation 5. define "Pressure-Controlled Inverse Ratio ventilation 6. describe weaning a pediatric patient from mechanical ventilation 7. describe common complications and hazards of mechanical ventilation

5 Unit VI - Partial Liquid Ventilation 1. describe infant respiratory distress syndrome 2. discuss the development of liquid ventilation techniques 3. describe the currently available liquids utilized for partial liquid ventilation and oxygenation Unit VII Non Invasive Positive Pressure Ventilation (NIPPV) 1. Discuss the guidelines for use of NIPPV in newborn and pediatric patients. 2. Recognize the indications, goals, limitations, and potentially harmful effects of NIPPV in a clinical case. 3. Describe the basic design of devices used to deliver CPAP and Bilevel positive airway pressure to an infant. Section Two - VENTILATOR WAVEFORMS Unit I - Work of Breathing (WOB) 1. define the work of breathing 2. define elastic resistance and non-elastic resistance to ventilation 3. state the physiological factors that influence the work of breathing 4. state the mechanical factors that may influence the work of breathing 5. define inspiratory workload

6 6. define expiratory workload 7. describe the method used to estimate the inspiratory workload during: a. spontaneous ventilation b. controlled ventilation 8. describe the ventilatory pattern that minimizes the inspiratory workload in patients with: a. obstructive lung diseases b. restrictive lung diseases Unit II - Waveform Analysis Upon completion of this unit, the student should be able to: 1. understand the concept of plotting graphs 2. describe the characteristics of flow, pressure and volume waveforms 3. describe the waveform patterns for various modes of ventilation 4. identify graphics produced under varying lung conditions 5. describe how to optimising ventilatory support by way of waveform analysis 6. draw and label components of a normal pressure/volume loop, including inspiratory and expiratory curves, work of breathing, peak inspiratory pressure, and tidal volume. 7. draw and label a normal flow/volume loop. 8. identify the presence of increased airway resistance (obstruction) in a flow/volume loop. 9. identify inadequate flow on a pressure/time graph. Section Three - VENTILATORY ADJUNCTS Unit I - Minimum Minute Ventilation

7 1. describe the general theory of MMV 2. state the advantages and disadvantages of MMV Unit II Bilevel Positive Airway Pressure on a Mechanical Ventilator 1. state the theory of bilevel positive airway pressure 2. describe how spontaneous ventilation is enhanced during bilevel positive airway pressure 3. state the pressure levels used during bilevel positive airway pressure 4. state a possible hazard of bilevel positive airway pressure ventilation 5. describe Airway Pressure Release Ventilation (APRV) 6. explain the differences between APRV (Evita) and Bi-Level (PB 840) Unit III - Pressure Support Ventilation (PSV) 1. describe the principle of PSV 2. describe how PSV is normally terminated during the inspiratory phase 3. describe the safety systems used to terminate the inspiratory phase during PSV 4. describe how PSV can alleviate the work of breathing (WOB) 5. describe the role of PSV in respiratory muscle conditioning 6. state the imposed inspiratory workload that PSV cannot alleviate 7. state the setting of PSV to alleviate resistance through the artificial airway 8. state the initial setting for PSVmax 9. describe the effects of lung characteristics on spontaneous ventilation during PSV 10. describe how PSV can be tailored to each patients comfort

8 11. list the initial settings for PSV Unit IV Non-Invasive Positive Pressure Ventilation (NPPV) Upon completion of this unit the student will be able to: 1. describe the principles of NPPV 2. state the goal(s) of NPPV 3. identify the pathological indications for NPPV 4. identify contraindications to NPPV 5. state how NPPV will control PaCO2 & PaO2 through inspiratory positive airway pressure (IPAP) and expiratory positive airway pressure (EPAP). 6. describe technical considerations for NPPV including: " types of ventilators acute care vs chronic care " modes of ventilation spontaneous vs timed " controls & settings IPAP, EPAP, rate, ramp, inspiratory time, FIO2, " alarms 7. describe the patient interface and circuit including: " masks nasal, pillows/prongs, full-face " headgear " sizing of masks and headgear " other circuitry 8. describe the ability to provide humidification to the NPPV circuit 9. describe the therapeutic application of NPPV including: " initiation and setting parameters " patient monitoring parameters & waveforms, alarms 10. describe considerations for and methods of weaning NPPV 11. describe complications of NPPV

9 Unit V - Other Ventilatory Modes 1. describe the following additional modes with respect to general set-up, clinical applications, complications: a. pressure control ventilation (PCV) b. volume support (VS) c. pressure regulated volume control (PRVC) d. proportional assist ventilation (PAV) e. Volume Assured Pressure Support (VAPS) f. NAVA (Neurally Adjusted Ventilatory Assist) 2. Compare the advantages and disadvantages of both volume and pressure limited ventilation. Section Four VENTILATING PARAMETERS Unit I - Initial set up of a Ventilator 1. describe how to check a ventilator circuit for completeness and proper function. 2. explain the general parameter set up of an adult or paediatric/neonatal ventilator with respect to: a. mode(s) b. frequency c. triggering d. back up ventilation e. alarms f. tidal volume g. flow

10 h. oxygen percentage i. monitoring 3. describe the initial procedures after the patient has been placed on the ventilator. 4. describe what is meant by the term therapist driven protocol as it pertains to Respiratory Therapy Unit II - Psychological Aspects of Mechanical Ventilation 1. describe common feelings and emotions patients may be feel while being mechanically ventilated 2. describe feelings and emotions visitors may experience when at the bedside of a mechanically ventilated patient in the intensive care unit (ICU) 3. describe emotions and feelings health care workers may experience at bedside of a mechanically ventilated patient 4. describe ways of improving communication between the patient and the health care worker at bedside in the ICU 5. describe what is meant by ICU delirium 6. list causes of ICU delirium 7. describe the effects of ICU delirium on ventilated patients Section Five - EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO) Unit I - Patient Selection 1. describe the issues to be considered in the application of ECMO Therapy 2. describe the disease processes that lend themselves to ECMO therapy 3. describe the contraindications to ECMO Therapy

11 Unit II - Technique 1. discuss differences in Veno-Arterial and Veno-Venous cannulation 2. describe the role of the ventilator during ECMO Therapy 3. explain the role of the Respiratory Therapist in ECMO therapy Unit III - ECMO Circuit 1. state the purpose of all components of the ECMO circuit 2. describe gas transfer within the membrane oxygenator Section Six - NITRIC OXIDE THERAPY (NO) Unit I - Indications 1. state the physiological effects of nitric oxide 2. list the indications for nitric oxide therapy 3. state the recommended dosage of NO Unit II - Technique 1. describe the equipment used and delivery methods for NO therapy

12 2. describe the contraindications for NO therapy in terms of: a. patient b. equipment Section Seven - WEANING FROM VENTILATORY SUPPORT Unit I - Nutrition Upon completion of this unit the student will 1. explain the special nutritional needs of a ventilated patient 2. explain why nutrition is important in the weaning process Unit II - Physiological Factors 1. describe spontaneous breathing trials 2. state the physiological criteria, which must be met to successfully wean a patient from ventilatory support. This is to include: a. the Vital Capacity b. the minute ventilation required to maintain a PCO2 at 40 mm Hg. c. the cardiovascular status d. the respiratory rate e. the A-aDo2 breathing 100% oxygen f. the VD/VT ratio g. the inspiratory force 3. state the cardiovascular complications of weaning

13 4. state the criteria which will determine that weaning efforts be discontinued 5. state the problems associated with patients who continuously fail to be weaned 6. state the major criteria for extubation Section Eight OTHER VENTILATORY STRATEGIES Unit I Permissive Hypercapnia Ventilation (PHY) Upon completion of this unit, the student should be able to: 1. describe indications and contraindications of PHY 2. describe clinical applications for PHY Section Nine HOME VENTILATION Unit I - Home Ventilation Upon completion of this unit, the student should be able to: 1. discuss various pathological indications for and complications arising from home ventilation. 2. state the indications for a tracheostomy airway as it relates to home ventilation and requirements for care and maintenance of this airway in the home setting. 3. discuss home ventilators and patient circuitry with respect to: principle of operation, modes of ventilation and back-up available, ventilation parameters, alarms, power requirements and availability of such, and assembly and connection of the patient circuitry. 4. describe various accessory equipment, which may be used in conjunction with home ventilation (eg. suction, resuscitator bags, oxygen, medication delivery, cardiorespiratory monitors). 5. discuss required monitoring, assessment and documentation of the patient & equipment. 6. explain infection control procedures as they relate to home ventilation.

14 7. describe the roles and responsibilities of all persons, health care professionals, institutions and agencies in the coordination and on-going existence of ventilation in the home. Teaching/Learning Methodology: 1. Lectures 2. Demonstrations 3. Overhead presentations Required Learning Resources: 1. Mosby's Respiratory Care Equipment, 8th Edition, J.M. Cairo and Susan P. Pilbeam, Mosby. (required) 2. Egan's Fundamentals of Respiratory Care, 9th Edition, Robert Wilkins, James Stoller, Craig Scanlan, Mosby. (required) 3. Ventilators - Theory and Application, 2nd Edition, abridged version, Yvon G. Dupuis, Mosby & Fanshawe College. (optional) 4. Mechanical Ventilation, 4th Edition, Susan P. Pilbeam, Mosby. (required) (Additional Required Learning Resources in Additional Information) Method Of Evaluation: The final mark/grade for this course will be determined as follows: Written multiple choice examinations: Method Percentage Test 1 30% Test 2 30% Test 3 30% Assignments &/or quizzes 10% TOTAL 100% NOTE: Test and assignment due dates, etc. will be provided by the professor at the beginning of the course. Consult the Program Division Policy for additional information on course evaluation and progression.

15 Grade Range Comment Grade Point A Distinguished 4.2 A B B C C D D Marginal 1.0 F 0-49 Unsatisfactory 0 P greater than 50 Pass N/A I N/A Incomplete N/A N N/A No Credit Achieved N/A W N/A Withdrawn N/A X N/A Audit N/A CHEATING - All forms of cheating are considered an academic offence and the College has a clear policy on cheating. Please refer to Policy 2-G-04 on Fanshawe Online or in the Student Handbook. PLAGIARISM - Plagiarism is cheating and an appropriate penalty will be applied and a report will be placed in the student's file in conformance with College Policy 2-G-04 on cheating. Plagiarism (the intellectual dishonesty resulting from a student's failure to acknowledge indebtedness to sources used) is a serious academic offence that shall result in appropriate penalties, to be determined at the discretion of the course professor in consultation with the Divisional Chair. Plagiarism includes, but is not limited to, submitting the same work to more than one professor for credit in different courses without prior written permission from the professors. Penalties shall range from failure of an assignment to possible failure of the course. REWRITES - Students cannot make the assumption that any provision will be made by the professor to permit a student to rewrite failed assignments or tests. Turnitin.com As part of Fanshawe College's commitment to fostering excellence in student assignments, this course may require students to submit their papers to Turnitin.com. This Web service is designed to help students understand the importance of identifying borrowed work in their essays, and how to correctly cite research sources. Instructions for how to use Turnitin.com will be provided by the professor, and additional information is available at Additional Information: Consult your Program Outline for information concerning the minimum passing grade needed for this course. Additional Required Learning Resources 5. Mechanical Ventilation Wookbook, 4th Edition, Susan P. Pilbeam, Mosby. 6. Clinical Application of Mechanical Ventilation, 2nd ed., David Chang, Delmar (optional - available in Fanshawe College library)

16 Prepared By: Dennis Hunter, B.Ed, RRT, EMCA The following applies for course offerings consistent with the Standard Academic Calendar: Internal/External Course Credit Application Deadline Applications for Internal/External Course Credit are available from the Office of the Registrar. Check college calendar for deadlines. Course Add/Drop Deadline You may withdraw from a course without academic penalty during the first 70% of the course duration. Application is made through the Office of the Registrar. Academic Assistance The primary resource for students experiencing difficulty with course material is the course professor. In addition, students who wish to attend study skills workshops or who require further assistance, can contact the Learning Centre in A2019 ( ) for one-to-one tutoring from staff in math, physics, chemistry and english, or they can contact Counselling and Student Life in F2010 ( ) for information about receiving peer tutoring. Student Success Advisors are available to assist students with academic concerns or other problems they may face while at Fanshawe. They can either assist you directly, or refer you to the appropriate resource on campus to get the help you need. Contact information for your Student Success Advisor can be found on the Web at Students who have been identified as having (or who wish to be assessed for) a specific learning disability, should contact Disability Services F2010 ( ) in Counselling and Student Life for information about available support services. Re-taking a Course: Subject to meeting any pre-requisite or co-requisite requirements, a student may retake a course. The second re-take must be approved by the Academic Manager or designate and will be granted based on extenuating circumstances and with recommended interventions such as counselling or a learning contract. Subsequent re-take opportunities will only be available as part of an overall success strategy developed in consultation with the student, program co-ordinator and the Academic Manager. The best grade achieved will be used in calculating the cumulative GPA. Related Policies Course Grade System - See College Policy 2-C-04 Prior Learning Assessment and Recognition - See College Policy 2-A-10 Evaluations - See College Policy 2-C-02 Academic Standing - See College Policy 2-C-05 Student Appeal of a Grade or Other Academic Decision - See College Policy 2-G-02 Academic Withdrawal and Termination - See College Policy 2-C-06 Academic Offences - See College Policy 2-G-04 Student Code of Conduct Policy - See College Policy 2-G-01 Respectful College Community Policy - See College Policy 1-B-46 Authorized By: Date: JANUARY 2010