Mechanical Ventilator Complete Revision | NORCET Special | 2026 MCQs | Magic Pills | 141 |

[00:00:02]Hello guys, welcome and welcome to median rash academy one of leading academy in training nurses in the nursing competitive exam as well as I sent and training. Welcome back to magic pool session. In magic session we are discussing very important topic previously question papers additional golden points rational for each and every option. There are so many magical videos streaming in nursing meteor YouTube channel. Watch those videos also. And today the topic what we are going to discuss is mechanical ventilator. Most of the students demanded for this topic. That's why I selected this one. So watch the video till the end. Definitely it is going to be very very useful for you for your upcoming competitive examination. Let's begin the session without wasting the time with your thought of the day. See there is no secret for success. If you want success in your life, you need to have three things. The first one keep on learning. Keep your preparation again and again. Okay? Even though there are so many failures coming in your life, just overcome the failure. Keep learning that hard work make you to success.

[00:01:01]Okay. So whenever you are learning from the failure that learning is very very important. You will not do the same mistake again. Understand? So three things are very important that is keep your preparation constant. Hard work is very very important and learn from your failure. If you have these three things then definitely your success is going to be very fast. Okay. So let's start the session. As I mentioned already the topic what we are going to discuss today is mechanical ventilator that is artificial lungs which is going to deliver a volume and pressure and maintain the lungs properly maintain the oxygen diffusion saturation each and everything will be maintained by the mechanical ventilator. Let's see discuss in detail important exam points related to mechanical ventilator. Two things whenever you come across the word mechanical ventilator two things should come into your mind. See mechanical ventilator it is a artificial lung which is supporting the respiratory system. So if you connecting a patient with the me mechanical ventilator either the machine is going to support the respiration otherwise the patient himself try to take the respiration. Okay, only these two concept you're supposed to remember. You connected the patient with the mechanical ventilator. Once connected, the machine is going to take responsibility of the respiration and in between sometimes the patient will recover and patient try to take his own respiration. Understand? Right? So when the patient is trying to take his own respiration that time what the mechanical ventilator is doing. Okay? So your first point should be related to who started the breathing. Once the patient connected with the mechanical ventilator who is giving the breathing whether the machine is giving the breath otherwise the patient himself is breathing. Okay. So these two point clarity has to be there in your mind because based upon who is taking the respiration a machine is giving the respiration or patient himself is taking the respiration. This makes you to understand the modes of respiration.

[00:03:19]Modes of respiration. Understand? Right?

[00:03:21]Fine. The next one is suppose if the machine is giving respiration two things you have to keep in mind. The first one is volume and second one is pressure.

[00:03:31]Volume in the sense tidal volume we all know that the normal tidal volume for an adult the average amount is 500 ml right fine and the pressure means the force or speed of volume entering inside the respiratory system that is called as what pressure usually pressure will be 20 uh cm of water understand so volume or pressure these two things are maintained by the mechanical ventilator to maintain the respiration of the patient okay So the first one who is taking the breathing mechanical ventilator or patient and the second one if the mechanical ventilator is taking responsibility what type of work it is doing whether it is giving volume to the patient or it is giving pressure to the patient that clarity should be there. Based upon these two points we are going to discuss about the modes of mechanical ventilator. There are so many modes of mechanical ventilator one by one. In short I have made here just to go through it. The first mode is assist control mode. Here the patient is totally dependent on the machine. Okay.

[00:04:38]That is mechanical ventilator. See in mechan from the mechanical ventilator continuous support will be given from the mechanical ventilator. Okay. The patient is not at all breathing. I'm giving an example. The patient is not at all breathing. For example, the respiratory rate is set for 16. Okay. So all the 16 breath will be given from the mechanical ventilator. Understand?

[00:05:00]Suppose if the patient is trying to take uh 10 percentage of effort in taking a breathing means rest 90%age of effort will be given by the machine. On the whole if you are setting 16 respiratory rate means all 16 respiratory rate it will be supported by the mechanical ventilator only. If the patient is trying to take a breath for 10 percentage or 15 percentage rest 85%age or 90%age will be supported by the mission mechanical medilator. Okay. So assist control means here the machine is taking the overall responsibility. Every breath gets full support from the machine. Every breath get full support from the machine. Understand? So if the patient is getting full support from the machine definitely two things as I mentioned in the previous slide very important the first one is volume and second one is pressure. Okay so machine will give two things the first one volume otherwise pressure understand right fine. So on the whole very simple concept assist control means the machine is totally taken the responsibility of respiration that is called as what assist control mode in that two things is there that is volume control otherwise pressure control we will discuss about these two things later the second one sim synchronized intermittent mandatory ventilation very very very important one this is a weaning mode assist control mode is not a weaning mode here patient totally depend upon the ventilator but here SI MV synchronized intermittent mandatory ventilation. It is a winning here. What is happening? I'm giving the same example. You fixed your respirator rate of 16. The first breath is given by the machine. I'm giving an example. Second breath also given by the machine. Third breath the patient is trying to take. So the third breath is spontaneous. The machine will not support the patient in the third breath. If the patient is taking a third breath or fourth breath or fifth breath doesn't matter when the patient started to take the breath means the machine will stop the helping for that particular breathing particular breathing. For example, third breath the patient is taking means for third breath the mission will not support. Again fourth breath the machine will support.

[00:07:17]Fifth breath the mission will support.

[00:07:18]Sixth breath the mission will support.

[00:07:20]And seventh breath again the patient is trying to take the breath means that time the machine will not support. The patient has to take the breath on its own. So in the 16 respiratory rate whenever the patient is initiating the breath that time the machine will not support the patient has to take the breath spontaneously.

[00:07:39]Okay. Whenever the patient is not taking the breath the mission will support. So two role is there. Machine is obviously giving the respiration but whenever the patient is taking respiration that time the machine is not helping. Okay. Right.

[00:07:52]Okay. So this is called as what?

[00:07:54]Synchronized intermittent mandatory ventilation. You can see here here the memory trick is some breath by the machine and some by the patient. Some breath taken by the given by the machine and some breath taken by the patient.

[00:08:06]Okay. Right. The next one pressure support ventilation. Again very very important. This is also a wheeling mode ventilation pressure support ventilation. Here the memory trick is patient starts the breathing and ventilator help the breathing.

[00:08:22]Patient is starting the breathing. For example, 20%age of effort the patient is taking in the breathing and 80%age of effort will be given from the machine.

[00:08:33]20% is from the patient. 80% is from the machine. Suppose 50%age from the patient effort the 50%age of effort is taken by the patient means rest 50% will be given by the mission. Okay. Right. But here definitely what is needed patient should start the breathing otherwise the mission will not support. The patient should start the breathing then only the mission will support that is called as what pressure support. Okay. The next one is CPAP continuous positive airway pressure. Here the memory trick is patient breathe completely on its own.

[00:09:09]CPAP biap. CPAP means continuous positive airway pressure. Bipap means ble posture airway pressure. In both the condition the patient has to take a spontaneous breath. The machine is not going to help. Okay. Here the patient has to take the effort in spontaneous breath. But in CPAP continuous positive RBF pressure will be delivered to the patient. Whether the patient is taking inspiration or the patient is taking expression doesn't matter. Continuous positive RBA pressure will be there getting to the patient. Understand right that is called as what CPAP. Same positive airway pressure during inspiration and during expiration that is called as what CPAP. It is used to maintain the airway open. It maintains the patency of the alvoli open.

[00:09:58]Understand? That is called as what?

[00:09:59]CPAP. And the next one is BIPAP. BiPAP.

[00:10:03]Already I said that B level positive airway pressure that is called as what?

[00:10:07]BiPAP. See the difference between CPAP and BPAP is you can see here this is the CPAP. Same mission only. Okay. This is the CPAP mission and this is the BiPAP machine. In CPAP only one positive pressure is there. During inspiration also same pressure will come. During expiration of the patient also same pressure will be there. That is called as what? CPAP. But bip it is totally different. During inspiration there will be some pressure difference and during expression there will be some pressure difference. Okay. During inspiration for example 50%age of pressure is going inside means during expression only 20%age of pressure will come. Okay. So during inspiration and during expiration there is a changes in the pressure but it maintains the patency of the airway.

[00:10:53]CPAP BiPAP both will maintain the patency of the airway. But in CPAP same pressure continuously delivered inside the lungs of the patient. Whereas in BiPAP during inspiration one pressure and during expression another pressure will be there. Understand? Right? But the core concept is same to maintain the patency of the airway to prevent adilct taxis to prevent the collapse of the alvolola. Understand right fine. So the next one volume control ventilation pressure control ventilation. See already we discussed about assist control mode. You can see here assist control. A mean AC means what? Assist control. AC means what? Assist control.

[00:11:31]Right? So already I clearly said that assist control mode the patient is totally depend upon the mechanical ventilator for the breathing. So mechanical ventilator is to taking total responsibility. So here two thing is very important volume and pressure. What the machine is delivering to the patient. For example patient needs the quantity of air. Yeah. Adequate quantity of air is needed for the patient. That time the patient will be in the assist control volume mode. Okay, assist control volume mode. Otherwise the patient need more pressure to maintain the airway pattern. See that time the physician will make the patient to be in assist control pressure mode. So what is required for the patient whether the patient need a air that time tidal volume means volume mode. Assist control volume mode otherwise the patient need a pressure to maintain the airway patency that time assist control pressure mode.

[00:12:30]You can see here volume control ventilation and pressure control ventilation. In volume control ventilation volume is guaranteed the tidal volume for example 500 ml is the tidal volume sitting in the machine means that 500 ml of tidal volume will definitely go inside the lungs. That is called as what? Volume control ventilation. Otherwise in order to maintain the airway patency the physician is switching to the pressure control mode that time pressure is guaranteed that is 20 cm of water pressure will be delivered to the lungs in order to maintain the airway patterns. Okay. Right. So assist control it has two things that is volume control ventilation pressure control ventilation. If the patient needs air volume control ventilation, if the pressure patient needs pressure to maintain the airway patency that time pressure control ventilation.

[00:13:21]Understand? So these are all the basics guys. Another important exam point. See in assist control mode.

[00:13:28]You can see here can the ventilator breathe for the patient if the patient stop breathing. If the patient stops breathing whether the ventilator will support. If support means in which mode it will support. The patient is breathing suddenly stopped breathing that time. In which mode if you are sitting means it will support the respiration. Two modes.

[00:13:53]The first one is assist control mode and second one is SIM mode. In assist control mode totally the machine will take care of the responsibility if the patient stop breathing in SIM mode. Here also the machine is taking the full responsibility but whenever the patient tries to take the breathing that time the machine is not supporting it will allow the patient to take the spontaneous breathing. So in SMV spontaneous breathing from the patient is also present and machine support is also present. Okay. Right. Whereas in PSV pressure support ventilation the patient should take the initiation then only the machine will support otherwise the machine will not support.

[00:14:33]Understand? Right? So you should have the knowledge about when the machine will support, when the machine will not support. Okay? Right? Fine. So the next one you can see here already I have said very clearly. Assist control volume mode. Assist control pressure mode.

[00:14:49]In assist control volume mode, who starts the breathing? Either the patient or the ventilator. But the full responsibility is taken by the ventilator. In assist control pressure mode here also the full responsibility is taken by the ventilator. SIMV mode here also full responsibility is taken by the ventilator but allowing the patient breathe spontaneous patient breathe. Understand? Right? So this concept you have to be very clear. Okay fine. So with this basic concept let's move into solving the question. The first question what we are going to discuss is a patient with acute respiratory distress syndrome is on mechanical ventilation. The ventilation ventilator alarm suddenly sounds high pressure alarm. Ventilator machine is having high pressure alarm or low pressure alarm like that. Okay. So high pressure alarm sound is coming. Now when the high pressure alarm will start in the mechanical ventilator machine that is very very important. Okay fine.

[00:15:57]So in what all the condition high pressure alarm will come from the mechanical ventilator. Here they have given four options. Emptying the humidifier water. Check for kinkedked tubing or patient coughing increased tidal volume and reduced FO2. Among the four option in what condition high pressure alarm will increase or beep sound will come from the high pressure alarm. So here the right answer is going to be one concept please remember here high pressure alarm when it will start whenever there is a obstruction in the pathway of delivering the air. Okay, see the patient is having endotrical tube and the endotrical tube is connected with the circuit and the circuit it is connected with the machine and the machine is delivering the air in the form of volume or in the form of pressure. Suppose the pathway is obstructed.

[00:16:55]Why? because of some uh uh kinking in the endotrachial tube or in the there is a bend in the circuit otherwise the patient is biting the endotrachial tube otherwise thick mucus secretion is present in the endotrachial tube okay all these things will cause what obstruction in the airway so whenever there is a obstruction in the flow of airway that kind pressure alarm will be there okay right so for this question the right answer is going to be what option B that is the tube is kinkedked.

[00:17:28]The tube is kinkedked and the patient is coughing. That time there is a blockage in the flow of air from the machine.

[00:17:37]Understand? So that's why high pressure alarm is coming. Understand? Right. So what about other options? Humidifier is a not common cause of high pressure alarm. Increased tidal volume will not cause high pressure alarm. Fio2 does not cause any high pressure alarm. The only thing which can cause the eye pressure alarm is kinking of the tube. Okay, kinking of the tube. Okay, so the next one is a patient receiving ventilator support suddenly develop low pressure alarm. Previous question we discussed about what eye pressure alarm because of some resistance. Okay. Or some blockage otherwise the patient is coughing otherwise severe mucus secretion is there means eye pressure alarm will be there. And here in this question they specifically mentioned about what low pressure alarm and the nurse noticed the patient chest movement was decreased. So two key points is there in this question. The first one is low pressure alarm and second one the patient chest movement is decreased. In what condition this type or this problems will happen?

[00:18:39]Four option they have given here bronospasm thick secretion ET tube cuff leakage or circute disconnected and pulmonary edema. Four option they have given here among these four option which is going to cause the low pressure alarm and also they mention one point clearly patient chest movement was decreased.

[00:18:58]Okay fine. So for this question the right answer is going to be ET tube cuff leak or circute disconnection. There is a leak in the ET tube endotrachal tube.

[00:19:07]Otherwise the circuit which is connected with the endotraal tube is disconnected.

[00:19:12]So air is leaking out. So if there is no resistance the air is easily leaking out that time there will not be any resistance. So that time low pressure alarm will be there. Okay. See the volume of air or pressure of air is coming to the patient but there is a leak means that amount of air will not reach the lungs. Right? So if it is not reaching the lungs the resistance will not be there. So if there is no resistance low pressure alarm will be there. Okay. Right. And for this question the right answer is going to be option C that is ET tube leak or circus disconnection. It leads to leakage of air. That one cause what? Low pressure alarm. Understand guys? Right. So what about other options? Bronospasm. If there is a bronospasm it will cause what? High pressure alarm. Because there is a contraction in the bronchi it will give more resistance to the machine.

[00:20:05]Okay. More resistance is there means what? High pressure alarm. Less resistance is there means low pressure alarm. And thick secretion already I said that it will also cause what?

[00:20:15]Obstruction. High resistance will be there. So high pressure alarm. Pulmonary edema in alvoli. Inside the alvoli fluid accumulation will be there. So that one will also cause what? High resistance.

[00:20:26]It leads to high pressure alarm. So based upon the resistance whether it is a high resistance or low resistance you have to decide which alarm is this high pressure or low pressure. Understand? So the next question a patient with acute respiratory distress syndrome has persistent hypoxmia as persistent hypoxmia despite receiving 100%age of oxygen. The physician increases the peep setting. What is the main purpose of this intervention? See basically here they are asking about P positive end expiratory pressure. So what is positive end expiratory pressure? The amount of air which is retained in the airway after the expiration. You are doing the expression. Okay. Full expression is over. After the expression also certain amount of air it is still retained in the what airway in order to maintain the patency of the airway and alvolite that is called as what? Positive end expiratory pressure. Okay. So four options they have given here increase respiratory rate prevent the alvolite collapse during expiration reduce airway secretion increase carbon dioxide elimination. So already I have said the rational for this question the right answer is going to be what option B that is prevent the alvolite collapse during the expiration. Understand right fine.

[00:21:45]So what about other options? See PEP does not control the respiratory rate that is what mentioned in the option A and option C reduce airway secretion.

[00:21:54]PEEP does not have any connection with the airway secretions. Increase carbon dioxide elimination. Carbon dioxide removal is mainly depends upon the minute ventilation. Minute ventilation is totally different. Okay. See uh minute ventilation means respiratory rate into tidal volume. If you are calculating means that is called as what? Minute ventilation that controls the carbon dioxide removal but PEP is not controlling the carbon dioxide remover. Understand? Right. So on the whole here the right answer is going to be what option B that is prevent the alvolar collapse during the expiration.

[00:22:28]Question number four. A patient recovering from the respiratory failure is shifted from assist control mode to SMA mode. The nurse explained the new ventilator mode to the patient family.

[00:22:40]Which explanation is correct? So new mode ventilator mode knowledge a nurse is giving to the patient attenders.

[00:22:50]Okay. So what is the new mode here? Same mode. So what is SM mode? That is the question. Four option they have given here. The ventilator provides every breath. The patient receives mandatory breath and can breathe spontaneously.

[00:23:04]The ventilator works only during apnea.

[00:23:07]The patient breath without ventilator assistance. So for this question the right answer is going to be what? Option B. Already I have explained very clearly in the introduction. SMV means spontaneous intermittent mandatory ventilation. That is the patient will al the mission will give the respiration.

[00:23:24]Suppose if the patient is trying to take the respiration that time the mission totally allow for the spontaneous respiration. Okay. 16 respiratory rate is set means the first respiration, second respiration the mission is giving and third respiration if the patient trying to take means that time the mission will allow the third respiration totally to the patient and fourth respiration if the patient is not taking that time the mission will support.

[00:23:50]Okay. So this is called as what spontaneous intermittent mandatory ventilation it is very very useful during the wheeling. Okay. So the next question, a ventilated patient suddenly becomes restless. The monitor shows the saturation is 82%age and the ventilator alarm starts sounding. What should the nurse do first? So SPO2 is very less and alarm is sounding. Okay. What should the nurse do first? Administer sedative? No, we cannot administer sedative. Already saturation is less. Assess the p patient airway, ET tube and oxygen supply. Okay, we can go with that. Call the physician before assessment. No, first we need to start with the uh ABC management because saturation is decreasing, switch off the ventilator. We should never do that, right? So for this question, the right answer is going to be what? Option B.

[00:24:44]Whenever the saturation is decreased for the patient who is connected with the ventilator, first you need to check the airway, breathing, circulation. So here the right answer is going to be what?

[00:24:53]Option B that is assess the patient airway, ET2 and oxygen supply. Okay.

[00:24:58]Right. So other options rational also I have mentioned here just go through it.

[00:25:03]Okay. Right. So question number six. A patient as he has stable vital signs follows the command maintain the saturation that is 96% saturation is maintained. Fio2 is 40. That is a good sign for weaning. See saturation more than 95 and Fio2 40%age means it is a good sign for weaning. Please remember this. If whenever you are increasing the FiO2, it shows the patient is not taking the respiration on its own. Okay? Not maintaining the oxygen saturation on its own. Okay? Whenever you are decreasing the FiO2 that is 40 or 39 or 38 or 35 that time it shows the patient is cooperating the patient is maintaining the oxygen saturation. Understand?

[00:25:48]Right. So here in this question two key points they have given here spo 2 is 96 and FYO2 is 40%age both or a good sign for what we okay so which nursing action is most appropriate. So this is the question four option they have given here increase ventilator support prepare the patient for weaning trial increase PP immediately continue full ventilator support indefinitely. So here it is a positive sign for weaning. So we can prepare the patient for weaning trial.

[00:26:19]So here the right answer is going to be what? Option B. Option B is the right answer. Okay. See the patient is recovering that's why saturation is 96.

[00:26:31]Fio2 is 40. Both are your good sign for weaning. That's why we have to prepare the patient for what we need.

[00:26:38]Understand? Right? Five. Question number seven. During endotrachial suction, a patient heart rate suddenly falls from 90 to 48. During suctioning, the heart rate is decreasing from 90 to 48. What should the nurse do immediately?

[00:26:54]Continue suction. Stop the suction and administer oxygen. Increase suction pressure. Suction for another 20 seconds. See, because of suctioning, the heart rate is decreasing. So, what we should do now? This is the question. So, what we will do?

[00:27:12]Stop the suction and administer oxygen is the right answer. Okay. See already the heart rate is decreasing. Why?

[00:27:18]Because of vagus nerve stimulation.

[00:27:20]Whenever you are doing suctioning the vagus nerve will get stimulated. Once the vagus nerve is stimulated it leads to bradicardia.

[00:27:28]Understand? Right. So continuing suctioning is contraindicated if the heart rate is decreasing. So stop suction and administer oxygen. That is the correct answer. Option B is the right one. Option C increase suction pressure. See the normal suction pressure for the adult is 100 to 120.

[00:27:44]Right? If you are increasing the suction pressure again the patient can go for what? Hypoxmia. Okay. And suction for another 20 seconds. No. Already the heart rate is decreasing. If you are increasing the suction for another 20 second again the patient will go for what? Bradicardia. So for this question the right answer is going to be what?

[00:28:01]Option B. Stop the suction and administer oxygen. And additional golden points I have added here. See for adult the suction uh pressure is going to be 100 to 120 ml of mercury and for children's 80 to 100 and for infant 60 to 80 and for neonate 40 to 60 mm of mercury.

[00:28:20]The next one question number eight. A nurse is caring for a patient who has been mechanically ventilated for 3 days.

[00:28:26]Which nursing intervention is most effective in reducing the risk of ventilator associated pneumonia? This question is led to web. So four option they have given here keep the patient in supine position. No we cannot keep there is a chance for aspiration. It increases the chances of ventilator associated pneumonia. So first question we can eliminate. Second one elevate the end head end head end head end head end head end head end head end head end head end head end head of the bed to 30 to 45°.

[00:28:51]Yes we can elevate the head of the bed to 30 to 45°. Disconnect the ventilator circuit every shift. No it is you if you are disconnecting you are contaminating the circuit. You are contaminating the airway. it will create the infection. So we can eliminate option C and option D perform endotrachial suction every hour.

[00:29:10]Whether it is indicated you can do if it is not indicated what is the necessary for doing suctioning every hour. So if you're doing suctioning unnecessarily every hour again you are inducing the infection. Okay. So on the whole here the right answer is going to be what option B that is elevate the head of the bed to 30 to 45°. Option B is the right.

[00:29:31]Okay right fine. So whatever the explanation I'm giving related to each and every options everything is mentioned here just pause the video and go through it. Okay. And question number nine. A patient has remained on FiO2 100%age means the patient is very sick.

[00:29:47]That's why 100%age FiO2 the patient is getting for 72 hours for a long time because of severe respiratory failure.

[00:29:54]Which complication should the nurse anticipate?

[00:29:57]Here they are asking about what complication hyperc calmia oxygen toxicity hypoglycemia bradicardia 100% FiO2 will cause oxygen toxicity guys there is no link between FiO2 and hypercalinia FiO2 and hypoglycemia FiO2 and bradigardia understand so it is a direct question it is directly taking you to what oxygen toxicity oxygen toxicity will cause what damage to the alvoli barot trauma will take place and surfactant will get affected the patient will go for further problem like A or DS. Okay. So for this question the right answer is what? Option B that is oxygen toxicity.

[00:30:38]Question number 10. While repositioning a patient the endotrical tube accidentally comes out. The patient is conscious but develop respiratory distress. What should the nurse do first? Document the incident. Call the physician. begin bag mask ventilation that is ambu bag ventilation with 100%age of oxygen and then call for help. Insert the new ET tube independently. So obviously this is also a direct question. So we cannot document. See first and foremost thing what we supposed to do? We always we have to go with ABC. If you are going with ABC the right answer is going to be start the ambu that is bag war mask ventilation with 100%age of oxygen.

[00:31:19]Okay. So for this question the right answer is going to be what option C that is begin by mask ventilation with 100%age of oxygen and then called for the health. Okay guys right so these are all the questions so far asked in the many competitive exams repeatedly that's why I added this question and a brief introduction about the modes of mechanical ventilator also I have given to you. So this is going to be a very important uh content. So watch the video again and again. If you are not getting a point, revise it again and again.

[00:31:51]Watch the video so that you will get an idea about the mechanical ventilator.

[00:31:56]And still you are having any doubts related to mechanical ventilator. You can drop your doubts in the comment session. And from the meteor side we are continuously providing the crash courses and regular batches. Hybrid classes is also going on in Delhi as well as in Ponticherry. Even we are going to start a new batch in Tamil Nadu also soon we will announce the place. So if you want to join us please call us in the number which is given down.

[00:32:24]Okay. So if there is any doubts anywhere you can drop your message in the comment section. Thank you very much for watching the video guys.

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