1.7 Nursing Problems Encountered with Asynchronous Independent Lung Ventilation

b) Limited supply of oxygen, compressed air and electricity
Oxygen and air supply had to be exlended from the adjacent bedunit for the use of the two Bear ventilators and a separate supply of oxygen for ambubagging of the patient (in case of a power failure or changing of ventilator circuits). Thirteen wall plugs for electricity were required to supply the equipment in use on our patient. Once again. supply was derived from the adjacent bed-unit. The adjacent bed had to be closed. and we theretore functioned with one bed less than normal. It is worthwhile stressing than an adequately designed ICU needs a large amount of floor space, enough power, oxygen and air outlet points to cope with unusual problems like these. It has been recorn· mended that each bed have 26 sq. metres space or that the space from bed centre to adjacent bed centre be 3.3 metresJ. However, even these areas would probably have been insufficient for our purposes. c) Observation Charts To provide optimal care to the patient, clear identification of set· tings and adjustments to the 2 ventilators was essential. Special obser· vation charts had to be drawn to accommooate these problems, thus facilitating nursing staff communication. d) Positioning at the double-lumen endo-bronchialtube The two protruding lumens of the endo-bronchial tube, connected to valves for maintenance of PEEP, extending to the individual ventilators, had to be secured and fixed to maintain isolation of the lungs whilst still ventilating all segments of the lung. The protruding ends of the endo-bronchial tube were firmly secured with elastoplast and supported with padding. The patient's head was secured with pillows and towels to prevent movement and thereby disloogment of the endobronchial tube. e) Performing bronchial toilet On admission our patient had copious secretions, but with the level at PEEP partially maintained throughout endo-bronchial suction· ing, it was very difficult to extract any bronchial secretions. Suctioning was performed through a specific PEEP valve ("Eiodai Suction Safe' A), and it is unit policy never to disconnect PEEP during procedures such as pulmonary artery pressure measurement or suctioning. An adequate supply of narrow lumen catheters (Fg. 8) was essential because of the narrow individual lumens of the double lumen tube.
DIE SUIDER·AFRIKAANSE TYDSKRIF VIR KRITIEKE SORG
Nursing Problems Encountered with Asynchronous Independent Lung Ventilation
G. M. DE BRUYN N. PRINS A.N.
illustrate many of the problems encountered in the use of AILV. Floor space, air and oxygen and power outlets all seemed insufficient Each lumen of the endobronchialE CARE UNIT, J.G. STRIJDOM HOSPITAL
Introduction
Asynchronous independent lung ventilation (AILV) is a form of ventilatory therapy described for the management of unilateral lung disease. ~ requires the use at a double lumen endobronchial tube and t'M> independently set ventilators. This in turn presents unique technical and nursing problems. AILV was used in the treatment of a case of Adult Respiratory Distress Syndrome (ARDS) with a broncho-p1eural fistula. This case is presented to
TABLE 1 VENTILATOR SETTINGS DURING AILV
Left ventilator ventilating left lung with severe
A.N.
a case report
Corres{XJndence to: Or J. Upman, Head of Department ofAnaesthesia
J. L1PMAN
M88
at DA. FeA
and ICU, J-G S/rijdom Hospital, Private Bag XI, Aucklandpark 2006.
separate bronchial toilet. Each ventilator needed different set-
tings, thus requiring separate monitoring charts. Accurate mea· surement of transmural intravascular pressures is difficult under these circumstances. These and other interesting and practical
problems and their solutions, where found. are discussed.
Case History
A 30 Year old female developed ARDS secondary to pulmonary infection. Despite an initial improvement her condition deteriorated and she required mechanical ventilation and drainage of a left sided empyema. Her condition remained critical, and further deterioration of gas exchange occurred follovving the development of a pneumothorax. Despite the insertion of several chest drains, the air leak was not controlled and the diagnosis of broncho-pleural fistula was made. As a resu~ of further deterioration in clinical status and failure to effect adequate gas exchange on conventional ventilatory therapy, AI LV using a double lumen tube was commenced 1• Our patient was then paralysed with alcuronium and sedated with f1unitrazepam. The patient was nursed only on her right side and not turned significantly after intubation. thus maintaining the better ventilation perfusion ratio with the right lung ('better lung'), down'. A sample of the ventilator settings required are shown in table 1.