Chapter 28: Supporting Ventilation in Acute Care

Airway clearance strategies are thoroughly explored, encompassing huff coughing techniques, chest physiotherapy methods such as postural drainage and percussion, and specialized devices including flutter valves, Acapella oscillating positive expiratory pressure devices, and high-frequency chest wall oscillation systems. Oxygen delivery methods are systematically presented, ranging from low-flow devices like nasal cannulas to high-flow systems including Venturi masks and high-flow nasal cannula therapy, with emphasis on preventing complications such as oxygen toxicity, carbon dioxide narcosis, and absorption atelectasis. The chapter extensively covers artificial airway management, including nasopharyngeal and oropharyngeal airways for basic airway maintenance, endotracheal intubation for acute respiratory failure, and tracheostomy procedures for long-term airway access. Pleural drainage systems and chest tube management are detailed for treating pneumothorax, hemothorax, and pleural effusions, with specific attention to monitoring drainage characteristics and preventing complications like re-expansion pulmonary edema. Thoracic surgical procedures including lobectomy, pneumonectomy, and video-assisted thoracic surgery are discussed alongside corresponding nursing interventions. Noninvasive ventilation strategies using continuous positive airway pressure and bilevel positive airway pressure are explored for managing conditions like obstructive sleep apnea and acute exacerbations of chronic obstructive pulmonary disease. Finally, mechanical ventilation principles are comprehensively addressed, including ventilator modes such as assist-control, synchronized intermittent mandatory ventilation, and pressure support ventilation, along with critical complications including ventilator-associated pneumonia, barotrauma, and strategies for successful weaning from mechanical support.