What is what to do when high pressure alarm on ventilator?

When a high-pressure alarm sounds on a ventilator, it indicates that the ventilator is encountering increased resistance to delivering the breath. Immediate action is required to identify and address the cause to prevent patient injury. Here's a breakdown of what to do:

1. Stay Calm and Assess the Patient: Quickly observe the patient's chest movement, respiratory effort, skin color, and overall condition. Is the patient struggling to breathe, cyanotic, or showing signs of distress?

2. Silence the Alarm: Temporarily silence the alarm to allow you to focus on troubleshooting, but don't forget to reactivate it once the issue is resolved.

3. Check the Ventilator Circuit:

   • Kinks or Obstructions: Inspect the tubing for any kinks, twists, or obstructions that might be increasing resistance.
   • Water in the Tubing: Drain any accumulated water in the ventilator circuit.
   • Disconnect: Ensure the circuit is securely connected to both the ventilator and the patient's airway.

4. Assess the Patient's Airway:

   • Coughing or Secretions: Suction the airway to remove any secretions or mucus plugs that may be causing obstruction.
   • Bronchospasm: If bronchospasm is suspected, consider administering a bronchodilator as prescribed.
   • Biting the Tube: If the patient is biting the endotracheal tube, insert an oral airway or bite block.
   • Pneumothorax: Consider the possibility of a pneumothorax, especially if there's sudden onset of respiratory distress and unequal breath sounds. This may require immediate intervention like needle decompression.
   • Endotracheal Tube Displacement: Ensure the endotracheal tube is properly positioned. If dislodged, prepare for re-intubation.

5. Check Ventilator Settings:

   • High Tidal Volume or Flow Rate: Verify that the tidal volume and flow rate settings are appropriate for the patient. Reducing these settings may lower the peak airway pressure.
   • PEEP (Positive End-Expiratory Pressure): While PEEP is usually beneficial, excessively high levels can contribute to increased airway pressure. Evaluate if the PEEP setting is optimal.

6. Manual Ventilation: If the cause of the high-pressure alarm cannot be quickly identified and resolved, disconnect the patient from the ventilator and manually ventilate with a bag-valve mask (Ambu bag) while continuing to troubleshoot. This ensures adequate oxygenation and ventilation.

7. Escalate if Necessary: If the problem persists or the patient's condition deteriorates, escalate to a more experienced clinician or respiratory therapist.

8. Document: Thoroughly document the alarm, the actions taken to resolve it, and the patient's response.

Here are links to important subjects mentioned above:

• Bronchospasm: https://www.wikiwhat.page/kavramlar/Bronchospasm
• Pneumothorax: https://www.wikiwhat.page/kavramlar/Pneumothorax
• PEEP%20(Positive%20End-Expiratory%20Pressure): https://www.wikiwhat.page/kavramlar/PEEP%20(Positive%20End-Expiratory%20Pressure)