Mechanical Ventilation: Troubleshooting (Respiratory Therapy)

The content in Clinical Skills is evidence based and intended to be a guide to clinical practice. Always follow your organization’s practice.

ALERT

If the cause of an alarm cannot be identified and corrected quickly, remove the patient from the ventilator and begin manual ventilation with a manual resuscitation bag (MRB).

To maintain patient safety, never disable alarms.

OVERVIEW

Mechanical ventilator alarms are used to warn of changes in patient or ventilator status. All alarms should be set according to the patient’s condition and the manufacturer’s instructions for the device. For patient safety, alarms should never be disabled.

Some essential alarms on the ventilator include ventilator inoperative (vent INOP), power failure, no gas delivery to the patient, low peak inspiratory pressure (PIP), low tidal volume (VT), low or high minute volume (MV), low positive end-expiratory pressure and continuous positive airway pressure (PEEP–CPAP), apnea, inspiratory:expiratory (I:E) ratio, high-pressure limit, high respiratory rate, and low or high fraction of inspired oxygen (FIO₂) (Box 1).^{undefined#ref1">1} The brand-specific mechanical ventilator manual should be consulted for all available alarms and troubleshooting options.

SUPPLIES

See Supplies tab at the top of the page.

EDUCATION

• Provide developmentally and culturally appropriate education based on the desire for knowledge, readiness to learn, and overall neurologic and psychosocial state.
• Explain the need for routine ventilator checks to verify the proper function of the system and alarms.
• Explain that it is normal for there to be audible and visual alarms and the healthcare team will address and correct them.
• Encourage questions and answer them as they arise.

ASSESSMENT AND PREPARATION

Preparation

1. Confirm the MRB with an appropriate-size face mask is readily available and attached to a supplemental oxygen source for all patients receiving mechanical ventilation.
2. Attach a PEEP valve, if necessary.

PROCEDURE

1. Perform hand hygiene before patient contact. Don appropriate personal protective equipment (PPE) based on the patient’s need for isolation precautions or the risk of exposure to bodily fluids.
2. Introduce yourself to the patient.
3. Quickly assess the patient’s status, including heart rate, respiratory rate, peripheral oxygen saturation (SpO₂), color, and breath sounds.
4. Simultaneously identify the highest priority alarm and correct it immediately.
5. If the reason for the alarm(s) cannot be immediately identified, begin manual ventilation with an MRB until alarm(s) can be corrected (Box 1).¹
6. Verify that the alarm has been corrected and the patient is comfortable.
7. Explain the reason for the alarms and corrective actions to the patient.
8. Ensure that the ventilator settings and alarms are set properly.
9. Remove PPE and perform hand hygiene.
10. Verify the patient using two identifiers and document emergent actions to correct the alarm and any adverse outcomes in the patient’s record.

MONITORING AND CARE

1. Ensure that the patient’s artificial airway is patent and secure.
2. Keep the ventilator tubing free from condensation. Drain tubing away from the patient and toward the expiratory limb or water trap.

EXPECTED OUTCOMES

• Resolution of alarms
• Return of heart rate, respiratory rate, breath sounds, and SpO₂ to baseline
• Properly functioning ventilator

UNEXPECTED OUTCOMES

• Patient death or harm
• Pulmonary barotrauma or volutrauma
• Discrepancy between set and measured values

DOCUMENTATION

• Education
• Alarm parameters
• Adverse patient response
• Patient’s vital signs
• Respiratory interventions in response to alarms
• Unexpected outcomes and related interventions

REFERENCES

1. Cairo, J.M. (2024). Chapter 18: Troubleshooting and problem solving. In Pilbeam’s mechanical ventilation: Physiological and clinical applications (8th ed., pp. 346-367). St. Louis: Elsevier.

Clinical Review: Jennifer Elenbaas, MA, BS, RRT, AE-C

Published: February 2024