Lippincott Nursing Pocket Card

Caring for the Mechanically Ventilated Patient


About Mechanical Ventilation

Mechanical ventilation is utilized in intensive care and long-term care settings to assist patients who require additional respiratory support. This handy reference guide provides critical patient care essentials, tips for trouble-shooting ventilator alarms, and potential complications.


Care Essentials for Patients on Mechanical Ventilation

  • Maintain a patent airway. Per policy, note endotracheal (ET) tube position (centimeters) and confirm that it is secure.
  • Assess oxygen saturation, bilateral breath sounds for adequate air movement, and respiratory rate per policy.
  • Check vital signs per policy, particularly blood pressure after a ventilator setting is changed. Mechanical ventilation increases intrathoracic pressure, which could affect blood pressure and cardiac output.
  • Assess patient’s pain, anxiety and sedation needs and medicate as ordered.
  • Complete bedside check: ensure suction equipment, bag-valve mask and artificial airway are functional and present at bedside. Verify ventilator settings with the prescribed orders.
  • Suction patient only as needed, per facility policy; hyperoxygenate the patient before and after suctioning and do not instill normal saline in the ET tube; suction for the shortest time possible and use the lowest pressure required to remove secretions.
  • Monitor arterial blood gas (ABG) after adjustments are made to ventilator settings and during weaning to ensure adequate oxygenation and acid-base balance.
  • To minimize the risk for ventilator-associated pneumonia (VAP), implement best practices such as strict handwashing; aseptic technique with suctioning; elevating head of bed 30-45 degrees (unless contraindicated); providing sedation vacations and assessing patient’s readiness to extubate; providing peptic ulcer disease prophylaxis; providing deep vein thrombosis prophylaxis; and performing oral care with chlorhexidine, per your facility policy.

High Peak Inspiratory Pressure (PIP) 
  • Blockage of ET tube (secretions, kinked tubing, patient biting on ET tube)
  • Coughing
  • Bronchospasm
  • Lower airway obstruction
  • Pulmonary edema
  • Pneumothorax
  • Ventilator/patient dyssynchrony 
  • Assess lung sounds.
  • Suction airway for secretions.
  • Insert bite block or administer sedation per orders if patient is agitated or biting on ET tube.
  • Assess breath sounds for increased consolidation, wheezing, and bronchospasm; treat as ordered.
Low Pressure Alarm
  • Air leak in ventilator circuit or in the ET tube cuff
  • Locate leak in ventilator system.
  • Check pilot balloon as an indicator of ET tube cuff failure.
  • Replace tubing as needed, per policy.
Low Minute Ventilation
  • Low air exchange due to shallow breathing or too few respirations
  • Check for disconnection or leak in the system.
  • Assess patient for decreased respiratory effort.
Low O2 Saturation (SpO2)
  • Pulse oximeter malpositioned
  • SpO2 cable unplugged
  • Ensure ventilator oxygen supply is connected.
  • Ensure pulse oximeter is positioned correctly.
  • Verify all cables are plugged in.
  • Assess patient for respiratory distress. 


  • Breaths are not being taken by the patient or triggered on the ventilator
  • Assess patient effort.
  • Check system for disconnections.
Cardiovascular issues
  • Decrease in venous return to the heart due to positive pressure applied to the lungs.
  • Assess for adequate volume status by checking heart rate, blood pressure, central venous pressure and urine output. 
  • Positive pressure applied to lungs.
  • Elevated mean airway pressures may rupture alveoli.
  • Notify healthcare provider.
  • Prepare patient for possible chest tube insertion.
  • Avoid high pressure settings for patients with chronic obstructive pulmonary disease (COPD), acute respiratory distress syndrome (ARDS), or history of pneumothorax.
  • Breaks in ventilator circuit.
  • Decreased mobility.
  • Impaired cough reflex.
  • Use aseptic technique.
  • Provide frequent mouth care.
  • Support proper nutritional status.

Courey, A., Overview of mechanical ventilation. UpToDate. Retrieved on October 3, 2017 from
Han, M. Management and prognosis of patients requiring prolonged mechanical ventilation. UpToDate. Retrieved on October 5, 2017 from
Kane, C., & York, N. (2012). Understanding the Alphabet Soup of Mechanical Ventilation. Dimensions of
Critical Care Nursing, 31(4), 217-222.
Miller, N. (2013). Set the Stage for Ventilator Settings. Nursing Made Incredibly Easy. 11(3), 44 – 52.