94002 Ventilation assist and management, initiation of pressure or volume preset ventilators for assisted or controlled breathing; hospital inpatient/observation, initial day

Name of the Procedure:

Ventilation assist and management, initiation of pressure or volume preset ventilators for assisted or controlled breathing; hospital inpatient/observation, initial day.

Summary

This procedure involves the initiation of mechanical ventilation to help patients breathe when they cannot do so adequately on their own. The ventilator can be set to provide a preset pressure or volume of air, ensuring the patient receives the necessary support for breathing.

Purpose

This procedure is intended to support or fully control the breathing of patients who are unable to breathe adequately on their own due to severe respiratory conditions. The goal is to maintain proper oxygen and carbon dioxide levels, prevent respiratory failure, and support the patient until they can breathe independently.

Indications

• Severe respiratory distress or failure
• Conditions like pneumonia, chronic obstructive pulmonary disease (COPD), acute respiratory distress syndrome (ARDS)
• Post-surgical support
• Conditions that impair the muscles involved in breathing, such as spinal cord injuries or certain neuromuscular diseases

Preparation

• Patients may need to fast for a few hours before the procedure if intubation is required.
• Medication adjustments might be necessary, especially for those on blood thinners or other significant treatments.
• Pre-procedure assessments may include blood tests, arterial blood gases, chest X-rays, and pulmonary function tests.

Procedure Description

1. Preparation: The ventilator is set up and tested to ensure it is functioning properly.
2. Sedation/Anesthesia: If intubation is required, the patient may be sedated or given anesthesia.
3. Intubation (if necessary): A tube is inserted through the patient’s mouth or nose into the trachea to connect to the ventilator.
4. Ventilation Initiation: The ventilator is connected, and settings are adjusted to provide the appropriate pressure or volume of air.
5. Monitoring: The patient's vital signs, oxygen levels, and ventilator parameters are continuously monitored to ensure proper function and adjust settings as needed.

Duration

The initial setup and initiation of mechanical ventilation typically take about 30 minutes to an hour.

Setting

This procedure is performed in a hospital setting, either in an Intensive Care Unit (ICU) or an observation unit.

Personnel

• Critical care physician or pulmonologist
• Respiratory therapist
• Intensive care nurse
• Anesthesiologist (if intubation and sedation are required)

Risks and Complications

• Common: Discomfort, anxiety, dry mouth, sore throat (if intubated)
• Rare: Pneumonia, lung damage, ventilator-associated infections, barotrauma (pressure-related lung injury)
• Management includes adjusting ventilator settings, using antibiotics for infections, and supportive care.

Benefits

• Immediate support for breathing, improving oxygenation and carbon dioxide elimination
• Stabilizes acute respiratory conditions
• Provides time for the underlying condition to be treated or resolved
• Benefits are often realized immediately after initiation.

Recovery

• Post-procedure, the patient will be continuously monitored.
• Regular assessments to determine when it is safe to reduce and eventually discontinue ventilator support.
• Weaning protocols may be used to gradually reduce dependence on the ventilator.
• Follow-up care typically includes respiratory therapy and monitoring lung function.

Alternatives

• Non-invasive ventilation using masks (e.g., CPAP or BiPAP)
• Oxygen therapy
• Extracorporeal membrane oxygenation (ECMO) for severe cases
• Pros and cons should be discussed; non-invasive options may be less risky but not suitable for all patients.

Patient Experience

• Patients may feel discomfort from the ventilator, especially if intubated.
• Sedation is commonly used to enhance comfort and reduce anxiety.
• Communication may be limited if intubation is involved.
• Pain management and other comfort measures will be provided as needed.