At some point in your career, you have probably dealt with a patient who was hyperventilating.
Problems with excessive ventilation during ACLS
Commonly, this corresponds to a respiratory rate greater than 20 breaths per minute. When breaths become much faster than this, oxygen levels drop and the patient begins to feel disoriented or dizzy. However, even when your patient cannot control their own breaths, such as during or after a resuscitation, they may still be hyperventilating due to attempts at rescue ventilation. There are three main reasons why you should be aware of excessive ventilation during patient care:
1. Gastric inflation
While gastric inflation is probably not your biggest concern during a patient’s resuscitation, it is something that can have eventual consequences. Too much air in the stomach can lead to the expulsion of gastric contents, some of which can enter the lungs and lead to serious infections. In fact, some studies have looked at how it can affect hemodynamic and lung function over time. Although additional studies still need to be done to analyze a larger portion of the population, initial results show that there is definitely a negative effect of this.
2. Decreased heart rate
While some of the air from excessive ventilation enters the gastric organs, some of them can also cause significant problems in the chest cavity. When there is increased pressure in the lungs due to excess air, the patient may suffer from decreased coronary perfusion. Obviously, if the heart muscle doesn’t get enough oxygen, it can no longer function well. In fact, studies have shown that the reduced survival rate is a direct result of this problem.
3. Altered blood gases
If you’ve ever had a patient on a mechanical ventilator, you’re probably familiar with the process of collecting blood gas on a regular basis. It is important to be able to determine if the patient is well oxygenated or if there is a respiratory or metabolic disorder that is causing it. Just as you or the respiratory therapist would adjust the ventilator settings to deal with any problems seen in these blood gases, you should consider the same options when the patient is being resuscitated. A patient whose blood gases are very acidic may have significant problems with brain function.
Focus on cardiac support measures
Because of these concerns about excessive ventilation during CPR (Cardiopulmonary Resuscitation), the American Heart Association has modified its recommendations to state that breathing for a patient being resuscitated should be limited to an average of 12 per minute, rather than the higher level. high recommended in the past. In addition, cardiac support measures, such as compressions, are a priority over ventilations, because, in addition to being more easily performed, they result in better outcomes for individuals.
Of course, in the hospital setting, when you have a lot of first responders, you can focus on chest compressions and ventilation. If you are responsible for bag valve mask breathing, be sure to carefully count the correct number of breaths per minute. In addition, you must ensure that the patient’s head and neck are positioned correctly, so that the airway is open and unobstructed, to ensure that ventilations are directed primarily to the lungs and not the stomach.