Care of the elderly mechanically ventilated patient: preserving the fragile environment

Caring for the elderly mechanically ventilated patient is a challenging and increasingly frequent clinical situation confronting critical nurses. The key complications and states to which the elderly patient is particularly susceptible are nosocomial pneumonia; congestive heart failure; malnutrition; reactions to medications, especially antibiotics, morphine sulfate, and valium; changes in mental status, and pneumothorax. These can significantly contribute to multisystem deterioration. It is unclear which mode of ventilation is best for sustaining the patient during the course of illness or the weaning process. It is critical to recognize the assessment indicators of failed weaning. Paramount in this assessment are rapid shallow breaths, change in blood pressure of 20 mmHg, change in respiratory rate of more than 10 breaths per minute, tidal volume of less than 250 to 300 mL, a minute ventilation with an increase of 5 L/minute, and an oxygen saturation of less than 90% per pulse oximeter. Research in these areas is needed.