Nursing assessment of intermittent mandatory ventilation.

IMV provides the ICU nurse responsible for total multifunctional patient care with many advantages. First of all, it allows more time to perform other needed tasks. Time is made available for counseling the patient and family; consulting with the social worker, occupational therapist, and other staff members; and participating actively on team patient care conferences. IMV permits the patient to perform at an optimal level throughout the ICU stay and to participate in the treatment program. This is perhaps the greatest advantage of IMV for both the nurse and the patient. The patient's comprehension and ability to communicate are not limited by sedation or anxiety, the patient is more responsive when at least some control is retained over the environment. This reassures the family. Allowing the patient to be as awake and alert as possible not only assists the staff in assessment but allows positive feedback to the patient. It is difficult for a nurse to argue with the advantages of this method in contrast to the difficulty of caring for a sedated patient receiving controlled ventilation. Incrementally decreased ventilatory support lessens anxiety during weaning, thereby minimizing one of the negative aspects of critical illness. Because less sedation is required, the patient's overall safety is improved. The ICU team can more easily find out about such problems as abdominal pain and difficulty in breathing. An alarm aids the nurse in discriminating anxiety from hypoxia/hypercapnia. With definitive guidelines for its use and careful delineation of team members' responsibilities, IMV provides the nurse with a simple, flexible, and innovative tool for patient care.