Download to read offline
More Related Content
Similar to VENTILATOR basics with modes DR MANOJ.pptx
VENTILATOR basics with modes DR MANOJ.pptx
- 1.
- 2. INDICATION OF MECHANICAL VENTILATION 1.Hypoxemia 2. Acute respiratory acidosis 3. Decrease / prevent muscle fatigue 4. Sedation / neuromuscular blockade 4. Decrease myocardial o2 demand 5. Stabilize chest wall 6. Protect airway
- 7. Peak pressure 3 seconds3 seconds Machine breath Time No patient inspiratory effort Airway pressure 2.5 seconds 2.7 seconds Time Airway pressure Patient’s inspiratory effort Control ventilation Assist Control ventilation
- 8. First breath assisted Second breath control Time Machine-controlledbreath Patient-assisted breath Airway pressure Assist control pressure curve
- 15. TYPES OF BREATH 1.SPONTANEOUS BREATH 2. ASISTED BREATH 3. MANDATORY BREATH
- 16. SPONTANEOUS BREATH Patient determine timingand size of breath And also trigger and cycled Eg.- CPAP mode
- 17. Airway pressure Time IPAP EPAP 10 CPAP – spontaneousbreath, Pressure remain positive , not Return to baseline Airway pressure Time 20 10 0 PEEP – in controlled Ventilation, no spontaneous Breaths in between mandatory breaths Airway pressure Time 20 10 0 IMV with PEEP or CPAP – Spontaneous breath in between Mandatory breaths
- 18. ASISTED BREATH Both mandatory andspontaneous breaths All or part of breath is generated by the ventilator, which does part of the WOB for the patient. Each breath is spontaneous as patient determines both trigger and cycle for breath Eg. Pressure supported breath
- 19. MANDATORY/CONTROLLED BREATH Trigger and cycled bothcontrolled by machine Eg.- PCV/VCV
- 20. Downward deflection in pressuretracing Time CONTROL BREATH ASISTED BREATH PROXIMAL AIRWAY PRESSURE
- 21.
- 22. Basic Modes of Ventilation FIVE basicmodes of ventilation include 1. VOLUME-CONTROLLED VENTILATION (VCV) 2. PRESSURE-CONTROLLED VENTILATION (PCV) 3. SYNCHRONISED INTERMITTENT MECHANICAL VENTILATION(SIMV) 4. PRESSURE-REGULATED VOLUME CONTROL(PRVC) 5. PRESSURE SUPPORT VENTILATION (PSV)
- 23.
- 24. VOLUME CONTROLLED VENTILATION The triggervariable for VCV is assist-control (hybrid between a patient trigger and a ventilator trigger. The patient-triggered (assist) component of the trigger can utilize either a pressure or flow trigger. The ventilator-triggered (control) component of the trigger is set by selecting the respiratory rate, which dictates the time between control breaths (rate = 1/time). VCV is a flow-targeted and volume(limit). Volume-cycled mode of ventilation in which the ventilator delivers a set flow waveform pattern to achieve a set tidal volume.
- 25. VOLUME CONTROL Set Vt Set flowrate Control- volume/flow Constant- volume/flow Pressure vary due changes in patient compliance and resistance.
- 26. VOLUME CONTROL ADVANTAGES: Guaranteed tidal volume,set minute ventilation and rate Lower work of breathing Maintain certain level of Pco2. DISADVANTAGE: Pressure changes in response to change in resistance and compliance. Flow is fixed (not meet patient demand)- patient- ventilator dysynchr ony. Regional alveolar overdistension. If volume lost in tubing – adequate volume not reach
- 27. WITHOUT PAUSE WITHPAUSE TRIGGER TIME PATIENT TIME PATIENT LIMIT FLOW VOLUME FLOW CYCLE VOLUME TIME
- 28. Factors affecting pressure during volumecontro lled ventilation PATIENT LUNG CHARACTERISTICS Reduction in lung/chest compliance- higher peak and plateau pressure and vice versa Increased airway resistance – higher peak pressure and vice versa. Inspiratory flow pattern- peak pressure high with constant flow but lower mean airway pressures Increase in PEEP , increases the peak and mean pressure High gas flow creates high peak pressure and plateau pressures
- 29. 1. Normal compliance 2. Decrease compliance 3.Increased compliance
- 34.
- 35. PRESSURE CONTROLLED VENTILATION The trigger variablefor PCV is assist-control. The patient-triggered (assist) component of the trigger can utilize either a pressure or flow trigger. The ventilator-triggered (control) component of the trigger is set by selecting the respiratory rate, which dictates the time between control breaths (rate = 1/time). The target variable is pressure. PCV is a pressure-targeted, time-cycled mode of ventilation, in which the ventilator delivers flow to quickly achieve and maintain a set proximal airway pressure for a set amount of time. The flow waveform is a in PCV is a decelerating ramp.
- 36. PRESSURE CONTROL ADVANTAGES: Improve better oxygenation Betterdistribution of ventilation ( decrease Risk of overdistension by limiting pressure) Prevent overinflation by limiting pressure so, PC is good for lung Precise control Pplat pressure, MAP , Ti/Te Responsive to patient inspiratory demands More comfortable for spontaneous breathing patient.
- 37. PRESSURE CONTROL DISADVANTAGES: Vt changes duechanges in C and R. No precise control blood gases. Vti and Vte decrease when lung bad.
- 38. PREESURE CONTROL Setting- : Setpressure control above PEEP – to achieve target volume Set rate Ti PEEP FIO2 Sensitivity
- 39. Factor affect volumedelivery during pressure controlled ventilation Pressure setting : increasing PIP with maintaining PEEP increases volume delivery Pressure gradient: increasing EEP (PEEP+ auto PEEP) while keeping PIP constant reduces pressure gradient (PIP-EEP) and lower volume delivery and vice versa. Increase compliance – increase volume delivery and vice versa Increase airway resistance – lower volume delivery and vice versa Increase Ti – increase volume Patient effort also increase volume delivery.
- 40.
- 46. PRESSURE CONTROL VOLUMECONTROL PRESSURE NON-DEPENDENT VOLUME NON-DEPENDENT VOLUME DEPENDENT PRESSURE DEPENDENT PREESURE IS CONSTANT FLOW IS CONSTANT HIGH MEAN AIRWAY PRESSURE LOW MEAN AIRWAY PRESSURE DECELERATING FLOW PATTERN CONSTANT FLOW PATTERN
- 47. PRESSURE CONTROL VOLUMECONTROL LESS PATIENT VENTILATOR ASYNCHRONY MORE ASYNCHRNY VARIABLE VT AND MV CONSTANT VT AND MV HOMOGENOUS DISTRIBUTION OF AIR OVERDISTENSION OF NORMAL ALVEOLI TIME CYCLED VOLUME CYCLED REDUCTION OF PEAK PRESSURE AND OF RISK OF BAROTRAUMA PRECISE CONTROL OVER PACO2 IMPROVED GAS EXCHANGE DUE TO DECELERATING FLOW COMPENSATE FOR LEAKS INABILITY TO COMPENSATES FOR LEAKS HYPOVENTILATION SECONDARY TO CHANGES IN LUNG POTENTIAL FOR ACUTE LUNG INJURY
- 48. SYNCHRONIZED INTERMITTENT MECHANICAL VENTILATION(SIMV- PC/VC) COMBINATION OF MANDATORY AND SPONTANEOUS BREATH (ASISTED)/PRESSURE SUPPORT VENTILATORDELIVER MINIMUM SET RATE (MANDATORY RATE) WITH FIXED INTERVAL BUT VENTILATOR TRY TO SYNCHRONIZE MANDATORY BREATH WITH PATEINT (TRIGGER WINDOW) PSV CAN BE ADDED TO SPONTANEOUS BREATH MANDATORY - MACHINE/PATIENT (TRIGGER) MACHINE (CYCLED) PRESSURE CONTROL(PRESSURE LIMITED ,TIME CYCLED), VOLUME CONTROL( FLOW LIMITED, VOLUME CYCLED)
- 49. 0 0 0 SIMV and PEEP Allmandatory breaths synchronized to patient’s inspiratory effort Stacking Airway pressure No synchronization Mandatory breath Spontaneous breath Mandatory breath Spontaneous ventilation IMV SIMV Exhalation Inspiration Inspiratory effort Time E E A B C D
- 50. SIMV SPONTANEOUS- PATIENT (TRIGGER/CYCLED) MAINTAINRESPIRATORY MUSCLE STRENGTH AND AVOID ATROPHY REDUCE V/Q MISMATCH DUE TO SPONTANEOUS VENTILATION FASCILITATES WEANING DISADVANTAGES: DESIRE TO WEAN TOO RAPIDLY RESULTS IN HIGH WORK OF SPONTANEOUS BREATHING AND MUSCLE FATIGUE AND THUS WEANING FAILURE INCREASING WEANING FAILURE VS PRESSURE SUPPORT SLOWER WEANING
- 52.
- 54. PESSURE REGULATED VOLUME CONTROL (PRVC)/ AUTO FLOW/ ADAPTIVE PRESSURE- VENTILATION/ PC-CMV ADAPTED BOTH PC AND VC FEATURES Pressure limited, volume targeted mechanical breath Actual pressure vary breath to breath to achieve target volume Dual controlled ( PRVC-A//C, PRVC-SIMV) Increase or decrease pressure to achieve set target tidal volume.
- 55. PRVC PHASE VARIABLE : Trigger: time Patient (depend upon mode) Limit : pressure limited ,volume targeted (controlling pressure) Cycle : Time ( backup volume cycled)
- 56. PRVC ADVANTAGES: Guranteed minute ventialtion Limitpressure lung exposed Better distribution of ventilation Improved oxygenation DISADVANTAGES: When patient demand increases ( increase Vt above set) so support from ventilation decreases.
- 57. PRVC Setting : targettidal volume , rate. Ti ,PEEP, Fio2, sensitivity Setting Set maximum pressure limit Set For exapmle : high pressure alarm set at 35 cmH20, so max. Pressure limit delivered on PRVC 5 cm H2o below (30 cmH2o) if vent. Cannot deliver target volume within this pressure limit alert alarm Pressure IF High pressure is required to deliver to target tidal volume, check for secretion , bronchospasm, changes in compliance . Check
- 60. PRESSURE SUPPORT VENTILATION Pressure Support Ventilation Thetrigger variable for PSV consists of only the patient (assist) trigger. As with the assist component of the assist- control trigger for both VCV and PCV, the trigger can be set as either a flow or a pressure trigger. this mode of ventilation can only be used if the patient initiates a sufficient number of breaths per minute. PSV is a pressure-targeted, flow-cycled mode of ventilation, in which the ventilator delivers flow to quickly achieve and maintain a set airway pressure until the inspiratory flow depreciates to a set percentage of peak inspiratory flow. The flow waveform, tidal volume, and inspiratory time vary depending on characteristics of the respiratory system and patient respiratory effort
- 61.
- 62. PRESSURE SUPPORT Setting ; Set PEEPfor increases oxygenation and recruitment PS- augments patient tidal volume Rise time FIO2 Apnea criteria( apnea time = 20-30 second, apnea ventilation –set Vt ,VC> PC, set RR
- 63.
- 64. PRESSURE SUPPORT DISADVANTAGES: NO guranteed tidalvolume No certain minute ventilation Less able to control ABG Require intact respiratory drive and fairly stable lung condition
- 65.
- 80.