Overview ventilation modes

Ventilation modes in anesthesia

1. Manual ventilation
used for anesthesia induction, recovery, in emergency situations

2. Controlled ventilation,
for use with muscle relaxants

3. Support of spontaneous breathing

for use without muscle relaxants or in the recovery phase of
anesthesia

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 Breathing modes in anesthesia

1. Manual ventilation

2. Controlled ventilation, for use with muscle relaxants

a) Volume controlled ventilation
b) Pressure controlled ventilation

3. Support of spontaneous breathing for use without muscle relaxants or in the

recovery phase of anesthesia
a) pure pressure support, if the frequency or breathing is stable, to overcome the
depression of the breathing during the anesthesia
b) synchronized pressure and volume controlled ventilation respectively together
with support of the spontaneous breathing to overcome the depression of the
spontaneous breathing and at the same time to guarantee a ventilation of a set
volume

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 Ventilation modes
Intended purpose

1. Man. Spont mode

Anesthesia induction, recovery, and in emergency situations

2.a Volume mode const. flow

Anesthesia in relaxed or partially relaxed patients
with healthy lungs or patients with head injuries,
aimed at achieving a constant volume or constant etCO2.

2b. Pressure mode

Anesthesia in relaxed or partially relaxed patients
Anesthesia in patients with diseased lungs (non-homogeneous lung),
neonates, children, mask ventilation, pulmonary fistulas, laryngeal masks,
Inversed Ratio Ventilation

3. Pressure support mode

Anesthesia in patients able to perform stable spontaneous breathing
with laryngeal mask during surgery without muscle relaxants.

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 Manual Ventilation

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 Controlled Ventilation,
Two Concepts

Volume controlled ventilation Pressure controlled ventilation

Pressure Pressure

PMax
PPeak
PPlateau
Pinsp

tI tE Time tI tE Time
1/f 1/f

Insp.- Insp.-
Flow Flow

Time Time

Constant inspiration Flow Decelerating inspiration Flow

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 Effects of the Controlled Ventilation Modes on the
Patient

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 Controlled Ventilation

characteristics: patient is passive (i.e. relaxed); the ventilation device takes over all the work

control: time-time control; the inspiratory time and the expiratory

time are prescribed

modes: Volume controlled Pressure controlled

essential parameters: volume VT pressure Pinsp

flow characteristics: constant inspiratory flow decelerating inspiratory flow

results: pressure build up depending delivered volume depending

on patient compliance on patient compliance
Pplat - PEEP = VT/CPat VPat = Cpat (Pinsp - PEEP)

risks: Ppeak might run too high, VPat might run too high,
pressure must be monitored volume must be monitored

emphasis of application: patients without pulmonary patients with pulmonary problems, pediatric
problems anesthesia, operations with patients from
intensive care, bronchoscopy

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 Ventilation modes
Pressure controlled ventilation PEEP - Pinsp settings

2 alternative Pinsp setting philosophies

a) Changing PEEP also brings about
a change in Pinsp.
=> Pinsp - PEEP = constant
 supports lung recruitment
b) PEEP and Pinsp are set
independently of one another

"Genuine" PEEP:
Patient cannot "breathe away" Peep
because TurboVent works with
pressure control.

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 Ventilation modes
Inspiratory time or I/E

setting of I/E only in controlled ventilation

Inspiratory time Tinsp for straightforward application in all modes

a) Setting the I/E ratio Tinsp:TE

Choice of I/E setting with SYNC = off by
Advantage:
=> Mean airway pressure (PMEAN) remains constant when frequency is adjusted
=> To switch quickly between child and adult with fixed
I/E basic setting

b) Setting the absolute inspiratory time Tinsp (sec)

(standard with SYNC=on)
Advantage:
=> Inspiratory time remains constant. Ventilator breath unchanged if frequency is
adjusted (important for adjusting mandatory part of ventilation with Sync = on)

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 MECHANICAL Ventilation in Anesthesia

Behaviour

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 VCV - FLUJO CONSTANTE

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 VCV - FLUJO CONSTANTE
R = INCREASING

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 VCV - FLUJO CONSTANTE
C = DECREASING

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 VCV - FLUJO CONSTANTE
TIP:Tinsp = 10 %

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 PCV – DECELERATING FLOW

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 PCV – DECELERATING FLOW
R = INCREASING

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 PCV – DECELERATING FLOW
C = DECREASING

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