Modes of ventilation

Presenter: Ramandeep Dhiman ( B.sc )

Negative pressure ventilator
Positive pressure ventilation
Phase variables
Phase variable begin , sustain , end and determine the characteristics of
the expiratory portion of each breath . Four phase variable are
1. The trigger variable begin inspiration
2. The limit variable limits the pressure, volume, flow or time during
inspiration but it does not end the breath
3. The cycle variable ends inspiratory and begin exhalation
4. The baseline variable is the expiratory baseline (pressure) before a
breath is triggered
Modes of ventilation
• Continous mandatory ventilation (CMV)
1. VT- CMV / VC – CMV ( may be assisted or controlled)
2. PT- CMV / PC – CMV (assisted /controlled)
• Synchronized intermittent mandatory ventilation (SIMV)
1. SIMV(PC) + Pressure support
2. SIMV(VC) + Pressure support
• Spontaneous mode
1. Spontaneous breathing
2. CPAP ( continous positive airway pressure)
3. PSV ( pressure support ventilation)
Continous mandatory ventilation
1. All breaths are mandatory, can be volume or pressure targeted
2. When the breath is time triggered, called controlled ventilation or if is
patient triggered called assisted ventilation
• Controlled ventilation
1. When patients effort are zero/ patient who is obtunded because of drugs
• Assisted ventilation
1. Triggered by patient/machine
2. Operator set a minimum breathing rate, sensitivity level and type of
breath ( v/p)
3. Patient triggering occur because the ventilator is sensitive to pressure/
flow change that occurs as the patient attempt to take breath
• Volume targeted continous mandatory ventilation (VTCMV)
1. Also called vc cmv
2. Volume is set as targeted variable
3. Increase WOB ( work of breathing) by 40-50% if flow is inadequate
4. Flow is inadequate if pressure doesn’t rise smoothly to peak during
inspiration in p vs time graph
5. Flow must be increasing until the patient demand is met
• PT- CMV
1. All breaths are time/ patient triggered, pressure targeted and time cycled
2. Ventilator provide constant pressure to patient during inspiration
3. PC cmv with peep is better than vc cmv with prep for ARDS patient
because it reduces WOB
• PC cmv (Patient triggered)
Intermittent mandatory ventilation
• It involves periodic vol/pressure targeted breath that occurs at set interval ( time
triggering)
• During IMV , the patient can breathe spontaneously b/w mandatory breath at any
desired baseline pressure without receiving a mandatory breath
• Ventilator provide pressure support for spontaneous breath
• This mode allows active participation of the patient in breath delivery (preserving
respiratory muscle strength)
• Imv has been used to wean patient from ventilator (patients breath increase)
• Mandatory breath synchronize with patient breath , therefore also SIMV mode
• It is of 2 type
1. PC – SIMV (pressure targeted)
2. VC – SIMV ( volume targeted)
Spontaneous mode (CSV)
1. Spontaneous breathing
• Patient can breathe spontaneously via a ventilator circuit without receiving any
mandatory breath , also called T piece method
• Increase WOB
• Patient vital are monitored during spontaneous breath trial
2. Pressure support ventilation (psv)
• The ventilator provide a constant pressure support during inspiration once it
senses that the patient has made an inspiratory effort
• The operator sets the inspiratory pressure, PEEP ,flow cycle criteria and sensitivity
level
• The patient establish rate, inspiratory flow Time of inspiration
• PSV is patient triggered, pressure limited and flow cycled mode
3. CPAP
• CPAP involves the application of pressure above ambient pressure
throughout inspiration and expiration in spontaneous/ assisted
breathing patient
• Externally applied cpap may reduce the pressure difference b/w
mouth and alveoli when flow limitation causes auto – peep
Non invasive mode ( NPPV)
• Aternative to IPPV ,via face mask
• Indications
1. RR>25 Bpm
2. Ph = 7.25 -7.30
3. Pco2 = 45 – 60 mg
4. Moderate to severe dystonia with use of accessory muscle and paradoxical breathing pattern
• Contraindications
1. Respiratory arrest
2. Cardiac arrest cardiovascular instability
3. Non respiratory organ failure
4. Tracheoesophageal fistula
5. High risk of aspiration
• Ventilator with NIV mode ( pressure triggered, pressure limited, flow cycled) are used
• Advantage of NIV
1. Reduce requirement for heavy sedation
2. Preserve airway defense, speech, swallowing mechanism
3. Reduce need for invasive monitoring
4. Avoid complications associated with artofficial airway
• Disadvantage
Cause gastric distension, skin pressure lesions, facial pain,eye irritation,
mask leak
Additional modes of ventilation
1. Pressure regulated volume control (PRVC)
• PRVC is volume targeted, pressure control breath
• Delivers pressure breath that are patient/ time triggered, volume
targeted, time cycled breath
• During breath delivery, the ventilator measures the tidal volume
delivered and compare it to set volume
• If measured volume is not equal to set volume then ventilator change
pressure delivery in an attempt to reach set volume
2. Pressure augmentation
• Also called volume assured pressure support (VAPS)
• The ventilator begins with a patient triggered, pressure targeted
breath but target the volume preset by the operator and deliver that
volume with every breath
Thank
you