Critical Care >Ventilator Technology and Management

John M. Oropello, Stephen M. Pastores, Vladimir Kvetan+

Table 18–3Commonly used ventilator modes.

Ventilator Modes Description Proprietary Name

Conventional Modes of Ventilation

All breaths are mandatory and delivered at a predetermined

frequency and inspiratory time. Ventilator triggers all breaths.
CMV Patients usually require deep sedation or paralysis, or do not have CMV-VC, CMV-PC
ventilatory drive. This mode has been replaced by the assist-
control mode.

All breaths are mandatory and delivered at a predetermined

minimum frequency. Breaths could be triggered by ventilator or
ACV A/C VC, A/C PC
patient. Preferred mode for primary support in most clinical
settings.

Breaths are mandatory and delivered by the ventilator at a preset

IMV frequency. Mandatory breaths are triggered by the ventilator. In IMV-VC, IMV-PC
between mandatory breaths, patient can breathe spontaneously.

Is a form of IMV but differs by ventilator's ability to detect patient

effort during preset intervals and delivering a mandatory breath is
in coordination with (ie, synchronized) patient's effort. If no effort
SIMV SIMV-VC, SIMV-PC
detected, ventilator will deliver a mandatory breath at the
scheduled time (ie, time triggered). SIMV has replaced IMV in
clinical practice. Used for primary support and weaning.

All breaths are spontaneous. Patient determines the respiratory

rate, inspiratory time, and VT . Patient-ventilator synchrony is
PSV enhanced. Used commonly as a weaning mode but can also be Pressure support
used for primary support or in combination with other modes such
as SIMV.

Dual-Control Modes of Ventilation

Pressure or volume delivered is controlled by the ventilator via a

feedback loop. Ventilator regulation of the pressure or volume
Dual control occurs within a breath, ie, intrabreath. VT is guaranteed by VAPS or PA
switching between PSV and VC. Breaths may be triggered by
patient or ventilator.

Pressure or volume delivered is controlled by the ventilator via a

feedback loop. Ventilator regulation of the pressure or volume
VS or VPS
occurs breath to breath, ie, interbreath. VT is guaranteed by
adjusting PS level. Breaths are all patient-triggered.

Pressure or volume delivered is controlled by the ventilator via a

feedback loop. Ventilator regulation of the pressure or volume
PRVC, APV, Autoflow, VPC or VCV+
occurs breath to breath, ie, interbreath. VT is guaranteed by
adjusting PC. Breaths may be triggered by patient or ventilator.

Combines dual-control, breath-to-breath, time-cycled (mandatory),

and flow-cycled (spontaneous) breaths into a single mode. Can
AutoMode
switch between PRVC and VS, or PC and PS, or VC and VS.
Breaths may be triggered by patient or ventilator.
 Combines dual-control, breath-to-breath, time-cycled (mandatory),
and flow-cycled (spontaneous) breaths into a single mode.
Ventilator chooses ventilator parameter based on clinician input of
IBW and percent minute volume to meet minute ventilation target ASV
while minimizing WOB. Can switch between APC and PS, and
SIMV-PC and PS. Breaths may be triggered by patient or
ventilator.

Nonconventional Modes of Ventilation

Uses 2 levels of continuous airway pressure, high and low, with

intermittent release to the lower level. Patients are able to take
APRV APRV
spontaneous breaths during any phase of the respiratory cycle. It
is commonly used as an alternative modality in ARDS patients.

Continuous spontaneous ventilation in which pressure generated

PAV is proportional to patient's inspiratory effort (volume and flow). It PAV
enhances patient-ventilator synchrony.

Continuous spontaneous ventilation in which pressure generated

NAVA is proportional to the electrical activity of the diaphragm. It NAVA
enhances patient-ventilator synchrony.

Generates very small tidal volumes with respiratory rates

HFV HFOV
>100/min. Has been used in patients with ARDS.

Generates very small tidal volumes with respiratory rates

>100/min. Has been used in patients with ARDS, bronchopleural
HFPV
fistulas, burns with significant airway secretions, and patients with
raised ICP.

A/C, assist control; ACV, assist control ventilation; APV, adaptive pressure ventilation; ARDS, acute respiratory distress syndrome; APRV, airway pressure release ventilation; ASV, adaptive support ventilation;
CMV, continuous mandatory ventilation; HFOV, high-frequency oscillatory ventilation; HFPV, high-frequency percussive ventilation; HFV, high-frequency ventilation; ICP, intracranial pressure; IMV, intermittent
mandatory ventilation; NAVA, neurally adjusted ventilatory assist; PA, pressure augmentation; PAV, proportional assist ventilation; PC, pressure control; PS, pressure support; PSV, pressure support ventilation;
SIMV, synchronized intermittent mandatory ventilation; VAPS, volume assured pressure support; VC, volume control; VCV, volume control ventilation; VPC, variable pressure control; VPS, variable pressure
support; VS, volume support; VT , tidal volume.

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