MECHANICAL VENTILATION MADE EASY

Less you know about ventilator is better

INDICATIONS FOR VENTILATING A PATIENT:

1. Airway control with poor GCS
2. Hemodynamic instability.
3. Respiratory diseases like pneumonia,ARDS
4. Severe organ injuries.

MODES OF VENTILATION:
1. Volume Control
2. Pressure Control
3. Pressure Regulated Volume Control.
4. Pressure Support With CPAP.

MONITORING:
1. SPO2
2. Respiratory rate-work of breathing.
3. Sweating.
4. Consciousness.
5. Heart rate.

BASIC SETTINGS
1. Tidal volume –for most of the indian origin people-420 ml -450 ml
2. Also target Same tidal volume with PRESSURE CONTROL MODE.
3. FIO2-Start with 100% and come down to as minimal as possible and
early.
4. Rate-set @18 to compensate for dead space created by tubings.
5. Minute ventilation-Target of more than 7 liters.
6. PEEP-Minimum of 5,for ARDS more PEEP is required.

MODES OF VENTILATION
1.VOLUME CONTROL:

1. Tidal volume is guaranteed.

2. Peak pressures are not gauarenteed,peak pressures depend on the
Airways(Block,bronchospasm)

DEPARTMENT OF CRITICAL CARE MEDICINE -PIMS

Dynamic parameters-Things which change with each patient.
1. Tidal volume
2. Resp rate
3. PEEP
4. O2 concentration.

Static parameters-Things which are constant for almost all patients.

1. Flow pattern
2. I:E
3. T Pause
4. T Inspiratory rate.
5. Trigger flow.

2.PRESSURECONTROL:
1. PC set will determine the TIDAL VOLUME depending on the ability of the
lung to distent.
2. Normal lungs will inflate with low PC set and generate good tidal volume.
3. ARDS lungs,pulmonary edema High PC are required as the distensibility
of the lung is hampered with fluid and infected materials in the alveoli.
4. Peak pressures are addition of PC + PEEP.
5. Pressures are guaranteed but tidal volumes are not guaranteed.
6. CAUTION: A normally ventilating lung may be filled with fluid any
time in the ICU Stay if any unnoticed fluid overload or ARDS leading
to compromised Tidal volume which goes unnoticed.

DEPARTMENT OF CRITICAL CARE MEDICINE -PIMS

Dynamic parameters- Things which change with each patient.
1. PC
2. Resp rate.
3. PEEP
4. O2 concentration.
Static parameters:- Things which are constant for almost all patients.
1. I:E
2. T Insp rise.
3. Trigger flow
3.PRESSURE REGULATED VOLUME CONTROL:
1. Newer modality of ventilation.
2. Ventilator Maintains good synchrony with the patient.
3. Ventilator adjusts the Pressure ( PRESSURE REGULATES) and deliver set
tidal volume,so called PRESSURE REGULATED VOLUME CONTROL.

DEPARTMENT OF CRITICAL CARE MEDICINE -PIMS

Dynamic parameters-Things which change with each patient.
1. Tidal volume
2. Resp rate
3. PEEP
4. O2 concentration.

Static parameters-Things which are constant for almost all patients.

1. I:E
2. T Inspiratory rate.
3. Trigger flow.

4.PRESSURE SUPPORT PLUS CPAP:

1. Weaning modality.
2. Patient need to be quite stable-on
a. Minimal FIO2,
b. PEEP,
c. Hemodynamics stable.
3. The ventilator HELPS patient with the PRESSURE SUPPORT(PS) to assist
his tidal volume.
4. Can be considered as 30% support provided by the ventilator.
5. Start with the same PRESSURE CONTROL(PC) with which he is
generating good tidal volume.
6. When the patient is decreased from VOLUME CONTROL(VC) –start PS @
18 and adjust according to tidal volume and patient comfort.

DEPARTMENT OF CRITICAL CARE MEDICINE -PIMS

 7. CAUTION:Closely monitor the patient as it leads to hypoventilation if
un noticed.
8. Ventilator goes to BACKUP VENTILATION mode if patient is not
breathing.
9. When patient is comfortable on PS of < 10 ,can be changed to T-Piece.

Dynamic parameters-Things which change with each patient.

1. PS above PEEP
2. PEEP
3. O2 concentration.

Static parameters-Things which are constant for almost all patients.

1. END INSPIRATION 30%
2. T Inspiratory rise.
3. Trigger flow.

DEPARTMENT OF CRITICAL CARE MEDICINE -PIMS