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NORMAL SCALARS ON VENTILATORY

INTERFACE
Initiation of Mechanical Ventilation

Volume Ventilation Pressure Ventilation

Dual Modes
Volume Ventilation
(Control Variable is Volume)
Clinician Sets

Tidal volume (VT) Respiratory Inspiratory Flowrate


or Minute volume Frequency (f) or Inspiratory Time (TI)
( VE ) or TI % or I:E ratio
Pressure Ventilation
(Control Variable is Pressure)
Clinician Sets

Pressure Level Respiratory Inspiratory Time (TI)


< 30 cm H2O Frequency (f) or TI %
or I:E ratio
Commonly used Ventilatory Modes
Volume Ventilation Pressure Ventilation

Control Mode Control Mode

Assisted mode Assisted mode

SIMV SIMV

SIMV + PSV SIMV + PSV

SIMV + PSV + CPAP SIMV + PSV + CPAP


Controlled Mode
(Volume- Targeted Ventilation)
Time triggered, Flow Limited, Volume Cycled Ventilation
Preset Peak Flow

Flow
L/m

Dependent on
Pressure CL & Raw
cm H2O

Preset VT
Volume Volume Cycling
mL

Fig 7.6 Time (sec)


CONTROLLED VENTILATION

 Operator sets the rate, VT and Inspiratory Flow rate


 Technically, sensitivity is “OFF”
 No WOB for the patient
CONTROLLED VENTILATION

Cautions:
 Patient “FIGHTING” the ventilator
 Inadequate flow
 Improper rate setting
Assisted Mode
(Volume-Targeted Ventilation)
Patient triggered, Flow limited, Volume cycled Ventilation

Flow
L/m

Pressure
cm H2O

Preset VT
Volume Volume Cycling

mL
Time (sec)
ASSISTED VENTILATION

 Minimum back up rate and VT set


 Patient sets the total ventilator rate
 Sensitivity adjusted to –1 to –2 cmH2O
 Every breath is initiated by the patient
 Every breath is a positive pressure breath.
Volume Targeted Ventilation
 Key Alarms

 High Pressure Alarm


Set at 10-15 cm H2O above
the ventilating pressure

 Low Pressure Alarm


Set at 10-15 cm H2O below
the ventilating pressure
Controlled Mode
(Pressure-Targeted Ventilation)
Time Triggered, Pressure Limited, Time Cycled Ventilation

Time-Cycled
Flow
(L/min)

Set PC level
Pressure
(cm H2O)

Volume
(ml)

Time (sec)
Assisted Mode
(Pressure-Targeted Ventilation)
Patient Triggered, Pressure Limited, Time Cycled Ventilation

Time-Cycled
Flow
(L/min)

Set PC level
Pressure
(cm H2O)

Volume
(ml)

Time (sec)
Pressure Targeted Ventilation

 Key Alarms

 Low VOLUME Alarm

 Set at ~ 100-200 ml below


the initial ventilating volume
IMV or SIMV

 IMV: Spontaneous breaths interposed between Controlled


Mandatory breaths
 SIMV: Spontaneous breaths interposed between Assisted
Mandatory breaths
 Used as one of the weaning method
 A PRESSURE SUPPORT MUST BE ADDED to enhance
spontaneous breaths
SIMV Mode
(Volume Ventilation)

Flow
L/m

Pressure
cm H2O

Volume
mL

Spontaneous Breaths
SIMV Mode
(Pressure Ventilation)

Flow
(L/min)

Set PC level
Pressure
(cm H2O)

Volume
(ml)

Time (sec)
Fig 7.19 Spontaneous Breath
SIMV + PS
(Pressure-Targeted Ventilation)
Time-Cycled Flow-Cycled

Flow
(L/min)

Set PC level
Pressure Set PS level
(cm H2O)

Volume
(ml)

Time (sec)
Fig 7.21 PS Breath
Pressure Support Ventilation
( PSV )

 Strictly an assist form of mechanical ventilation


 Augments spontaneous tidal volume with a preselected
level of positive inspiratory pressure
 Overcomes imposed work of breathing due to :
 Artificial Airways
 Demand valve system
 Ventilator circuitry

 Classified as a Pressure-limited, flow-cycled, assisted


ventilation

Fig 7.22
Delivery of PSV
The Expiratory Phase :

 When the inspiratory flow decreases to a system


specific minimal level ( 25% of the peak flow), or the
pressure increases to a system specific level , the
inspiratory phase is terminated and the exhalation
valve opens.
 Flow cycled mode.

Fig 7.24
PSV
Patient Triggered, Flow Cycled, Pressure limited Mode

Flow Flow Cycling


L/m

Set PS
level
Pressure
cm H2O

Volume
mL
Time (sec)
Fig 7.25
Pressure Support Ventilation
The Tidal Volume depends on:

 The Set Pressure ( PSV)


 Airway Resistance (Raw)
 Lung Compliance ( CL)
 Patient Effort

Fig 7.26
CPAP

Flow
L/m

Pressure
cm H2O CPAP level

Volume
mL
Time (sec)

Fig 7.28
SIMV + PS + CPAP
(Pressure Ventilation)

Flow
(L/min)

Set PC level
Pressure Set PS level
(cm H2O)

CPAP level

Volume
(ml)

Time (sec)
Fig 7.29
SIMV+PS + CPAP
(Volume Ventilation)

Flow
(L/min)

Set PS Level
Pressure
(cm H2O)

CPAP level

Volume
(ml)

Time (sec)
Fig 7.30
CPAP + PSV ( BiPAP )

Flow Cycling

Flow
L/m

Set PS level
Pressure
cm H2O
CPAP level

Volume
mL

Time (sec)
NPPV
Noninvasive Positive Pressure Ventilation

20

15

IPAP
Pressure 10
PS PS

5
CPAP (EPAP)
0
Time
Bi-level Positive Airway Pressure
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