Vent therapy

Richard Evans, D.O.

Pulmonary and Critical Care
Medicine Associates
 Physiologic definitions
• Ventilation – movement of air
• Respiration – gas exchange
• external – gas exchange btwn alveoli
and capillary
• internal – gas exchange btwn tissue
capillary and tissue (cellular level)
• Ventilator – Mechanical device which performs
function of ventilation (movement of air)
 Assessment of Ventilatory Status
• Respiratiory rate
• Depth of breathing
• Inspiratory/Expiratory airflow
• Apnea
• Arterial blood gasses
• Overall – ribcage/abdominal
movement,use of accessory
muscles,cyanosis,vital signs, diaphoresis
 Variable affecting ventilation
• Elastance – quality of recoil upon removal of
pressure without disruption
• Resistance – opposition to airflow. Variable
include length, diameter and area
• Compliance – quality of yielding to pressure
or force; variance in volume for a given
change in pressure.
• C = change vol/ change pressure
 Respiration/ventilation
• Reasons to breathe:
• to 1. oxygenate (respire)
• To 2. ventilate CO2

• Lack of adequate oxygenation is

respiratory failure
• Lack of ventilation (increased pCO2 in
acidosis) is ventilatory failure
 Hypoxia
• Hypoventilation
• Diffusion abnormality – (fibrosis, collvasc
ds)
• V/Q mismatch (most common)
• Very Low Cvo2
• R to L shunt (most dangerous)
 Therapy for hypoxia
• All are relatively fixable by increasing
alveolar diffusion gradient of Oxygen
except R to L shunt.
• Increase alveolar oxygen concentration
by:
• 1 Increase oxygen (FIO2)
• 2. increase pressure (PEEP)
 Hypoxia due to shunt
• Have to reduce the shunt

• Try position changes

• Good lung down
 Ventilatory failure treatment
• Increase alveolar ventilation

• Ve = resp rate x Vt
• Vt = alveolar ventilation + dead space

• Therefore: treat by increasing resp rate or

by increasing tidal volume.
• Most efficient is to change Vt
 Ventilatory failure treatment
• Multiplying resp rate multiplies inefficiency
of multiplying dead space ventilation.