VENTILATOR MEKANIS

• Mechanical ventilation (MV) works by applying a positive pressure breath and is

dependent on the compliance and resistance of the airway system.
• The primary indications for invasive mechanical ventilation can be divided into the
following categories:
1. Airway disease of compromise.
2. Hypoventilation due to impaired drive, pump failure, or inability to exchange gases
resulting in hypercapnic respiratory failure
3. Hypoxemic respiratory failure can be due to the inability to exchange oxygen or
delivery to the peripheral tissues
4. Increased ventilatory demand due to severe sepsis, shock, or severe metabolic acidosis
 TYPE OF MECHANICAL VENTILATION

• Invasive Positive pressure ventilation (IPPV)  diberikan melalui ETT atau

tracheostomy
• Non-invasive positive pressure ventilation (NIPPV)  diberikan melalui
masker
 VOLUME VS PRESSURE

• Volume and pressure only one can be set constant

 MODE OF VENTILATOR

• Controlled Mandatory Ventilation (CMV Mode)

• Assist Control Mode (AC Mode)
• Synchronized intermittent mandatory ventilation (SIMV)
• Spontaneous Breathing Mode
 SETTING UP MODE

1. Rate 4. Laju Aliran Inspirasi (IFR)  ditetapkan

• 12-20 breath/min pada 40 hingga 60 L/menit untuk
• 12-14  Obstruksi/asma menargetkan rasio inspirasi: ekspirasi 1:2
• 18-20  ARS dan pneumonia atau 1:3
• Decision base on clinical condition dan
5. Positive end-expiratory pressure (PEEP)
ABG
 4-5 cmH2O
2. Tidal Volume (VT)  6-8 mL/Kg ideal
body weight
3. FiO2  80-90%
 SETTING UP MODE

6. PIP (Peak inspiratory pressure)  9. Plateu pressure (Pplat)  tekanan yang

Puncak tekanan yang dibutuhkan saat dibutuhkan untuk mempertahankan
memberikan volume tidak pada pasien pengembangan paru saat inspirasi.

7. I:E ratio  perbandingan waktu inspirasi

dan waktu ekspirasi

8. Inspiratory time (Ti)  waktu yang di

perlukan untuk memberikan volume tidal
 CMV MODE

• Patient sedated, paralyzed Drawbacks:

• You set a constant volume, rate - Atrophy of respiratory muscle
• Ventilator control everything - Barotrauma
• Patient cannot trigger breathing - Accidental disconnection result in death
 ASSIST CONTROL (AC)MODE

• You set a constant volume Drawbacks:

• Patient trigger breathing - If patient trigger breath more patient will
develop respiratory alkalosis
• Back up rate (eg 12 breath/min)
• Volume and Pressure control
• High peak pressure
 SYNCHRONIZED INTERMITTENT
MANDATORY VENTILATION (SIMV)
 PRESSURE CONTROL VENTILATON
(PVC)

• You get a constant pressure

• Volume generated by venti variable
• Indication: ARDS where peak pressure are higt
 SPONTANEOUS MODE

• All effort breaths by patient ventilator just support each breath by providing
pressure
WEANING
 KOMPLIKASI

• Infeksi nasoklomial
• Pneumothoraks
• Barotrauma
• Ateletaksis
• Ulkus decubitus
TERIMA KASIH