Download - Basic Modes of Mechanical Ventilation -
![Page 1: Basic Modes of Mechanical Ventilation -](https://reader031.vdocuments.net/reader031/viewer/2022022712/621a1da364bd52151a357b16/html5/thumbnails/1.jpg)
MODES OF MECHANICAL VENTILATION
Mazen Kherallah, MD, FCCP
![Page 2: Basic Modes of Mechanical Ventilation -](https://reader031.vdocuments.net/reader031/viewer/2022022712/621a1da364bd52151a357b16/html5/thumbnails/2.jpg)
POINTS OF DISCUSSIONS
Advanced Basics:Flow and TimeLimit and cyclingRise TimeVolume vs Pressure Control
Mandatory Modes of VentilationControlled Mandatory Ventilation (CMV or IPPV)
Triggered Modes of VentilationContinuous Positive Airway Pressure (CPAP) Pressure Support Ventilation (PSV)
Hybrid Modes of VentilationAssist Control Mode (A/C)Synchronized Intermittent Mandatory Ventilation (SIMV)
![Page 3: Basic Modes of Mechanical Ventilation -](https://reader031.vdocuments.net/reader031/viewer/2022022712/621a1da364bd52151a357b16/html5/thumbnails/3.jpg)
ADVANCED BASICS
![Page 4: Basic Modes of Mechanical Ventilation -](https://reader031.vdocuments.net/reader031/viewer/2022022712/621a1da364bd52151a357b16/html5/thumbnails/4.jpg)
RESPIRATORY CYCLE
Inspiration
Expiration
![Page 5: Basic Modes of Mechanical Ventilation -](https://reader031.vdocuments.net/reader031/viewer/2022022712/621a1da364bd52151a357b16/html5/thumbnails/5.jpg)
ExpInsp
RELATIONSHIP BETWEEN TIDAL VOLUME, INSPIRATORY TIME AND FLOW
VT 1
Ti a
VT 2
VT 3
Time
Volume
Flow= 30 L/min
Flow= 15 L/min
Flow= 37.5 L/min
![Page 6: Basic Modes of Mechanical Ventilation -](https://reader031.vdocuments.net/reader031/viewer/2022022712/621a1da364bd52151a357b16/html5/thumbnails/6.jpg)
ExpExpInspInspInsp
RELATIONSHIP BETWEEN TIDAL VOLUME, INSPIRATORY TIME AND FLOW
VT 1
Ti a
Time
Volume
Ti b Ti c
Flow= 30 L/min
Flow= 20 L/min
Flow= 60 L/min
![Page 7: Basic Modes of Mechanical Ventilation -](https://reader031.vdocuments.net/reader031/viewer/2022022712/621a1da364bd52151a357b16/html5/thumbnails/7.jpg)
PRESSURE LIMITED BREATH
Time
Volume
Pressure Limit
![Page 8: Basic Modes of Mechanical Ventilation -](https://reader031.vdocuments.net/reader031/viewer/2022022712/621a1da364bd52151a357b16/html5/thumbnails/8.jpg)
EXPIRATORY FLOW CYCLING
Time
Flow
50%
100%
Flow Cycling
![Page 9: Basic Modes of Mechanical Ventilation -](https://reader031.vdocuments.net/reader031/viewer/2022022712/621a1da364bd52151a357b16/html5/thumbnails/9.jpg)
RISE TIME
Time
Flow
Pressure
Volume
TI TE
![Page 10: Basic Modes of Mechanical Ventilation -](https://reader031.vdocuments.net/reader031/viewer/2022022712/621a1da364bd52151a357b16/html5/thumbnails/10.jpg)
MANDATORY, SPONTANEOUS AND TRIGGEREDINSPIRATORY CYCLING
M
S
Tsynch
M M
M
MM
M
M
S
M
Tsupp Tsupp
Tsupp Tsupp
Tsupp
Tsupp
S
![Page 11: Basic Modes of Mechanical Ventilation -](https://reader031.vdocuments.net/reader031/viewer/2022022712/621a1da364bd52151a357b16/html5/thumbnails/11.jpg)
VOLUME CONTROLLED INFLATION
Time
Flow
Pressure
Volume
TI TE
Tidal Volume
![Page 12: Basic Modes of Mechanical Ventilation -](https://reader031.vdocuments.net/reader031/viewer/2022022712/621a1da364bd52151a357b16/html5/thumbnails/12.jpg)
If compliance decreases the pressure increases to maintain the same Vt
1 2 3 4 5 6
SEC
1 2 3 4 5 6
PawcmH20
50
-20
120
120
SEC
INSP
EXH
FlowL/min
VOLUME CONTROL BREATHS
Decreased Compliance
![Page 13: Basic Modes of Mechanical Ventilation -](https://reader031.vdocuments.net/reader031/viewer/2022022712/621a1da364bd52151a357b16/html5/thumbnails/13.jpg)
VOLUME CONTROL WITH END-INSPIRATORYPAUSE
Time
Flow
Pressure
Volume
TI TE
Tidal Volume
End Inspiratory Pause
![Page 14: Basic Modes of Mechanical Ventilation -](https://reader031.vdocuments.net/reader031/viewer/2022022712/621a1da364bd52151a357b16/html5/thumbnails/14.jpg)
PRESSURE CONTROLLED INFLATION
Time
Flow
Pressure
Volume
TI TE
Tidal Volume
Rise Time
Peak Inspiratory Flow
![Page 15: Basic Modes of Mechanical Ventilation -](https://reader031.vdocuments.net/reader031/viewer/2022022712/621a1da364bd52151a357b16/html5/thumbnails/15.jpg)
Inspiration Expiration
0 120
00 1 2
3
-3
0
20
0 21
20
00 1 2
3
-3
0
20
0 2
Inspiration Expiration
Volume/Flow Control Pressure Control
Time (s) Time (s)
PawPaw
Pressure
Volume
Flow
![Page 16: Basic Modes of Mechanical Ventilation -](https://reader031.vdocuments.net/reader031/viewer/2022022712/621a1da364bd52151a357b16/html5/thumbnails/16.jpg)
TRIGGERED MODES OFVENTILATIONCPAP and PSVV
![Page 17: Basic Modes of Mechanical Ventilation -](https://reader031.vdocuments.net/reader031/viewer/2022022712/621a1da364bd52151a357b16/html5/thumbnails/17.jpg)
SPONTANEOUS BREATHING
Time (sec)
Flow(L/m)
Pressure(cm H2O)
Volume(mL)
![Page 18: Basic Modes of Mechanical Ventilation -](https://reader031.vdocuments.net/reader031/viewer/2022022712/621a1da364bd52151a357b16/html5/thumbnails/18.jpg)
CONTINUOUS POSITIVE AIRWAY PRESSURE(CPAP)
Time (sec)
Flow(L/m)
Pressure(cm H2O)
Volume(mL)
CPAP Level
![Page 19: Basic Modes of Mechanical Ventilation -](https://reader031.vdocuments.net/reader031/viewer/2022022712/621a1da364bd52151a357b16/html5/thumbnails/19.jpg)
PRESSURE SUPPORT VENTILATION(PSV)
Time (sec)
Flow(L/m)
Pressure(cm H2O)
Volume(mL)
Set PS Level
Flow Cycling
Better Efforts
Longer Inspiration
Patient Triggered, Flow Cycled, Pressure limited Mode
![Page 20: Basic Modes of Mechanical Ventilation -](https://reader031.vdocuments.net/reader031/viewer/2022022712/621a1da364bd52151a357b16/html5/thumbnails/20.jpg)
CPAP+PSV
Time (sec)
Flow(L/m)
Pressure(cm H2O)
Volume(mL)
Set PS Level
Flow Cycling
Patient Triggered, Flow Cycled, Pressure limited Mode
CPAP Level
![Page 21: Basic Modes of Mechanical Ventilation -](https://reader031.vdocuments.net/reader031/viewer/2022022712/621a1da364bd52151a357b16/html5/thumbnails/21.jpg)
TRIGGERED MODES OF VENTILATIONPRESSURE SUPPORT VENTILATION
Control Trigger Limit Target Cycle
Pressure Patient Pressure Flow
Patient Triggered Flow Cycled Ventilation
![Page 22: Basic Modes of Mechanical Ventilation -](https://reader031.vdocuments.net/reader031/viewer/2022022712/621a1da364bd52151a357b16/html5/thumbnails/22.jpg)
PRESSURE OR VOLUME-TARGETEDVENTILATION
Full to partial ventilatory supportAugments the patients spontaneous VTDecreases the patient’s spontaneous respiratory rateDecreases patient WOB by overcoming the resistance of the artificial airway, vent circuit and demand valvesAllows patient control of TI, Vm I, f and VTSet peak pressurePrevents respiratory muscle atrophyFacilitates weaningImproves patient comfort and reduces need for sedationMay be applied in any mode that allows spontaneous breathing, e.g., VC-SIMV, PC-SIMV
Requires consistent spontaneous ventilationPatients in stand-alone mode should have back-up ventilationVT variable and dependant on lung characteristics and synchronyLow exhaled VE
Fatigue and tachypnea if PS level is set too low
Advantages Disadvantages
![Page 23: Basic Modes of Mechanical Ventilation -](https://reader031.vdocuments.net/reader031/viewer/2022022712/621a1da364bd52151a357b16/html5/thumbnails/23.jpg)
MANDATORY MODES OFVENTILATIONCMV or IPPV
![Page 24: Basic Modes of Mechanical Ventilation -](https://reader031.vdocuments.net/reader031/viewer/2022022712/621a1da364bd52151a357b16/html5/thumbnails/24.jpg)
MANDATORY MODES OF VENTILATIONCMV
Control Trigger Limit Target Cycle
PressureOr
Volume
Time Time
Time Triggered Time Cycled Ventilation
![Page 25: Basic Modes of Mechanical Ventilation -](https://reader031.vdocuments.net/reader031/viewer/2022022712/621a1da364bd52151a357b16/html5/thumbnails/25.jpg)
CONTROL MODE(PRESSURE-TARGETED VENTILATION)
Flow(L/m)
Pressure(cm H2O)
Volume(mL)
Time Triggered, Pressure Limited, Time Cycled Ventilation Time (sec)
Time CyclingSet PC Level
![Page 26: Basic Modes of Mechanical Ventilation -](https://reader031.vdocuments.net/reader031/viewer/2022022712/621a1da364bd52151a357b16/html5/thumbnails/26.jpg)
CONTROL MODE(VOLUME-TARGETED VENTILATION)
Flow(L/m)
Pressure(cm H2O)
Volume(mL)
Time Triggered, Flow Limited, Volume Cycled Ventilation Time (sec)
Preset VTVolume Cycling
Time Cycling
Dependent onCL & Raw
![Page 27: Basic Modes of Mechanical Ventilation -](https://reader031.vdocuments.net/reader031/viewer/2022022712/621a1da364bd52151a357b16/html5/thumbnails/27.jpg)
PRESSURE OR VOLUME-TARGETEDVENTILATION
Decreases the work of breathing (WOB)Helps maintain a normal PaCO2
Not able to assist the ventilator
Advantages Disadvantages
![Page 28: Basic Modes of Mechanical Ventilation -](https://reader031.vdocuments.net/reader031/viewer/2022022712/621a1da364bd52151a357b16/html5/thumbnails/28.jpg)
![Page 29: Basic Modes of Mechanical Ventilation -](https://reader031.vdocuments.net/reader031/viewer/2022022712/621a1da364bd52151a357b16/html5/thumbnails/29.jpg)
HYBRID MODES OFVENTILATIONSIMV and A/C
![Page 30: Basic Modes of Mechanical Ventilation -](https://reader031.vdocuments.net/reader031/viewer/2022022712/621a1da364bd52151a357b16/html5/thumbnails/30.jpg)
HYBRID MODES OF VENTILATIONA/C
Control Trigger Limit Target Cycle
PressureOr
Volume
Time Or
Patient
Time
Time or PatientTriggered Time Cycled Ventilation
![Page 31: Basic Modes of Mechanical Ventilation -](https://reader031.vdocuments.net/reader031/viewer/2022022712/621a1da364bd52151a357b16/html5/thumbnails/31.jpg)
ASSISTED MODE(VOLUME-TARGETED VENTILATION)
Flow(L/m)
Pressure(cm H2O)
Volume(mL)
Patient Triggered, Flow limited, Volume Cycled Ventilation Time (sec)
Preset peak Flow
Time Cycling
![Page 32: Basic Modes of Mechanical Ventilation -](https://reader031.vdocuments.net/reader031/viewer/2022022712/621a1da364bd52151a357b16/html5/thumbnails/32.jpg)
ASSISTED MODE(PRESSURE-TARGETED VENTILATION)
Flow(L/m)
Pressure(cm H2O)
Volume(mL)
Patient Triggered, Pressure Limited, Time Cycled Ventilation Time (sec)
Time CyclingSet PC Level
![Page 33: Basic Modes of Mechanical Ventilation -](https://reader031.vdocuments.net/reader031/viewer/2022022712/621a1da364bd52151a357b16/html5/thumbnails/33.jpg)
PRESSURE OR VOLUME-TARGETEDVENTILATION
Decreases the work of breathing (WOB)Allows patients to regulate respiratory rateHelps maintain a normal PaCO2
Alveolar hyperventilation
Advantages Disadvantages
![Page 34: Basic Modes of Mechanical Ventilation -](https://reader031.vdocuments.net/reader031/viewer/2022022712/621a1da364bd52151a357b16/html5/thumbnails/34.jpg)
HYBRID MODES OF VENTILATIONSIMV/PS
Breath Type
Control Trigger Limit Cycle
Mandatory PressureOr
Volume
Time Or
Patient
Time
Spontaneous Pressure Patient Pressure Flow
![Page 35: Basic Modes of Mechanical Ventilation -](https://reader031.vdocuments.net/reader031/viewer/2022022712/621a1da364bd52151a357b16/html5/thumbnails/35.jpg)
SIMV(VOLUME TARGETED VENTILATION)
Flow(L/m)
Pressure(cm H2O)
Volume(mL)
Spontaneous Breaths
M M M
Time (sec)
![Page 36: Basic Modes of Mechanical Ventilation -](https://reader031.vdocuments.net/reader031/viewer/2022022712/621a1da364bd52151a357b16/html5/thumbnails/36.jpg)
SIMV+PS(VOLUME TARGETED VENTILATION)
Flow(L/m)
Pressure(cm H2O)
Volume(mL)
MTsuppTsynch
Set PS Level
Flow-cycled
Time (sec)
![Page 37: Basic Modes of Mechanical Ventilation -](https://reader031.vdocuments.net/reader031/viewer/2022022712/621a1da364bd52151a357b16/html5/thumbnails/37.jpg)
SIMV + PS (PRESSURE-TARGETED VENTILATION)
Flow(L/m)
Pressure(cm H2O)
Volume(mL)
Tsupp
Tsynch
Time CycledFlow-cycled
Tsynch
Set PC Level Set PS Level
Time (sec)
![Page 38: Basic Modes of Mechanical Ventilation -](https://reader031.vdocuments.net/reader031/viewer/2022022712/621a1da364bd52151a357b16/html5/thumbnails/38.jpg)
HYBRID MODE VENTILATION: SUPPRESSION
Time (sec)
Flow
(L/m
)Pr
essu
re(c
m H
2O)
Cyc
les
M Tsupp MM Tsupp
M M
Tsupp Tsupp
![Page 39: Basic Modes of Mechanical Ventilation -](https://reader031.vdocuments.net/reader031/viewer/2022022712/621a1da364bd52151a357b16/html5/thumbnails/39.jpg)
HYBRID MODE VENTILATION: SYNCHRONIZATION(SIMV+PSV)
Time (sec)
Flow(L/m)
Pressure(cm H2O)
Cycles
Triggered window for supported breaths
Triggered window for synchronized breaths
Mandatory Cycle Time
M Tsupp Tsynch M Tsynch Tsupp
![Page 40: Basic Modes of Mechanical Ventilation -](https://reader031.vdocuments.net/reader031/viewer/2022022712/621a1da364bd52151a357b16/html5/thumbnails/40.jpg)
SIMV
Maintains respiratory muscle strength by avoiding muscle atrophyDecreases mean airway pressureFacilitates ventilator discontinuation –“weaning”!
When used for weaning, may be done too quickly and cause muscle fatigueMechanical rate and spontaneous rate may asynchronous causing “stacking”
May cause barotrauma or volutrauma
Advantages Disadvantages
![Page 41: Basic Modes of Mechanical Ventilation -](https://reader031.vdocuments.net/reader031/viewer/2022022712/621a1da364bd52151a357b16/html5/thumbnails/41.jpg)
ALL MODES TABLES
![Page 42: Basic Modes of Mechanical Ventilation -](https://reader031.vdocuments.net/reader031/viewer/2022022712/621a1da364bd52151a357b16/html5/thumbnails/42.jpg)
Mandatory Modes of VentilationsMandatory breaths
Inspiratory cycling Time Time Time Time
Control Volume Volume Volume (Pressure)
Target/Limit - Pressure-limited Volume-targeted
Feeadback - - Intra-breath Inter-breathExpiratory cycling Time Time Time TimeTriggered BreathsTypes None None None None
Supported Breaths
Control - - - -Target - - - -Feedback - - - -Expiratory Cycling - - - -Spontaneous Breaths
During mandatory inspiration Not accommodated
Not accommodated
Not accommodated Accommodated
Otherwise Not accommodated Accommodated Not
accommodated Accommodated
Synonyms
IPPV (Draeger)Controlled Mandatory Ventilation
Intermittent Mandatory Ventilation
IPPV (Draeger): trigger off, autoflow off
IPPV (Draeger): trigger off,autoflow on
![Page 43: Basic Modes of Mechanical Ventilation -](https://reader031.vdocuments.net/reader031/viewer/2022022712/621a1da364bd52151a357b16/html5/thumbnails/43.jpg)
Triggered Modes of Ventilations
Mandatory breaths
Inspiratory cycling - - -
Control - - -
Target/Limit - - -
Feeadback - - -
Expiratory cycling - - -
Triggered Breaths
Types Supported breaths Supported breaths Supported breaths
Supported Breaths
Control Pressure (Pressure) (Pressure)
Target -- Volume-targeted Flow and Volume
Feedback -- Inter-breath Intra-breath
Expiratory Cycling Flow Flow Flow
Spontaneous Breaths
During mandatory inspiration - - -
Otherwise - - -
Synonyms
Assisted Spontaneus Breathing (Draeger)Spontaneous Mode (Hamilton, Puritan Bennet)Pressure Support (MaquetPressure Support Ventilation (Viasys)CPAP (Respironics)
Volume Support (Maquet, Puritan-Bennett)
Propotional Assist Ventilation, Proportional Pressure Suport (Draeger)Propotional Assist Ventilation Plus (Puritan-Bennet)
![Page 44: Basic Modes of Mechanical Ventilation -](https://reader031.vdocuments.net/reader031/viewer/2022022712/621a1da364bd52151a357b16/html5/thumbnails/44.jpg)
Hybrid Mode: Assist Control
Mandatory breaths
Inspiratory cycling Time or trigger Time or trigger Time or trigger
Control Volume Pressure (Pressure)
Target/Limit - - Volume-targeted
Feeadback - - Inter-breath
Expiratory cycling Time Time Time
Triggered Breaths
Types Mandatory pattern Mandatory pattern Mandatory pattern
Supported Breaths
Control - - -
Target - - -
Feedback - - -
Expiratory Cycling - - -
Spontaneous Breaths
During mandatory inspiration Not accommodated Accommodated Accommodated
Otherwise - - -
Synonyms
IPPVASSIST (Draeger)Synchronized cCntrolledMandatory Ventilation (Hamilton)Volume Control (Maquet)VCV-A/C (Puritan-Bennett, Respironics)Volume A/C (Viasys)
BIPAPASSIST (Draeger)P-CMV (Hamilton)Pressure Control (Maquet)PCV-A/C (Puritan-Bennett, Respironics)Pressure A/C (Viasys)
Adaptive Pressure Ventilation CMVPRVC (Maquet)VC+A/C (Puritan-Bennet)PRVC A/C (Viasys)IPPV Assist Autoflow(Draeger)
![Page 45: Basic Modes of Mechanical Ventilation -](https://reader031.vdocuments.net/reader031/viewer/2022022712/621a1da364bd52151a357b16/html5/thumbnails/45.jpg)
Hybrid Mode: Synchronized Intermittent Mandatory Ventilation
Mandatory breaths
Inspiratory cycling Time or trigger Time or trigger Time or trigger
Control Volume Pressure (Pressure)
Target/Limit - - Volume-targeted
Feeadback - - Inter-breath
Expiratory cycling Time Time Time
Triggered Breaths
Types Mandatory and supported pattern
Mandatory and supported pattern
Mandatory and supported pattern
Supported Breaths
Control Pressure Pressure Pressure
Target - - -
Feedback - - -
Expiratory Cycling Flow Flow Flow
Spontaneous Breaths
During mandatory inspiration Not accommodated Accommodated Accommodated
Otherwise Only if support is off Only if support is off Only if support is off
Synonyms
SIMV (Draeger, Hamilton)SIMV (VC)+PS (Maquet)VCV-SIMV (Puritan-Bennett, Respironics)Volume SIMV (Viasys)
P-SIMV (Hamilton)SIMV(PC)+PS (Maquet)PCV-SIMV (Puritan-Bennett, Respironics)Pressure SIMV (Viasys)
SIMV+AutoflowAdaptive Pressure Ventilation SIMV (Hamilton)SIMV (PRVC)+PS (Puritan-Bennett)PRVC SIMV (Viasys)
![Page 46: Basic Modes of Mechanical Ventilation -](https://reader031.vdocuments.net/reader031/viewer/2022022712/621a1da364bd52151a357b16/html5/thumbnails/46.jpg)
Hybrid Mode: Bi-Level Ventilatio
Mandatory breaths
Inspiratory cycling Time or trigger Time or trigger Time or trigger Time or trigger
Control Pressure Pressure Pressure Pressure
Target/Limit - - - -
Feeadback - - - -
Expiratory cycling Time or trigger Time or trigger Time or trigger Time or trigger
Triggered Breaths
Interaction Mandatory and supported
Mandatory pattern and supported
Mandatory and supported
Mandatory and supported
Supported Breaths
Control Pressure Pressure Pressure Pressure
Target - - - -
Feedback - - - -
Expiratory Cycling Flow Flow Flow Flow
Spontaneous Breaths
During mandatory inspiration Accommodated
Trigers suuport to PEEP+Psupport If this>Phigh (Hamilton DuoPAP)Plow+Psupport If this>Phigh (Hamilton APRV)PEEPL+PsuppIf this>PEEPH (Puritan-Bennett)
Triggers support to PRES HIGH + PSV if Thigh PSV is activated
Tigger support to PSV above PHigh
Otherwise Triggers support
Triggers support to PEEP+Psupport(Hamilton) DuoPAP)Plow+Psupport (Hamilton APRV)PEEPL+Psupp (Puritan-Bennett)
Triggers support to PREDSLOW=PSV
Triggers support to PSV above PEEP
Synonyms BIPAP (Draeger)
DuoPAP/APRV (Hamilton)BiLevel (Puritan-Bennet)
APRV/Bi-phasic(Viasys) Bi-vent (Maquet)
![Page 47: Basic Modes of Mechanical Ventilation -](https://reader031.vdocuments.net/reader031/viewer/2022022712/621a1da364bd52151a357b16/html5/thumbnails/47.jpg)
THANK YOU