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Mechanical Ventilation for the Non-Intensivist: Theory
Ewan C. Goligher MD PhDAssistant Professor,Interdepartmental Division of Critical Care MedicineUniversity of Toronto
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Educational Objectives
Concepts• Goals of mechanical ventilation
• How breathing works
• How mechanical ventilation works
• Side effects of mechanical ventilation
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Goals of Mechanical Ventilation
•Primum non nocere
•Oxygen delivery
•Acid-base homeostasis
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How Breathing Works
•Gas exchange- Oxygen
- Carbon dioxide
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How Breathing Works
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How Breathing Works
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How Breathing Works
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How Breathing Works
•Control of breathing- Trigger
- Target
- Limit/cycling criterion
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How Mechanical Ventilation Works
•CO2 clearance - minute ventilation- Trigger
- Target
- Limit/cycling criterion
•Oxygenation- FIO2
- PEEP
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How Mechanical Ventilation Works
•Getting a respiratory rate (f)
Controller Trigger
Ventilator Time (1/F set by RT)
Patient Flow or pressure
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How Mechanical Ventilation Works
•Getting a tidal volume (Vt)
Mode Target Limit
Volume control Flow Volume
Pressure control Pressure Time
Pressure support Pressure Flow
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How Mechanical Ventilation Works
Pressure
Flow
Volume
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How Mechanical Ventilation Works
•How does mechanical ventilation improve oxygenation?
- Improves V/Q matching
- Reduces shunt
- Allows delivery of assured high FIO2
FIO2 Increases alveolar PAO2
Positive end-expiratory pressure (PEEP)
Keeps alveoli open (recruitment)
Goligher, Ferguson, Brochard Lancet 2016
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Side Effects of Mechanical
Ventilation
• Hemodynamic effects of positive pressure
• Ventilator-induced lung injury
• Ventilator-induced respiratory muscle weakness
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Hemodynamic Effects
•Heart-lung interactions
•Specific examples- LV dysfunction
- RV dysfunction
• Intubation considerations
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Ventilator-Induced Lung InjuryVentilator-Induced Lung Injury
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Ventilator-Induced Lung InjuryVentilator-Induced Diaphragm Dysfunction
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Mechanical Ventilation…Is not a benign intervention!
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•Basic respiratory physiology
•How mechanical ventilation works
•Mechanical ventilation is not a benign intervention!
Key Points