modes of mechanical ventilation. p oints of d iscussions advanced basics: flow and time limit and...
TRANSCRIPT
Modes of Mechanical Ventilation
POINTS OF DISCUSSIONS
Advanced Basics: Flow and Time Limit and cycling Rise Time Volume vs Pressure Control
Mandatory Modes of Ventilation Controlled Mandatory Ventilation (CMV or IPPV)
Triggered Modes of Ventilation Continuous Positive Airway Pressure (CPAP) Pressure Support Ventilation (PSV)
Hybrid Modes of Ventilation Assist Control Mode (A/C) Synchronized Intermittent Mandatory Ventilation (SIMV)
RESPIRATORY CYCLET
rans
ition
=In
spira
tory
Cyc
ling
Transition=Expiratory Cycling
Inspiration
Expiration
MANDATORY, SPONTANEOUS AND TRIGGERED INSPIRATORY CYCLING
M
S
Tsynch
M M
M
MM
M
M
S
M
Tsupp Tsupp
Tsupp Tsupp
Tsupp
Tsupp
S
PRESSURE LIMITED BREATH
Time
Volume
Pressure Limit
EXPIRATORY FLOW CYCLING
Time
Flow
50%
100%
Flow Cycling
VOLUME CONTROLLED INFLATION
Time
Flow
Pressure
Volume
TI TE
Tidal Volume
If compliance decreases the pressure increases to maintain the same Vt
11 22 33 44 55 66
SECSEC
11 22 33 44 55 66
PPawaw
cmHcmH2200
5050
-20-20
120120
120120
SECSEC
INSPINSP
EXHEXH
FlowFlowL/minL/min
VOLUME CONTROL BREATHS
Decreased Compliance
PRESSURE CONTROLLED INFLATION
Time
Flow
Pressure
Volume
TI TE
Tidal Volume
Rise Time
Peak Inspiratory Flow
Inspiration Expiration
0 1
20
00 1 2
3
-3
0
20
021
20
00 1 2
3
-3
0
20
02
Inspiration Expiration
Volume/Flow Control Pressure Volume/Flow Control Pressure ControlControl
Time (s) Time (s)
PawPaw
Pressure
Volume
Flow
RISE TIME
Time
Flow
Pressure
Volume
TI TE
VOLUME CONTROL WITH END-INSPIRATORY PAUSE
Time
Flow
Pressure
Volume
TI TE
Tidal Volume
End Inspiratory Pause
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
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
TRIGGERED MODES OF VENTILATION
CPAP and PSVV
SPONTANEOUS BREATHINGSPONTANEOUS BREATHING
Time (sec)Time (sec)
Flow(L/m)
Pressure(cm H2O)
Volume(mL)
CONTINUOUS POSITIVE AIRWAY PRESSURE(CPAP)
CONTINUOUS POSITIVE AIRWAY PRESSURE(CPAP)
Time (sec)Time (sec)
Flow(L/m)
Pressure(cm H2O)
Volume(mL)
CPAP Level
PRESSURE SUPPORT VENTILATION(PSV) 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
CPAP+PSVCPAP+PSV
Time (sec)Time (sec)
Flow(L/m)
Pressure(cm H2O)
Volume(mL)
Set PS Level
Flow Cycling
Patient Triggered, Flow Cycled, Pressure limited Mode
CPAP Level
TRIGGERED MODES OF VENTILATIONPRESSURE SUPPORT VENTILATION
Control Trigger Limit Target Cycle
Pressure Patient Pressure Flow
Patient Triggered Flow Cycled Ventilation
MANDATORY MODES OF VENTILATION
CMV or IPPV
MANDATORY MODES OF VENTILATIONCMV
Control Trigger Limit Target Cycle
PressureOr
Volume
Time Time
Time Triggered Time Cycled Ventilation
CONTROL MODE (PRESSURE-TARGETED VENTILATION)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
CONTROL MODE(VOLUME-TARGETED VENTILATION)CONTROL MODE(VOLUME-TARGETED VENTILATION)
Flow(L/m)
Pressure(cm H2O)
Volume(mL)
Time Triggered, Flow Limited, Volume Cycled Ventilation Time (sec)
Preset VT
Volume Cycling
Time Cycling
Dependent onCL & Raw
HYBRID MODES OF VENTILATION
SIMV and A/C
HYBRID MODES OF VENTILATIONA/C
Control Trigger Limit Target Cycle
PressureOr
Volume
Time Or
Patient
Time
Time or PatientTriggered Time Cycled Ventilation
ASSISTED MODE(VOLUME-TARGETED VENTILATION)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
ASSISTED MODE (PRESSURE-TARGETED VENTILATION)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
HYBRID MODES OF VENTILATIONSIMV/PS
Breath Type
Control
Trigger
Limit Cycle
Mandatory PressureOr
Volume
Time Or
Patient
Time
Spontaneous
Pressure Patient Pressure Flow
SIMV(VOLUME TARGETED VENTILATION)SIMV(VOLUME TARGETED VENTILATION)
Flow(L/m)
Pressure(cm H2O)
Volume(mL)
Spontaneous Breaths
M M M
Time (sec)
SIMV+PS(VOLUME TARGETED VENTILATION)SIMV+PS(VOLUME TARGETED VENTILATION)
Flow(L/m)
Pressure(cm H2O)
Volume(mL)
MTsuppTsynch
Set PS Level
Flow-cycled
Time (sec)
SIMV + PS (PRESSURE-TARGETED VENTILATION)SIMV + PS (PRESSURE-TARGETED VENTILATION)
Flow(L/m)
Pressure(cm H2O)
Volume(mL)
Tsupp
Tsynch
Time Cycled Flow-cycled
Tsynch
Set PC Level
Set PS Level
Time (sec)
HYBRID MODE VENTILATION: SUPPRESSION
Time (sec)Time (sec)
M Tsupp MM Tsupp
M M
Tsupp Tsupp
HYBRID MODE VENTILATION: SYNCHRONIZATION(SIMV+PSV)
HYBRID MODE VENTILATION: SYNCHRONIZATION(SIMV+PSV)
Time (sec)Time (sec)
Flow(L/m)
Pressure(cm H2O)
Cycles
Triggered window for supported breaths
Triggered window for synchronized breaths
Mandatory Cycle Time
M Tsupp TsynchM Tsynch Tsupp
ALL MODES TABLES
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