3. INDICATIONS
Airway Compromise/ Respiratory Failure
Type 1 respiratory failure or
Type 2 respiratory failure
Acute lung injury (including ARDS, trauma)
Apnea or Respiratory Arrest including cases from Intoxication,
Chronic obstructive pulmonary disease (COPD), Myasthenia
gravis or Spinal cord injury.
4. INDICATIONS continued..
Increased work of breathing as evidenced by significant
tachypnea, retractions, and other physical signs of respiratory
distress
Hypotension including sepsis, shock, congestive heart failure
Neurological diseases such as Muscular Dystrophy
Amyotrophic Lateral Sclerosis
Airway Protection/Prophylactic Ventilatory Support
5. Types or Forms Of Mechanical
Ventilation
Negative Pressure Ventilator Positive Pressure Ventilator
6. Settings of Mechanical Ventilation
Mechanical Ventilator Settings regulates the rate,
depth and other characteristics of ventilation. Settings
are based on the patient’s status (ABGs, Body
weight, level of consciousness and muscle strength)
12. Basic Ventilator Parameters
Tidal volume
Frequency
Peak Inspiratory Pressure PIP
Positive End Expiratory Pressure PEEP
Inspiratory Time
Expiratory time
I:E Ratio
15. Ventilatory Phases
• Inspiration: Inspiratory valve opens and
expiratory valve is closed
• Inspiratory pause: inspiratory valve and
expiratory valve closed
• Expiration: Inspiratory valve closed and
expiratory valve open
• Expiratory pause: Inspiratory valve and
expiratory (or PEEP) valve closed at end
of expiration
Ti Te
0
16. Phase variables
Trigger : ventilator (time)- triggered or patient (pressure or flow)
triggered
Limit: flow-limited orpressure-limited
17. Starting a ventilator: Mode
Mode denotes interplay b/w patient and the
ventilator
Describes the style of breath support based on
relationship between the various possible types of
breath and inspiratory – phase variables
18. Where to Start?
CPAP, IPAP, EPAP, NIV
Pressure control, Volume control
CMV, Assist Control, IMV, SIMV,
PSV, ASV, MMV,
APRV
PCV, PRVC, PSV, VCIRV, Volume
Support,
Auto Mode,
BiLevel, BiPAP,
HFJV, HFOV
22. Controlled Mandatory
Ventilation(CMV)
The ventilator delivers
Preset tidal volume (or pressure) at a time triggered (preset) respiratory
rate.
As the ventilator controls both tidal volume (pressure) and respiratory rate,
the ventilator “controls” the patients minute volume.
Pressure
25. Controlled mandatory
ventilation(CMV)
Patient can not breath spontaneously
Patient can not change the ventilator respiratory
rate
Suitable only when patient has no breathing
efforts
Disease or
Under heavy sedation and muscle relaxants
29. Intermittent Mandatory Ventilation(IMV)Pressure
Machine breaths are delivered at a set rate (volume or pressure
limit)
Patient is allowed to breath spontaneously from either a
demand valve or a continuous flow of gases but not offering
any inspiratory assistance.
Time (sec)
31. Intermittent Mandatory Ventilation(IMV)
Freedom for natural
spontaneous breaths even
on machine
Lesser chances of
hyperventilation
Asynchrony
Random chance of breath
stacking.
Increase work of breathing
Random high airway pressure
(barotrauma) and lung volume
(volutrauma)
Setting appropriate pressure limit is important to reduce the risk of barotrauma
Pros: Cons:
33. Synchronized Intermittent Mandatory
Ventilation (SIMV)
Ventilator delivers either patient triggered assisted
breaths or time triggered mandatory breath in a
synchronized fashion so as to avoid breath stacking
If the patient breathes between mandatory breaths, the
ventilator will allow the patient to breathe a normal breath
by opening the demand (inspiratory) valve but not
offering any inspiratory assistance.
34. SIMVPressure
If patient does not make an inspiratory effort then ventilator will deliver a
time triggered mandatory breath.
Patient trigerred
synchronized breath
Time trigerred
mandatory breath
36. Synchronized Intermittent Mandatory
Ventilation (SIMV)
It allows patients to assume a portion of their ventilatory drive:
Weaning is possible
Greater work of breathing and therefore some may not consider
it as the initial ventilator mode
Friendly cardiopulmonary interaction: Negative inspiratory
pressure generated by spontaneous breathing leads to increased
venous return, which theoretically may help cardiac output and
function
38. Pressure Support Ventilation
Pressure (or Pressure above PEEP) is the setting
variable
No mandatory breaths
Applicable on Spontaneous breaths
Patient effort determines size of breath and flow
rate.
39. Pressure Support Ventilation
It augments spontaneous VT, decreases spontaneous rates
and WOB.
Used in conjunction with spontaneous breaths in any mode
of ventilation.
No back up ventilation in the event of apnea.
40. Pressure Support Ventilation
Provides pressure support to overcome the increased work of
breathing imposed by the disease process, the endotracheal
tube, the inspiratory valves and other mechanical aspects of
ventilatory support.
Allows for titration of patient effort during weaning.