Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Mechanical Ventilation

Indications, modes and detailed description of the mechanical ventilation.

  • Be the first to comment

Mechanical Ventilation

  1. 1. MECHANICAL VENILATION DR. FARRUKH FINAL YEAR RESIDENT
  2. 2. DEFINITION:  Mechanical Ventilation is a method to mechanically assist or replace spontaneous breathing.
  3. 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. 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. 5. Types or Forms Of Mechanical Ventilation Negative Pressure Ventilator Positive Pressure Ventilator
  6. 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)
  7. 7. Ventilator Circuit
  8. 8. Air Filters
  9. 9. Vent Mount/Catheter
  10. 10. Flow Sensor
  11. 11. Ventilator
  12. 12. Basic Ventilator Parameters  Tidal volume  Frequency  Peak Inspiratory Pressure PIP  Positive End Expiratory Pressure PEEP  Inspiratory Time  Expiratory time  I:E Ratio
  13. 13. PARAMETERS OF MECHANICAL VENTILATION  Respiratory Rate (f) :-Normally 10-20b/m  Tidal Volume (VT) :-5-15ml/kg  Oxygen Concentration(FIO2):-b/w 21-90%  I:E Ratio:-1:2  Flow Rate:-40-100L/min  Sensitivity/Trigger:- 0.5-1.5 cm H2O  Pressure Limit:-10-25cm H2O  PEEP :- Usually, 5-10 cmH2O
  14. 14. Modes of Mechanical Ventilation • Controlled Mandatory Ventilation (CMV) • Asst-Control Mandatory Ventilation (ACV) • Synchronized Intermittent Mandatory Ventilation(SIMV) • Positive Expiratory End Pressure(PEEP) • Continuous Positive Airway Pressure (CPAP) • Pressure Support Ventilation (PSV)
  15. 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. 16. Phase variables  Trigger : ventilator (time)- triggered or patient (pressure or flow) triggered  Limit: flow-limited orpressure-limited
  17. 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. 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
  19. 19. Mode?
  20. 20. Mechanical Time (sec) SpontaneousPaw (cm H2O) Inspiration Expiration Expiration Inspiration Breath type: Spontaneous vs Mechanical vs Assisted Assisted
  21. 21. 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
  22. 22. Volume Control Ventilation Pressure Volume FlowPreset Peak Flow Preset Vt Dependent on Cl &Raw Time (sec)
  23. 23. Pressure Control Ventilation Flow Pressure Volume Cl Cl Set PC level Time (sec)
  24. 24. 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
  25. 25. Controlled Mandatory Ventilation (CMV) Asynchrony and increased work of breathing. Not suitable for patient who is awake or has own respiratory efforts Can not be used during weaning
  26. 26. Controlled mandatory Ventilation (CMV) – Volume Controlled
  27. 27. Pressure Control Ventilation (PCV)
  28. 28. 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)
  29. 29. Intermittent Mandatory Ventilation(IMV)Pressure  Patient’s capability determines Tidal volume of spontaneously breaths  Some freedom to breath naturally even on mechanical ventilator Time (sec)
  30. 30. 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:
  31. 31. Can we synchronize it?
  32. 32. 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.
  33. 33. 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
  34. 34. Synchronized Intermittent Mandatory Ventilation Pressure 3 types of breathing: 1. Patient initiated assisted ventilation, 2. Ventilator generated controlled ventilation, 3. Unassisted spontaneous breath.
  35. 35. 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
  36. 36. Synchronized Intermittent Mandatory Ventilation (SIMV)
  37. 37. 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.
  38. 38. 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.
  39. 39. 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.
  40. 40. Spontaneous Mode
  41. 41. Pressure-controlled Synchronized Intermittent Mandatory Ventilation (PSIMV)
  42. 42. Adaptive Support Ventilation (ASV)
  43. 43. Thank you!! You have done it!!!
  44. 44. Example 1
  45. 45. Example 2
  46. 46. Read more…  https://www.aic.cuhk.edu.hk/web8/mechanical_ventilation.htm

×