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Mechanical ventillation
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  • 1. MECHANICALVENTILATION BY P. ARUL VALAN
  • 2. DEFINITIONA mechanical ventilator is a positive or a negative pressure breathing device that can maintain ventilation and oxygen delivery for a prolonged period.
  • 3. INDICATIONS• Acute lung injur y.• Apnea with respirator y ar rest.• COPD.• Acute respir ator y acidosis.• Hypoxemia.
  • 4. TERMINOLOGIES• Tidal volume ( vt )• Inspiratory reserve volume ( IRV )• Expiratory reserve volume (ERV )• Residual volume ( RV )• Vital capacity ( Vc )• Inspiratory capacity ( IC )• Functional residual capacity ( FRC )• Total lung capacity ( TLC )• Minute volume
  • 5. CLASSIFICATION OFVENTILATORS NEGATIVE PRESSURE VENTILATOR. POSITIVE PRESSURE VENTILATOR.
  • 6. NEGATIVE PRESSUREVENTILATOR
  • 7. THE IRON LUNG
  • 8. POSITIVEPRESSUREVENTILATOR INFLATES THE LUNG BY EXERTING POSITIVE PRESSURE ON THE AIRWAY FORCING ALVEOLI TO EXPAND DURING INSPIRATION AND EXPIRATION OCCURS PASSIVELY.
  • 9. TYPES• PRESSURE CYCLED • VOLUME CYCLED • TIME CYCLED
  • 10. PRESSURE CYCLED ENDS INSPIRATION WHEN A PRESET PRESSURE HAS BEEN REACHED. THE PRESSURE APPLIED TO THE AIRWAY IS CONSTANT. VOLUME OF AIR VARY AS PATIENTS AIRWAY RESISTANCE CHANGES. THEY ARE ALSO TIME CYCLED ( BREATHS ARE GIVEN AT FIXED INTERVALS )
  • 11. VOLUME CYCLED THE VOLUME OF AIR DELIVERED TO THE PATIENT AT EACH INSPIRATION IS PRESET . ONCE THE PRESET VOLUME IS DELIVERED THE VENTILATOR CYCLES OFF AND EXHALATION OCCURS PASSIVELY. VOLUME OF AIR DELIVERED IS CONSTANT DESPITE VARYING PRESSURE.
  • 12. TIME CYCLED ENDS INSPIRATION AFTER THE PRESET TIME. VOLUME OF AIR THE PATIENT RECIEVES IS REGULATED BY THE LENGTH OF INSPIRATION AND THE FLOW RATE.
  • 13. OTHERS INVASIVE VENTILATION . NON INVASIVE VENTILATION. FULL VENTILATION. PARTIAL VENTIATION.
  • 14. VENTILATOR SETTINGS TIDAL VOLUME.6 TO 8 ml/KgPredicted body weight :MALE : 50+2.3 X { Ht – 60 }FEMALE : 45.5+2.3 X { Ht – 60 }6ml/Kg : ARDS6 to 8ml/Kg : OBSTRUCTED LUNG DISEASE8 to 10ml/Kg :NEUROMUSCUL AR DIEASE
  • 15. RESPIATORY RATE 15 TO 25 /min TO ACHIEVE A MINUTE VOLUME OF 7 TO 10 L/min. LOWER RR PREVENTS AIR TRAPPING.
  • 16. I:E RATIO,Fio2I:E RATIO IS 1:2START Fio2 WITH 1 . O ANDREUCE IT TO 0.6TITRATE USING PULSEOXYMETRY.
  • 17. What is the extent of the What is the patient chest patients lung injury? wall (Cw) compliance? NORMAL Target PaO2>60-80 LOW -obesity What FiO2 is required to -edema achieve this? -abdominal hypertension Normal Cw Compliance Low Cw Compliance FiO2 PEEP in cmH2O PEEP in cmH2O 0.3 5 10 0.4 8 12 0.5 10 14 0.6* 12 16 0.7* 14 18 0.75* 16 20 0.8* 18 22 0.9* 20 22 1* 22 24
  • 18. MODES OF VENTILATOR CONTROLED VENTILATION PRESET VOLUME OF AIR IS DELIVERED UNDER POSITIVE PRESSURE. SPONTANEOUS PATIENT RESPIRATION IS LOCKED OUT.
  • 19. ASSIST CONTROL VENTILATION ALLOWS PATIENT TO INTIATE MECHANICAL BREATH BUT CAN ALSO DELIVER A PRESET LEVEL OF MINUTE VENTILATION IF THE PATIENT CANNOT TRIGGER. PATIENT IS FULLY RESTED ON THE VENTILATOR AND CAN BREATH SPONTANEOULY WITHOUT WORKING.
  • 20. ASSIST CONTROL VETILATION
  • 21. SIMV MODE• GAS FLOWS IN THE SIMV MODE .A PRESET MINIUM NUMBER OF BREATHS ARE DELIVERED TO THE PATIENT BUT THE PATIENT ALSO TAKES SPONTANEOUS BREATHS OF VARIOUS VOLUMES.
  • 22. SYNCHRONIZEDINTERMITENT MANDATORYVENTILATION
  • 23. PRESSURE SUPPORT VENTILATION
  • 24. IMV CONTROLLED BREATH
  • 25. IMV SPONTANEOUS BREATH
  • 26. SYNCHRONIZED INTERMITENT MANDATORY VENTILATION
  • 27. SENSOR MEDICS 3100 A
  • 28. SEIMON SERVO 900C
  • 29. DRAGER BABYLOG 8000