It describe about definitions and parameters of mechanical Ventilation

1. Mechanical Ventilation
•Why do we ventilate?
– Inadequate Ventilation (C02 too high)
– Inadequate Oxygenation (02 too low)
– Patients intubated for Airway protection
•How do we ventilate?
– Invasively
• Via Endotracheal / Tracheostomy tube
– Non-invasively
• Via mask
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2. Indications for Mechanical Ventilation
•Elective
– To allow for sedation and paralysis during major
surgery
•Therapeutic
– Inadequate Alveolar Ventilation
– Refractory Hypoxemia
– Airway protection (indication for intubation)
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3. Inadequate Alveolar Ventilation
•Apnea
•Respiratory Failure
•Impending Respiratory Failure
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4. Inadequate Alveolar Ventilation
– Resuscitation
– Neuromuscular Disorders
• Poliomyelitis
• Guillian-Barre
• Phrenic Nerve Paralysis
– CNS disorders
• Cerebral trauma
• Spinal cord injury
• Narcotic / barbiturate poisoning
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5. Inadequate Alveolar Ventilation
– Chest Wall Diseases
– Excessive Work of Breathing
– Acute Airway Obstruction
• COPD exacerbation
• Severe Asthma
• Excessive Secretions
– Intra-thorax
• Pleural disease
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6. Refractory Hypoxemia
– Pneumonia
– Atelectasis
– Pulmonary Edema
– ARDS
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7. Airway protection
•Inadequate cough / gag
•Tracheal obstruction / trauma
•Severe Allergic Reaction
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8. Signs of Respiratory Failure
•Respiratory Rate >35/minute
•Tidal Volume <2mL/kg
•Minute Ventilation <5L/minute or > 12L/minute
•Vital Capacity <10mL/kg (N=65/75)
•Negative Inspiratory <20cmH20
•Force
•Vd / Vt 0.60 (N=0.3)
•PaC02 >10 above baseline
•pH <7.30 with increased C02
•HR and BP > 20% baseline
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9. Signs of Respiratory Failure
•Subjective signs
– Increasing breathlessness
– Fatigue
– Change in level of consciousness
– Use of accessory muscles
– Diaphoresis
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10. Ventilation system
PMOUTH
.
VPATIENT
Patient Y
CI, RI
P
. e
VE
CE, RE Humidifier
CH
Return To
Ventilator
We measure pressure and flow at
the inspiratory and expiratory
sides of the circuit, but we want
pressure and flow at the Y and Pi From
.
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| | volume
VI Ventilator

11. Modes of Ventilation
•Assist / Control
– All breaths are machine delivered breaths
– Can be machine or patient initiated
•Mixed Modes
– Combination of machine breaths and patient’s
own spontaneous breaths
•Spontaneous
– All breaths initiated by the patient
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12. Classification of Breath Types
•What are we controlling or targeting?
– Volume
– Pressure
– % Work of Breathing
•Why does the breath stop?
– A set volume has been delivered (vent decides)
– A set pressure has been reached (vent decides)
– A set period of time has elapsed (vent decides)
– The breath is at its natural completion (flow into the patient has stopped)
(patient can decide)
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