simplified demonstration of pulmonary graphicsto be easly used on bed side by neonatologests

1. BedsideBedside
pulmonarypulmonary
graphicsgraphics
momitoring inmomitoring in
PICU .What,sPICU .What,s
the rulethe rule??
ByBy
Dr Amal GaberDr Amal Gaber
Assist.prof. of ped.faculty ofAssist.prof. of ped.faculty of
medi.Al Azhar universitymedi.Al Azhar university

3. Physics review
The Compliance:
The compliance of a system is the volume
change per unit change in pressure
p
V
C
∆
∆
=

4.  The Resistance:
 It is the pressure difference divided by
the flow caused by it
Physics review

5. Ventilator Waveforms Depend
on:
•Mode of ventilation
•Ventilator properties and settings
•Respiratory properties of the patient

6. Types of Ventilator
Waveforms
 Scalar:
Pressure – time
Volume – time
Flow – time
 Loops:
Pressure – volume
Volume – Flow
Flow – pressure
 Trends:

7. Pressure – time curve
Volume–oriented breath (modes)
Pressure–oriented breath (modes)

8. Pressure – time curve
Pressure – time curve shows airway pressure,
breath timing, the breath type delivered and patient
versus machine triggering

9. Pressure – time curve (pressure – oriented mode)
In pressure-oriented ventilation, Pressure increases rapidly from the
lower pressure level until it reaches the upper pressure value and then
remains constant for the inspiration time set on the ventilator.

10. Flow – time curve
Constant flow is a
typical feature of a
classic volume –
oriented mode of
ventilation.

11. Flow – time curve

12. Flow – time curve
Decelerating flow
is a typical feature
of a pressure –
oriented mode of
ventilation.

13. Flow – time curve

15. Volume – time curve

23. Pressure – volume loop
As compliance decreases, and the ventilator settings
remain the same, the PV loop in volume-controlled
ventilation takes an increasingly flat course.

24. Pressure – volume loop
A change in the height of the PV loop is a measure of
the strength of the patient’s inspiratory effort (if the
ventilator parameters are unchanged)

29. Volume – flow loop
Changes in the shape of volume – flow loop are
used to obtain information about airway resistance

30. Volume – flow loop
Increased airway resistance
due to increased secretions

31. What is going on here?

32. What is going on here?

33. What is going on here?

34. Air leak

35. Air leak
Approximately 200ml of volume is lost

36. Air leak
Approximately 75ml of volume is lost

37. What is going on here?

38. What is going on here?

39. Auto - PEEP

40. Auto - PEEP

41. Auto - PEEP
The presence of positive pressure in the lung
at the end of exhalation due to air trapping
Causes:
Insufficient expiratory time
Increased expiratory resistance
Early collapse of unstable airway

42. Over-distention

43. Flow asynchrony
(flow starvation)

44. Flow asynchrony
(flow starvation)

45. Cycling asynchrony

46. Cycling asynchrony

47. trigger asynchrony

48. Thank youThank you