Basic Principles of Critical Care

1. VENTILATOR MODES AND SETTINGS
Gradian Health Systems
Basic Principles of Critical Care
RESPIRATORY SYSTEM

2. Disclaimer
Basic Principles of Critical Care Training I Ventilator Modes and Settings
Disclaimer: Gradian Health Systems cannot provide formal recommendations or indications
regarding medical care and clinical service delivery. The tables, checklists, and other clinical
documents referenced in this training have not been validated in all settings. These documents are
intended to serve as examples only. We recognize that all clinical training content and activities
must be customized to meet the needs of each facility and its clinical staff, factoring in available
resources, practitioner skill level, and other environmental considerations.
For any questions regarding the contents or applications of this training,
please contact Gradian Health Systems:
40 W 25th St, 6th Floor
New York, NY 10010 USA
+1 212-537-0340
training@gradianhealth.org

3. Module 2
Gradian Health Systems
Basics Principles of Critical Care
Respiratory System

4. Module 2: Respiratory System
MODULE OVERVIEW
Lesson 1 I Respiratory System Anatomy and Physiology
Lesson 2 I Oxygen Therapy
Lesson 3 I Evaluation of the Respiratory System
Lesson 4 I Airway Equipment and Management
Lesson 5 I Invasive and Non-invasive Ventilation
Lesson 6 I Basics of Mechanical Ventilation
Lesson 7 I Ventilator Modes and Settings
Lesson 8 I Ventilation Complications
Basic Principles of Critical Care Training I Ventilator Modes and Settings

5. Components of the Gradian CCV SystemLesson 7: Ventilator Modes and Settings
Lesson Objectives
• Explain the various ventilator modes and settings
Basic Principles of Critical Care Training I Ventilator Modes and Settings

6. Components of the Gradian CCV SystemLesson 7: Ventilator Modes and Settings
Key Concepts
• Control modes
• Assist modes
• Support modes
• Ventilator settings
Basic Principles of Critical Care Training I Ventilator Modes and Settings

7. Components of the Gradian CCV SystemVentilator Modes and Settings
Volume Control Mode
• Also known as continuous mandatory ventilation (CMV or VCV)
• Volume is the controlled parameter and breaths are fixed (mandatory)
• Trigger  time
• Limit  volume
• Cycle  time
Assist Control Ventilation
• Breaths have the same tidal volume, but patient can make respiratory effort
• If the patient is making no efforts, it is the same as CMV
• Trigger  flow
• Limit  volume
• Cycle  time
Basic Principles of Critical Care Training I Ventilator Modes and Settings

8. Components of the Gradian CCV SystemVentilator Modes and Settings
Synchronized Intermittent Mandatory Ventilation (SIMV)
• Minimum (mandatory) breaths are set and will be delivered, however the
machine will synchronize with the patient's effort
• Pressure support is usually added so that non-mandatory breaths are
supported
• Total breath will be the total of the set rate and any additional breaths the
patient makes
• Trigger  time
• Limit  volume
• Cycle  time
Basic Principles of Critical Care Training I Ventilator Modes and Settings

9. Components of the Gradian CCV SystemVentilator Modes and Settings
Pressure Assist Control Ventilation
• Controlled parameter is the pressure
• Tidal volume varies in each breath
• Breaths the patient makes above the set rate are assisted with the set
pressure
• If patient is not breathing spontaneously, mode is similar to Pressure
Controlled Ventilation (PCV)
• Trigger  time
• Limit  pressure
• Cycle  time
Basic Principles of Critical Care Training I Ventilator Modes and Settings

10. Components of the Gradian CCV SystemVentilator Modes and Settings
Pressure Support Ventilation
• Patient initiates breath and the inspiratory effort determines the tidal volume
• Pressure is set to provide support as the patient takes a breath
• Usually used with SIMV
• Trigger  flow
• Limit  volume or flow
• Cycle  flow
Basic Principles of Critical Care Training I Ventilator Modes and Settings

11. Components of the Gradian CCV SystemVentilator Modes and Settings
Continuous Positive Airway Pressure (CPAP)
• Spontaneous mode
• PEEP is set to act as the baseline
• Trigger  None
• Limit  None
• Cycle  None
Bi-level Positive Airway Pressure (BiPAP)
• Both inspiratory and expiratory positive airway pressure is set
Basic Principles of Critical Care Training I Ventilator Modes and Settings

12. Components of the Gradian CCV SystemVentilator Modes and Settings
Ventilator Settings
Clinicians set the parameters that determine the type of mechanical ventilation to
be provided to the patient. Common settings include:
• Mode
• Tidal volume (Vt or TV)
• Respiratory rate
• Fraction of inspired oxygen (FiO2)
• Pressure support (PS)
• Trigger
• Flow rate
• Positive end expiratory pressure (PEEP)
• Alarms
Basic Principles of Critical Care Training I Ventilator Modes and Settings