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Mechanical Ventilation Dr. Shalini Garg
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],NORMAL MECHANICS OF SPONTANEOUS  VENTILATION
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DEFINITION OF PRESSURES AND GRADIENTS IN THE LUNGS ,[object Object],[object Object],[object Object]
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The mechanism of spontaneous ventilation and the resulting pressure waves. During inspiration P PL  decreases to – 10 cm of H2O. During exhalation, P PL  increases from -10 to -5 cm of H2O.
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HOW VENTILATORS WORK ,[object Object],[object Object]
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[object Object],Basic Elements of a Patient Circuit : 1. Main inspiratory line, which connects the ventilator output to the patient's airway adapter or connector. 2. Adapter, which fits the main inspiratory line to the patient's airway (also called a patient adapter or Y-connector because of its shape)  3. Expiratory line, which carries expired gas from the patient to the exhalation valve  4. Expiratory valve, which releases exhaled gas from the expiratory line into the room air
 
 
[object Object],Adjuncts Used with a Patient Circuit  1. A device to warm and humidify inspired air  2. A thermometer to measure the temperature of inspired air  3. An apnea or low-pressure alarm that indicates leaks or that the patient is not ventilating adequately  4. A nebulizer line to power a micronebulizer for delivery of aerosolized medications  5. A volume measuring device to determine the patient's exhaled volume'  6. Bacterial filters to filter gas administered to the patient and exhaled by the patient  7. A pressure gauge to measure pressures in the upper airway
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Contraindications for Heat Moisture Exchangers  1. In patients with thick, copious, or bloody secretions  may accumulate on the HME and increase resistance to flow, both inspiratory and expiratory  2. When exhaled V T  is less than 70% of inhaled V T   3. In patients with body temperatures of <32° C (hypothermia)  4.When spontaneous V E  is >10 L/min  5. When an aerosolized medication must be given.  6. Very small V T  delivery, in which case the HME may significantly increase V Dmech  and compromise CO2 clearance  Large V T  delivery may compromise the ability of the HME to humidify inspired gases .
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Equation of Motion  Muscle pressure + Ventilator pressure = Elastic recoil pressure +  Flow resistance pressure  where    Elastic recoil pressure = Elastance x Volume    = Volume/Compliance(V/C)  and  Flow resistance pressure = Resistance x Flow = (R aw  x Flow)  The equation can be rewritten as follows:  P mus  + P TR  = V/C + (R aw  x Flow)  P mus  is the pressure generated by the muscles of venti­lation (muscle pressure). If these muscles are inactive, P mus  = 0 cm H20.  P TR  is the transrespiratory pressure (P awo  - P bs ); this is the pressure read on the ventilator gauge (manometer) during inspiration with positive pressure ventilation (i.e., the ventilator pressure).
V is the volume delivered, C is respiratory system compliance,  V/C is the elastic recoil pressure, Raw is respiratory system resistance, and Flow is the gas flow during inspiration  (Raw x Flow = Flow resistance).  Because PTA = Raw x Flow and PA = V/C, substituting in the above equation results in  P mus  + P TR  = P A  + P TA  where P A  is the alveolar pressure and P TA  is the transairway pressure.
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[object Object],[object Object],[object Object],Phase Variables  A phase variable begins, sustains, and ends each of the four phases of a breath. The four phases are  1. Change from exhalation to inspiration  2. Inspiration  3. Change from inspiration to exhalation  4. Exhalation
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Mechanical Ventilation
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Mechanical Ventilation

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  • 13. The mechanism of spontaneous ventilation and the resulting pressure waves. During inspiration P PL decreases to – 10 cm of H2O. During exhalation, P PL increases from -10 to -5 cm of H2O.
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  • 70. Contraindications for Heat Moisture Exchangers 1. In patients with thick, copious, or bloody secretions may accumulate on the HME and increase resistance to flow, both inspiratory and expiratory 2. When exhaled V T is less than 70% of inhaled V T 3. In patients with body temperatures of <32° C (hypothermia) 4.When spontaneous V E is >10 L/min 5. When an aerosolized medication must be given. 6. Very small V T delivery, in which case the HME may significantly increase V Dmech and compromise CO2 clearance Large V T delivery may compromise the ability of the HME to humidify inspired gases .
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  • 81. Equation of Motion Muscle pressure + Ventilator pressure = Elastic recoil pressure + Flow resistance pressure where Elastic recoil pressure = Elastance x Volume = Volume/Compliance(V/C) and Flow resistance pressure = Resistance x Flow = (R aw x Flow) The equation can be rewritten as follows: P mus + P TR = V/C + (R aw x Flow) P mus is the pressure generated by the muscles of venti­lation (muscle pressure). If these muscles are inactive, P mus = 0 cm H20. P TR is the transrespiratory pressure (P awo - P bs ); this is the pressure read on the ventilator gauge (manometer) during inspiration with positive pressure ventilation (i.e., the ventilator pressure).
  • 82. V is the volume delivered, C is respiratory system compliance, V/C is the elastic recoil pressure, Raw is respiratory system resistance, and Flow is the gas flow during inspiration (Raw x Flow = Flow resistance). Because PTA = Raw x Flow and PA = V/C, substituting in the above equation results in P mus + P TR = P A + P TA where P A is the alveolar pressure and P TA is the transairway pressure.
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