This document discusses mechanical ventilation and ventilator settings. It defines mechanical ventilation as using a mechanical device to assist breathing. The main types are negative pressure ventilation, which applies pressure lower than atmospheric pressure during inspiration, and positive pressure ventilation, which applies higher pressure during inspiration. Modes of ventilation discussed include volume control, pressure control, SIMV, PSV, and CPAP. Key ventilator settings covered are tidal volume, respiratory rate, FiO2, PEEP, I:E ratio, and pressure support. Causes of respiratory failure and appropriate ventilator care are also summarized.

1. CARE AND BASIC SETTINGS OF
PORTABLE VENTILATOR

2. Introduction
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WHAT IS MECHANICAL VENTILATION?
Defined as the use of a mechanical device
to assist the respiratory muscles in the
work of breathing and to improve gas
exchange

6. TYPES OF MECHANICAL VENTILATION

7. NEGATIVE PRESSURE VENTILATION
- pressure lower than atmospheric pressure is
applied to the
extrathoracic space during inspiration
POSITIVE PRESSURE VENTILATION
- pressure higher than atmospheric pressure is
applied to the
intraalveolar space during inspiration

8. NEGATIVE PRESSURE VENTILATION

10. POSITIVE PRESSURE VENTILATION
PPV inflate the lung by exerting positive
pressure on the intraalveolar forcing the
alveoli to expand during inspiration.
PPV
Non Invasive
ventilation (NIV)
- via nasal or face
mask
Invasive Ventilation
- via endotracheal
tube or tracheostomy
tube

12. RESPIRATORY FAILURE
Oxygenation failure
- Characterised by
decreased PaO2
Ventilation failure
-Characterized by increased
PaCO2

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Acute Respiratory Distress
Syndrome (ARDS)
Pneumonia
Chronic obstructive
pulmonary disease (COPD)
/ Severe asthma
Pneumothorax
Pulmonary embolism
Obesity
Pulmonary Hypertension
Pulmonary Fibrosis
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Chronic obstructive
pulmonary disease (COPD)
/ Severe asthma
Drug overdose
Central Nervous System
(CNS) injury
primary muscle disorder
(Duchenne muscular
dystrophy)
Neuromuscular junction
disorder (Myasthenia
Gravis)
Anatomical chest
deformities
(Kyphoscoliosis, Flail chest)
Obesity hypo ventilatory
(Pickwickian syndrome)

14. Measurement
s
Type of information
FiO2 Inspired Oxygen Fraction (%)
VT Tidal Volume (mL)
VTe Volume exhaled during the cycle (mL)
RR Ratio of inspiration time to total cycle time (bpm)
TI/Ttot Ratio of inspiration time to total cycle time (%)
Ppeak Peak inspiratory pressure Peak inspiratory pressure (cmH2O)
PEEP Pressure measured 80 ms before the end of expiration (cmH2O)
Pplat Pressure measured at the end of the plateau or inspiratory pause
(cmH2O)
I:E Ration of inspiration time to expiration time
Invasive Positive pressure ventilation applied via an endotracheal or
tracheotomy tube
Non
Invasive
Administration of ventilator support without using an invasive
artificial airway (Endotracheal tube or Tracheostomy tube)
(A)VCV Volume Controlled Ventilation
(A)PCV Pressure Controlled Ventilation
CPAP Continuous Positive Airways Pressure Ventilation (cmH2O)
PSV Pressure Support Ventilation (cmH2O)

15. Ventilator Settings
1)Mode
2)Tidal volume
3)Respiratory Rate
4)Inspired Oxygen Concentration (FiO2)
5)Positive end expiratory pressure (PEEP)
6)Inspiratory:Expiratory ratio
7)PR support

16. Tidal volume
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The normal value of air in the lungs
displaced during normal inhalation and
exhalation
Based upon ideal predicted body weight
(height)
Set between 6-8ml/kg lean body weight
Height ,rather than weight correlates more
with lung volume
Soft tissue mass does not affect lung
volume

17. Respiratory rate
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Number of breath taken per minute
Formula : Minute Ventilation=Vt x
RR
Normal minute ventilation (MV)(4-6 L/min)
Minute ventilation (VE) is the quantity of
air moved into and out of the lungs in a
minute and dictates CO2 elimination from
alveoli.

18. FiO2
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Inspired fraction of oxygen
% oxygen in inspired air
Start with Fio2 100%,then titrate down
Goal: -PaO2>60 mmhg
-O2 saturation:95%

19. Positive end expiratory pressure
(PEEP)
-Pressure applied by the ventilator at the end
of each breath to ensure that the alveoli
are not so prone to Injury.

20. Inspiratory:Expiratory ratio
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Inspiratory:Expiratory ratio refers to the ratio
of inspiratory time:expiratory time. In
normal spontaneous breathing, the
expiratory time is about twice as long as the
inspiratory time. This gives an I:E ratio of 1:2
and is read "one to two".
This ratio is typically changed in asthmatics
due to the prolonged time of expiration.
They might have an I:E ratio of 1:3 or 1:4.

21. Pressure support
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Spontaneous mode of ventilation which
the ventilator deliver support with the
preset pressure value.
With support from the ventilator,the
patient also regulates his own respiratory
rate and tidal volume.

22. Basic modes
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A/C-Assisted/Controlled,Volume Cycled
Ventilation
A/C,PCV-Assisted/Controlled,Pressure
Controlled Ventilation (time cycled)
SIMV-Synchronized Intermittent
Mandatory Ventilation
PSV-Pressure support ventilation

23. Modes of ventilation
VC (Volume Control)
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Characteristics:preset rate and tidal volume on the
patient's initiative or at the set interval a full
mechanical breath is delivered.
Uses: for patients who have a very weak respiratory
effort, allows synchrony with the patient but maximal
support.
Contraindications: none in particular
Advantages: a fairly comfortable mode, providing a
lot of support
Disadvantages: can lead to hyperventilation if not
closely monitored, risk of barotrauma with poor lung
compliance

24. Modes of ventilation
PC (Pressure Control)
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Characteristics:preset rate and peak
inspiratory pressure and not the set tidal
volume
Uses: in neonates, or in patients with high
airway pressures(such as ARDS) to avoid
barotrauma
Contraindications: none in particular, not a
friendly mode in an awake patient
Advantages: Pressure limited, decreases the
risk of barotrauma
Disadvantages: no guaranteed tidal volume

25. Modes of ventilation
SIMV (Synchronous Intermittent Mandatory
Ventilation)
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Characteristics: set breath delivered within
an interval based on the set respiratory rate.
Ventilator waits for spontaneous breath
from the patient, which it will use as a
trigger to deliver a full breath. If not sensed
it will automatically give a breath at the end
of the period.
Uses: commonly used in many settings.
Contraindications: none in particular
Advantages: allows work with the patient,
more friendly.
Disadvantages: Any other breaths during
the cycle are not supplemented

26. Modes of ventilation
PSV (Pressure Support Ventilation)
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Characteristics: supports each
spontaneous breath with supplemental flow
to achieve a preset pressure.
Uses: In the spontaneously breathing
patient this helps overcome the airway
resistance of the endotracheal tube. A
weaning mode.
Contraindications: patient who is not
spontaneously breathing, i.e. on muscle
relaxants
Advantages: helps overcome resistance of
tube, making spontaneous breathing easier

27. Modes of ventilation
SIMV + PSV
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Characteristics: combination of the
previous two modes. Extra breaths in the
cycle are supplemented with pressure
support.
Uses: useful in most circumstances,
including weaning.
Contraindications: none in particular.
Advantages: allows both synchrony with the
patient and help in overcoming the
resistance in the endotracheal tube, to allow
easier spontaneous breathing.
Disadvantages: none in particular.

28. 
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PEEP ( Positive End-Expiratory Pressure)
-- pressure above atmospheric maintained
at the airway at
the end of expiration.
-- May be during spontaneous or
mechanical ventilation
CPAP ( Continuous Positive Airway
Pressure)
-- PEEP during spontaneous ventilation
Physiological PEEP
-- PEEP of 3-5 cmH2O
-- in non-intubated , glottis is closed at end
of expiration –
generates positive pressure

29. Modes of ventilation
CPAP (Continuous Positive Airway Pressure)
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Characteristics: same as PEEP.
Uses: for patients with upper airway soft
tissue obstruction or tendency for airway
collapse. As a final mode prior to extubation
in some patients.
Contraindications: any patient without
spontaneous respiratory effort. Not a good
idea in a patient with obstructive pulmonary
disease (like asthma, COPD)
Advantages: simple, easy to use
Disadvantages: provides no supportive
ventilation.

31. Care of ventilator
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Use the ventilator by interval
The equipment should be inspected
before each use and cleaned as often as
necessary
The ventilator should be stored in a clean
and dry location so that it is not exposed
to dust,direct sunlight,moisture,extreme
temperature or other potentially
hazardous forces.

32. Thank You