A basic approach to Mechanical ventilation

1. A basic approach to
Mechanical ventilation
By:
Prof. Khaled Hussein, MD
Professor of Pulmonology & Critical care

23. 1. Nasal masks:
A. Standard

24. B.Custom fitted masks
Fit the size of the face. It is preferred than
standard types due to its smaller dead
space and less air leak .Several
generations of these masks are available

25. 1)Profile Lite Gel masks
Heat sensitive plastics that mould to the face,
thus reform the mask to fit the face

26. 2) Gold Seal Gel nasal mask
Closely matches the contour of the face

27. 3) Phantom gel nasal mask

28. 4) Comfort select 5) Ultramirage mask

29. Mini masks, minimize the bulk of the
mask,thus reducing the fellings of
claustrophobia, and permitting patients
to wear glasses.
6) Mini masks

30. 2.oronasal masks:
They cover both the nose and the mouth.
They have been used mainly on patients with
ARF with mouth breathing due to disturbed
conscious level and/or respiratory distress.

31. Problems with the use of oronasal mask.
 Asphyxiation may be concern in the
event of ventilator malfunction.
 Interfere with speech, eating and expec-
toration, claustrophobic reactions.
 Increase risks of aspiration .
 Increased CO2 rebreathing.

32. Standard mask
NIV from ICU to home care-Dr.khaled Hussein

33. Ultramirage mask

34. Comfort full mask

36. Total face mask (TFM)
Made of clear plastic, it uses a soft cuff that
seals around the perimeter of the face,
avoiding direct pressure on facial structures.
Restricted for use after failure of oronasal
mask

37. 3.Nasal pillows
Consist of soft rubber or silicone
pledgets that are directly introduced
into the nostrils.

38. 4.Mouth piece with lipseal:
Oracle
Simple and inexpensive, and mainly used in-patients
with neuromuscular disease. The disadvantages are
nasal air leaking, and interference with speech and
swallowing.

40. 5. Helmet

41. NIV from ICU to home care-Dr.khaled Hussein

43. Transverse
Triangular
NIV from ICU to home care-Dr.khaled Hussein

47. Acute respiratory failure(ARF)
Long term treatment in chronic
respiratory Failure(CRF)
•Weaning from invasive ventilation

48. There are three levels at which NIV may
be used in ARF:
1. At an earlier stage than that at which
tracheal intubation would be considered
(Prophylactic use).
2. As a trial alternative to intubation.
3. As the ceiling of treatment in-patients
who are not candidates for intubation.

49. Selection guidelines for use of NIV in
ARF
1. Respiratory distress despite O2 therapy :
- Increased dyspnea.
- Tachypnea > 30 breath/minute.
- Use of accessory muscles.
- Paradoxical breathing.
2. Gas exchange abnormalities despite O2 therapy:
- PH<7.35 .
- PaO2 / FiO2 < 200 .

50. NIV from ICU to home care-Dr.khaled Hussein

51. Flow chart of the application of noninvasive ventilation (NIV) in
acute exacerbations of chronic obstructive pulmonary disease,
according to the severity of acute respiratory failure.

52. •Weaning from invasive ventilation

53. NIV from ICU to home care-Dr.khaled Hussein

54. Long term treatment in chronic
respiratory Failure(CRF)

55. A) Restrictive thoracic disorders (as
kyphoscoliosis):
1. PaCO2 >45 mm Hg.
2. Nocturnal oximetry demonstrating oxygen
saturation< 88% for 5 consecutive minutes.
3. FVC < 50% predicted.

56. B) Obstructive disorders (as COPD):
1. PaO2< 55mmHg despite optimal medical
treatment including LTOT.
2. Nocturnal desaturation (oxygen saturation by
pulse oximeter <88% for 5 minutes) while
receiving oxygen therapy.
3. Hospitalization related to recurrent (2 in a 12
month period) episodes of hypercapnic
respiratory failure.
4. Overlap syndrome.

57. Discontinuation of NIV (weaning)
 Weaning was attempted, once clinical
stability had been achieved defined as:
 Reduction in respiratory rate to less than 24
breath/ minutes.
 Heart rate of less than 110/minutes.
 A compensated pH > 7.35.
 Adequate oxygenation > 90% O2 saturation
with FiO2 not more than 35%.

58. NIV from ICU to home care-Dr.khaled Hussein

60. Q: The highest level of evidence now
supports the use of NIV as a standard of
care in the treatment of ?
A) Community-acquired pneumonia
B) Severe stable COPD
C) Acute severe asthma
D) Acute exacerbation of COPD

61. Q: The highest level of evidence now
supports the use of NIV as a standard of
care in the treatment of ?
A) Community-acquired pneumonia
B) Severe stable COPD
C) Acute severe asthma
D) Acute exacerbation of COPD

62. Q:The assessment of ABGs for a patient wit
AE COPD without comorbidity (Isolated
hypercapnic RF) revealed pH 7.12. What is
the best management?
A) Venturi mask at 28%.
B) Start NIV with IPAP >15 cmH2O.
C) Intubation and mechanical ventilation.
D) Start nasal CPAP.

63. Q:The assessment of ABGs for a patient
with AE COPD without comorbidity
(Isolated hypercapnic RF) revealed pH
7.12. What is the best management?
A) Venturi mask at 28%.
C) Intubation and mechanical ventilation.
D) Start nasal CPAP.
B) Start NIV with IPAP >15cmH2O.

69. Dr.Khaled Hussein- Modes of
mechanical ventilation
Monitored parameters

70. Dr.Khaled Hussein- Modes of
mechanical ventilation

71. Dr.Khaled Hussein- Modes of
mechanical ventilation

72. Dr.Khaled Hussein- Modes of
mechanical ventilation
EasyView

74. Bargraph of
instantaneous pressure
Pressure curve
Flow curve
Ventilation measures
Trigger