This document discusses different types of mechanical ventilation and ventilation modes. It begins by outlining four types of respiratory failure that may require mechanical ventilation. It then discusses goals of mechanical ventilation related to oxygenation and ventilation. The document goes on to explain various ventilation modes including volume control, pressure control, pressure support, and APRV. It provides details on settings for tidal volume, minute ventilation, and initial mechanical ventilation settings. Overall, the document provides an overview of mechanical ventilation types, goals, modes, and initial settings.
The document discusses various aspects of mechanical ventilation including:
1) Different ventilator settings such as mode, respiratory rate, tidal volume, and PEEP that can be adjusted for different patient types.
2) Monitoring pressures such as peak pressure and auto-PEEP is important to avoid complications.
3) Specific considerations for ventilating patients with COPD/asthma include permissive hypercapnia to reduce dynamic hyperinflation and work of breathing.
4) Ventilating ARDS patients should use low tidal volumes, as clinical trials have shown this approach reduces mortality compared to traditional higher volumes.
This document provides an overview of basic mechanical ventilation principles and techniques. It discusses establishing harm-free goals, synchronization between patient demand and ventilator delivery, avoiding lung injury through proper pressure and volume settings, identifying the target lung zone, modes of ventilation including CPAP, SIMV, APRV, and disorders related to flow such as starvation, excess flow, outflow obstruction, and inflow obstruction. Key conclusions are to understand ventilator waveforms, synchronize the ventilator to the patient, analyze problems, and use sedation judiciously.
Mechanical ventilation can be used to support or replace spontaneous breathing in patients unable to maintain adequate ventilation on their own. It aims to facilitate carbon dioxide release and maximize oxygen delivery. Modes include controlled mandatory ventilation where the ventilator controls both tidal volume and rate, and assist-control where the ventilator provides a minimum rate with additional breaths triggered by the patient. Synchronized intermittent mandatory ventilation delivers mandatory breaths at set intervals while allowing spontaneous breathing in between to reduce asynchrony.
This document provides information on mechanical ventilation, including indications, criteria, principles, terminology, modes, pressures, and settings. The key points are:
1. Mechanical ventilation is indicated for respiratory failure (type I or II) or to provide airway protection. Criteria include clinical assessment, ABGs, and physiological parameters.
2. Ventilation aims to facilitate CO2 release while maintaining normal PaCO2. Oxygenation aims to maximize O2 delivery by improving V/Q matching.
3. Common modes include controlled mandatory ventilation (CMV), intermittent mandatory ventilation (IMV), and synchronized IMV (SIMV). Settings must be tailored to the individual patient.
Monitoring of mechanical ventilation involves assessing pressure, flow, volume, and calculated and measured parameters. Calculated parameters include compliance, resistance, and time constants. Waveform analysis uses pressure, flow, and volume waveforms. Loops such as pressure-volume and flow-volume can be used to evaluate lung mechanics. Monitoring compliance, resistance, and loops can help determine the condition of the lungs.
PRVC (Pressure Regulated Volume Control) is a mode of mechanical ventilation that uses pressure control adjusted breath-to-breath to deliver a set tidal volume. It sets a minimum respiratory rate, target tidal volume, and maximum pressure limit. The ventilator measures the tidal volume on each breath and adjusts the inspiratory pressure up or down as needed to try and deliver the set tidal volume with each subsequent breath. This allows the ventilator to compensate for changes in lung compliance to help guarantee tidal volume delivery while limiting pressures. However, tidal volumes can still vary with intermittent patient effort.
This document discusses ventilator settings and modes. It begins by defining a ventilator and listing some key settings such as respiratory rate, tidal volume, minute ventilation, fraction of inspired oxygen, and positive end expiratory pressure. It then discusses the different types of ventilator modes: controlled modes (e.g. volume control, pressure control), supported modes (e.g. pressure support), and combination modes (e.g. SIMV with pressure support). The document concludes by outlining the steps for assessing a patient's readiness for weaning from the ventilator and describing methods for weaning such as a spontaneous breathing trial.
This document describes a 65-year-old male patient who was intubated and connected to a mechanical ventilator for acute exacerbation of COPD and cor pulmonale. It then provides details on the history, components, modes, and goals of mechanical ventilation. Various modes discussed include controlled mandatory ventilation, assist-control ventilation, synchronized intermittent mandatory ventilation, and pressure-controlled ventilation. The document outlines the responsibilities of nurses in monitoring patients on mechanical ventilation. It also briefly introduces newer ventilation methods such as high frequency oscillation, bipap, airway pressure release ventilation, and liquid ventilation.
The document discusses various aspects of mechanical ventilation including:
1) Different ventilator settings such as mode, respiratory rate, tidal volume, and PEEP that can be adjusted for different patient types.
2) Monitoring pressures such as peak pressure and auto-PEEP is important to avoid complications.
3) Specific considerations for ventilating patients with COPD/asthma include permissive hypercapnia to reduce dynamic hyperinflation and work of breathing.
4) Ventilating ARDS patients should use low tidal volumes, as clinical trials have shown this approach reduces mortality compared to traditional higher volumes.
This document provides an overview of basic mechanical ventilation principles and techniques. It discusses establishing harm-free goals, synchronization between patient demand and ventilator delivery, avoiding lung injury through proper pressure and volume settings, identifying the target lung zone, modes of ventilation including CPAP, SIMV, APRV, and disorders related to flow such as starvation, excess flow, outflow obstruction, and inflow obstruction. Key conclusions are to understand ventilator waveforms, synchronize the ventilator to the patient, analyze problems, and use sedation judiciously.
Mechanical ventilation can be used to support or replace spontaneous breathing in patients unable to maintain adequate ventilation on their own. It aims to facilitate carbon dioxide release and maximize oxygen delivery. Modes include controlled mandatory ventilation where the ventilator controls both tidal volume and rate, and assist-control where the ventilator provides a minimum rate with additional breaths triggered by the patient. Synchronized intermittent mandatory ventilation delivers mandatory breaths at set intervals while allowing spontaneous breathing in between to reduce asynchrony.
This document provides information on mechanical ventilation, including indications, criteria, principles, terminology, modes, pressures, and settings. The key points are:
1. Mechanical ventilation is indicated for respiratory failure (type I or II) or to provide airway protection. Criteria include clinical assessment, ABGs, and physiological parameters.
2. Ventilation aims to facilitate CO2 release while maintaining normal PaCO2. Oxygenation aims to maximize O2 delivery by improving V/Q matching.
3. Common modes include controlled mandatory ventilation (CMV), intermittent mandatory ventilation (IMV), and synchronized IMV (SIMV). Settings must be tailored to the individual patient.
Monitoring of mechanical ventilation involves assessing pressure, flow, volume, and calculated and measured parameters. Calculated parameters include compliance, resistance, and time constants. Waveform analysis uses pressure, flow, and volume waveforms. Loops such as pressure-volume and flow-volume can be used to evaluate lung mechanics. Monitoring compliance, resistance, and loops can help determine the condition of the lungs.
PRVC (Pressure Regulated Volume Control) is a mode of mechanical ventilation that uses pressure control adjusted breath-to-breath to deliver a set tidal volume. It sets a minimum respiratory rate, target tidal volume, and maximum pressure limit. The ventilator measures the tidal volume on each breath and adjusts the inspiratory pressure up or down as needed to try and deliver the set tidal volume with each subsequent breath. This allows the ventilator to compensate for changes in lung compliance to help guarantee tidal volume delivery while limiting pressures. However, tidal volumes can still vary with intermittent patient effort.
This document discusses ventilator settings and modes. It begins by defining a ventilator and listing some key settings such as respiratory rate, tidal volume, minute ventilation, fraction of inspired oxygen, and positive end expiratory pressure. It then discusses the different types of ventilator modes: controlled modes (e.g. volume control, pressure control), supported modes (e.g. pressure support), and combination modes (e.g. SIMV with pressure support). The document concludes by outlining the steps for assessing a patient's readiness for weaning from the ventilator and describing methods for weaning such as a spontaneous breathing trial.
This document describes a 65-year-old male patient who was intubated and connected to a mechanical ventilator for acute exacerbation of COPD and cor pulmonale. It then provides details on the history, components, modes, and goals of mechanical ventilation. Various modes discussed include controlled mandatory ventilation, assist-control ventilation, synchronized intermittent mandatory ventilation, and pressure-controlled ventilation. The document outlines the responsibilities of nurses in monitoring patients on mechanical ventilation. It also briefly introduces newer ventilation methods such as high frequency oscillation, bipap, airway pressure release ventilation, and liquid ventilation.
This document provides an overview of neonatal ventilator graphics and waveforms. It discusses the key waveforms of pressure, volume, and flow and how they depict the respiratory cycle. Specific features of each waveform are described, including how they can reveal conditions like leaks, auto-triggering, gas trapping, and changes in compliance. Pulmonary loops like the pressure-volume and flow-volume loops are introduced and how they can provide information about lung mechanics, resistance, compliance, and other conditions. Interpretation of loop features is covered for various pathological states and responses to treatments.
This document discusses using airway graphic analysis to optimize patient-ventilator interactions in a case of a 5 month old infant with chronic lung disease admitted with respiratory exacerbation. The infant experienced an acute episode of tachypnea and agitation. Airway graphs and scalars showed flow asynchrony between the patient and ventilator, most likely due to trigger insensitivity. Optimizing patient-ventilator synchrony through settings like inspiratory flow, trigger sensitivity, and expiratory time can improve outcomes.
The document discusses various ventilator settings including tidal volume, minute ventilation, peak inspiratory pressure, positive end-expiratory pressure, inspiratory-to-expiratory ratios, and modes of ventilation such as pressure control, volume control, assisted ventilation and spontaneous breathing modes. It provides details on anatomy of the ventilator, how to start a ventilator, and disease-based strategies for setting appropriate ventilation parameters for conditions like normal lung, CNS pathology, parenchymal lung disease, and airway diseases.
Mechanical ventilation Basics and waveformsHardeep Jogi
This document defines key terms and concepts related to mechanical ventilation. It discusses pressures such as airway opening pressure, intrapleural pressure, transpulmonary pressure, and others. It also describes lung characteristics like compliance and resistance. The document outlines the basics of negative and positive pressure ventilation. It discusses variables that control the ventilator cycle, including triggers, limits, and cycles. Finally, it examines various waveforms produced by mechanical ventilation like pressure/time scalars and esophageal pressure curves.
Mechanical Ventilation (MV) is almost always a challenging topic for ICU nurses and practitioners. In this presentation we are going to review and relearn basics of MV together.
The document discusses mechanical ventilation and the mechanics of breathing. It covers topics like spontaneous breathing, respiration, ventilation, gas flow and pressure gradients in the lungs during breathing, compliance, resistance, time constants, and different types of ventilators including conventional and high frequency ventilators.
The evolution of pediatric mechanical ventilatorsDang Thanh Tuan
1. Mechanical ventilators have evolved from simple analog machines to sophisticated microprocessor-controlled devices with advanced modes of ventilation.
2. Early ventilators were open-loop controlled while modern ventilators use various closed-loop and dual-loop control schemes to better match ventilation to patient needs.
3. The newest generations of ventilators use proportional assist, automatic tube compensation, adaptive support ventilation, and other advanced modes that aim to provide more patient-synchronized support and facilitate weaning. However, further research is still needed to fully understand the outcomes of these newer ventilation strategies.
Mechanical ventilation and physiotherapy managementMuskan Rastogi
Mechanical ventilation involves using a machine to breathe for patients who cannot breathe effectively on their own. It works by delivering pressurized air into the lungs via a tube in the airway. Physiotherapists help optimize ventilation, clear secretions, prevent complications, and facilitate weaning patients off the ventilator using techniques like suctioning, drainage positions, percussion, and vibrations. The ventilator settings control aspects of breathing like tidal volume, oxygen levels, and respiratory rate. Modes include mandatory breaths or assisting patients' own breaths. Weaning gradually reduces support as the patient recovers lung function and the ability to breathe independently.
Patient Ventilator Synchrony & Successful Weaning講義Dr. Shaheer Haider
This document discusses patient-ventilator synchrony and successful weaning. It defines weaning as the gradual decrease of ventilatory support to prepare for extubation. Optimal synchrony depends on factors like trigger sensitivity, ventilator response time, appropriate tidal volume, and complete expiration to minimize work of breathing. Various ventilator modes and settings can be adjusted to improve synchrony and reduce the risk of reintubation during weaning and extubation.
This document provides an overview of ventilator basics and parameters including:
1) It describes the basic components and parameters of ventilators such as modes, controls, triggers and adjunct therapies.
2) It explains some common ventilator modes like pressure control ventilation, BiPAP, and APRV and notes some safety considerations.
3) It outlines potential complications from mechanical ventilation and stresses the importance of monitoring patients and equipment.
This document discusses various modes of mechanical ventilation. It begins by covering advanced basics related to flow, time, pressure and volume control. It then describes the main categories of ventilation modes: mandatory modes like controlled mandatory ventilation which are time-triggered and time-cycled; triggered modes like CPAP and PSV which are patient-triggered; and hybrid modes like assist-control and SIMV which combine mandatory and spontaneous breaths. For each mode, it provides details on controls, targets, feedback and cycling. The document provides examples of pressure and volume graphs to illustrate different mode functions and interactions. It concludes with tables summarizing the key characteristics of different mandatory, triggered and hybrid ventilation modes.
This document provides an overview of basic mechanical ventilation. It discusses how oxygen is delivered and carbon dioxide is removed from the lungs through factors like FiO2, mean alveolar pressure, ventilation, and respiratory rate. It also covers settings like inspiratory time, PEEP, trigger sensitivity, and rise time. Complications of mechanical ventilation like barotrauma, gas trapping, and their causes are summarized. The effects of positive pressure on cardiovascular function are briefly outlined.
The document discusses basic principles of mechanical ventilation including factors that can lead to ventilatory failure, airway resistance, lung compliance, hypoventilation, V/Q mismatch, intrapulmonary shunting, and diffusion defects. It also covers different types of ventilator waveforms including pressure, volume, flow and pressure/volume loops which can be used to assess a patient's respiratory status and response to therapy.
Andreas Vesalius in 1555 suggested opening the trachea and inserting a tube to allow the lung to reinflate and strengthen the heart, representing one of the earliest descriptions of mechanical ventilation.
Dr. Nikhil Yadav's document discusses various modes of mechanical ventilation including controlled modes like volume control and pressure control ventilation, assisted modes like assist-control and synchronized intermittent mandatory ventilation, and spontaneous breathing modes like pressure support ventilation and proportional assist ventilation. The summary provides a high-level overview of the key topics and historical context covered in the document.
The document discusses mechanical ventilation, providing definitions and discussing the basics of anatomy and physiology related to breathing. It covers indications for intubation and mechanical ventilation, principles of mechanical ventilation including modes and patterns of ventilation. Key terms are defined such as tidal volume, respiratory rate, FiO2, and settings that must be determined when setting up a ventilator such as PEEP levels. Modes of ventilation covered include controlled, assisted-control, and spontaneous modes.
This document discusses mechanical ventilation, including its indications, contraindications, types, modes, and strategies. It begins by defining mechanical ventilation as a method of assisting or replacing spontaneous breathing through specialized devices. The primary indications are respiratory failure characterized by hypoxemia or hypercapnia. Invasive mechanical ventilation requires endotracheal intubation while noninvasive ventilation does not. Common modes include assist-control, intermittent mandatory ventilation, pressure support ventilation, and pressure-control ventilation. Protective ventilatory strategies aim to optimize oxygenation while avoiding ventilator-induced lung injury. Weaning and discontinuing mechanical ventilation involves a spontaneous breathing trial.
PC mode uses pressure control ventilation where the ventilator controls the inspiratory pressure and the patient controls the respiratory rate and inspiratory time. The tidal volume depends on the inspiratory pressure set, lung compliance, and airway resistance. Key settings include inspiratory pressure, respiratory rate, inspiratory time, and PEEP. Plateau pressure and driving pressure should be monitored to avoid overinflation and volutrauma. PEEP is used to prevent alveolar collapse and improve oxygenation but can impact hemodynamics at higher levels by decreasing venous return and cardiac output.
Optimizing Critical Care Ventilation: What can we learn from Ventilator Wavef...Dr.Mahmoud Abbas
This document provides an overview of optimizing critical care ventilation based on ventilator waveforms. It discusses:
1. The basic physiology of ventilation and the equation of motion of the respiratory system.
2. Different modes of mechanical ventilation including volume-controlled, pressure-controlled, bi-level, and pressure support ventilation.
3. How changes in ventilator settings and patient physiology affect breath delivery and waveforms.
4. Specific situations like ARDS and weaning where understanding waveforms can help guide ventilation.
This document provides an overview of neonatal ventilator graphics and waveforms. It discusses the key waveforms of pressure, volume, and flow and how they depict the respiratory cycle. Specific features of each waveform are described, including how they can reveal conditions like leaks, auto-triggering, gas trapping, and changes in compliance. Pulmonary loops like the pressure-volume and flow-volume loops are introduced and how they can provide information about lung mechanics, resistance, compliance, and other conditions. Interpretation of loop features is covered for various pathological states and responses to treatments.
This document discusses using airway graphic analysis to optimize patient-ventilator interactions in a case of a 5 month old infant with chronic lung disease admitted with respiratory exacerbation. The infant experienced an acute episode of tachypnea and agitation. Airway graphs and scalars showed flow asynchrony between the patient and ventilator, most likely due to trigger insensitivity. Optimizing patient-ventilator synchrony through settings like inspiratory flow, trigger sensitivity, and expiratory time can improve outcomes.
The document discusses various ventilator settings including tidal volume, minute ventilation, peak inspiratory pressure, positive end-expiratory pressure, inspiratory-to-expiratory ratios, and modes of ventilation such as pressure control, volume control, assisted ventilation and spontaneous breathing modes. It provides details on anatomy of the ventilator, how to start a ventilator, and disease-based strategies for setting appropriate ventilation parameters for conditions like normal lung, CNS pathology, parenchymal lung disease, and airway diseases.
Mechanical ventilation Basics and waveformsHardeep Jogi
This document defines key terms and concepts related to mechanical ventilation. It discusses pressures such as airway opening pressure, intrapleural pressure, transpulmonary pressure, and others. It also describes lung characteristics like compliance and resistance. The document outlines the basics of negative and positive pressure ventilation. It discusses variables that control the ventilator cycle, including triggers, limits, and cycles. Finally, it examines various waveforms produced by mechanical ventilation like pressure/time scalars and esophageal pressure curves.
Mechanical Ventilation (MV) is almost always a challenging topic for ICU nurses and practitioners. In this presentation we are going to review and relearn basics of MV together.
The document discusses mechanical ventilation and the mechanics of breathing. It covers topics like spontaneous breathing, respiration, ventilation, gas flow and pressure gradients in the lungs during breathing, compliance, resistance, time constants, and different types of ventilators including conventional and high frequency ventilators.
The evolution of pediatric mechanical ventilatorsDang Thanh Tuan
1. Mechanical ventilators have evolved from simple analog machines to sophisticated microprocessor-controlled devices with advanced modes of ventilation.
2. Early ventilators were open-loop controlled while modern ventilators use various closed-loop and dual-loop control schemes to better match ventilation to patient needs.
3. The newest generations of ventilators use proportional assist, automatic tube compensation, adaptive support ventilation, and other advanced modes that aim to provide more patient-synchronized support and facilitate weaning. However, further research is still needed to fully understand the outcomes of these newer ventilation strategies.
Mechanical ventilation and physiotherapy managementMuskan Rastogi
Mechanical ventilation involves using a machine to breathe for patients who cannot breathe effectively on their own. It works by delivering pressurized air into the lungs via a tube in the airway. Physiotherapists help optimize ventilation, clear secretions, prevent complications, and facilitate weaning patients off the ventilator using techniques like suctioning, drainage positions, percussion, and vibrations. The ventilator settings control aspects of breathing like tidal volume, oxygen levels, and respiratory rate. Modes include mandatory breaths or assisting patients' own breaths. Weaning gradually reduces support as the patient recovers lung function and the ability to breathe independently.
Patient Ventilator Synchrony & Successful Weaning講義Dr. Shaheer Haider
This document discusses patient-ventilator synchrony and successful weaning. It defines weaning as the gradual decrease of ventilatory support to prepare for extubation. Optimal synchrony depends on factors like trigger sensitivity, ventilator response time, appropriate tidal volume, and complete expiration to minimize work of breathing. Various ventilator modes and settings can be adjusted to improve synchrony and reduce the risk of reintubation during weaning and extubation.
This document provides an overview of ventilator basics and parameters including:
1) It describes the basic components and parameters of ventilators such as modes, controls, triggers and adjunct therapies.
2) It explains some common ventilator modes like pressure control ventilation, BiPAP, and APRV and notes some safety considerations.
3) It outlines potential complications from mechanical ventilation and stresses the importance of monitoring patients and equipment.
This document discusses various modes of mechanical ventilation. It begins by covering advanced basics related to flow, time, pressure and volume control. It then describes the main categories of ventilation modes: mandatory modes like controlled mandatory ventilation which are time-triggered and time-cycled; triggered modes like CPAP and PSV which are patient-triggered; and hybrid modes like assist-control and SIMV which combine mandatory and spontaneous breaths. For each mode, it provides details on controls, targets, feedback and cycling. The document provides examples of pressure and volume graphs to illustrate different mode functions and interactions. It concludes with tables summarizing the key characteristics of different mandatory, triggered and hybrid ventilation modes.
This document provides an overview of basic mechanical ventilation. It discusses how oxygen is delivered and carbon dioxide is removed from the lungs through factors like FiO2, mean alveolar pressure, ventilation, and respiratory rate. It also covers settings like inspiratory time, PEEP, trigger sensitivity, and rise time. Complications of mechanical ventilation like barotrauma, gas trapping, and their causes are summarized. The effects of positive pressure on cardiovascular function are briefly outlined.
The document discusses basic principles of mechanical ventilation including factors that can lead to ventilatory failure, airway resistance, lung compliance, hypoventilation, V/Q mismatch, intrapulmonary shunting, and diffusion defects. It also covers different types of ventilator waveforms including pressure, volume, flow and pressure/volume loops which can be used to assess a patient's respiratory status and response to therapy.
Andreas Vesalius in 1555 suggested opening the trachea and inserting a tube to allow the lung to reinflate and strengthen the heart, representing one of the earliest descriptions of mechanical ventilation.
Dr. Nikhil Yadav's document discusses various modes of mechanical ventilation including controlled modes like volume control and pressure control ventilation, assisted modes like assist-control and synchronized intermittent mandatory ventilation, and spontaneous breathing modes like pressure support ventilation and proportional assist ventilation. The summary provides a high-level overview of the key topics and historical context covered in the document.
The document discusses mechanical ventilation, providing definitions and discussing the basics of anatomy and physiology related to breathing. It covers indications for intubation and mechanical ventilation, principles of mechanical ventilation including modes and patterns of ventilation. Key terms are defined such as tidal volume, respiratory rate, FiO2, and settings that must be determined when setting up a ventilator such as PEEP levels. Modes of ventilation covered include controlled, assisted-control, and spontaneous modes.
This document discusses mechanical ventilation, including its indications, contraindications, types, modes, and strategies. It begins by defining mechanical ventilation as a method of assisting or replacing spontaneous breathing through specialized devices. The primary indications are respiratory failure characterized by hypoxemia or hypercapnia. Invasive mechanical ventilation requires endotracheal intubation while noninvasive ventilation does not. Common modes include assist-control, intermittent mandatory ventilation, pressure support ventilation, and pressure-control ventilation. Protective ventilatory strategies aim to optimize oxygenation while avoiding ventilator-induced lung injury. Weaning and discontinuing mechanical ventilation involves a spontaneous breathing trial.
PC mode uses pressure control ventilation where the ventilator controls the inspiratory pressure and the patient controls the respiratory rate and inspiratory time. The tidal volume depends on the inspiratory pressure set, lung compliance, and airway resistance. Key settings include inspiratory pressure, respiratory rate, inspiratory time, and PEEP. Plateau pressure and driving pressure should be monitored to avoid overinflation and volutrauma. PEEP is used to prevent alveolar collapse and improve oxygenation but can impact hemodynamics at higher levels by decreasing venous return and cardiac output.
Optimizing Critical Care Ventilation: What can we learn from Ventilator Wavef...Dr.Mahmoud Abbas
This document provides an overview of optimizing critical care ventilation based on ventilator waveforms. It discusses:
1. The basic physiology of ventilation and the equation of motion of the respiratory system.
2. Different modes of mechanical ventilation including volume-controlled, pressure-controlled, bi-level, and pressure support ventilation.
3. How changes in ventilator settings and patient physiology affect breath delivery and waveforms.
4. Specific situations like ARDS and weaning where understanding waveforms can help guide ventilation.
1. Mechanical ventilation settings like PEEP aim to reduce ventilator-induced lung injuries from atelectrauma and overdistension while improving oxygenation.
2. The optimal PEEP level can be determined through methods like the ARDSnet table, transpulmonary pressure measurements, lung compliance curves, and stress indexes. Higher PEEP recruits more alveoli but may affect hemodynamics.
3. Pressure-volume curves can help identify the lower inflection point and lower deflection point to guide PEEP setting, along with recruitment maneuvers. Slow-flow curves more accurately detect inflection points.
This document discusses mechanical ventilation and the weaning process. It outlines the 7 stages of weaning and indicators for readiness to wean, including parameters like respiratory rate, tidal volume, rapid shallow breathing index, and maximum inspiratory pressure. It describes methods for spontaneous breathing trials and criteria for weaning failure. Difficult weaning can be caused by respiratory, cardiac, psychological, ventilator or nutritional factors. Daily assessment is important to evaluate readiness and avoid complications from prolonged mechanical ventilation.
1. The document discusses approaches for ventilating patients with asthma, focusing on the benefits of decelerating flow over constant flow.
2. Data from studies on pediatric and adult asthma patients show that pressure control ventilation with decelerating flow results in better oxygenation, lower carbon dioxide levels, and shorter time to clinical improvement compared to volume control ventilation with constant flow.
3. The preferred ventilation approach for asthma is to use pressure control modes with decelerating flow, limit lung injury by avoiding dynamic hyperinflation, minimize plateau pressures, and allow some hypercapnia to prevent barotrauma.
The document discusses various aspects of mechanical ventilation including:
1. Indications for ventilation include acute ventilatory failure, impending failure, severe hypoxemia, and prophylactic support.
2. Goals of ventilation are to improve gas exchange, relieve respiratory distress, improve pulmonary mechanics, permit airway healing, and avoid complications.
3. Initial modes of ventilation include full support modes where the ventilator does all the work of breathing or partial support modes where the ventilator assists with some work of breathing.
The document discusses the different modes, parameters, and variables of mechanical ventilation, providing definitions and examples of various modes like volume control, pressure control, PRVC, SIMV, and pressure support and discussing parameters like tidal volume, respiratory rate, PEEP, and I:E ratio that must be set and monitored to effectively ventilate patients using these different modes.
The “How To” of BiVent
Created by: David Pitts II, RRT
Clinical Applications Specialist, Maquet
Birmingham, Alabama
Sponsored by Maquet, Inc – Servo Ventilators
1. Mechanical ventilation troubleshooting involves identifying the cause of a patient's sudden respiratory distress by analyzing monitor alarms, physical signs, and ventilator graphs.
2. Common causes include ventilator issues like leaks, circuit blocks, or setting errors as well as patient issues such as pneumonia or pneumothorax.
3. The document outlines steps for troubleshooting including disconnecting the patient to manually bag and assess response, then treating the most likely problem by procedures like suctioning, adjusting settings, or emergency thoracostomy.
The document discusses mechanical ventilation settings and principles. It indicates that the goals of ventilation are to facilitate CO2 release and maintain normal PaCO2 levels. Different modes of ventilation are described, including assist-control mode, SIMV, and PSV. Key settings discussed include tidal volume, respiratory rate, I:E ratio, PEEP, and FiO2. The document notes that patients with COPD should aim for controlled hypercapnia to limit high airway pressures. For ARDS patients, a low tidal volume ventilation strategy is recommended based on clinical trial evidence showing lower mortality.
Mechanical ventilation in COPD Asthma drtrcchandra talur
Conventional mechanical ventilation can help respiratory failure in COPD patients by supporting inspiration. Key challenges include dynamic hyperinflation due to expiratory flow limitation and air trapping. Settings should aim for low minute ventilation to prevent hyperinflation, including low tidal volumes, respiratory rates, I:E ratios favoring expiration and addition of PEEP if needed. Intubation criteria include accessory muscle use, worsening gas exchange and hemodynamics.
The document discusses various aspects of mechanical ventilation settings that impact patient-ventilator synchrony and work of breathing. These include:
1. Rise time, which is the rate of pressure rise during inspiration. Slower rise times can reduce work of breathing.
2. Expiratory sensitivity, which determines the point at which expiration is triggered. Adjusting this setting to account for leaks can improve synchrony.
3. Flow triggering, which detects very small amounts of inspiratory effort from the patient. This results in lower work of breathing compared to pressure triggering.
This document discusses mechanical ventilation and its physiology. It covers the main functions of the lungs related to gas exchange, oxygen diffusion pathways, and factors that determine oxygen diffusion. It then introduces mechanical ventilation, its aims, categories of invasive and non-invasive ventilation, and types of ventilators including conventional and high frequency ventilators. Various ventilation modes, controls, indications, and examples of negative pressure and positive pressure ventilation are also summarized.
Mechanical ventilation provides oxygen and removes carbon dioxide from the lungs using positive pressure when a patient's breathing is compromised. It is indicated to improve oxygenation, ventilation, or reduce work of breathing. Various ventilator modes exist depending on how breaths are triggered and cycled. The goal is to support the patient until their underlying condition improves enough for breathing without assistance. Adverse effects can impact the lungs, heart, gastrointestinal system, and brain, so strategies aim to prevent overdistention and repetitive opening/closing of alveoli. Weaning considers respiratory muscle strength and workload. Noninvasive ventilation can sometimes achieve the goals of mechanical ventilation without intubation.
This document provides information on the management of patients on mechanical ventilation. It discusses the indications for mechanical ventilation including inadequate oxygenation and ventilation. It then covers the mechanisms of oxygen transport and various causes of inadequate oxygenation and perfusion. The document outlines the purposes of ventilation and procedures for initiation and settings of mechanical ventilation including modes, parameters, and monitoring of patients. It discusses potential problems during ventilation and goals of ventilation. Finally, the document reviews weaning from mechanical ventilation.
Mechanical ventilation involves using a ventilator to mechanically move air into and out of the lungs to maintain proper oxygen and carbon dioxide levels. It has several purposes including improving gas exchange, relieving respiratory distress, and avoiding complications. There are various modes of ventilation including pressure control, volume control, and time-cycled modes. Parameters like tidal volume, respiratory rate, and PEEP must be set and monitored appropriately for different patients and conditions.
Mechanical ventilators generate a controlled flow of gas into a patient's airways using various modes of ventilation. There are both positive and negative pressure machines that can be either invasive or non-invasive. Modes include volume cycled, pressure cycled, time cycled, and flow cycled. Ventilators aim to provide oxygenation through settings like FIO2 and PEEP, and ventilation through tidal volume and respiratory rate. They are indicated for conditions causing respiratory failure and can have complications like lung injury, infection, and decreased blood pressure. Settings must be adjusted based on blood gas results and the patient's condition. Weaning involves gradually reducing support as the patient improves. Non-invasive ventilation
This document discusses several advanced modes of mechanical ventilation. It begins by describing triggered modes like volume support (VS) and proportional assist ventilation (PAV) which provide pressure support that varies based on patient effort. It then covers hybrid modes like volume-assured pressure support and pressure regulated volume control (PRVC) which use dual controls. Newer dual-controlled modes are presented that regulate pressure and volume both within and between breaths. Modes like adaptive support ventilation (ASV) automatically adapt settings to patient changes. Pros, cons and indications are provided for some of the more complex modes.
This document discusses nutrition guidelines for critically ill patients. It recommends starting enteral nutrition within 24-48 hours of admission to provide 25 kcal/kg/day and over 1.2 g/kg/day of protein. Enteral nutrition is preferred over parenteral nutrition when possible. Guidelines suggest not stopping nutrition without a definite medical cause and consulting nutrition support teams.
1. The patient is a 75-year-old male admitted to the EICU for septic shock due to pneumonia and colitis. He received TPN for nutrition support from admission until signs of bowel recovery were seen.
2. Enteral nutrition was started with 500 kcal/day of tube feeding once bowel sounds returned, but was reduced due to distension. IV fluids were given initially until TPN was started providing over 1300 kcal per day.
3. Laboratory findings and the patient's clinical status including hemodynamics, mottling, and ventilator settings are discussed to determine the adequacy and progression of nutrition support and management of septic shock. Further suggestions may be considered.
1. Mechanical ventilation can be associated with significant morbidity and mortality if prolonged. Weaning patients from mechanical ventilation in a timely manner is important.
2. There are seven stages of weaning which include assessing patient readiness, conducting spontaneous breathing trials, and using various ventilator modes like pressure support to gradually reduce support.
3. Spontaneous breathing trials for 30 minutes to 2 hours are generally preferred for weaning but gradual reduction over days may be better in some cases. Daily assessment of readiness and trials are recommended with prompt reintubation if trials fail.
This document provides an overview of electrolyte disorders including hypernatremia, hyponatremia, hyperkalemia, hypokalemia, and hyperglycemia. It discusses the etiology, clinical effects, and approaches to management. Specifically, it covers how these disorders disrupt osmotic balance and cell volume, outlines factors that influence electrolyte concentrations, and provides guidelines for treatment including shifting electrolytes between intra and extracellular compartments or removing excess amounts. The document compares US and European guidelines for hyponatremia and concludes by thanking the reader.
Cardiogenic shock is a serious condition where the heart cannot pump enough blood to vital organs, causing hypotension and end-organ damage. The most common cause is acute myocardial infarction with left ventricular dysfunction. In-hospital mortality from cardiogenic shock is high, around 27-51%. Treatment involves stabilization, vasopressor support, mechanical circulatory support if needed, and identifying and treating the underlying cardiac cause, such as through coronary angiography and PCI. Despite aggressive treatment, cardiogenic shock remains a medical emergency with high mortality.
1. The document discusses definitions of sepsis, severe sepsis, septic shock from 1992, 2001, and 2016. It describes the criteria for systemic inflammatory response syndrome, sepsis, and septic shock.
2. Guidelines for management of sepsis from the Surviving Sepsis Campaign are summarized, including early goal directed therapy, resuscitation bundles, and antimicrobial therapy recommendations.
3. Key aspects of the updated 2018 Surviving Sepsis Campaign guidelines are highlighted, such as initial fluid resuscitation, hemodynamic support, antimicrobial administration, and duration of therapy.
This document discusses post-cardiac arrest syndrome (PCAS), which refers to the pathology caused by complete whole body ischemia and reperfusion following cardiac arrest. PCAS involves (1) post-cardiac arrest brain injury, (2) post-cardiac arrest myocardial dysfunction, (3) systemic ischemia/reperfusion response, and (4) persistent precipitating pathology. The document outlines recommendations for targeted temperature management, hemodynamic goals, prognostication of outcome, and organ donation for patients experiencing PCAS.
This document discusses acute kidney injury (AKI). It notes that AKI is common in ICU patients and associated with increased mortality. Sepsis and postoperative/toxic causes are common. It defines AKI and discusses causes including prerenal, postrenal, and intrarenal. For intrarenal causes, it mentions glomerulonephritis, vasculitis, interstitial nephritis, acute tubular necrosis, and sepsis-induced AKI. It reviews diagnosis and novel biomarkers. Prevention and treatment sections discuss volume expansion, diuretics, vasopressors, vasodilators, sedation, hormonal manipulation, metabolic interventions, statins, and renal replacement therapy.
This document provides an overview of acid-base principles and disorders. It discusses the normal ranges for pH, PCO2, and HCO3 and defines acid-base disorders. Primary acid-base disorders are classified as respiratory or metabolic based on changes in PCO2 or HCO3. Secondary responses to primary disorders and mixed acid-base disorders are also covered. Evaluation of acid-base disorders follows a stepwise approach identifying the primary disorder and any secondary responses. Metabolic acidosis is further evaluated using anion gap, delta gap, and urine anion gap. Causes and treatments of various acid-base disorders are outlined.
This study summarizes the outcomes of a surgical technique for pulmonary artery reconstruction in 56 patients who had previously failed pulmonary artery stent procedures. The surgery successfully removed prior stents in 71% of cases and repaired peripheral pulmonary arteries distal to stents in 91% of patients. Following surgery, central pulmonary artery pressures significantly decreased compared to preoperative levels. At 2 years, freedom from death or need for reintervention was 87%. The study concludes that this surgical reconstruction approach can be very effective for managing pulmonary artery stenosis in patients with a history of failed pulmonary artery stenting.
This study examined the association between preoperative left atrial volume index (LAVI) and postoperative outcomes in patients undergoing mitral valve repair for chronic mitral regurgitation. The study found that higher preoperative LAVI was associated with less left atrial reverse remodeling after surgery and marginally increased the risk of postoperative atrial fibrillation and late death, independent of age and sex. The study suggests that a LAVI threshold of less than 60mL/m2 may be a better indicator of risk than guidelines that advocate 60mL/m2. The extent of preoperative left atrial enlargement as measured by LAVI can help predict postoperative outcomes in patients undergoing mitral valve repair.
Here are my thoughts on the discussion questions:
Q1. The study found that the no-AC cohort had lower rates of hemorrhagic and thrombotic complications compared to the AC cohort, though the difference was not statistically significant.
Q2. The traditional approach is to anticoagulate patients on VA-ECMO based on ELSO guidelines to target an ACT of 180-220 seconds. This study evaluated a non-traditional approach of not routinely anticoagulating patients in the first 24 hours.
Q3. You're right that not reporting coagulation data for the no-AC cohort limits reliability. Without knowing coagulation status, it's difficult to fully evaluate thrombotic risk in that group
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The Fascinating World of Bats: Unveiling the Secrets of the Night
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Biography and career history of Bruno AmezcuaBruno Amezcua
Bruno Amezcua's entry into the film and visual arts world seemed predestined. His grandfather, a distinguished film editor from the 1950s through the 1970s, profoundly influenced him. This familial mentorship early on exposed him to the nuances of film production and a broad array of fine arts, igniting a lifelong passion for narrative creation. Over 15 years, Bruno has engaged in diverse projects showcasing his dedication to the arts.
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5. Mode of MV
Ventilation Mode 분류 기준
변수(variable)에 따라 Mode를 분류 : 3T
Trigger (흡기 시작) : 환자 노력 or 시간 (기계)
Target (흡기 목표) : Volume or Pressure
Termination (흡기 종료 시점) : 시간 or 유속
+
Together with spontaneous breathing (SIMV)
6. 2. Flow Trigger1. Pressure Trigger
환자의 흡기 노력 감지
Ventilation Mode (variable) : Trigger
설정된 시간에 기계에 의해 시작
3. Time Trigger
16. Pressure support mode
Trigger : Patient (flow, pressure) or Ventilator (back up)
Target : Pressure
Termination : Patient (flow)
PS level is the pressure above PEEP (baseline)
Volume is determined by pt’s effort, lung mechanics, PS level
Maximum PS (minimum effort required by patient)
Minimum PS (usually PS level : 2~ 6 cmH20)
- To compensate for ET tube resistance
Used for weaning (decreased slowly from PSmax to PSmin)
PS may support the spontaneous breaths in SIMV for tube compensation
Advantage
Better ventilator–patient synchrony (comfortable)
Weaning mode of ventilation
Disadvantage
Variable tidal volume (by respiratory mechanic change)
Respiratory muscle fatigue (if pressure support is too low)
Mode of MV : PSV
22. Mode of MV : APRV
APRV (Airway Pressure Release Ventilation) mode
Trigger : Ventilator (Time)
Target : Pressure
Termination : Ventilator (Time)
+
Allowing spontaneous breathing (± pressure support)
Advantage
Lower PIP to maintain oxygenation & ventilation
(without compromising patient’s hemodynamics)
Higher MAP : Improved Oxygenation & V/Q matching
Lower minute ventilation (less dead space ventilation)
Preservation of spontaneous breathing
(throughout entire respiratory cycle)
Disadvantage
Variable VT (with change in lung compliance & resistance)
Auto-PEEP is usually present
Could be harmful to patients with high expiratory resistance
(i.e., COPD, asthma)
Not completely support CO2 elimination
(relies on spontaneous bereathing)
23. Mode of MV : APRV
Intensive Care Med (2017) 43:1648–1659
Clinicaltrials.gov : NCT01862016 ~
Early spontaneous breathing in ARDS
Enrollment : 702
Procedure : APRV
Primary outcome : All cause hospital mortality (~60 day)
Study completion : May, 2019
31. Stress & Strain
Stress : The distribution of internal forces per unit of area
induced by an external force applied onto a specific material
Strain : Ratio of total deformation to the initial dimention of the material body
in which the forces (stress) are being applied
34. Strain & Transpulmonary pressure
Gattinoni et al. Critical Care (2017) 21:183
(Transpulmonary pressure)
35. Driving pressure (strain)
Mild Moderate Severe
키 175cm로 동일한 3명의 ARDS 환자
실제 functional lung volume (FRC)은 서로 다름
Q. 동일하게 6 ml/kg PBW로 계산한 420 ml를
주는 것이 lung protective가 되겠는가 ?
Severe ARDS - FRC 280cc
Mild ARDS - FRC 3600cc
36. Higher Plateau Pressure : Not always Risky
Higher PEEP : Not always Protective
NEJM 2015;372:747-55
Driving pressure (strain)
37. CRS (respiratory system의 compliance)는 residual aerated lung volume, 즉 functional lung size(FRC)와 strongly correlation한다
Tidal volume / CRS 은 허탈된 폐를 제외한 실제 남아 기능하는 폐용량(baby lung)에 대비하여 투여되는 일회 호흡량의 비율를 의미하게 된다
DP = VT /CRS ≈ VT /FRC = Strain (Normalized VT to functional lung size)
Driving pressure (strain)
Driving Pressure
40. 1. Diffusion of gases into and out of liquids
- Henry’s law : 기체의 용해도는 기체 분압에 비례한다
- Solubility coefficient (용해 계수) : CO2가 O2보다 약 24배 물에 더 잘 녹는다
2. Diffusion of gases through the respiratory membrane
- Partial pressure gradient of the gas : 기체 분압 차이가 클수록 확산 ↑
Room air : O2 Partial pressure = 760 mmHg × 0.21 = 159.6 mmHg
FiO2 0.6 : O2 Partial pressure = 760 mmHg × 0.6 = 456 mmHg
- Alveolar ventilation 증가할수록 폐포내 PO2 ↑ & PCO2 ↓ 잘 유지되어 가스 교환 촉진됨
- Diffusion coefficient : CO2가 O2보다 호흡막을 통한 확산이 약 20배 잘 일어남
- Thickness of membrane : 폐부종, 폐렴 등에서 호흡막의 fluid 축적은 확산 ↓
- Surface area of membrane : 폐절제, destructive lung, 무기폐 등의 면적 감소시 확산 ↓
Minute Ventilation (VT × RR) ↑ = PaCO2 ↓
Surface area (PEEP) ↑ = PaO2 ↑
Partial pressure gradient (FiO2) ↑ = PaO2 ↑
MV Setting : Minute Ventilation
41. Minute Ventilation = VT × RR
Minute Ventilation : 100 mL/kg IBW per minute (approximately)
Initial Setting : 6~8 L/min
Minute Ventilation must be adjusted for abnormal conditions
- Hyperthermia or Hypothermia
- Hypermetabolism and metabolic acidosis
- Lung disorder ( physiologic dead space↑)
MV Setting : Minute Ventilation
42. 만약 CO2 생성에 변화가 없다면,
- PaCO2 (Initial) x VA (1) = PaCO2 (Desire) x VA (2)
- PaCO2 (Initial) x (VT – VDphys)(1) x RR(1) = PaCO2 (Desire) x (VT – VDphys)(2) x RR(2)
만약 CO2 생성에 변화가 없고 생리적 사강에도 변화가 없다면,
- 호흡수만 변경하여 PaCO2 교정 : PaCO2 (Initial) x RR(1) = PaCO2 (Desire) x RR(2)
- 호흡량만 변경하여 PaCO2 교정 : PaCO2 (Initial) x VT (1) = PaCO2 (Desire) x VT (2)
Minute Ventilation (VT × RR) ↑ = PaCO2 ↓
VA :Alveolar ventilation
VDphys : Physiologic Dead space
VCO2 : CO2 Production
VA = (VT – VDphys) x RR
PaCO2 = 0.863 x VCO2 / VA
MV Setting : Minute Ventilation
44. MV Setting : Inspiratory Time (I : E ratio)
For most adults (good starting point) :
- Initial inspiratory time : approximately 0.8 ~ 1 sec (0.6~1.2 sec)
+
- Inspiratory-to-Expiraotry (I:E) ratio : 1:2 ~ 1:4
↓
This value corresponds to an initial peak flow setting of
approximately 60 L/min (flow range 40~80 L/min)
COPD : High flow rate up to 80~100 L/min can improve gas
exchange (providing long TE : risk of air trapping↓)
51. Mean Airway Pressure (Paw)
PPV에 의한 cardiovascular의 harmful effect를 줄이려면 Mean Airway Pressure를 감소시켜야 한다
PaO2는 Mean Airway Pressure에 절대적으로 영향을 받기 때문에 어느 정도의 Paw 유지는 반드시 필요
ARDS에서 Mean Airway Pressure↑ → FRC ↑ → Oxygenation ↑
55. MV Setting : Inspiratory Rise Time (Flow rate)
Inspiratory Rise Time
- Time to peak inspiratory flow or pressure at
the start of each breath as a percentage of
total cycle time (TCT) or in second
- Clinician must carefully adjust the flow and
flow pattern to suit the patient’s ventilator
needs
Inspiratory Flow Rate
- Initial peak flow setting : about 60 L/min (range 40~80 L/min)
- Flow is normally set to deliver inspiration in about 1 sec
(Range : 0.6~1.2sec , 일반적으로 1초를 넘기지 않는다)
- COPD : High flow rate up to 80~100 L/min can improve gas exchange
(providing long TE of 3~4 time constants : risk of air trapping↓)
- Flow must be set to meet a patient’s inspiratory demand
(lower inspiratory flow tend to increased patient’s work of breathing)
59. MV Setting : Trigger
More Sensitivity
Auto-trigger가 발생하지 않는 범위내에서 최대한 민감하게 세팅해야 함
Flow Trigger : 1 ~ 2 L/min
(일반적으로 숫자가 낮을수록 민감, but Servo의 경우 숫자가 높을수록 민감)
Pressure Trigger : - 1 cmH2O
너무 민감하면 auto-trigger 발생함
너무 둔감하면 trigger 되지 않아 asynchrony & WOB ↑
일반적으로 Flow triggering이 pressure trigger 보다 WOB가 적다고
알려져 있으나 최근의 ventilator 들은 차이가 없다고 함
63. MV Setting : FiO2
FiO2
Unless detailed information identifying precise FiO2 needed available
→ Initiation of treatment for most patients is with 100% O2
FiO2 is tiltrated to achieve PaO2 of 60~80 mmHg
with SaO2 or SpO2 90% or greater
Titration is followed by oximetry or measurement of blood gases
(when titrating FiO2↓, should wait at least 20 min for O2 level stabilizing)
Using P/F ratio is not as accurate as using the PaO2/PAO2 ratio
When minimal FiO2 is identified, further reduction in FiO2 should be
in steps of 5% to 10% followed by pulse oximetry measurements
(Decrements not to exceed 20%)
64. FIO2 농도 노출시간 특징
1.0
> 12h FVC 감소, 기침, 흉통
> 24h 내피세포 기능 변화
> 36h A-a DO2 증가, DLCO 감소
> 48h Alveolar permeability 증가, Pul.edema 발생
> 60h ARDS
0.8 > 24h Toxicity can occur (same as FiO2 1.0)
0.6 > 36h 경미한 흉통, 폐기능 불변
0.24 ~ 0.28 Months No clinical toxicity
MV Setting : FiO2 & O2 Toxicity