This document discusses ventilators, their types, modes, and use in assisting patients with respiratory failure. It covers: 1) There are two main types of ventilators - invasive, which require an endotracheal or tracheostomy tube, and non-invasive which use face or nasal masks. 2) Modes include CMV for full support, and modes like SIMV, PSV, and BiPAP that allow some spontaneous breathing. 3) Weaning involves gradually reducing ventilator support using modes that promote patient breathing, like SIMV, PSV, BiPAP, and CPAP. Parameters are monitored to ensure patient readiness before removing all support.

1. VENTILATOR
YASH.GIRISHBHAI.PATEL

2. DEFINITION
 It is piece or equipment whose function is to move gas in
and out of lungs.
 It is a artificial supporting system when natural system of
respiration aids fail.

3. TYPE
 TWO TYPE
1) invasive :
Full support – CMV (VC, PC)
Partial support – IMV, SIMV, PSV, BIPAP

4. TYPE
2) non- invasive : it doesn’t require ETT or Tracheostomy
 Positive pressure (via face or nasal mask)
- CPAP, BiPAP, NIPPV
 Negative pressure
-cuirass tank, iron lung

5. THREE WAYS OF VENTILIATION
1) VOLUME.CYCLE:
Cycling to expiration occur after per-selected volume is
delivered to patient.
2)PRESSURE CYCLE:
Cycle terminates inspiration when development of a preset
pressure.
3) TIME CYCLE:
Form inspiration phase, cycling to expiration occur after a
set length of time.

6. MODES OF VENTILATOR
 CMV- controlled mechanical
 It does not allow spontaneous breathing.
 It requires patient be sedated and paralyzed.
 The ventilator derive all breath at per-set. Frequency,
volume or pressure and flow rate.
 The patient, can not take spontaneous breath or trigger
the machine.

7. INDICATION
 Initial control of patient with little respiratory drive,
severe lung disease, gas traping or circulatory instability.

8. MODES OF VENTILATOR
 IMV- intermittent mandatory ventilation
 Pt. is allowed to take spontaneous breaths between cycles
of ventilator.
 The machine gives pre-set no. of breath each minute. But
in between these he can breath for himself.

9.  SIMV- synchronized intermittent ventilator
 It improves on that of IMV.
 Mandatory breaths are delivered in synchrony with the
pt’s breathing.
 When pt. is maintaining creation degree of respiratory
effort, that is he can support himself.

10.  Mode of weaning
 Indication : to provide partial ventilator support to the
pt.
 Advantage :
1) Maintains respiratory muscle strength/ avoid muscle
atrophy
2) Reduce ventilation- perfusion mismatch.
3) Decrease mean airway pressure.

11.  PSV- pressure support ventilation.
 Breath are initiated or triggered by the pt. but pressure
support is provided to augment pt’s own respiration.
 Use – when pt. controls the frequency, tidal volume,
inspiratory time but pressure is not achieved.
 Used in conjunction with SLMV

12. MODE OF VENTILATOR
 PEEP- positive end expiratory pressure
 It increase functional residual capacity by recruiting areas
of collapsed/ atelectasis or edema lung and improves o2.
 CPAP – continuous positive airway
 It is used when pt. is having spontaneous breathing.
 It maintain +ve pressure in the circuitry and airway
throughout inspiration and expiration.

13. MODES OF VENTILATOR
 CPAP mask Is a tight fitting mask secured around the pt’s
mouth and nose.
 Pre-set (+ve) pressure and o2 percentage is delivered
 USE
 1) When lung volumes are reduced, in particular the FRC.
E.g. sudsegmetal lung collapse, pneumonia and acute
respiratory distress syndrome.

14. 2) Improves ventilation/perfusion (V/Q) mismatch.
3) Improves lung compliance so it reduces the work of
breathing.

15. MODES OF VENTILATOR
 BiPAP – bilevel PAP: ( biphasic positive airway pressure)
It ranges from purely mechanical ventilation to purely
spontaneous breathing.
This rang can cover entire course of therapy form
intubations to weaning.

16.  Ventilator produces +ve
pressure and inspiratory
muscle -ve pressure.

17.  Genuine – BiPAP:
Continuous spontaneous breathing at 2 pressure level.
 CPAP:
Continuous spontaneous breathing and both pressure level
are equal.

18.  It delivers 2 leave of pressure in phase with respiration.
 The higher pressure provides inspiratory support and
augments tidal volume.
 The low pressure is applied during expiration and increase
FRC.
 May be applied via face or nasal mask.

19. INDICATION
 Post operative
 Respiratory
 Circulatory
 Neurological
 Multiple trauma
 Additional consideration
-metabolic factors

20. CLASSIFICATION OF VENTILATORS
1) Inspiratory phase :
-ventilators generate either flow or pressure.
 Pressure generators: expose the lung to a pressure, gas
flows into the lung until the pressure within the patient is
equal to the ventilator pressure.
 Flow generators: it expose the lung to a flow of gas, gas
enters the lung for as the flow continues, and the
pressure and volume raise accordingly.

21. CLASSIFICATION OF VENTILATORS
2) Cycling to expiration:
I. Pressured cycled
II. Volume cycled
III. Time cycled
3) Expiratory phase:
I. Expiration
II. PEEP
III. NEEP
IV. ZEEP

22. CLASSIFICATION OF VENTILATORS
4) Cycling to inspiration:
machine adjust the expiratory time to fulfill the presser I:E
ration

23. ALARM
 It indicates pt's condition or machine malfunction.
 It monitors – high and low pressure, Fio2, apnea,
disconnection and volume.
 High pressure alarm signify
-Secretion buildup,
-Ventilator tube occlusion
-Excessive water buildup

24.  Low pressure signify
-Leak in the ventilator circuitry,
-Bad pt connection.

25. HIGH FREQUENCY VENTILATOR
 It is the type of mechanical ventilation. That employs very
high respiratory rate (60bpm) and small tidal volume.
 It reduces ventilator associated lung injury.

26.  The rates depending upon pt. type and dz condition.
 It generates very low tidal volume that are less than the
dead space.
 Use : hypoxia , sever ARDS, other o2 issues.
In these case, normal ventilators are not used.
It is 1 line of ventilation in some neonatal pt. -becoz risk of
lung injury from conventional ventilation.

27. WEAINNG FORM MECHANICAL
VENTILATOR
 SIMV, PSV, BiPAP , CPAP are the weaning technique used to
allow the gradual withdrawal of mechanical support.

28.  SIMV : frequency and
duration are preset by
staff.
 In PSV : frequency and
duration depends in
patient.

29. POINTS OF CONSIDERATION FOR
WEAANING
I. Pt should not be under the effect of any respiratory
depressive drug.
II. The chest x-ray should be cleared.
III. Pt. should not wean off immediately following physiotherapy.
IV. Pt’s T.V should approximate that delivered by the ventilator.

30. POINTS OF CONSIDERATION FOR
WEAANING
 Pt should able to generate sufficient intrathorassic
pressure (-ve inspiratory pressure) for deep breathing.
 The arterial blood gases should be relatively normal
without the need for high inspired concentration of o2

31. GENERAL STEPS IN WEANING A PT FROM
THE MECHANICAL VENTILATION.
 Period of time are spent off the ventilator and ‘T’ tune
that delivers appropriate o2 and humidity. Mornings are
often good time.
 Physical therapist offer support and reassurance and ask
pt. to take deep breath.
 Monitor constantly vital signs and deep breaths.
Deterioration in vital sign indicate that we have to return
to a ventilator assistant.

32. PARAMETERS
 TV> 5 ml/k body weight.
 RR<30/ min
 Breathing pattern synchronous
 Compliance>25Ml/cm h2o
 pao2> 60 mm hg
 Paco2< 50 mm hg

33. GENERAL STEPS IN WEANING A PT. FROM
MECHANICAL VENTILATION
 Rest period at least of 1 hour.
 Pt’s having cardiopulmonary disease, who are older,
malnourished, older or smoker can be expected to take
longer to be completely weaned from the ventilator.
 Weaning is faster in pts who have required a shorter
period of mechanical ventilation.

34. GENERAL STEPS IN WEANING A PT. FROM
MECHANICAL VENTILATION
 Once the pt with tracheostomy tube has ben weaned off
the ventilator, the cuff, plastic tube is changed for an
unstuffed silver tube which has an inner speaking tube
enabling him to talk.
 Before the removal of this tube, we must to ensure that
pt is capable of clearing his own secretion by hufing and
cuffing.
 Then the silver tube will be removed and a dry dressing
placed over stoma which will heal in a few days.

35. PHYSIOTHERAPIST ROLE IN WEANING
 Early assessment of patient rehabilitation potential(strength,
endurance be mobility, transfer)
 Assistance in secretion clearance
 Respiratory muscle training
 Identification of readiness or extubation
-minimal secretion
-Effective cough
-Airway reflexes present
-Neurological status

36.  Facilitation of endotracheal extubation to non invasive
ventilation.
 Assistance with tracheostomy weaning (periods of
spontaneous batching interspersed with periods of
respiratory muscle rest on mechanical ventilator)
 Recognizing patients at risk of difficulties in weaning
(COPD, heart failure, obesity , renal failure, flial chest.)