Ventilators a basic tutorial

What is the point? To provide oxygenation and ventilation. Or to reduce work of breathing.
How do you ventilate soeone? !ut air in their lungs" either a set volue or set pressure.
Vocabulary#
$. Tidal volue
%. !ressure support pressure that augents a spontaneous breath
&. !''! positive end expiratory pressure. !ressure that is aintained at the end of
expiration to prevent alveolar collapse. This in effect increases copliance" and thus
oxygenation.
(. )#' ratio the inspiratory tie to expiratory tie ratio. *oral is &#$.
+. ,$- over +. or ,$-/+. 0pressure support1 above 0!''!1. The assigned pressure
support" which is above and beyond the continuous !''!" for spontaneous breaths.
What can we control?
$. The aount of air we put into the lungs either by volue 0tidal volue1 or pressure.
We can also control pressure support and !''!.
%. Oxygen 2iO%
&. Tiing 3espiratory rate. )#' ratio.
What can we easure?
$. !ressures
a. !eak
b. !lateau a easure of how copliant the lung is
c. 4tatic 5 0!eak !lateau1. 6 easure of resistance in the circuit.
%. 7inute Ventilation 0total volue ventilated in $ inute1
7odes of ventilation 'ach has distinct advantages and disadvantages.
Volue8based ventilation#
$. 6ssist89ontrol.
a. ,assist. refers to assisting a spontaneous breath
b. ,control. refers to a fully controlled breath without spontaneous effort
c. 3esult There is a basal rate of full breaths" and each spontaneous breath gets
a full volue.
%. )7V interittent andatory ventilation
a. ,andatory. refers to assigned rate of full andatory breaths
b. 6ll other breaths are spontaneous or assisted with pressure support
c. ,synchroni:ed. refers to synchroni:ation of andatory breaths with pt;s
diaphrag
!ressure8based ventilation#
$. !ressure 9ontrol
a. 6ssigned rate of full pressure breaths
b. Volues will vary.
c. 2low rate will vary.
%. !ressure 4upport
a. 6ugents spontaneous breathing. Helps overcoe tubing.
&. !3V9 pressure regulated volue control
a. 6d<usts )#' tie and other factors to accoplish a rate with volue inius
and pressure axius.
*oninvasive ventilation#
$. 9!6! continuous positive airway pressure
a. Tight fitting ask" only teporary" can;t eat
b. 4tents open alveoli with continuous pressure. *o rate" no volue.
%. =i!6! bidirectional positive airway pressure
a. Tight fitting ask" only teporary" can;t eat
b. )!6! inspiratory positive airway pressure
c. '!6! expiratory positive airway pressure
d. 9an set rate 0not that helpful1
e. )n =i!6! ,$-/+." the )!6! is $-" the '!6! is +. )n 4)7V ,$-/+." the )!6! is $+"
the '!6! is +.
4oe troubleshooting and anageent issues#
$. 6uto!''! !''! that results because of incoplete exhalation of air.
%. The =''!)*>/6ngry ventilator often due to increased peak pressures. )f you see this"
a. 9heck end expiratory pressure to see if this is autopeep.
b. 9heck end inspiratory pressure this is your plateau pressure 0ie copliance1.
c. 9heck static pressure this is your resistance. )f elevated" think obstruction in
the circuit and check 9?3" 'TT placeent" suction" etc.
&. 6lways see the effect of vent change in real tie" and reevaluate pt after &- inutes on
a vent change.
(. 63@4 6cute respiratory distress syndroe
a. 9riteria
i. =ilateral infiltrates
ii. 6cute onset A(B;
iii. !#2 ratio A %--
iv. *o C atrial HT*
b. !athophysiology in<ury and inflaation to lung D !7*s D alveolar wall in<ury
D exudates D hyaline ebranes and fluid D collagen D fibrosis. The result is
decreased copliance and increased resistance" and decreased diffusing
capacity for O%.
c. *oral tidal volues are $-8$+ C/kg of )=W
d. 63@4 tidal volues should be E C/kg of )=W" which iproves outcoes. >oal
plateau ! should be A&-8&+. 9auses perissive hypercapnea. Fse !''! and
other aneuvers to recruit and aintain alveoli.
+. 3eeber the 7)9F vent order set.
9ases#
$. E-yo7 with +- pack year of tobacco and 9O!@" presents with increased dry cough and
respiratory difficulty x % days. He is entating well" but is tachypneic and has increased
work of breathing.
&G.-" $--" %(" $$-/G-" BEH on 36.
6=> G.%+/G-/+-
What edical treatent does he need?
What respiratory support does he need?
%. %%yo7 college student presents with fever and 674. He has purpura everywhere and
looks extreely toxic.
(-.$" $(+" &-" G+/(-" I-H on 36.
6=> G.$-/&-/E-" lactate G.-" hgb $%.
He gets EC of *4 but is still in shock. )s started on pressors. He can counicate but
is confused.
He is intubated with the plan to provide echanical ventilation. Why?
What is a reasonable ventilation strategy?
% days later the patient develops bilateral pulonary infiltrates. Ventilated 2iO% is G-H.
What ventilator ad<ustent do you ake?