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  • Mechanical Ventilation I

    Diunggah oleh

    Adimas Ratmanhana Kesuma
    15 tayangan22 halaman
    This document discusses mechanical ventilation and various ventilator modes. It describes types of ventilator breaths including volume-cycled, time-cycled, and flow-cycled breaths. Various modes of mechanical ventilation are outlined such as continuous positive airway pressure (CPAP), assist-control ventilation, pressure-support ventilation, synchronized intermittent mandatory ventilation (SIMV), and controlled mechanical ventilation. Key parameters like inspiratory plateau pressure, inspiratory to expiratory ratio, and auto-PEEP are also summarized. The goal of mechanical ventilation is to provide adequate ventilation and oxygenation while decreasing work of breathing and ensuring patient comfort.

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    This document discusses mechanical ventilation and various ventilator modes. It describes types of ventilator breaths including volume-cycled, time-cycled, and flow-cycled breaths. Various modes of mechanical ventilation are outlined such as continuous positive airway pressure (CPAP), assist-control ventilation, pressure-support ventilation, synchronized intermittent mandatory ventilation (SIMV), and controlled mechanical ventilation. Key parameters like inspiratory plateau pressure, inspiratory to expiratory ratio, and auto-PEEP are also summarized. The goal of mechanical ventilation is to provide adequate ventilation and oxygenation while decreasing work of breathing and ensuring patient comfort.

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    © All Rights Reserved
    Unduh sebagai PPT, PDF, TXT atau baca online dari Scribd
    Tandai sebagai konten tidak pantas
    15 tayangan22 halaman

    Mechanical Ventilation I

    Diunggah oleh

    Adimas Ratmanhana Kesuma
    This document discusses mechanical ventilation and various ventilator modes. It describes types of ventilator breaths including volume-cycled, time-cycled, and flow-cycled breaths. Various modes of mechanical ventilation are outlined such as continuous positive airway pressure (CPAP), assist-control ventilation, pressure-support ventilation, synchronized intermittent mandatory ventilation (SIMV), and controlled mechanical ventilation. Key parameters like inspiratory plateau pressure, inspiratory to expiratory ratio, and auto-PEEP are also summarized. The goal of mechanical ventilation is to provide adequate ventilation and oxygenation while decreasing work of breathing and ensuring patient comfort.

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    © All Rights Reserved
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    dari 22

    Mechanical Ventilation I

    MVA

    Objectives

    Describe types of breaths and modes of


    mechanical ventilation
    Describe interactions between ventilatory
    parameters and modifications needed to
    avoid harmful effects

    MVA

    Indications for
    Mechanical Ventilation

    Ventilation abnormalities
    Respiratory muscle dysfunction
    Respiratory muscle fatigue
    Chest wall abnormalities
    Neuromuscular disease

    Decreased ventilatory drive


    Increased airway resistance and/or
    obstruction
    MVA

    Indications for
    Mechanical Ventilation

    Oxygenation abnormalities
    Refractory hypoxemia

    Need for positive end-expiratory


    pressure (PEEP)
    Excessive work of breathing

    MVA

    Types of Ventilator Breaths

    Volume-cycled breath
    Volume breath
    Preset tidal volume

    Time-cycled breath
    Pressure control breath
    Constant pressure for preset time

    Flow-cycled breath
    Pressure support breath
    Constant pressure during inspiration
    MVA

    Modes of Mechanical
    Ventilation

    Consider trial of NPPV


    Determine patient needs
    Goals of mechanical ventilation
    Adequate ventilation and oxygenation
    Decreased work of breathing
    Patient comfort and synchrony

    MVA

    Modes of Mechanical Ventilation


    Point of Reference:
    Spontaneous Ventilation

    MVA

    Continuous Positive Airway


    Pressure (CPAP)

    No machine breaths delivered

    Allows spontaneous breathing at elevated


    baseline pressure
    Patient controls rate and tidal volume

    MVA

    Assist-Control Ventilation

    Volume or time-cycled breaths + minimal ventilator


    rate
    Additional breaths delivered with inspiratory effort
    Advantages: reduced work of breathing; allows
    patient to modify minute ventilation
    Disadvantages: potential adverse hemodynamic
    effects or inappropriate hyperventilation

    MVA

    Pressure-Support Ventilation

    Pressure assist during spontaneous inspiration


    with flow-cycled breath
    Pressure assist continues until inspiratory effort
    decreases
    Delivered tidal volume dependent on inspiratory
    effort and resistance/compliance of lung/thorax

    MVA

    Pressure-Support Ventilation

    Potential advantages

    Patient comfort
    Decreased work of breathing
    May enhance patient-ventilator synchrony
    Used with SIMV to support spontaneous breaths

    MVA

    Pressure-Support
    Ventilation

    Potential disadvantages
    Variable tidal volume if pulmonary
    resistance/compliance changes rapidly
    If sole mode of ventilation, apnea alarm mode
    may be only backup
    Gas leak from circuit may interfere with cycling

    MVA

    Synchronized Intermittent
    Mandatory Ventilation (SIMV)

    Volume or time-cycled breaths at a preset


    rate
    Additional spontaneous breaths at tidal
    volume and rate determined by patient
    Used with pressure support

    MVA

    Synchronized Intermittent
    Mandatory Ventilation
    (SIMV)

    Potential advantages

    More comfortable for some patients


    Less hemodynamic effects

    Potential disadvantages
    Increased work of breathing

    MVA

    Controlled Mechanical
    Ventilation

    Preset rate with volume or time-cycled breaths


    No patient interaction with ventilator
    Advantages: rests muscles of respiration
    Disadvantages: requires sedation/neuro-muscular
    blockade, potential adverse hemodynamic effects

    MVA

    Inspiratory Plateau Pressure


    (IPP)

    Airway pressure measured at end of inspiration with


    no gas flow present
    Estimates alveolar pressure at end-inspiration
    Indirect indicator of alveolar distension
    PIP
    Plateau pressure

    Inspiration

    Peak pressure

    Expiration
    MVA

    Plateau pressure

    Inspiratory Plateau Pressure

    High inspiratory plateau pressure


    Barotrauma
    Volutrauma
    Decreased cardiac output

    Methods to decrease IPP


    Decrease PEEP
    Decrease tidal volume

    MVA

    Inspiratory Time: Expiratory


    Time Relationship (I:E ratio)

    Spontaneous breathing I:E = 1:2


    Inspiratory time determinants with volume
    breaths

    Tidal volume
    Gas flow rate
    Respiratory rate
    Inspiratory pause

    Expiratory time passively determined


    MVA

    I:E Ratio during Mechanical


    Ventilation

    Expiratory time too short for exhalation


    Breath stacking
    Auto-PEEP

    Reduce auto-PEEP by shortening


    inspiratory time
    Decrease respiratory rate
    Decrease tidal volume
    Increase gas flow rate
    MVA

    Auto-PEEP

    Can be measured on some ventilators


    Increases peak, plateau, and mean airway
    pressures
    Potential harmful physiologic effects

    MVA

    Auto-PEEP

    Can be measured on some ventilators


    Increases peak, plateau, and mean airway
    pressures
    Potential harmful physiologic effects

    MVA

    Key Points

    MVA

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