Ruben D Restrepo, MD, RRT, FAARC

Professor
The University of Texas Health Science Center at San Antonio

Essentials of Ventilator Graphics

2000 RespiMedu

Objectives
Identify

graphic display options

provided by mechanical
ventilators.

Describe

how to use graphics to

more appropriately adjust the
patient ventilator interface.

Essentials of Ventilator Graphics

2000 RespiMedu

Introduction
Monitoring and analysis of
graphic display of curves and
loops during mechanical
ventilation has become critical
to determine
how patient is being ventilated
to assess problems occurring during
ventilation
Essentials of Ventilator Graphics
2000 RespiMedu

Uses of Flow, Volume, and

Pressure
Graphic Displays
Confirm mode functions

Detect auto-PEEP
Determine patient-ventilator synchrony
Assess and adjust trigger levels
Measure the work of breathing
Adjust tidal volume and minimize
overdistension
Assess the effect of bronchodilator
administration

Essentials of Ventilator Graphics

2000 RespiMedu

Uses of Flow, Volume, and

Pressure
Graphic Displays

Detect equipment malfunctions

Determine appropriate PEEP level
Evaluate adequacy of inspiratory time
in pressure control ventilation
Detect the presence and rate of
continuous leaks
Assess inspiratory termination criteria
during Pressure Support Ventilation
Determine appropriate Rise Time

Essentials of Ventilator Graphics

2000 RespiMedu

SCALARS

Essentials of Ventilator Graphics

2000 RespiMedu

Graphics

LOOPS

Flow/Time
Pressure/Time
Volume/Time
Essentials of Ventilator Graphics
2000 RespiMedu

Pressure-Volume
Essentials of Ventilator Graphics
2000 RespiMedu

Flow-Volume

Flow/Time
Pressure/Time
Volume/Time
Essentials of Ventilator Graphics
2000 RespiMedu

Flow (L/min)

Spontaneous Breath

Inspiration
Time
(sec)
Expiration

Essentials of Ventilator Graphics

2000 RespiMedu

Flow (L/min)

Mechanical
Breath
Inspiration
Time
(sec)
Expiration
Essentials of Ventilator Graphics
2000 RespiMedu

Typical Flow Patterns

SQUARE

ACCELERATING
Essentials of Ventilator Graphics
2000 RespiMedu

DECELERATING

SINE

Inspiratory Flow
Pattern
Peak inspiratory flow rate
PIFR

Beginning of expiration
exhalation valve opens

Flow (L/min)

Inspiration
Insp. time
TI

Expiratory Time
TE

Time (sec)
Beginning of inspiration
exhalation valve closes

Essentials of Ventilator Graphics

2000 RespiMedu

Expiration

Total cycle time

TCT

Expiratory Flow
Pattern
Beginning of expiration
exhalation valve opens

Inspiration
Flow (L/min)

Expiratory
time
TE

Time (sec)
Duration of
expiratory flow

Expiration

Peak Expiratory Flow Rate

PEFR

Essentials of Ventilator Graphics

2000 RespiMedu

Inspiratory Pause

pause

Flow (L/min)

Inspiration

Time
(sec)

Expiration

Essentials of Ventilator Graphics

2000 RespiMedu

Inadequate Inspiratory
Flow
Patients effort

Active
Inspiration
Normal
Abnormal

Flow
(L/min)

Essentials of Ventilator Graphics

2000 RespiMedu

Time (sec)

Air Trapping

Flow (L/min)

Inspiration

Time (sec)
}
Air Trapping
Auto-PEEP

Expiration

Essentials of Ventilator Graphics

2000 RespiMedu

Normal
Patient

Response to
Bronchodilator
After

Flow (L/min)

Before

Time (sec)

PEFR

Long TE

Higher
PEFR
Essentials of Ventilator Graphics
2000 RespiMedu

Shorter TE

SCALARS

Flow/Time
Pressure/Time
Essentials of Ventilator Graphics
2000 RespiMedu

Volume/Time

Volume vs Time

Volume (ml)

Inspiratory Tidal Volume

Inspiration
Expiration

TI

Essentials of Ventilator Graphics

2000 RespiMedu

Time (sec)

Volume (ml)

Air Leak/Air
Trapping

Volume lost

Time (sec)
Essentials of Ventilator Graphics
2000 RespiMedu

SCALARS

Flow/Time
Pressure/Time
Volume/Time
Essentials of Ventilator Graphics
2000 RespiMedu

Spontaneous Breath
P aw (cm H 20)

Expiration

Time (sec)
Inspiration

Essentials of Ventilator Graphics

2000 RespiMedu

Paw (cm H2O)

Mechanical Breath
Peak Inspiratory Pressure
PIP

Inspiration

TI

Expiration
TE

PEEP

Time (sec)
Essentials of Ventilator Graphics
2000 RespiMedu

CONTROLLED BREATH

Paw (cm H2O)

(Time Triggered)
Mechanical

Time (sec)
Time Triggered Breath

Essentials of Ventilator Graphics

2000 RespiMedu

Assisted Breath

Paw (cm H2O)

(Patient Triggered)
Mechanical

Time (sec)
Patient Triggered Breath
Essentials of Ventilator Graphics
2000 RespiMedu

Assisted vs
Controlled
Pressure
(cmH20)

Assisted

Controlled

Time (sec)
Essentials of Ventilator Graphics
2000 RespiMedu

Paw (cm H2O)

Spontaneous vs.
Mechanical
Mechanical
Inspiration

Spontaneous
Expiration

Inspiration

Essentials of Ventilator Graphics

2000 RespiMedu

Expiration

Time (sec)

Paw (cm H2O)

Components of Inflation
Pressure
PIP

Pplateau

Transairway Pressure
(PTA)

Exhalation Valve Opens

Inspiratory Pause

(Palveolar)

Expiration

Time (sec)
Begin Inspiration

Essentials of Ventilator Graphics

2000 RespiMedu

Begin Expiration

Inadequate Inspiratory
Flow
Inadequate Flow

Paw
(cm H2O)

Adequate Flow

Time (sec)
Essentials of Ventilator Graphics
2000 RespiMedu

LOOPS

Pressure-Volume
Essentials of Ventilator Graphics
2000 RespiMedu

Flow-Volume

Pressure-Volume
Loop
(Type of Breath)
Vol (ml)

E
E
I

I
Controlled

Essentials of Ventilator Graphics

2000 RespiMedu

Assisted

I: Inspiration
E: Expiration

Spontaneous

Paw
(cm
H2O)

Components of
Pressure-Volume Loop

Volume
(mL)

In
sp
ir
at
io
n

Ex
pi
ra
tio
n

Paw (cm H2O)

Essentials of Ventilator Graphics
2000 RespiMedu

PIP

PEEP and P-V Loop

VT

Volume
(mL)

PEEP
Paw (cm H2O)

Essentials of Ventilator Graphics

2000 RespiMedu

PIP

Work of Breathing
Volume (ml)

Pressure (cm
H2O)
Essentials of Ventilator Graphics
2000 RespiMedu

A: Resistive Work
B: Elastic Work

Inflection Points
Upper Inflection Points

Volume (mL)

Lower Inflection Point

Pressure (cm H2O)
Essentials of Ventilator Graphics
2000 RespiMedu

Inadequate
Sensitivity
Volume
(mL)

Increased WOB
Essentials of Ventilator Graphics
2000 RespiMedu

Paw (cm H2O)

Air Leak/Air
Trapping
Volume (ml)

Air Leak
Pressure (cm H2O)

Essentials of Ventilator Graphics

2000 RespiMedu

Inadequate Inspiratory
Flow
Volume
(ml)

Active Inspiration
Inappropriate Flow

Normal
Abnormal

Paw (cm
H2O)
Essentials of Ventilator Graphics
2000 RespiMedu

Increased Raw
Higher PTA
Volume
(ml)

Higher PTA

Paw (cm
H2O)
Essentials of Ventilator Graphics
2000 RespiMedu

Hysteresis
Volume (ml)

Normal
Hysteresis
Abnormal
Hysteresis
Pressure (cm
H2O)
Essentials of Ventilator Graphics
2000 RespiMedu

Lung Compliance Changes

and the P-V Loop
Volume Targeted Ventilation

Preset VT

COMPLIANCE

Increased
Normal
Decreased
Volume (mL)
Paw (cm H2O)

Essentials of Ventilator Graphics

2000 RespiMedu

PIP levels

Lung Compliance Changes

and the P-V Loop

Pressure Targeted
Ventilation

Increased
Normal
Decreased

VT
levels

COMPLIANCE

Volume (mL)

Paw (cm H2O)

Essentials of Ventilator Graphics
2000 RespiMedu

Preset PIP

Overdistension
With little or no change in VTT

Volume (ml)

Normal
Abnormal

Pressure (cm H2O)

Essentials of Ventilator Graphics
2000 RespiMedu

Paw
rises

LOOPS

Pressure-Volume
Essentials of Ventilator Graphics
2000 RespiMedu

Flow-Volume

Flow-Volume Loop
Flow (L/min)

Inspiration
PIFR
FRC

VT

PEFR
Expiration
Essentials of Ventilator Graphics
2000 RespiMedu

Volume (ml)

Air Leak
Inspiration
Flow
(L/min)

Volume (ml)
Air Leak in mL

Normal
Abnormal
Expiration
Essentials of Ventilator Graphics
2000 RespiMedu

Air
Trapping
Inspiration
Flow
(L/min)
Does not return
to baseline

Volume (ml)

Normal
Abnormal

Essentials of Ventilator Graphics

2000 RespiMedu

Expiration

Increased Airway
Resistance
Inspiration
Flow
(L/min)
Volume (ml)

Normal
Abnormal

Scooped out
pattern
Decreased
PEFR

Essentials of Ventilator Graphics

2000 RespiMedu

Expiration

Airway Secretions/
Condensate in the Circuit
Inspiration
Flow
(L/min)
Volume (ml)

Normal
Abnormal

Essentials of Ventilator Graphics

2000 RespiMedu

Expiration

Essentials of Ventilator Graphics

2000 RespiMedu

Modes of Ventilation

Spontaneous
Volume
Targeted
Essentials of Ventilator Graphics
2000 RespiMedu

Mechanical

Pressure
Targeted

Spontaneous
Breath
Flow
L/m

Pressure
cm H2O

Volume
mL

Time (sec)
Essentials of Ventilator Graphics
2000 RespiMedu

CPAP
Flow
L/m

Pressure
cm H2O

CPAP level

Volume
mL
Time (sec)
Essentials of Ventilator Graphics
2000 RespiMedu

PSV
Patient Triggered, Flow Cycled, Pressure limited Mode
Flow Cycling

Flow
L/m

Pressure
cm H2O

Set PS
level

Volume
mL

Time (sec)
Essentials of Ventilator Graphics
2000 RespiMedu

CPAP + PSV
Flow Cycling
Flow
L/m

Set PS level

Pressure
cm H2O

CPAP level

Volume
mL
Time (sec)
Essentials of Ventilator Graphics
2000 RespiMedu

Modes of Ventilation

Mechanical

Spontaneous

Volume
Targeted
Essentials of Ventilator Graphics
2000 RespiMedu

Pressure
Targeted

Controlled Mode
(Volume- Targeted Ventilation)
Time triggered, Flow limited, Volume cycled Ventilation
Preset Peak Flow

Flow
L/m

Dependent on
CL & Raw

Pressure
cm H2O

Preset VT
Volume Cycling

Volume
mL
Essentials of Ventilator Graphics
2000 RespiMedu

Time (sec)

Assisted Mode
(Volume-Targeted Ventilation)
Patient triggered, Flow limited, Volume cycled Ventilation
Flow
L/m

Pressure
cm H2O
Preset VT

Volume
mL
Essentials of Ventilator Graphics
2000 RespiMedu

Volume Cycling

Time (sec)

SIMV
(Volume-Targeted Ventilation)

Flow
(L/min)

Press
(cm H O)
ure
2

Volume
(ml)

Essentials of Ventilator Graphics

2000 RespiMedu

Spontaneous Breaths

Controlled Mode
(Pressure-Targeted Ventilation)
Time Triggered, Pressure Limited, Time Cycled Ventilation

Time-Cycled
Time-

Flow
(L/min)

Pressure
(cm H2O)

Set PC
level

Volume
(ml)
Essentials of Ventilator Graphics
2000 RespiMedu

Time (sec)

Assisted Mode
(Pressure-Targeted Ventilation)
Patient Triggered, Pressure Limited, Time Cycled Ventilation
Time-Cycled

Flow
(L/min)

Press
(cm H O)
ure

Set PC
level

Volume
(ml)
Essentials of Ventilator Graphics
2000 RespiMedu

Time (sec)

SIMV Mode
(Pressure-Targeted Ventilation)

Flow
(L/min)

Press
(cm H O)
ure

Set PC level

Volume
(ml)

Time (sec)
Spontaneous Breath
Essentials of Ventilator Graphics
2000 RespiMedu

SIMV + PS
(Pressure-Targeted Ventilation)
Time-Cycled

FlowCycled

Flow
(L/min)

Press
(cm H O)
ure

Set PC level

Set PS level

Volume
(ml)

Time (sec)
Essentials of Ventilator Graphics
2000 RespiMedu

PS Breath

SIMV+PS
(Volume-Targeted Ventilation)
Flow

Flowcycled

(L/min)

Pressure

Set PS level

(cm H2O)

Volume
(ml)
Essentials of Ventilator Graphics
2000 RespiMedu

PS Breath

SIMV + PS + CPAP
(Pressure-Targeted Ventilation)
Flow
(L/min)

Press
(cm H O)
ure

Set PC level
Set PS level

CPAP level

Volume
(ml)

Time (sec)
Essentials of Ventilator Graphics
2000 RespiMedu

SIMV+PS + CPAP
(Volume-Targeted Ventilation)
Flow

(L/min)

Set PS level

Pressure
(cm H2O)

CPAP level

Volume
(ml)
Essentials of Ventilator Graphics
2000 RespiMedu

Time (sec)

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