ESSENTIALS OF VENTILATOR GRAPHICS

Developed by:

Ruben D Restrepo, MD, RRTVijay M Deshpande, MS, RRT, FAARC

Assistant ProfessorsGeorgia State University

Atlanta, Georgia

ESSENTIALS ESSENTIALS OF OF

VENTILATOR GRAPHICSVENTILATOR GRAPHICS

Except as permitted under the Copyright Except as permitted under the Copyright Act of 1976, no part of this material may Act of 1976, no part of this material may be reproduced in whole or in part in any be reproduced in whole or in part in any

manner without permission in writing from manner without permission in writing from the copyright ownersthe copyright owners. . Printed in the U.S.A.Printed in the U.S.A.

Mechanical Ventilation

GraphicsGraphicsSCALARS LOOPS

SCALARS

Flow/TimePressure/Time

Volume/Time

Pressure-Volume Flow-Volume

SCALARS

Volume/Time

Spontaneous Breath

Time (sec)

in) InspirationInspiration

ExpirationExpiration

Mechanical Breath

Inspiration

Expiration

Time (sec)

Typical Flow Patterns

ACCELERATINGACCELERATING

DECELERATINGDECELERATING

SINESINE

SQUARESQUARE

Inspiratory Flow Pattern

Inspiration

Expiration

Time (sec)

Beginning of inspirationexhalation valve closes

Peak inspiratory flow ratePIFR

Beginning of expirationexhalation valve opens

Total cycle timeTCT

Insp. timeTI

Expiratory Time TE

Expiratory Flow Pattern

Inspiration

Expiration

Time (sec)

Beginning of expirationexhalation valve opens

Peak Expiratory Flow RatePEFR

Duration of expiratory flow

Expiratory time

Inadequate Inspiratory Flow

Flow (L/min)

Time (sec)

NormalAbnormal

Active Inspiration or Active Inspiration or AsynchronyAsynchrony

Patient’s effort

Obstruction vs Active Expiration

Obstruction Active Expiration

Time (sec)

NormalAbnormal

Flow (L/min)

Air TrappingInspiration

Expiration

NormalNormalPatientPatient

Time (sec)

Air TrappingAuto-PEEP

Response to Bronchodilator

Before

Time (sec)

Long TE

Higher PEFR

Shorter TE

SCALARS

Volume/Time

Volume vs Time

InspirationInspiration

Expiration

Time (sec)Time (sec)

Inspiratory Tidal Volume

Air LeakVo

Air LeakAir Leak

Active Exhalation

Volume (ml)Volume (ml)

SCALARS

Volume/Time

Spontaneous BreathPP awaw

220)0)

InspirationInspiration

Mechanical Breath

InspirationExpirationP a

Time (sec)

Peak Inspiratory PressurePIP

PEEPPEEPTE

Mechanical

Time (sec)

P aw (

Time Triggered Breath

CONTROLLED BREATH(Time Triggered)

Assisted Breath(Patient Triggered)

Mechanical

Time (sec)

P aw (

Patient Triggered Breath

Assisted vs Controlled

Time (sec)

Assisted ControlledPressure (cmH20)

Spontaneous vs. Mechanical

MechanicalMechanical

Time (sec)

SpontaneousSpontaneousPaw (cm H2O)

Inspiration

Components of Inflation Pressure

Begin Expiration

P aw (

Time (sec)

Begin Inspiration

PIPPIP

Pplateau

(Palveolar)

Transairway Pressure (PTA)}}

Exhalation Valve Opens

Inspiratory Pause

Begin Inspiration Begin Expiration

P aw (

Time (sec)

Airway

Resistan

Distending (Alveolar) Pressure Expiration

Inflation Hold(seconds)

Begin Expiration

P aw (

Time (sec)Begin Inspiration

PIPPIP

Pplateau

(Palveolar

Transairway Pressure (PTransairway Pressure (PTATA))}}Exhalation Valve Opens

Expiration

PIP vs Pplat

Normal High Raw

High Flow Low Compliance

Time (sec)

PIPPIP

PPPlatPlat

PIPPIP

PIPPIP PIPPIP

PPPlatPlatPPPlatPlat

Normal

Normal PPlat(Normal Compliance)

Increased PIP

} Increased PTA(increased Airway Resistance))

NormalNormalPIPPIP

PPPlatPlat

High RHigh RawawPIPPIP

PPPlatPlat

Increased Airway Resistance

Effect of increased Flow

Time (sec)

)NormalNormal

PIPPIPHigh FlowHigh Flow

PIPPIP

Dynamic Inspiratory TimeDecreased Inspiratory TimeInspiratory Time(Due to High Inspiratory Flow)

Normal

DECREASED COMPLIANCE

Time (sec)

)Low CompliancePIPPPlat

NormalNormalPIP

Normal PPlat(Normal Compliance)

Increased PPlat(Decreased Compliance))

Normal

Adequate Flow

Time (sec)

Inadequate Flow

Pressure-Volume Loop

(Type of Breath)

Controlled Assisted Spontaneous

Paw (cm H2O)

I: InspirationE: Expiration

FRC and PV Loop

FRCVOLU

Negative Positive0

DISTENDING PRESSURE

Normal Compliance

Components of Pressure-Volume

Volume Volume (mL)(mL)

iratio

PPawaw (cm H (cm H22O)O)

PEEP and P-V Loop

Volume (mL)

PIPPIPPaw (cm H2O)

PEEP PEEP

Work of Breathing

A: Resistive Work B: Elastic Work

Pressure (cm H2O)

Volume (ml)

Inflection Points

Pressure (cm H2O)

Volume (mL)

Upper Inflection Point

Lower Inflection Point

Inadequate Sensitivity

Volume Volume (mL)(mL)

PPawaw (cm H (cm H22O)O)Increased WOB

Air LeakVolume (ml)

Pressure (cm HPressure (cm H22O)O)

Air Leak

PPaw aw (cm (cm HH22O)O)

Volume Volume (ml)(ml)

NormalAbnormal

Active InspirationActive Inspiration

Inappropriate FlowInappropriate Flow

Increased Raw

Pressure (cm Pressure (cm HH22O)O)

Higher PTA

Normal

Vol (mL)Vol (mL)

Lower Slope

HysteresisVolume (ml)

Pressure (cm Pressure (cm HH22O)O)

Abnormal Hysteresis

Normal Hysteresis

Lung Compliance Changes and the P-V

Volume (mL)Volume (mL)

PIP levels

Preset VT

COMPLIANCEIncreasedNormalDecreased

Volume Targeted Ventilation

Lung Compliance Changes and the P-V

Volume (mL)Volume (mL)

Preset PIP

COMPLIANCEIncreasedNormalDecreased

Pressure Targeted Ventilation

Overdistension

Pressure (cm HPressure (cm H22O)O)

With little or no change in VT

Paw rises

NormalAbnormal

Flow-Volume Loop

Inspiration

Expiration

i n) PIFR

Air Leak

Inspiration

Expiration

Volume (ml)

Flow Flow (L/min)(L/min)

Air Leak in mL

NormalAbnormal

Air Trapping

Inspiration

Expiration

Flow (L/min)

Does not returnDoes not returnto baselineto baseline

NormalAbnormal

Increased Airway Resistance

Inspiration

Expiration

VolumeVolume (ml) (ml)

Flow (L/min)

Decreased PEFR

NormalNormalAbnormal“Scooped out”

pattern

Airway Secretions/Water in the Circuit

Inspiration

Expiration

Flow (L/min)

NormalAbnormal

Modes of Ventilation

Spontaneous Mechanical

Volume Targeted

PressureTargeted

Volume Targeted

PressureTargeted

Spontaneous Breath

Time (sec)

FlowL/m

Pressurecm H2O

VolumemL

CPAP level

FlowL/m

Pressurecm H2O

VolumemL

Time (sec)

FlowL/m

Pressurecm H2O

VolumemL

Flow Cycling

Set PS level

Patient Triggered, Flow Cycled, Pressure limited Mode

CPAP + PSV

Set PS level

CPAP level

FlowL/m

Pressurecm H2O

VolumemL

Flow Cycling

Volume Targeted

PressureTargeted

Controlled Mode (Volume- Targeted

Ventilation)

Preset VT

Volume Cycling

Dependent onCL & Raw

FlowL/m

Pressurecm H2O

VolumemL

Preset Peak Flow Time triggered, Flow limited, Volume cycled Ventilation

Assisted Mode(Volume-Targeted

Ventilation)

FlowL/m

Pressurecm H2O

VolumemL

Preset VT

Volume Cycling

Patient triggered, Flow limited, Volume cycled Ventilation

SIMV(Volume-Targeted

Ventilation)

Spontaneous Breaths

FlowL/m

Pressurecm H2O

VolumemL

Controlled Mode (Pressure-Targeted

Ventilation)

Pressure

Volume

(L/min)

(cm H2O)

(ml)Time (sec)Time (sec)

Time-Time-Cycled

Set PC level

Time Triggered, Pressure Limited, Time Cycled Ventilation

Assisted Mode (Pressure-Targeted

Ventilation)

Pressure

Volume

(L/min)

(cm H2O)

Set PC level

Time-Cycled

Patient Triggered, Pressure Limited, Time Cycled Ventilation

Pressure

Volume

(L/min)

(cm H2O)

Set PC levelSet PC level

SIMV Mode (Pressure-Targeted

Ventilation)

Spontaneous Breath

Pressure

Volume

(L/min)

(cm H2O)

SIMV + PS (Pressure-Targeted

Ventilation)

PS Breath

Set PS levelSet PC levelSet PC level

Time (sec)

Time-Cycled Flow-Cycled

SIMV+PS(Volume-Targeted

Ventilation)

Pressure

Volume

(L/min)

(cm H2O)

Set PS level

PS Breath

Flow-cycled

Pressure

Volume

(L/min)

(cm H2O)

Set PC levelSet PC level

SIMV + PS + CPAP (Pressure-Targeted

Ventilation)

Set PS level

CPAP levelCPAP level

SIMV+PS + CPAP(Volume-Targeted

Ventilation)

Pressure

Volume

(L/min)

(cm H2O)

Set PS level

CPAP levelCPAP level

Time (sec)

ESSENTIALS OF VENTILATOR GRAPHICS

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