Basic Principles of Mechanical Ventilation Andventilator Graphics

7/24/2019 Basic Principles of Mechanical Ventilation Andventilator Graphics

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BASIC PRINCIPLES OF MECHANICALBASIC PRINCIPLES OF MECHANICAL

VENTILATION ANDVENTILATORVENTILATION ANDVENTILATOR

GRAPHICSGRAPHICS


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BASIC PRINCIPLES OF MECHANICALBASIC PRINCIPLES OF MECHANICAL

VENTILATIONVENTILATION

Regardless of the disease states he! a "atie!tfails to #e!tilate or o$%ge!ate ade&'atel% the"ro(le) lies i! * of + "atho"h%siologi,al fa,tors

*- I!,reased aira% resista!,e

.- Cha!ge i! l'!g ,o)"lia!,e

/- H%"o#e!tilatio!

0- V12 )is)at,h3- I!tra"'l)o!ar% sh'!ti!g

+- Di4'sio! defe,ts


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CONDITIONS LEADING TO AIRWAY RESISTANCEE)"h%se)aAsth)aBro!,hie,tasisPosti!t'(atio! o(str',tio!Foreig! (od%E!dotra,heal t'(e Co!de!satio! i! #e!t ,ir,'itALTBBro!,hiolitisE"iglottitis


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AIRWAY RESISTANCE AND WORK OF

BREATHINGAira% resista!,e < Ra> is P1 V

P9"ea? aira% "ress're6"latea' "ress're

V9:oI!,rease i! aira% resista!,e )ea!s i!,rease

i! or? of (reathi!g


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VENTILATOR@ FAILRE is fail're of l'!gs to

eli)i!ate CO.

OGENATION FAILRE is fail're of l'!g a!dheart to "ro#ide ade&'ate o$%ge! for)eta(oli, !eeds


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LUNG COMPLIANCE

Co)"lia!,e is l'!g e$"a!sio!


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LUNG COMPLIANCE CONT-Stati, ,o)"lia!,e re:e,ts the elasti,

"ro"erties of l'!g a!d,hest all

D%!a)i, ,o)"lia!,e re:e,ts the aira%resista!,e a!d the elasti,

"ro"erties of l'!g a!d,hest all

Co!ditio!s ,a'si!g ,ha!ge i! stati,

,o)"lia!,e i!#o?e si)ilar ,ha!ges i! d%!a)i,

,o)"lia!,e

here aira% resista!,e is the o!l%a(!or)alit% d%!a)i, ,o)"lia!,e ,ha!ge

i!de"e!de!tl%


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CLINICAL CONDITIONS THAT DECREASE THE

COMPLIANCE

T@PE OF COMPLIANC

1. STATIC

1. DYNAMIC

CONDITIONS

*- ATELECTASIS

.- ARDS/- P!e')othora$

0- O(esit%

3- Retai!ed se,retio!s

*- Bro!,hos"as)

.- i!?i!g of ET t'(e

/- Aira% o(str',tio!


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HIGH COMPLIANCEE)"h%se)a

S'rfa,ta!t thera"%


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VENTILATORY FAILURE

3 )e,ha!is)s lead to #e!tilator% fail're

*- H%"o#e!tilatio!

.- Persiste!t #e!tilatio! "erf'sio! )is)at,h/- Persiste!t i!tra"'l)o!ar% sh'!ti!g

0- Di4'sio! defe,t

3- Red',tio! i! PIO. i-e- i!s"ired o$%ge!te!sio!


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HYPOVENTILATIONCa'sed (% de"ressio! i! CNS

Ne'ro)'s,'lar disease

Aira% o(str',tio!I! a ,li!i,al setti!g h%"o#e!tilatio! is

,hara,terised (% a red',tio!of al#eolar#e!tilatio! a!d i!,rease i! arterial CO.

te!sio!


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VENTIATION PERFSION MISMATCHDisease "ro,ess hi,h ,a'ses o(str',tio! or

atele,tasis res'lt i! less o$%ge! (ei!g a#aila(leleadi!g to lo V12

P'l)o!ar% e)(olis) is a! e$a)"le that de,reases"'l)o!ar% "erf'sio! a!d high V12

T1T i! )e,ha!i,al #e!tilatio! i!,l'de i!,reasi!grate ; tidal #ol')e ; FiO.

T1t dire,ti!g toards re)o#i!go(str',tio!;re,r'iti!g atele,tati, =o!es a!d"re#e!ti!g ,los're


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INTRAPULMONARY SHUNTINGCa'ses refra,tor% h%"o$ia

!or)al sh'!t is less tha! *5

*56.5)ild sh'!t.56/5 sig!i7,a!t sh'!t

/5 ,riti,al a!d se#ere sh'!t

eg "!e')o!ia a!d ARDS

Classi, 2s12t9< C,O.6CaO.>1


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DIFFUSION DEFECT

TYPE1. Decrease ! "ress#re

$ra%e!&

'. T(c)e!!$ *+ A-C,e,ra!e

. Decrease s#r+acearea*+ A-C ,e,ra!e

/. I!s#0ce!& &,e *+%#s*!

CLINICAL CONDITIONS1. H$( a2&%e3 4re

c*,#s&*!

'. P#2,*!ar5 e%e,a a!%re&a!e% secre&*!s

. E,"(5se,a 3"#2,*!ar5 4r*ss

/. &ac(5car%a


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T%"es of a#efor)sT%"es of a#efor)sVol')e Modes Press're Modes

Vol')e Co!trol1 SIMV Press're Co!trol1PRVC

SIMV SIMV

Press're S'""ort1Vol')e S'""ort

Press'r

e

Flo

Vo

l')e

Press'r

e

Flo

Vol')e


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Press're1Ti)e S,alarPress're1Ti)e S,alar

I! Vol')e )odes;the sha"e ill (ea! e$"o!e!tialrise or a!a,,elerati!g ra)"for )a!dator%

(reaths-

I! Press're )odes; thesha"e ill (ere,ta!g'lar or s&'are-

This )ea!s that"ress're re)ai!s,o!sta!t thro'gho'tthe (reath ,%,le-

I! Vol')e )odes; addi!g a! i!s"irator% "a'se )a% i)"ro#e distri('tio! of #e


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Air tra""i!g


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The (aseli!e for the "ress're a#efor) i!,reases he! PEEP isadded-

There ill (e a !egati#e de:e,tio! J'st (efore the a#efor) ithatie!t tri ered (reaths-

3

*3

No "atie!t e4ort Patie!t e4ort

PEEP K3


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AB

1

2

I!s"irator% "a'se

= MAP

* 9 Pea? I!s"irator% Press're . 9 Platea' Press're


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I!,reased Aira%Resista!,e

De,reasedCo)"lia!,e

PIP

P"lat

PIP

P"lat

A. B.

A6A! i!,rease i! aira% resista!,e ,a'ses the PIP to i!,rease; ('t P"lat"ress're re)ai!s !or)al-B6A de,rease i! l'!g ,o)"lia!,e ,a'ses the e!tire a#efor) to i!,rease i!

si=e-The di4ere!,e (etee! PIP a!d P lat re)ai! !or)al-


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Vol')e1Ti)e S,alarVol')e1Ti)e S,alar

The Vol')e a#efor) ill ge!erall% ha#e a )o'!tai!"ea? a""eara!,e at the to"- It )a% also ha#e a "latea';or :atte!ed area at the "ea? of the a#efor)-

There ill also (e a "latea' if a! i!s"irator% "a'se set or i!s"irator% hold

)a!e'#er is a""lied to the (reath-


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Vol')e1Ti)e S,alarVol')e1Ti)e S,alar

Air6Tra""i!g or Lea?

If the e$halatio! side of the a#efor) does!8t ret'r! to (aseli!e; it

,o'ld (e fro) air6tra""i!g or there ,o'ld (e a lea?


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Flo1Ti)e S,alarFlo1Ti)e S,alar

I! Vol')e )odes; thesha"e of the a#efor)ill (e s&'are orre,ta!g'lar-

This )ea!s that :ore)ai!s ,o!sta!tthro'gho't the (reath,%,le-

I! Press're )odes;

the sha"e of thea#efor) ill ha#ea de,elerati!gra)" :o "atter!-


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Air tra""i!g Flo a#efor) Sha"eI!s"irator% FloAs%!,hro!%

Triggeri!g E4ort

Ca! (e 'sed to assess


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Vol')e Press're


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The de,elerati!g :o "atter! )a% (e "referred o#er the ,o!sta!t :o

"atter!- The sa)e tidal #ol')e is deli#ered; ('t ith a loer "ea? "ress're-


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A'to6Pee"

If e$"irator% :o does!8t ret'r! to (aseli!e (efore the !e$t (reath starts;

there8s a'to6PEEP "rese!t ; e-g- e)"h%se)a-

Start of !e$t (reath

E$"irator% :odoes!8t ret'r!

to (aseli!e

9 Nor)al


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Bro!,hodilator Res"o!se

To assess res"o!se to (ro!,hodilator thera"%; %o' sho'ld see a! i!,rease i!"ea? e$"irator% :o rate-

The e$"irator% ,'r#e sho'ld ret'r! to (aseli!e soo!er-

Pea? E$"- Flo

I)"ro#ed Pea? E$"- Flo

ShorterE6ti)e

Lo!gerE6ti)e

Pre6Bro!,hodilator Post6Bro!,hodilator


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T%"es of a#efor)sT%"es of a#efor)sVol')e Modes Press're Modes

I! Press're Li)ited; Ti)e6,%,led )odes; i!s"irator% :o sho'ld ret'r! to(aseli!e- 6

Vol')e Co!trol1 SIMV Press're Co!trol1PRVC

SIMV SIMV

Press're S'""ort1Vol')e S'""ort

Press'r

e

Flo

Vo

l')e

Press'r

e

Flo

V

ol')e


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Noti,e the area of !o :o i!di,ated (% the red li!e- This is ?!o! as a =ero6:o state-

T%"es of a#efor)sT%"es of a#efor)s


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15 305

250

500

Press're1Vol')e Loo"sPress're1Vol')e Loo"s


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Vol')e is "lotted o! the %6a$is; Press're o!the $6a$is-

I!s"irator% ,'r#e is '"ard; E$"irator% ,'r#e

is do!ard-S"o!ta!eo's (reaths go ,lo,?ise a!d

"ositi#e "ress're (reaths go ,o'!ter,lo,?ise-The (otto) of the loo" ill (e at the set PEEP

le#el- It ill (e at 5 if there8s !o PEEP set-If a! i)agi!ar% li!e is dra! do! the )iddle

of the loo"; the area to the right re"rese!tsi!s"irator% resista!,e a!d the area to the leftre"rese!ts e$"irator% resista!,e-


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L'!g O#erdiste!tio!

Aira% O(str',tio!Bro!,hodilator Res"o!seRes"irator% Me,ha!i,s

OBFlo Star#atio!Lea?sTriggeri!g E4ort



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inspira

tion

expirati

on

15 305

D%!a)i,Co)"lia!,e

AA9I!s"irator%Resista!,e1Resisti#eOB

B


(Cdyn)

The to" "art of the P1V loo" re"rese!ts D%!a)i, ,o)"lia!,e -Cd%! 9 #ol')e1"ress're

500

250

B= Exp.

Resistance/Elastic WOB


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15 305

O#erdiste!tio!

beaking

Press're ,o!ti!'es to rise ith little or !o ,ha!ge i! #ol')e; ,reati!g a (ird

(ea?-Fi$ ( red',i! a)o'!t of tidal #ol')e deli#ered

500

250


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15 305

250

500

15 305


I!,reased Co)"lia!,e De,reasedCo)"lia!,e

E$a)"le

E)"h%se)a;

E$a)"le ARDS; CHF;

Atele,tasis

500

250


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Poi!t of '""er i!:e,tio!


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Flo1Vol')e Loo"sFlo1Vol')e Loo"s

0

200 400 600

20

40

60

-20

-40

-60


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Flo is "lotted o! the % a$is a!d #ol')e o! the $a$is

Flo #ol')e loo"s 'sed for #e!tilator gra"hi,s

are the sa)e as o!es 'sed for P'l)o!ar% F'!,tio!Testi!g;


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Air tra""i!g

Aira% O(str',tio!Aira% Resista!,eBro!,hodilator Res"o!seI!s"1E$" Flo

Flo Star#atio!Lea?sater or Se,retio!a,,')'latio!

As%!,hro!%



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0

200 400 600

20

40

60

-20

-40

-60

PEF

Start ofI!s"iratio!

Start ofE$"iratio!


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DIFFERENT FLO VOLME LOOPS

A; !or)al loo"

B s?i6slo" o(ser#er#ed i! e$"-Flo li)itatio!

C E$trathora,i, aira%o(str',tio! ith i!s"irator%a!d e$"irator% air :oli)itatio! see! i! s'(gloti,ste!osis a!d !arroe!dotra,heal t'(e

D I!trathora,i, i!s"irator%air:o li)itatio!as see! ith(a(ies ith i!tral')i!alo(str',tio!

E '!sta(le aira% egtra,heo)ala,ia

F Errati, air:o i! se,retio!s


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0

200 400 600

20

40

60

-20

-40

-60

E$"irator%"ortio! of loo"does !otret'r! tostarti!g "oi!t;i!di,ati!g alea?-

A Lea?

If there is a lea?; the loo" ill !ot )eet at the starti!g "oi!t here i!halatio!

starts a!d e$halatio! e!ds- It ,a! also o,,'r ith air6tra""i!g-

9 Nor)al


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Air Tra""i!g

Ca'ses

I!s',ie!t e$"irator% ti)e

Earl% ,olla"se of '!sta(le al#eoli1aira%s d'ri!g e$halatio!

Ho to Ide!tif% it o! the gra"hi,s

Press're a#e hile "erfor)i!g a! e$"irator% hold; thea#efor) rises a(o#e (aseli!e-

Flo a#e the e$"irator% :o does!8t ret'r! to (aseli!e(efore the !e$t (reath (egi!s-

Vol')e a#e the e$"irator% "ortio! does!8t ret'r! to (aseli!e-

Flo1Vol')e Loo" the loo" does!8t )eet at the (aseli!e

Press're1Vol')e Loo" the loo" does!8t )eet at the (aseli!e


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Aira% Resista!,eAira% Resista!,e

Cha!gesCha!gesCa'ses

Bro!,hos"as) ETT "ro(le)s


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Co)"lia!,e Cha!gesCo)"lia!,e Cha!ges

De,reased ,o)"lia!,e Ca'ses

ARDS Atele,tasis A(do)i!al diste!sio!

CHF Co!solidatio! Fi(rosis H%"eri!:atio! P!e')othora$ Ple'ral e4'sio!

Ho to Ide!tif% it o! thegra"hi,s

Press're a#e PIP a!d"latea' (oth i!,rease

Press're1Vol')e loo" la%s)ore hori=o!tal

I!,reased ,o)"lia!,e Ca'ses

E)"h%se)a S'rfa,ta!t Thera"%

Ho to Ide!tif% it o! thegra"hi,s

Press're a#e PIP a!d"latea' (oth de,rease

Press're1Vol')e loo"Sta!ds )ore #erti,al


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Lea?sLea?s

Ca'ses E$"irator% lea? ETT ,'4 lea? ; ,hest t'(e lea?; BP 7st'la; NGt'(e i! tra,hea

I!s"irator% lea? loose ,o!!e,tio!s; #e!tilator )alf'!,tio!;fa'lt% :o se!sor

Ho to ID it Press're a#e De,reased PIP

Vol')e a#e E$"irator% side of a#e does!8t ret'r! to(aseli!e

Flo a#e PEF de,reased

Press're1Vol')e loo" e$" side does!8t ret'r! to the (aseli!e Flo1Vol')e loo" e$" side does!8t ret'r! to (aseli!e

Ho to 7$ it Che,? "ossi(le ,a'ses listed a(o#e

Do a lea? test a!d )a?e s're all ,o!!e,tio!s are tight


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As%!,hro!%As%!,hro!% Ca'ses

Air h'!ger Ne'rologi,al I!J'r% I)"ro"erl% set se!siti#it%

Ho to ID it Press're a#e "atie!t tries to i!hale1e$hale i! the )iddle of the

a#efor); ,a'si!g a di" i! the "ress're

Flo a#e "atie!t tries to i!hale1e$hale i! the )iddle of the a#efor);,a'si!g errati, :os1di"s i! the a#efor)

Press're1Vol')e loo" "atie!t )a?es e4ort to (reath ,a'si!g di"s i!loo" either I!s"1E$"-

Flo1Vol')e loo" "atie!t )a?es e4ort to (reath ,a'si!g di"s i! loo"either I!s"1E$"-

Ho to 7$ it Tr% i!,reasi!g the :o rate; de,reasi!g the I6ti)e; or i!,reasi!g the setrate to ,a"t're the "atie!t-

Cha!ge the )ode 6 so)eti)es ,ha!gi!g fro) "artial to f'll s'""ort illsol#e the "ro(le)

If !e'rologi,al; )a% !eed "aral%ti, or sedati#e AdJ'st se!siti#it%


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As%!,hro!%As%!,hro!%Flo Star#atio!

The i!s"irator% "ortio! of the "ress're a#e shos a s,oo"i!g or di"; d'eto i!ade&'ate :o-


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As%!,hro!%As%!,hro!%

F1V Loo" P1V Loo"


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Rise Ti)eRise Ti)e

The i!s"irator% rise ti)e deter)i!es thea)o'!t of ti)e it ta?es to rea,h the desiredaira% "ress're or "ea? :o rate-

sed to assess if #e!tilator is )eeti!g "atie!t8s de)a!d i! Press're S'""ort

)ode-I! SIMV rise ti)e (e,o)es a of the (reath , ,le-


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Rise Ti)eRise Ti)e

If rise ti)e is too fast; %o' ,a! get a! o#ershoot i! the"ress're a#e; ,reati!g a "ress're s"i?e- If this o,,'rs; %o'

!eed to i!,rease the rise ti)e- This )a?es the :o #al#eo"e! a (it )ore slol%-

If rise ti)e is too slo; the "ress're a#e (e,o)es ro'!dedor sla!ted; he! it sho'ld (e )ore s&'are- This ill de,reaseVt deli#er% a!d )a% !ot )eet the "atie!t8s i!s"irator%de)a!ds- If this o,,'rs; %o' ill !eed to de,rease the riseti)e to o"e! the #al#e faster-

too slotoo fast

"ress're s"i?e


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I!s"irator% C%,le O4I!s"irator% C%,le O4

The i!s"irator% ,%,le o4 deter)i!es he! the#e!tilator :o ,%,les fro) i!s"iratio! toe$"iratio!; i! Press're S'""ort )ode-

The :o6,%,li!g #aria(le is gi#e! di4ere!t !a)es de"e!di!g o! the t%"e of#e!tilator-

Also ?!o asI!s"irator% :oter)i!atio!;E$"irator% :o se!siti#it%;

I!s"irator% :o ,%,le ;E6,%,le et,


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The (reath e!ds he! the #e!tilator dete,ts i!s"irator% :o has dro""ed to

a s"e,i7, :o #al'e-

I!s"iratio! e!ds

"ress're

:o


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I! the a(o#e e$a)"le; the )a,hi!e is set to ,%,le i!s"iratio! o4 at /5 ofthe "atie!t8s "ea? i!s"irator% :o-

*55 of Patie!t8sPea? I!s"irator%Flo

Flow

*55

35

/5

3


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A The ,%,le o4 "er,e!tage is too high; ,%,li!g o4 too soo!- This )a?es the(reath too s)all-


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So'r,esSo'r,es

Ra"id I!ter"retatio! of Ve!tilator a#efor)sVe!tilator a#efor) A!al%sis

S'sa! Pearso!

Golde! Mo)e!ts i! Me,ha!i,al Ve!tilatio! Ma&'et; i!,-

Ser#o6I Gra"hi,s Ma&'et; i!,-

te$t (oo? of "h%siolog%6 Ga!o!g Da#id Cha!g ,li!i,al a""li,atio! of )e,ha!i,al

#e!tilatio!

P'l)o!ar% f'!,tio! a!d gra"hi,s 6Golds)ith


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Tha!? @o'Tha!? @o'

Basic Principles of Mechanical Ventilation Andventilator Graphics

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