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Essentials of Ventilator Graphics ©2000 RespiMedu
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
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Essentials of Ventilator Graphics ©2000 RespiMedu
COPYRIGHT NOTICECOPYRIGHT NOTICE© 2000 RespiMedu, Inc.© 2000 RespiMedu, Inc.
Essentials of Ventilator Graphics. Essentials of Ventilator Graphics. All rights reserved. All rights reserved.
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.
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Essentials of Ventilator Graphics ©2000 RespiMedu
Mechanical Ventilation
GraphicsGraphicsSCALARS LOOPS
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Essentials of Ventilator Graphics ©2000 RespiMedu
SCALARS
Flow/TimePressure/Time
Volume/Time
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Essentials of Ventilator Graphics ©2000 RespiMedu
Pressure-Volume Flow-Volume
LOOPS
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Essentials of Ventilator Graphics ©2000 RespiMedu
SCALARS
Flow/TimePressure/Time
Volume/Time
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Essentials of Ventilator Graphics ©2000 RespiMedu
Spontaneous Breath
Time (sec)
Flow
(L/m
in) InspirationInspiration
ExpirationExpiration
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Essentials of Ventilator Graphics ©2000 RespiMedu
Mechanical Breath
Inspiration
Expiration
Flow
(L/m
in)
Time (sec)
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Essentials of Ventilator Graphics ©2000 RespiMedu
Typical Flow Patterns
ACCELERATINGACCELERATING
DECELERATINGDECELERATING
SINESINE
SQUARESQUARE
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Essentials of Ventilator Graphics ©2000 RespiMedu
Inspiratory Flow Pattern
Inspiration
Expiration
Time (sec)
Flow
(L/m
in)
Flow
(L/m
in)
Beginning of inspirationexhalation valve closes
Peak inspiratory flow ratePIFR
Beginning of expirationexhalation valve opens
Total cycle timeTCT
Insp. timeTI
Expiratory Time TE
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Essentials of Ventilator Graphics ©2000 RespiMedu
Expiratory Flow Pattern
Inspiration
Expiration
Time (sec)
Flow
(L/m
in)
Beginning of expirationexhalation valve opens
Peak Expiratory Flow RatePEFR
Duration of expiratory flow
Expiratory time
TE
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Essentials of Ventilator Graphics ©2000 RespiMedu
Inadequate Inspiratory Flow
Flow (L/min)
Time (sec)
NormalAbnormal
Active Inspiration or Active Inspiration or AsynchronyAsynchrony
Patient’s effort
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Essentials of Ventilator Graphics ©2000 RespiMedu
Obstruction vs Active Expiration
Obstruction Active Expiration
Time (sec)
NormalAbnormal
Flow (L/min)
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Essentials of Ventilator Graphics ©2000 RespiMedu
Air TrappingInspiration
Expiration
NormalNormalPatientPatient
Time (sec)
Flow
(L/m
in)
Air TrappingAuto-PEEP
}
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Essentials of Ventilator Graphics ©2000 RespiMedu
Response to Bronchodilator
Before
Time (sec)
Flow
(L/m
in)
PEFR
After
Long TE
Higher PEFR
Shorter TE
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Essentials of Ventilator Graphics ©2000 RespiMedu
SCALARS
Flow/TimePressure/Time
Volume/Time
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Essentials of Ventilator Graphics ©2000 RespiMedu
Volume vs Time
InspirationInspiration
Expiration
Time (sec)Time (sec)
Volu
me
(ml)
Volu
me
(ml)
Inspiratory Tidal Volume
TTII
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Essentials of Ventilator Graphics ©2000 RespiMedu
Air LeakVo
lum
e (m
l)Vo
lum
e (m
l)
Time (sec)Time (sec)
Air LeakAir Leak
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Essentials of Ventilator Graphics ©2000 RespiMedu
Active Exhalation
Volume (ml)Volume (ml)
Time (sec)Time (sec)
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Essentials of Ventilator Graphics ©2000 RespiMedu
SCALARS
Flow/TimePressure/Time
Volume/Time
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Essentials of Ventilator Graphics ©2000 RespiMedu
Spontaneous BreathPP awaw
(cm
H (c
m H
220)0)
Time (sec)Time (sec)
InspirationInspiration
ExpirationExpiration
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Essentials of Ventilator Graphics ©2000 RespiMedu
Mechanical Breath
InspirationExpirationP a
w (
cm H
2O)
Time (sec)
}}TI
Peak Inspiratory PressurePIP
PEEPPEEPTE
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Essentials of Ventilator Graphics ©2000 RespiMedu
Mechanical
Time (sec)
P aw (
cm H
2O)
Time Triggered Breath
CONTROLLED BREATH(Time Triggered)
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Essentials of Ventilator Graphics ©2000 RespiMedu
Assisted Breath(Patient Triggered)
Mechanical
Time (sec)
P aw (
cm H
2O)
Patient Triggered Breath
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Essentials of Ventilator Graphics ©2000 RespiMedu
Assisted vs Controlled
Time (sec)
Assisted ControlledPressure (cmH20)
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Essentials of Ventilator Graphics ©2000 RespiMedu
Spontaneous vs. Mechanical
MechanicalMechanical
Time (sec)
SpontaneousSpontaneousPaw (cm H2O)
Inspiration
ExpirationExpiration
Inspiration
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Essentials of Ventilator Graphics ©2000 RespiMedu
Components of Inflation Pressure
Begin Expiration
P aw (
cm H
2O)
Time (sec)
Begin Inspiration
PIPPIP
Pplateau
(Palveolar)
Transairway Pressure (PTA)}}
Exhalation Valve Opens
ExpirationExpiration
Inspiratory Pause
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Essentials of Ventilator Graphics ©2000 RespiMedu
Begin Inspiration Begin Expiration
P aw (
cm H
2O)
Time (sec)
Airway
Resistan
ce
Distending (Alveolar) Pressure Expiration
Inflation Hold(seconds)
Begin Expiration
P aw (
cm H
2O))
Time (sec)Begin Inspiration
PIPPIP
Pplateau
(Palveolar
Transairway Pressure (PTransairway Pressure (PTATA))}}Exhalation Valve Opens
Expiration
PIP
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Essentials of Ventilator Graphics ©2000 RespiMedu
PIP vs Pplat
Normal High Raw
High Flow Low Compliance
Time (sec)
Paw
(cm
H2O
)
PIPPIP
PPPlatPlat
PIPPIP
PIPPIP PIPPIP
PPPlatPlatPPPlatPlat
PPlat
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Essentials of Ventilator Graphics ©2000 RespiMedu
Pa
w (
cm H
Paw
(cm
H22O
)O
)
Normal
Normal PPlat(Normal Compliance)
Increased PIP
} Increased PTA(increased Airway Resistance))
NormalNormalPIPPIP
PPPlatPlat
High RHigh RawawPIPPIP
PPPlatPlat
Increased Airway Resistance
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Essentials of Ventilator Graphics ©2000 RespiMedu
Effect of increased Flow
Time (sec)
Paw
(cm
H2O
)NormalNormal
PIPPIPHigh FlowHigh Flow
PPlat
PIPPIP
Dynamic Inspiratory TimeDecreased Inspiratory TimeInspiratory Time(Due to High Inspiratory Flow)
Normal
PPlat
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Essentials of Ventilator Graphics ©2000 RespiMedu
DECREASED COMPLIANCE
Time (sec)
Paw
(cm
H2O
)Low CompliancePIPPPlat
NormalNormalPIP
PPlat
Normal PPlat(Normal Compliance)
Increased PPlat(Decreased Compliance))
Normal
PIP
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Essentials of Ventilator Graphics ©2000 RespiMedu
Inadequate Inspiratory Flow
Adequate Flow
Time (sec)
Inadequate Flow
P aw
(cm
H2O
)
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Essentials of Ventilator Graphics ©2000 RespiMedu
Pressure-Volume Flow-Volume
LOOPS
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Essentials of Ventilator Graphics ©2000 RespiMedu
Pressure-Volume Loop
(Type of Breath)
Controlled Assisted Spontaneous
Vol (
ml)
Paw (cm H2O)
I: InspirationE: Expiration
I
E
E
E
II
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Essentials of Ventilator Graphics ©2000 RespiMedu
FRC and PV Loop
FRCVOLU
ME
TLC
Negative Positive0
DISTENDING PRESSURE
Normal Compliance
FRC
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Essentials of Ventilator Graphics ©2000 RespiMedu
Components of Pressure-Volume
Loop
Volume Volume (mL)(mL)
Insp
iratio
n
Expi
ratio
n
PIP
VT
PPawaw (cm H (cm H22O)O)
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Essentials of Ventilator Graphics ©2000 RespiMedu
PEEP and P-V Loop
Volume (mL)
VT
PIPPIPPaw (cm H2O)
PEEP PEEP
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Essentials of Ventilator Graphics ©2000 RespiMedu
Work of Breathing
A: Resistive Work B: Elastic Work
Pressure (cm H2O)
Volume (ml)
BB
AA
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Essentials of Ventilator Graphics ©2000 RespiMedu
Inflection Points
Pressure (cm H2O)
Volume (mL)
Upper Inflection Point
Lower Inflection Point
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Essentials of Ventilator Graphics ©2000 RespiMedu
Inadequate Sensitivity
Volume Volume (mL)(mL)
PPawaw (cm H (cm H22O)O)Increased WOB
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Essentials of Ventilator Graphics ©2000 RespiMedu
Air LeakVolume (ml)
Pressure (cm HPressure (cm H22O)O)
Air Leak
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Essentials of Ventilator Graphics ©2000 RespiMedu
Inadequate Inspiratory Flow
PPaw aw (cm (cm HH22O)O)
Volume Volume (ml)(ml)
NormalAbnormal
Active InspirationActive Inspiration
Inappropriate FlowInappropriate Flow
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Essentials of Ventilator Graphics ©2000 RespiMedu
Increased Raw
Pressure (cm Pressure (cm HH22O)O)
Higher PTA
Normal
Slope
Normal
Slope
Vol (mL)Vol (mL)
Lower Slope
Lower Slope
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Essentials of Ventilator Graphics ©2000 RespiMedu
HysteresisVolume (ml)
Pressure (cm Pressure (cm HH22O)O)
Abnormal Hysteresis
Normal Hysteresis
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Essentials of Ventilator Graphics ©2000 RespiMedu
Lung Compliance Changes and the P-V
Loop
Volume (mL)Volume (mL)
PIP levels
Preset VT
PPawaw (cm H (cm H22O)O)
COMPLIANCEIncreasedNormalDecreased
Volume Targeted Ventilation
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Essentials of Ventilator Graphics ©2000 RespiMedu
Lung Compliance Changes and the P-V
Loop
Volume (mL)Volume (mL)
Preset PIP
VT
leve
ls
PPawaw (cm H (cm H22O)O)
COMPLIANCEIncreasedNormalDecreased
Pressure Targeted Ventilation
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Essentials of Ventilator Graphics ©2000 RespiMedu
Overdistension
Volu
me
(ml)
Pressure (cm HPressure (cm H22O)O)
With little or no change in VT
Paw rises
NormalAbnormal
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Essentials of Ventilator Graphics ©2000 RespiMedu
Pressure-Volume Flow-Volume
LOOPS
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Essentials of Ventilator Graphics ©2000 RespiMedu
Flow-Volume Loop
Volume (ml)Volume (ml)
PEFR
FRC
Inspiration
Expiration
Flo w
(L/
mi n
)Fl
o w (
L/m
i n) PIFR
VT
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Essentials of Ventilator Graphics ©2000 RespiMedu
Air Leak
Inspiration
Expiration
Volume (ml)
Flow Flow (L/min)(L/min)
Air Leak in mL
NormalAbnormal
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Essentials of Ventilator Graphics ©2000 RespiMedu
Air Trapping
Inspiration
Expiration
Volume (ml)Volume (ml)
Flow (L/min)
Does not returnDoes not returnto baselineto baseline
NormalAbnormal
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Essentials of Ventilator Graphics ©2000 RespiMedu
Increased Airway Resistance
Inspiration
Expiration
VolumeVolume (ml) (ml)
Flow (L/min)
Decreased PEFR
NormalNormalAbnormal“Scooped out”
pattern
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Essentials of Ventilator Graphics ©2000 RespiMedu
Airway Secretions/Water in the Circuit
Inspiration
Expiration
Volume (ml)Volume (ml)
Flow (L/min)
NormalAbnormal
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Essentials of Ventilator Graphics ©2000 RespiMedu
Modes of Ventilation
Spontaneous Mechanical
Volume Targeted
PressureTargeted
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Essentials of Ventilator Graphics ©2000 RespiMedu
Modes of Ventilation
Spontaneous Mechanical
Volume Targeted
PressureTargeted
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Essentials of Ventilator Graphics ©2000 RespiMedu
Spontaneous Breath
Time (sec)
FlowL/m
Pressurecm H2O
VolumemL
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Essentials of Ventilator Graphics ©2000 RespiMedu
CPAP
Time (sec)Time (sec)
CPAP level
FlowL/m
Pressurecm H2O
VolumemL
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Essentials of Ventilator Graphics ©2000 RespiMedu
PSV
Time (sec)
FlowL/m
Pressurecm H2O
VolumemL
Flow Cycling
Set PS level
Patient Triggered, Flow Cycled, Pressure limited Mode
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Essentials of Ventilator Graphics ©2000 RespiMedu
CPAP + PSV
Set PS level
CPAP level
Time (sec)Time (sec)
FlowL/m
Pressurecm H2O
VolumemL
Flow Cycling
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Essentials of Ventilator Graphics ©2000 RespiMedu
Modes of Ventilation
Spontaneous Mechanical
Volume Targeted
PressureTargeted
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Essentials of Ventilator Graphics ©2000 RespiMedu
Controlled Mode (Volume- Targeted
Ventilation)
Preset VT
Volume Cycling
Dependent onCL & Raw
Time (sec)Time (sec)
FlowL/m
Pressurecm H2O
VolumemL
Preset Peak Flow Time triggered, Flow limited, Volume cycled Ventilation
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Essentials of Ventilator Graphics ©2000 RespiMedu
Assisted Mode(Volume-Targeted
Ventilation)
Time (sec)Time (sec)
FlowL/m
Pressurecm H2O
VolumemL
Preset VT
Volume Cycling
Patient triggered, Flow limited, Volume cycled Ventilation
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Essentials of Ventilator Graphics ©2000 RespiMedu
SIMV(Volume-Targeted
Ventilation)
Spontaneous Breaths
FlowL/m
Pressurecm H2O
VolumemL
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Essentials of Ventilator Graphics ©2000 RespiMedu
Controlled Mode (Pressure-Targeted
Ventilation)
Pressure
Flow
Volume
(L/min)
(cm H2O)
(ml)Time (sec)Time (sec)
Time-Time-Cycled
Set PC level
Time Triggered, Pressure Limited, Time Cycled Ventilation
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Essentials of Ventilator Graphics ©2000 RespiMedu
Assisted Mode (Pressure-Targeted
Ventilation)
Pressure
Flow
Volume
(L/min)
(cm H2O)
(ml)
Set PC level
Time (sec)Time (sec)
Time-Cycled
Patient Triggered, Pressure Limited, Time Cycled Ventilation
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Essentials of Ventilator Graphics ©2000 RespiMedu
Pressure
Flow
Volume
(L/min)
(cm H2O)
(ml)
Set PC levelSet PC level
Time (sec)Time (sec)
SIMV Mode (Pressure-Targeted
Ventilation)
Spontaneous Breath
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Essentials of Ventilator Graphics ©2000 RespiMedu
Pressure
Flow
Volume
(L/min)
(cm H2O)
(ml)
SIMV + PS (Pressure-Targeted
Ventilation)
PS Breath
Set PS levelSet PC levelSet PC level
Time (sec)
Time-Cycled Flow-Cycled
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Essentials of Ventilator Graphics ©2000 RespiMedu
SIMV+PS(Volume-Targeted
Ventilation)
Flow
Pressure
Volume
(L/min)
(cm H2O)
(ml)
Set PS level
PS Breath
Flow-cycled
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Essentials of Ventilator Graphics ©2000 RespiMedu
Pressure
Flow
Volume
(L/min)
(cm H2O)
(ml)
Set PC levelSet PC level
Time (sec)Time (sec)
SIMV + PS + CPAP (Pressure-Targeted
Ventilation)
Set PS level
CPAP levelCPAP level
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Essentials of Ventilator Graphics ©2000 RespiMedu
SIMV+PS + CPAP(Volume-Targeted
Ventilation)
Flow
Pressure
Volume
(L/min)
(cm H2O)
(ml)
Set PS level
CPAP levelCPAP level
Time (sec)