How To Ventilate ICU How To Ventilate ICU Patient Patient Dr Mohammed Bahzad Dr Mohammed Bahzad MBBS.FRCPC,FCCP,FCCM MBBS.FRCPC,FCCP,FCCM Head Of Critical Care Head Of Critical Care Department Mubarak Alkbeer Department Mubarak Alkbeer Hospital Hospital
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How To Ventilate ICU Patient Dr Mohammed Bahzad MBBS.FRCPC,FCCP,FCCM Head Of Critical Care Department Mubarak Alkbeer Hospital.
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How To Ventilate ICU How To Ventilate ICU PatientPatient
Dr Mohammed Bahzad Dr Mohammed Bahzad MBBS.FRCPC,FCCP,FCCMMBBS.FRCPC,FCCP,FCCM
Head Of Critical Care Department Head Of Critical Care Department Mubarak Alkbeer HospitalMubarak Alkbeer Hospital
AimsAims
Get oxygen inGet oxygen in Get carbon dioxide outGet carbon dioxide out Minimize adverse effectsMinimize adverse effects Maximize patient comfortMaximize patient comfort
Case ACase A
60 kg male60 kg male Post operative – complicated wipel Post operative – complicated wipel
procedureprocedure No previous lung or heart diseaseNo previous lung or heart disease Still paralyzedStill paralyzed
Make the ventilator fit the Make the ventilator fit the patientpatient
Pick a mode you understand and are Pick a mode you understand and are familiar withfamiliar with
Assist controlAssist control
Set tidal volumeSet tidal volume Inspiratory-expiratory cyclingInspiratory-expiratory cycling
– Time cycledTime cycled Time is setTime is set Ventilator adjusts flow to deliver set tidal volume in Ventilator adjusts flow to deliver set tidal volume in
the set timethe set time
– Volume cycledVolume cycled
Assist controlAssist control
Breaths:Breaths:– Ventilator initiated (control breaths)Ventilator initiated (control breaths)– Patient initiated (assist breaths)Patient initiated (assist breaths)– Set minimum frequencySet minimum frequency
Characteristics of each inspiration are the Characteristics of each inspiration are the samesame– Not affected by whether breath is control breath Not affected by whether breath is control breath
Patient’s spontaneous respiratory rate < set rate Patient’s spontaneous respiratory rate < set rate ventilator gives additional control breaths to make ventilator gives additional control breaths to make up differenceup difference
Patient’s spontaneous rate > set rate Patient’s spontaneous rate > set rate no control no control breathsbreaths
SetSet– Minimum respiratory rateMinimum respiratory rate– Tidal volumeTidal volume– Inspiratory time or I:E ratioInspiratory time or I:E ratio– Inspiratory pause timeInspiratory pause time
may result in excessive may result in excessive minute ventilationminute ventilation
lung compliance lung compliance alveolar pressure with risk alveolar pressure with risk of barotraumaof barotrauma
– Often requires sedation to Often requires sedation to achieve synchrony. achieve synchrony.
Pressure controlPressure control
Pressure preset assist/control ventilationPressure preset assist/control ventilation Similar to volume control except pressure is Similar to volume control except pressure is
DisadvantagesDisadvantages– No apnoea back-up in No apnoea back-up in
older ventilatorsolder ventilators
– Change in lung Change in lung compliance or compliance or resistance resistance change in change in tidal volumetidal volume
Pressure supportPressure support
Pressure support of 3.5-14.5 cmHPressure support of 3.5-14.5 cmH22O O required to overcome the additional work required to overcome the additional work of breathing due to breathing through ETT of breathing due to breathing through ETT and demand valveand demand valve
Patients who require pressure support of < Patients who require pressure support of < 6 cmH6 cmH22O can probably be extubatedO can probably be extubated
SIMV almost always combined with SIMV almost always combined with pressure supportpressure support
SIMVSIMV
Patient receives a minimum number of Patient receives a minimum number of mandatory breathsmandatory breaths
Able to breath in between these breathsAble to breath in between these breaths– ± pressure support breaths± pressure support breaths
SIMVSIMV
Pressure
Flow
PEEP
Time
Trig Trig
Time
Mandatory breath
SIMVSIMV
Pressure
Flow
PEEP
Time
Trig Trig
Time
Pressure support breath
Mandatory breathsMandatory breaths
Volume control breathsVolume control breaths– Set tidal volumeSet tidal volume
Pressure control breathsPressure control breaths– Set pressureSet pressure
Mandatory breathsMandatory breaths
Synchronized with patients inspiratory Synchronized with patients inspiratory effortsefforts
TriggeringTriggering
Effect of triggering depends on its timingEffect of triggering depends on its timing– Close to time that a mandatory breath is due Close to time that a mandatory breath is due
Pulse oximetryPulse oximetry Arterial blood gasArterial blood gas
SummarySummary
Chose the mode that fits the patientChose the mode that fits the patient Set the ventilator to achieve your aimsSet the ventilator to achieve your aims Often more than one way to achieve your Often more than one way to achieve your
aimsaims– Select the method with the least adverse effectsSelect the method with the least adverse effects