SERVO-i VENTILATOR GRAPHICS
SERVO-i VENTILATOR GRAPHICS. 09-03-25© MAQUET3 INTRODUCTION MCV00009701 REVA.
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SERVO-i VENTILATOR GRAPHICS
09-03-25 © MAQUET 2
INTRODUCTION
MCV00009701 REVA
09-03-25 © MAQUET 3
MEDIASTINUM AND CHEST WALL
INTRODUCTION
MCV00009701 REVA
09-03-25 © MAQUET 4
AIRWAYS AND ALVEOLI
INTRODUCTION
MCV00009701 REVA
09-03-25 © MAQUET 5
KEEP IN MIND WHEN EVALUATING VENTILATOR GRAPHICS
What type of ventilation is the patient receiving? What are you looking at? Does it make sense?
INTRODUCTION
MCV00009701 REVA
09-03-25 © MAQUET 6
TYPES OF VENTILATOR GRAPHICS
Scalars:
Pressure - Time
Flow - Time
Volume - Time
Loops:
Volume - Pressure
Flow - Volume
INTRODUCTION
MCV00009701 REVA
09-03-25 © MAQUET 7
VOLUME VS. PRESSURE VENTILATION - SCALARS
Volume Breath Pressure Breath
Time Time
PAW
Flow
PAW
Flow
INTRODUCTION
MCV00009701 REVA
You read a waveform like you read a sentence…from left to right. By the time
you get to the end, you should have a complete thought, just like reading a
sentence.
Determine whether the waveform you are examining
belongs to a constant flow mode or a decelerating flow mode.
That way you will know how the waveform is expected to
behave. Then you can compare the expectation to the actual
behavior as you read from left to right.
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VOLUME VS. PRESSURE VENTILATION - LOOPS
Volume Breath Pressure Breath
INTRODUCTION
MCV00009701 REVA
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VOLUME VENTILATION
Constant Flow
Pressure
INTRODUCTION
MCV00009701 REVA
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Decelerating Flow
Pressure
PRESSURE VENTILATION INTRODUCTION
MCV00009701 REVA
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Inspirationbegins
Inspirationends
Expirationbegins
Expirationends
INSPIRATION AND EXPIRATION INTRODUCTION
MCV00009701 REVA
Read waveforms one at a time. Don’t try to assimilate all three at once.
Identify the beginning and end of inspiration and the beginning and end of
expiration.
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MODES OF VENTILATION
MCV00009701 REVA
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VOLUME CONTROL SCALARS
MODES OF VENTILATION
MCV00009701 REVA
Know what kind of waveform you’re reading
and note the value to which the scale is set.
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VOLUME CONTROL LOOPS AND SCALARS
MODES OF VENTILATION
MCV00009701 REVA
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FLOW-ADAPTIVE VOLUME CONTROLLERTM
Volume controlled ventilation:
MODES OF VENTILATION
MCV00009701 REVA
If during a positive pressure breath, the patient makes an inspiratory effort, you may see a “dip” in the pressure curve.
A waveform can change in appearance with a change in the patient’s compliance,
resistance or effort.
09-03-25 © MAQUET 16
PRESSURE CONTROL SCALARS
MODES OF VENTILATION
MCV00009701 REVA
09-03-25 © MAQUET 17
PRESSURE CONTROL LOOPS AND SCALARS
MODES OF VENTILATION
MCV00009701 REVA
09-03-25 © MAQUET 18
SIMV (PRESSURE) WITH PRESSURE SUPPORT SCALARS
MODES OF VENTILATION
MCV00009701 REVA
09-03-25 © MAQUET 19
PRVC START UP PROCESS
MODES OF VENTILATION
MCV00009701 REVA
09-03-25 © MAQUET 20
PRVC IN USE: PATIENT‘S ADJUSTMENTS
MODES OF VENTILATION
MCV00009701 REVA
09-03-25 © MAQUET 21
PRESSURE SUPPORT SCALARS AND LOOPS
MODES OF VENTILATION
MCV00009701 REVA
09-03-25 © MAQUET 22
Time
Flow
25%
Peak Inspiratory Flow
50%
25%50%
FLOW-CYCLING
MODES OF VENTILATION
MCV00009701 REVA
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100%
INSPIRATORY CYCLE OFF
MODES OF VENTILATION
MCV00009701 REVA
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INSPIRATORY CYCLE OFF
MODES OF VENTILATION
MCV00009701 REVA
09-03-25 © MAQUET 25
INSPIRATORY CYCLE OFF
MODES OF VENTILATION
MCV00009701 REVA
09-03-25 © MAQUET 26
INSPIRATORY CYCLE OFF
MODES OF VENTILATION
MCV00009701 REVA
If you see a curious aberration on one waveform and you can’t account for it, look at the other waveforms at the same point in time to see if
there is a cause and effect relationship.
If during a positive pressure breath the patient tries to exhale against a closed exhalation valve, you may see a spike in the pressure
curve.
09-03-25 © MAQUET 27
VOLUME SUPPORT SCALARS
MODES OF VENTILATION
MCV00009701 REVA
09-03-25 © MAQUET 28
INSPIRATORY RISE TIME
MCV00009701 REVA
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INSPIRATORY RISE TIME
MCV00009701 REVA
Adjust Inspiratory Rise Time to satisfy the patient’s inspiratory demand without
causing turbulent flow.
Or, adjust the IRT for patient comfort without causing “flow hunger”.
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INSPIRATORY RISE TIME
MCV00009701 REVA
09-03-25 © MAQUET 31
LEAKS
MCV00009701 REVA
09-03-25 © MAQUET 32
LOOK AT VOLUME
Volume - Time Scalar
Volume - Pressure Loop
Flow - Volume Loop
LEAKS
MCV00009701 REVA
09-03-25 © MAQUET 33
VOLUME – TIME SCALAR
Vol
ume
Time
Expiratory
LEAKS
MCV00009701 REVA
09-03-25 © MAQUET 34
LEAKS
MCV00009701 REVA
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LEAKS
MCV00009701 REVA
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INSPIRATORY CYCLE OFF
2.5 seconds
LEAKS
MCV00009701 REVA
Waveforms should start at the baseline and end at the
baseline.
09-03-25 © MAQUET 37
Time
Flow
25%
Peak Inspiratory Flow
50%
25%50%
FLOW-CYCLING
MODES OF VENTILATION
MCV00009701 REVA
09-03-25 © MAQUET 38
INSPIRATORY CYCLE OFF
LEAKS
MCV00009701 REVA
The “igloo” or “fish mouth” on the Volume-Time curve is the classic
picture of a leak!
Use the ICO control to deal with leak situations by limiting the
inspiratory time in support modes in the interest of patient comfort.
09-03-25 © MAQUET 39
AUTO-PEEP
MCV00009701 REVA
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LOOK AT FLOW
Flow - Time Scalar
Flow - Volume Loop
AUTO-PEEP
MCV00009701 REVA
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AUTO-PEEP
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13 total pressure
- 5 peep set
= 8 auto peep
AUTO-PEEP
MCV00009701 REVA
Waveforms should start at the baseline and end at the baseline.
If the expiratory flow curve does not return to baseline before the next inspiration starts, the patient
is trapping gas.
09-03-25 © MAQUET 43
AUTO-PEEP
MCV00009701 REVA
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OTHER ISSUES
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Volume – Constant Flow Pattern Pressure –Decelerating Flow Pattern
OPTIMIZING I-TIME
MCV00009701 REVA
Generally speaking, in decelerating flow modes, the Ti
should be set to that the inspiratory flow just reaches the
baseline before expiration starts. By doing so in the PC mode, tidal volume can be maximized for any given pressure level; By doing so in the PRVC mode, PIP can be minimized for any given tidal
volume.
09-03-25 © MAQUET 46
Volume – Constant Flow Pattern Pressure –Decelerating Flow Pattern
SHORT I-TIME
MCV00009701 REVA
09-03-25 © MAQUET 47
Volume – Constant Flow Pattern Pressure –Decelerating Flow Pattern
LONG I-TIME
MCV00009701 REVA
Generally speaking, in decelerating flow modes, the Ti
should be set to that the inspiratory flow just reaches the
baseline before expiration starts. By doing so in the PC mode, tidal volume can be maximized for any given pressure level; By doing so in the PRVC mode, PIP can be minimized for any given tidal
volume.
09-03-25 © MAQUET 48
ASSESSING PLATEAU PRESSURE
MCV00009701 REVA
09-03-25 © MAQUET 49
ASSESSING PLATEAU PRESSURE
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TRIGGER AND CYCLE ASYNCHRONY
Mode: PRVC
MONITORING EDI AND NAVA
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PATIENT SWITCHED FROM MONITORING EDI TO NAVA
Mode: NAVA
MONITORING EDI AND NAVA
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EARLY SMALL AIRWAY COLLAPSE
MCV00009701 REVA
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EARLY SMALL AIRWAY COLLAPSE
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09-03-25 © MAQUET 54
EARLY SMALL AIRWAY COLLAPSE
MCV00009701 REVA
09-03-25 © MAQUET 55
THE END
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