Mechanical Vent Me
Mechanical Vent Me
Mechanical Vent Me
Mechanical Ventilation
Prepared By-
Sonali Koiri
Rachana Shrestha
BNS 3rd Year
Introduction
Mechanical Ventilator:
• A mechanical ventilator is a positive or
negative pressure breathing device that can
maintain ventilation and oxygen delivery for a
prolong period.
• It is a machine that generates a controlled flow
of gas into a patient’s airway.
• Dis-advantages
Limited access for patient care
Inability to properly monitor
pulmonary mechanics
Patient discomfort
Positive Pressure Ventilation
• A positive pressure ventilation inflate the lungs
by exerting positive pressure in the airway
forcing the alveoli to expand during inspiration.
Expiration occurs passively.
• It requires an artificial airway (endotracheal or
tracheostomy tube) and use positive pressure
to force gas into patient’s lungs.
• Inspiration can be triggered either by the
patient or machine.
Positive Pressure Ventilation
Classification of Positive Pressure Ventilation
1. Volume controlled
Deliver a preset tidal volume
Allows pressure to vary with changes in resistance and
compliance
Volume delivery remains constant
2. Pressure controlled
Deliver a preset inspiratory pressure during each
inspiration
Volume delivery may vary 39
Pressure and Gradients
• Peak inspiratory pressure (Ppeak)
• Plateau pressure (Pplateau)
• Baseline pressure
• Mean airway pressure (Pmean)
40
Peak Inspiratory Pressure (Ppeak):
42
Plateau pressure (Pplateau):
• The plateau pressure is the pressure applied
to small airways and alveoli.
• It is measured during an inspiratory pause on
the ventilator.
• Exhalation is prevented by the ventilator for a
brief moment(0.5-1.5sec)
• The plateau pressure <30cmH2O
43
Baseline pressure
• Pressure in the ventilator circuit at the end of exhalation.
• Normally, the baseline pressure is zero(or atmospheric), which
indicates that no additional pressure is applied at the airway opening
during expiration and before inspiration.
• Sometimes the baseline pressure is higher than zero, such as when
the ventilator operator selects a higher pressure to be present during
exhalation. This is called Positive End Expiratory Pressure (PEEP).
• When PEEP is set, the ventilator prevents the patient from exhaling
to zero(atmospheric pressure).
• PEEP increases the volume of gas left in the lungs at the end of a
normal exhalation; that is, PEEP increases the functional residual
capacity (FRC)
44
Mean Airway Pressure (Pmean):
Average pressure over the entire respiratory
cycle
Affected by PEEP, Inspiratory time (TI).
Has significant affect on oxygenation.
45
PHASES OF VENTILATORY CYCLES CONTROL VARIABLE
1. TRIGGERING (Initiation of 1. PRESSURE (cm H2O)
inspiration) 2. FLOW (L/min)
1. INSPIRATION 3. VOLUME (ml)
2. CYCLING (Change over 4. TIME (sec)
from inspiration to
expiration)
3. EXPIRATION
Modes of Mechanical Ventilation
Defined as a set of operating characteristics that
control how the ventilator functions, in what way
a ventilator is triggered into inspiration and cycled
into exhalation, what variables are limited during
inspiration and whether or not the mode allows
mandatory breaths, intermittent breaths, or
spontaneous breaths.
48
Selection of Modes of Ventilation
Regardless of which operating mode is selected, it
should achieve four main goals:
• Provide adequate ventilation and oxygenation.
52
Contd…
Advantages
• Guaranteed volume(or pressure ) with each
breath
• Low patient workload
Disadvantages
• Spontaneous breath not allowed
• Needs deep sedation & Paralysis
• Apnea & Hypoxia if accidentally disconnected
• Ventilator dependence
53
Assist Control mode (AC)
55
Contd…
Advantages
• Increase Patients comfort
• Patients work of breathing is low
• Patient can control the frequency
Disadvantages
• Risk of Hyperventilation
56
Intermittent Mandatory Ventilation
Intermittent mandatory ventilation provides a
combination of mechanical breaths and spontaneous
breaths .
Mechanical breaths are delivered at preset intervals
and a preselected tidal volume, regardless of patient’s
efforts.
Although the patient can increase the respiratory rate
by initiating inspiration between ventilator delivered
breaths, these spontaneous breaths are limited to the
tidal volume generated by the patient.
57
IMV
58
Contd…
Advantages
• Allows spontaneous breath of any tidal
volume
Disadvantages
• Increase work of breathing
• Asynchrony leading to Breath Stacking
59
Synchronized Intermittent Mandatory
Ventilation (SIMV)
SIMV also delivers a preset tidal volume and number of
breaths per minute .
Between ventilator delivered breaths the patient can
breath spontaneously with no assistance from the
ventilator on those extra breaths.
Mandatory breaths are synchronised with the patient's
own inspiratory effort which is more comfortable for the
patient
Machine-delivered breaths are initiated only after patient
exhales, preventing breath stacking
60
Contd…
Contd…
Advantages
• The mandatory breath is delivered in synchrony with patient
effort. This makes greater comfort during breathing.
• The patients respiratory muscles remain active, and so disuse
atrophy is less common.
• Prevents breath stacking
Disadvantages
• Hypoventilation is possible if the patient is not capable of
spontaneous breathing
• Excessive work of breathing is possible during spontaneous
breaths unless an adequate level of pressure support is applied.
62
Pressure Support Ventilation
PSV can be used in conjunction with spontaneous
breathing in any ventilator mode. ( eg.SIMV +
PSV).
Pressure support ventilation (PSV) is pressure-
augmented spontaneous breathing.
Pressure support ventilation applies a pressure to
the airway throughout the patient triggered
inspiration to decrease resistance within the
tracheal tube and ventilator tubing.
63
Contd…
Pressure support is typically used in the SIMV
mode to facilitate weaning
• Increases the patient’s spontaneous tidal
volume
• Decreases the patient’s spontaneous
frequency.
• Decreases the work of breathing
64
PSV
PSV applies a preset pressure plateau to the patient’s airway for the duration of a
spontaneous breath 65
Contd…
Advantages
• The patient can control the depth, the length
and the flow of each breath.
• Allows flexibility in ventilatory support.
Disadvantages
• Excessive levels of support can result in:
Respiratory alkalosis, Hyperinflation,
Ineffective triggering, Apneic spells
66
TO BE CONTINUED…….
• https://www.slideshare.net/Harshita89/ventilators-32613130
• https://www.aafp.org/afp/2004/0801/p596.html
• http://www.sle.co.uk/files/library/files/PDFs/howto/How%20to%
20clean%20your%20ventilators.pdf
• http://www.en.carefusion.com.br/documents/international/guid
es/user-guides/RC_VELA-Operator-Manual_UG_EN.pdf
• http://rtasap.com/ppt/vela.pdf
• https://ann-clinmicrob.biomedcentral.com/articles/10.1186/147
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