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    Ventilator Graphics & Trouble-Shooting - Edited

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    Abhishek Singh
    The document discusses various ventilator parameters and graphics used to optimize mechanical ventilation including tidal volume, rate, pressures, and ratios. Different ventilator waveforms like flow-time, volume-time, and pressure-volume loops are used to assess patient-ventilator interaction, respiratory mechanics, asynchrony, air trapping, and response to therapy. Understanding these graphics allows clinicians to interpret the patient's condition, evaluate ventilator function, and fine tune settings to decrease work of breathing and improve oxygenation.

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    Ventilator Graphics & Trouble-Shooting - Edited

    Uploaded by

    Abhishek Singh
    31 views64 pages
    The document discusses various ventilator parameters and graphics used to optimize mechanical ventilation including tidal volume, rate, pressures, and ratios. Different ventilator waveforms like flow-time, volume-time, and pressure-volume loops are used to assess patient-ventilator interaction, respiratory mechanics, asynchrony, air trapping, and response to therapy. Understanding these graphics allows clinicians to interpret the patient's condition, evaluate ventilator function, and fine tune settings to decrease work of breathing and improve oxygenation.

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    Ventilator Graphics & Trouble-shooting - Edited (3)

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    The document discusses various ventilator parameters and graphics used to optimize mechanical ventilation including tidal volume, rate, pressures, and ratios. Different ventilator waveforms like flow-time, volume-time, and pressure-volume loops are used to assess patient-ventilator interaction, respiratory mechanics, asynchrony, air trapping, and response to therapy. Understanding these graphics allows clinicians to interpret the patient's condition, evaluate ventilator function, and fine tune settings to decrease work of breathing and improve oxygenation.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    31 views64 pages

    Ventilator Graphics & Trouble-Shooting - Edited

    Uploaded by

    Abhishek Singh
    The document discusses various ventilator parameters and graphics used to optimize mechanical ventilation including tidal volume, rate, pressures, and ratios. Different ventilator waveforms like flow-time, volume-time, and pressure-volume loops are used to assess patient-ventilator interaction, respiratory mechanics, asynchrony, air trapping, and response to therapy. Understanding these graphics allows clinicians to interpret the patient's condition, evaluate ventilator function, and fine tune settings to decrease work of breathing and improve oxygenation.

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    Modes of ventilation

    and
    Ventilator graphics

    Presenter: Dr. Abraar Sheriff


    Moderator: Prof. Narayanan P
    06.03.2019
    Macquet Bella Vista Puritan Bennett

    Drager Hamilton Avea SLE


    BASIC VENTILATOR PARAMETERS

    v Tidal volume
    v Frequency/ Rate
    v PIP
    v PEEP
    v Inspiratory Time/ Expiratory time/ I:E Ratio
    v FiO2
    Tidal volume

    • Volume of breath inspired/expired (VTe / Vti)

    • VTi > VTe in case of circuit leak/ peritubal


    leak

    • Determines the ventilation (MV = TV × Rate)


    Frequency/ Rate

    • No of breath per minute

    • Determines Ventilation (MV = TV × Rate)

    • Initial rates are set as per age


    • Neonate: 30-50
    • Younger children: 20-30
    • Older children: 15-25
    PIP

    • Pressure which expands the lungs during inspiration

    • PIP - PEEP (ΔP) determines ventilation

    • PIP also affects oxygenation by increasing MAP


    PEEP
    • Prevents closure or collapse of recruited alveoli during
    expiration
    • Increases FRC, thereby improves V/Q mismatch
    • Improves Oxygenation
    • Should be more than lower infection point, to avoid
    atelectotrauma
    • Higher PEEP is set in case of parenchymal lung disease
    • Lower PEEP is set in obstructive airway disease
    • Too much PEEP can cause
    - Overdistension and gas trapping
    - Decrease venous return and precipitate hypotension
    FiO2

    • Influences Oxygenation

    • Too much FiO2 can cause


    - Absorption atelectasis
    - Oxygen free radical injury
    - Tracheo-bronchitis
    Inspiratory/ expiratory (I:E) ratio

    • Ratio of inspiratory time to Expiratory time of one breath


    cycle

    • Usually kept at 1:2


    • Lower in bronchospasm/asthma
    • Higher in ARDS

    • Ti increases MAP & hence, the oxygenation


    Each breath, either spontaneous or mechanical,
    consists of 4 phases:
    1. Initiation of inspiration
    2. Inspiration
    3. End of inspiration
    4. Expiration

    Phase variables: Parameters that are measured and


    utilized to initiate, sustain, or terminate some phase of
    the ventilatory cycle
    Phase Variables: Trigger, Limit and Cycling
    Trigger Limit Cycling

    Ø Patient Ø Patient Ø Patient- Flow

    üFlow Ø Machine Ø Machine

    üPressure üPressure üTime

    Ø Machine- Time üVolume üVolume


    Types of Breaths
    Breath type Trigger Cycling Limit

    Mandatory M M M

    Assisted P M M

    Supported P P M

    Spontaneous P P P
    Ventilator Modes
    vIMV- PC/VC

    vACV- PC/VC

    vSIMV- PC/VC

    vPSV/VSV

    vHybrid modes
    Ventilator graphics
    • Graphics are waveforms that reflect the mechanics of
    ventilation

    • Purpose of monitoring graphics:


    – Monitoring patient’s disease status (C and Raw)
    – Calculate respiratory mechanics
    – Assesses patient response to therapy
    – Monitor ventilator function
    – Allow fine tuning of ventilator to decrease WOB and
    optimize ventilation
    – Allow users to interpret, evaluate, and troubleshoot
    ventilator
    Graphics
    Scalars Loops

    Pressure-
    Flow/Time Pressure/Time Volume/Time Flow-Volume
    Volume
    Types of waveforms
    1. Rectangular: square wave or constant waveform

    2. Ascending ramp: accelerating ramp

    3. Descending ramp: decelerating ramp

    4. Sinusoidal: sine wave

    5. Exponential rising

    6. Exponential decaying
    Flow-Time scalar
    Volume-Time scalar
    Pressure-Time scalar
    In Volume control mode
    Pressure-Volume loop
    Flow-Volume loop
    Modes of ventilation on
    scalar graphics
    THANK YOU
    Use of Flow-Time scalars
    Patient Ventilator Pt-Vent Interaction

    • Air trapping • Breath types • Asynchrony


    • Airway • Flow waveform • Triggering effort
    obstruction shape
    • Active • Flow starvation
    exhalation • Adjustment of
    • Bronchodilator Inspiratory time
    response
    Use of Volume-Time scalars
    Patient Ventilator Pt-Vent
    Interaction
    • Air trapping • Tidal volume • Asynchrony
    (auto-PEEP) • Volume
    • Active waveform
    exhalation shape
    • Leaks
    Use of Pressure-Time scalars
    Patient Ventilator Pt-Vent Interaction

    • Air trapping • Breath type • Asynchrony


    (auto-PEEP) • PIP and plateau • Triggering effort
    • Airway • PEEP/CPAP
    obstruction • It/Et (I:E ratio)
    • Bronchodilator
    response
    Use of PV Loops
    Patient Ventilator Pt-Vent
    Interaction
    • Airway obstrn • Flow • Triggering
    • Bronchodilator starvation effort
    response • Leaks
    • Lung over-
    distension
    • WOB
    Use of FV Loops
    Patient Ventilator Pt-Vent
    Interaction
    •Air trapping •Flow starvation •Asynchrony
    •Airway obst •Tidal volume
    •Airway •Leaks
    resistance •Water or
    •Bronchodilator secretion build-
    response up

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