Ventilation

Ventilation
presented by

Draeger-Medical

Ventilation

Spontaneous breathing

Mandatory Ventilation

Basic ventilator settings

The model of density

Resistance,Compliance,Time constant

Ventilation,Perfusion,Diffusion,Distribution

Ventilation

Spontaneous breathing

Ventilation

Spontaneous breathing
INSPIRATION
Contraction of the diaphragm and the
intercostal muscles
Negative pressure is generated in the lungs
to the atmospheric pressure
Expansion of the chest
Increase in lung volume
Air comes passive from the environment
through the upper airways pressure
compensation to the atmosphere

Ventilation

Spontaneous breathing
INSPIRATION
Contraction of the diaphragm and the
intercostal muscles
Negative pressure is generated in the lungs
to the atmospheric pressure
Expansion of the chest

- 2 mbar

Increase in lung volume

Air comes passive from the environment
through the upper airways pressure
compensation to the atmosphere

Muscular Force
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Ventilation

Spontaneous breathing
INSPIRATION

Position of the diaphragm before inspiration

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Ventilation

Spontaneous breathing
EXPIRATION
Relaxation of the diaphragm and the
intercostal muscles
Positive pressure is generated in the lungs
to the atmospheric pressure
Reduction of the chest
Decrease in lung volume
Air comes passive through the airways
to the environment pressure compensation to the atmosphere

Ventilation

Spontaneous breathing
EXPIRATION
Relaxation of the diaphragm and the
intercostal muscles
Positive pressure is generated in the lungs
to the atmospheric pressure
Reduction of the chest

+2 mbar

Decrease in lung volume

Air comes passive through the airways
to the environment pressure compensation to the atmosphere

Elasticity
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Ventilation

Spontaneous breathing
EXPIRATION

Position of the diaphragm after expiration

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Ventilation
Spontaneous breathing

PAW
in
mbar

Pressure-time-diagram

Expiration
Inspiration
t in sec.

V
in
l/min

Flow-time-diagram

Inspiratory flow
t in sec.

Expiratory flow

vt
in
ml

Tidal volume - vt

Volume-time-diagram

1
0

t in sec.

Ventilation

Vocabulary of ventilation
Fi O 2

fraction of oxygen in the inspired air

0,21 - 1,0

vt

tidal volume, volume per breath

4 - 8 ml/kgBW

breathing frequency
10 - 15 / min

MV

minute volume, calculated from the tidal volume and the frequency
MV = f * vt

I:E

inspiration - expiration ratio

1 : 1,5

PEEP a positive pressure in the alveoli in comparison to the atmospheric

pressure - is increasing the endexpiratory lung volume

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Ventilation

Vocabulary of ventilation
paO2

partial pressure of oxygen in the arterial blood

75 - 105 mmHg

paCO2 partial pressure of carbon dioxide in the arterial blood

35 - 45 mmHg
Sa O 2

oxygen saturation of the arterial blood

95 - 98 %

AaDO2 difference between the partial pressure of oxygen in the alveoli and
the arterial blood
AaDO2 = pAO2 - paO2
at FiO2 = 0,2 10 - 20 mmHg
at FiO2 = 1,0 25 - 65 mmHg
paO2/ FiO2

value with information about the transpulmonary oxygen transport

normal > 450

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Ventilation
Static Lung Volumes

Inspiratory
Expiratory
Reserve
Reserve
Volume
Volume
- IRV--:ERV
Vital
Functional
Capacity
Residual
- VC
: TLC
Capacity
FRC ::
Total
Lung
Capacity
:
the Residual
the volume
volume
that
can
that
can
inhaled
be
further
exVolume
-the
RV
: further
the
the
volume
volume
difference
left
inbe
lungs
between
at
the
maxiInspiratory
Capacity
: lungs

maximal
air
capacity
of
the
Tidal
volume
after
a
haled
quiet
after
inspiration,
a- vquiet
expiration,
that
the
that
the
volume
remaining
in is
the
lungs
t:
mum
end
of
inspiration
a
quit
expiration
and
maximum
expi
about
3
l
it isafter
calculated
from
the
VC
and
RV
difference
is
the
between
difference
normal
between
and
normal
maximal
a
maximal
expiration
the
volume
inhaled
and
exhaled
ration
about
3.0
3,5
l
approximately
6,0
inspiration
and 3,5
maximal
about
1,5
- 2,0
ll
during
quiet
breathing
about
- 5,5
l expiration
about
about
2,5 l 500
1,5 -l 600 ml
about

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Ventilation

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Mandatory Ventilation

Ventilation
Mandatory ventilation

- Inspiration started by the ventilator

- gas delivered by the ventilator goes through the tube,
through the airways into the lung
- Lung will be stretched
- Thorax will be extended and the diaphragm will be
pressed down positive pressure inside the thorax

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Ventilation
PAW
in
mbar

Peak pressure - ppeak

Plateau pressure - pplat

Pressure-time-diagram

End expiratory pressure - PEEP

t in sec.

Constant flow

V
in
l/min

Zero-flow-phase

Flow-time-diagram
t in sec.

Tidal volume - vt
vt
in
ml

Volume-time-diagram

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Volume Controlled
Ventilation

t in sec.

Ventilation
PAW
in
mbar

Inspiration pressure - pinsp

Pressure-time-diagram

End expiratory pressure - PEEP

t in sec.

Decelarating flow

V
in
l/min

Flow-time-diagram

Zero-flow-phase

t in sec.

vt
in
ml

Tidal volume - vt

Volume-time-diagram

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Pressure Controlled
Ventilation

t in sec.

Ventilation

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Basic ventilator settings

Ventilation
Volume controlled ventilation - Basic settings
e.g. SIMV

t ca.
FV
i O2
4-8 ml/kgBW
0,21-1,0

taken from the inspiration time

and the frequency the
Flow =
endexpiratory pressure
ispositive
calculated
velocity of breathingI:E-ratio
gas
7 - 15 mbar
tinsp=2 secca.
; f=10/min
ca. 40 -60 l/min
/ FRC-increase
I:ELungprotection
= 1:2

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Ventilation
Pressure controlled ventilation - Basic settings
e.g. BIPAP

F i O2
0,21-1,0

2
0

taken from the inspiration time

inspiration pressure and
- pinspthe
ca.frequency
20-25 mbar
the
positive
endexpiratory pressure
I:E-ratio
is calculated
vt depends on pressure
difference
to PEEP
7 - 15 mbar
tinsp=2 secca.
; f=10/min
C =
V
/ FRC-increase
I:ELungprotection
= 1:2
P

Ventilation

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1

The model of density

Ventilation

Mandatory ventilated patient in supine

positioning

Position of the diaphragm

after expiration

Position of the diaphragm

after inspiration

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Ventilation
Modell of density of the human body
1 cm H2O 1 mbar
0 cm

off ion
k
o
s
i
a
RAre ntsiliaotn
svteen
i
d
d
r
e
oveas

re
inc

25 cm

Thickness

RiAsrkeaofof
eecdtpaesrisfusion
l
e
t
a
s
a
e
r
c
in
25 cm

2,5 cm H2O

d
d
d
d
d
=
=
=
=
=
d
0,1dkg/l 0,2dkg/l 0,5dkg/l 0,8dkg/l 1kg/l
=
=
=
=
=
0,1 kg/l 0,2 kg/l 0,5 kg/l 0,8 kg/l 1kg/l
5 cm H2O

2
3

12,5 cm H2O

20 cm H2O

25 mbar

25 cm H2O

Pressure 0 mbar

Ventilation

2
4

Resistance,Compliance,Time constant

Ventilation

Compliance

2
5

Ventilation

Compliance
p0

Normal value - Adult

50-80 ml/mbar

2
6

Ventilation

Compliance

v
C= p
2
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Ventilation

Resistance

Normal value - Adult

( intubated patient )

8-12 mbar/l/sec

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Ventilation

Resistance
Law of Hagen-Poiseuille
The flow resistance through a tube with a defined length
is dependent upon the viscosity of the medium flowing
through and the fourth power of the tube radius.

In case of an intubated patient the endotracheal tube is

a resistance because of the lower diameter in relationship to the trachea.
The resistance of the tube is reduced by 50 % when using
a tube with 8,0 mm ID instead of 7,5 mm ID.

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Ventilation

V0
*
*
*
*
*
*
*
Vt
*
*
*
*
*
*
*
*
*
*
*
*
3
0

Time constant

100%

R*C=t
Filling and evacuation of functional compartment take place
exponentially.
The volume is decreased by the same percentage within the
same time intervals.
Above all, the important point is the fact that the duration of
expiration is determined by the product of resistance and
compliance.
36.8%

13.5%
5.0%
0

1.8%
4

0.7%
5

0.24%
6

R * C in sec.

Ventilation

Time constant - one more time

V0
*
*
*
*
*
*
*
Vt
*
*
*
*
*
*
*
3
1

R*C=t
Pendel-Luft and air trapping
Air oscillates from the fast compartment to the
slow ones until there is pressure equilibrium.
A certain volume remains trapped at the end of
expiration, if the expiration phase does not last
long enough = intrinsic PEEP.

R * C in sec.

Ventilation

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2

Ventilation,Perfusion,Diffusion,Distribution

Ventilation

Ventilation
Inspiration
Ventilation describes the process of inspiration and expiration - the transport of
breathing gas between the alveoli and the
atmosphere.
Expiration

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Ventilation

Shunt

Normal state

If an alveolus is perfused but not ventilated, because

it is blocked or collapsed - Atelectasis - the blood
which flows past it will not be oxygenated.
As a result it is the so called intrapulmonary right-toleft-shunt.

Alveolar occlusion

Shunt
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Ventilation

Perfusion

Pulmonary artery
O2
CO2

Pulmonary vein
O2
CO2
Perfusion refers to the passage of blood through the capillaries of the lung, whereby
carbon dioxide is transported to the alveolar membran and oxygen is taken to the pulmonary veins.
Blood which is not enriched with oxygen - normaly 2 % - is described as shunt.
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Ventilation

Dead Space Ventilation

The alveolar areas which are ventilated but not
perfused are described as the alveolar dead space,
as no gas exchange can take place here.
Normal state

Dead space ventilation

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Ventilation

Diffusion
Pulmonary artery
O2
CO2

Pulmonary vein
O2
CO2
The process of gas exchange between the alveoli and the blood flow is known as diffusion.
O2 and CO2 are diffusing because of the concentration gradient.
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Ventilation

Distribution

The breathing gas is distributed throughout

the different areas of the lung. It is important
for the breathing gas to be as evenly distributed as possible.
The distribution of the breathing gas and the
pressure compensation occur on the gas conducting side, that is from the trachea and the
bronchi to the alveoli and alveolar areas.

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