Using Common Ventilator Graphics to Provide Optimal Ventilation
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1 Using Common Ventilator Graphics to Provide Optimal Ventilation David Vines, MHS, RRT, FAARC Associate Professor Chair / Program Director Department of Respiratory Care RUSH UNIVERSITY MEDICAL CENTER
2 Disclosure Information No disclosure information related to this topic
3 Objectives Identify clinical problems associated with mechanical ventilation using a modern ventilator and their graphic package Discuss the adjustment of settings and use of graphics in correcting common clinical problems
4 Topics Common graphics displays Pressure, flow and volume - time curves during VCV, PCV, PRVC, SIMV, PSV Pressure - volume curves Flow-volume loops Common clinical conditions Case study
5 Common Graphics Displays A. Pressure - Time curves B. Flow - Time curves C. Volume - Time curves D. Pressure -Volume curves E. Flow - Volume curves A B C D E
6 Modes of Ventilation Two parts Pattern of the Breaths Type of Breath Delivered
7 Modes of Ventilation Pattern of the Breaths Assist/Control SIMV Patient/time triggered into inspiration Patient/time triggered into inspiration Spontaneous Breathing / CPAP Patient triggered into inspiration
8 Modes of Ventilation Type of Breath Delivered Volume Ventilation Patient/ time triggered, flow/volume limited, Volume / time cycled Pressure Control Ventilation Patient/ time triggered, pressure limited, time cycled Dual Control / Pressure Regulated Volume Control (PRVC) Patient/ time triggered, pressure limited and volume targeted, time cycled Spontaneous ventilation with Pressure Support Patient triggered, pressure limited, flow cycled
9 Flow, Pressure, & Volume Time Curves during Volume Control Ventilation
10 Flow, Pressure, & Volume Time Curves during Volume Control Ventilation
11 Flow, Pressure, & Volume Time Curves during Volume Control Ventilation Assisted
12 Flow, Pressure, & Volume Time Curves during Pressure Control Ventilation
13 Flow, Pressure, & Volume Time Curves during AutoFlow (PRVC)
14 Flow, Pressure, & Volume Time Curves during SIMV- volume with CPAP + 8 cm H2O
15 Flow, Pressure, & Volume Time Curves during Spontaneous Breathing on PSV
16 Flow, Pressure, & Volume Time Curves during Spontaneous Breathing on CPAP + 5 cm H20
17 Pressure-Volume Curve during Volume Control Ventilation
18 Pressure-Volume Curve during Volume Control Ventilation Trigger work
19 Pressure-Volume Curve during Volume Control Ventilation Elastic Work
20 Pressure-Volume Curve during Volume Control Ventilation Resistance
21 Pressure-Volume Curve & Trigger Work Pressure Trigger Flow Trigger
22
23 Flow-Volume Loop during Volume Control Ventilation
24
25 Common Clinical Problems Increased Impedance Compliance and Resistance Over distension Inadequate inspiratory flows Air leak Auto PEEP and I:E Ratio Setting Rise Time or Pressure Ramp Setting Expiratory Trigger Sensitivity (ETS)
26 Decreased Compliance during Volume Control Ventilation C=.05;R=5 C=.02;R=5
27 Decreased Compliance during Volume Control Ventilation C=.05;R=5; C=.02;R=5;
28 Decreased Compliance during Pressure Control Ventilation
29 Decreased Compliance during PRVC
30 Increased Resistance during Volume Control Ventilation C=.05;R=5 C=.05;R=20
31 Increased Resistance during Pressure Control Ventilation
32 Increased Resistance during PRVC
33 Increased Resistance C=.05;R=5 C=.05;R=20
34 Over Distention No patient effort
35 Air Leak
36 Inadequate Inspiratory Flow
37 Inadequate Inspiratory Flow
38 Auto PEEP 1:1 1.5:1 2:1
39 Auto PEEP Set rate -15 1:2 Total rate -22 1:1 Total rate -30 2:1
40 Setting Rise Time or Pressure Ramp PS- 15; Pramp 20 ms; Resistance- 20 RR- 20; Exhaled VT- 591 ml
41 Setting Rise Time or Pressure Ramp PS- 15; Pramp 50 ms; Resistance- 20 RR- 20; Exhaled VT- 580 ml
42 Setting Rise Time or Pressure Ramp PS- 15; Pramp 100 ms; resistance- 20 RR- 20; Exhaled VT- 597 ml
43 Setting Rise Time or Pressure Ramp PS- 15; Pramp 200 ms; Resistance- 20 RR- 20; Exhaled VT- 625 ml
44 Setting Expiratory Trigger Sensitivity PS- 15; Pramp 50 ms; ETS- 10% RR- 20; Exhaled VT- 700 ml
45 Setting Expiratory Trigger Sensitivity PS- 15; Pramp 50 ms; ETS- 25% RR- 20; Exhaled VT- 654 ml
46 Setting Expiratory Trigger Sensitivity PS- 15; Pramp 50 ms; ETS- 40% RR- 20; Exhaled VT- 604 ml
47 Avoid a Low ETS when Airway Resistance is High! PS- 15; Pramp 50 ms; ETS- 10%
48 Increase ETS 40%
49 Case: 38 Year Old Trauma Patient A male weighing 90 Kg (IBW) Obtunded, labored breathing 15 L/min O 2, SpO 2-85% Intubated and placed on an Avea Initial ventilator settings are Tidal volume 720 ml Rate- 12 PEEP- 10 FIO I-Time- 1.0 / Decelerating flow- 60 L/min
50
51
52
53 1. Which one of the following changes would you recommend?
54 A. Increase Flow B. Increase Rate C. Decrease Tidal Volume D. Decrease PEEP
55 A. Increase Flow B. Increase Rate C. Decrease Tidal Volume D. Decrease PEEP
56 Increase Peak Flow 70 L/min
57 Increase Peak Flow 80 L/min
58 Adjusting the Graphic Scales 70 L/min 80 L/min
59 SpO 2-92%, FIO2-.80, PEEP- 10 to 14
60 2. Which one of the following changes would you recommend?
61 A. Decrease Flow B. Decrease Rate C. Decrease Tidal Volume D. Decrease PEEP
62 A. Decrease Flow B. Decrease Rate C. Decrease Tidal Volume D. Decrease PEEP
63 Decreased Tidal Volume
64 Decreased Flow Increase I-Time
65 Turn on V-sync
66
67 Increase I-Time
68 Decreased Tidal Volume
69
70 3. Which one of the following best explains these changes?
71 A. Decrease in Airway Resistance B. Decrease in Compliance C. Increase in Airway Resistance D. Increase in Compliance
72 A. Decrease in Airway Resistance B. Decrease in Compliance C. Increase in Airway Resistance D. Increase in Compliance
73
74
75
76
77 3. Which of the following changes would you recommend?
78 A. Decrease in Time Low B. Decrease in Pressure High C. Increase in Pressure Low D. Increase in PSV
79 A. Decrease in Time Low B. Decrease in Pressure High C. Increase in Pressure Low D. Increase in PSV
80 Habashi. Crit Care Med, 2005;33(3):S228-S240
81 Habashi. Crit Care Med, 2005;33(3):S228-S240
82 Habashi. Crit Care Med, 2005;33(3):S228-S240
83
84
85 4. If his respiratory acidosis worsens, which one of the following changes would you recommend?
86 A. Increase in Pressure Low B. Increase in Pressure High C. Decrease in Time High D. Decrease in Time Low
87 A. Increase in Pressure Low B. Increase in Pressure High C. Decrease in Time High D. Decrease in Time Low
88
89 Conclusion It is important to be knowledgeable of the equipment you use and adapt it to the patient s pathophysiology.
90 Thank You RUSH UNIVERSITY MEDICAL CENTER
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New Modes of Ventilation. Dr. Zia Hashim
New Modes of Ventilation Dr. Zia Hashim Mode Describes the specific combination of: control phase conditional variables Defined for spontaneous mandatory breaths Variable Control variable : Constant throughout
The anaesthesia workstation focused on you
by The anaesthesia workstation focused on you The anaesthesia Accuracy and performance Equipped with the most advanced ventilation modes. Electronic rotameters with precise mass-flow sensors, allowing
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Aimsandobjec5ves TheBasicsofMechanical Ven5la5on January2012 Whyweven5latepeople Terms,acronymsandotherconfusingthings Basicven5latorseFngs/modes Thosewavylinestheyaskyouaboutinthe exam ThisisNOTanencyclopediclectureon
VENTILATION SERVO-s EASY AND RELIABLE PATIENT CARE
VENTILATION SERVO-s EASY AND RELIABLE PATIENT CARE Critical Care SERVO-s 3 SERVO-s SIMPLY MAKES SENSE MAQUET THE GOLD STANDARD Leading the way: MAQUET is a premier international provider of medical products
DATA SHEET. VENTILATION SERVO-s
DATA SHEET VENTILATION The Gold Standard Critical Care 3 PROVEN SERVO SIMPLICITY, RELIABILITY AND SENSITIVITY MAQUET THE GOLD STANDARD Leading the way: MAQUET is a premier international provider of medical
Oxylog VE300 Emergency & Transport Ventilation
Oxylog VE300 Emergency & Transport Ventilation The straightforward and user-friendly Dräger Oxylog VE300 is built to face your challenges in preclinical emergency services With reliable ventilation technology,