VENTILATION STRATEGIES FOR THE CRITICALLY UNWELL

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "VENTILATION STRATEGIES FOR THE CRITICALLY UNWELL"

Transcription

1 VENTILATION STRATEGIES FOR THE CRITICALLY UNWELL Dr Nick Taylor Visiting Emergency Specialist Teaching Hospital Karapitiya Senior Specialist and Director ED Training Clinical Lecturer, Australian National University Canberra Hospital, Australia

2 CASE 1 19 yo with severe hypoxia Widespread B profile on USS lung Intubated with sucker through cords

3 HOW WILL YOU VENTILATE HIM?

4 CASE 2 25 yo female with severe asthma Intubated Sudden drop in sats, high pressures and low BP

5 HOW WILL YOU VENTILATE HER?

6 INTRO Traditional ventilation teaching is often complicated and difficult to understand There are only 2 main reasons for respiration

7 Supplying Oxygen Getting Rid of CO2

8 There are also essentially only two main types of lung pathology requiring ventilation

9 TWO TYPES OF VENTILATION LUNG INJURY (Oxygen Supply is the problem) LUNG OBSTRUCTION (Getting rid of CO2 is the problem)

10 Today we will learn to apply these principles to a critically unwell patient You can use these principles for NIV or IPPV

11 FIRST: VERY SIMPLE PULMONARY PHYSIOLOGY

12 HOW DO WE MEASURE VENTILATION? Minute Volume = Tidal Volume x Respiratory Rate

13 MINUTE VOLUME FOR A NORMAL CO2 Around 60mL/kg in spont breathing pt Because of dead space it s closer to mL/kg when intubated

14 How does our body control ventilation?

15 PRIMARY SERVO CONTROL OF MINUTE VENTILATION Respiratory centre in the medulla (brain stem) ph sensitive cells (dissolved CO2 changes ph in CSF) Responds to changes in arterial CO2, and adjusts minute volume accordingly As CO2 rises we ventilate more, if CO2 falls, we ventilate less

16 CO2 is inversely proportional to MV Thus when ventilating a patient, we guide ventilation adequacy with ETCO2

17 Note ETCO2 will differ from PaCO2 It is usually lower by 5-10 but varies substantially with different circuits and lung pathology This is because of non ventilated dead space or shunt

18 BACK UP PLAN Hypoxic respiratory drive Need PO2 < 50 Clearly not your day to day ventilation controller!

19 OTHER VARIABLES What is the inevitable 3 rd major variable which goes along with TV and RR? Pressure

20 HOW DOES PRESSURE VARY WITH MV? Lung dynamics (particularly compliance) and coexisting pathology play a major role in how the lung will respond to a given RR and TV

21 COMPLIANCE Change in pressure for a given volume Low compliance = high elastic recoil and difficult to expand - a thick balloon (hard to inflate, easy to deflate) High compliance = low elastic recoil, Easy to expand - a plastic bag (easy to inflate, hard to deflate)

22 PRESSURES PIP (Peak inspiratory pressure) and EEP (end expiratory pressure) PIP is less useful as a measure of barotrauma than Alevolar pressure Plateau pressures (alveolar pressures) can be measured using an inspiratory breath hold Plateau pressures should be kept <30mmHg

23 Notice oxygen hasn t been mentioned in regards to ventilation yet

24 OXYGENATION Depends on: FiO2 Quality and size of surface area available for gas exchange Perfusion of lungs Oxygen carrying capacity of blood Tissue perfusion at end-organ

25 Positive end expiratory pressure PEEP Use PEEP to prevent derecruitment of alveolar units (decrease shunt) Increase FRC (functional residual capacity) eg in the obese patient Also reduces venous return (Preload) as mean intrathoracic pressure rises Predominately helps oxygenation

26 PEEP CONTINUED PEEP of 3-5 cmh 2 O thought to be physiological when ETT insitu Thus all patients except those with extremely high auto PEEP (severe asthma) should have around 5 of PEEP

27 AUTO PEEP All lungs have a low amount of auto-peep which rises in disease states like asthma Measure with expiratory breath hold Difference between applied PEEP and Exp pressure is the auto PEEP

28 FLOW RATE Is the speed at which VT is delivered Normal setting L/min Flow rate sets Tinsp and thus I:E ratio High flow > 60 L/min good for asthma (shorter Tinsp) but may increase Peak inspiratory Pressure (PiP) Low flow rates (20 to 50 L/min) = increase inspiratory time with improved distribution gases

29 I:E RATIOS Normal 1:2 Shorter insp times increase dead space ventilation Longer insp times improve oxygenation but increase haemodynamic instability Dependant on flow rate, inspiratory time and frequency

30 RISE TIME (RAMP) The amount of time it takes for set pressure to be reached from beginning inspiration Adjusts the peak inspiratory flow rate

31 LUNG INJURY VENTILATION

32 Injury ventilation is for basically everything except obstruction and thus includes ARDS, APO, pneumonia, contusions etc Oxygenation is the primary problem

33 NIV Mode CPAP PEEP start at 5-10 and increase by 2-3 every 5-10 minutes FiO2 depends on starting sats Aim to lower to <0.5 ASAP

34 IPPV MODE SIMV in Volume control mode

35 TV 6-8 ml/kg of ideal body weight This is a lung protective strategy For ARDS aim 6mL/kg

36 For ventilation Start at 18 Why 18? Dead space As a proportion of TV it s higher at lower TVs Need to compensate with rate to achieve MV RATE

37 PEEP/FIO2 For oxygenation Use PEEP tables No mortality diff high vs low PEEP but high PEEP may oxygenate better

38 IFR AND I:E Flow rates 50-80ml/min I:E ration 1:1.5-2

39 PERMISSIVE HYPERCAPNOEA Don t try and chase the CO2 unless acidosis (ph <7.15) becomes an issue

40 PLATEAU PRESSURES FOR INJURY Alveolar pressure Keep <30 cm H20 as associated with lower mortality

41 FIXING P PLAT Check P plat after changing TV /PEEP or q4h If Pplat > 30 cm H2O: decrease VT by 1ml/kg steps (minimum = 4 ml/kg). If Pplat < 25 cm H2O and VT< 6 ml/kg, increase VT by 1 ml/kg until Pplat>25cmH2OorVT =6ml/kg. If Pplat < 30 and breath stacking or dys-synchrony occurs: increase VT in 1ml/kg increments to 7 or 8 ml/kg if Pplat remains < 30 cm H2O.

42 LUNG INJURY SALVAGE

43 RECRUITMENT Maybe useful when unable to achieve adequate oxygenation Multiple different methods described Pros/cons to doing it Simplest is PEEP 30-40cm/H2O for 1-2 minutes PRONING is another recruitment method which can decrease mortality on the very critically hypoxic

44 Volume mode Start at 8ml/kg TV SUMMARY INJURY VENTILATION Set initial rate for goal MV Reduce TV over 1-2 hours to 6ml/kg Adjust TV and RR for P plat and CO2 goals

45 OBSTRUCTION

46 Commonest causes are asthma and COPD Failure to expel CO2 A Ventilation problem

47 NIV Bi-Level mode Start at 10/4 Start with FiO2 0.4 or so Increase IPAP/PS by 2-3cm H20 every 10-15minutes using MV and CO2 goals to guide you

48 IPPV MODE SIMV VC (PC if you like, no real difference)

49 TV Start at 8mL/kg of ideal body weight

50 RATE Start at 10 bpm and be ready to lower it Time in expiration is important

51 I:E AND IFR Use high IFR of L/min Aim to get I:E 1:4-5

52 PERMISSIVE HYPERCAPNOEA ph >7.1 is OK

53 PEEP/FIO2 0 added PEEP Check auto PEEP with Expiratory Breath Hold FiO2 at 0.4 to start

54 Breath stacking DYNAMIC HYPERINFLATION Leads to High intrathoracic pressures and decreased venous return sometimes to arrest

55 OBSTRUCTION RESCUE STRATEGIES If BP drops profoundly or pressures rise dramatically think pneumothorax or dynamic hyperinflation Disconnect from ventilator Allow sec apnoea Lung USS with slow RR for PTx May need chest compressions to reduce hyperinflation

56 OBSTRUCTION SUMMARY Low RR High IFR Long I:E ratio Moderate TVs Permissive hypercapnoea Watch out for dynamic hyperinflation

57 CASE 1 19 yo with severe hypoxia Widespread B profile on USS lung Intubated with sucker through cords

58 CASE CONTINUED Handbagged with PEEP valve no suction!!! When connected to ventilator: TV 60mL with PIP 50 What can you do??

59 Return to hand bagging CAN T VENTILATE LUNG INJURY Raise P limit of ventilator to 50 Set VC initially in CMV Rapid exchange back to vent circuit No suctioning!!! PEEP for 1-2 minutes Ventilate with ARDS PEEP/FiO2 tables and injury strategy

60 CASE 2 25 yo female with severe asthma Intubated and ventilated with obstruction strategy Sudden drop in sats, high pressures and low BP

61 WHATS SHOULD YOU DO Hand bag at slow rate Pressures very high Lung USS done: Normal BP 50/25 Apnoea trialled no success 5 slow chest compressions with audible exhalation BP increased Return to ventilator at RR 6, I:E 1:5

62 THANKYOU! QUESTIONS?

Basics of Mechanical Ventilation. Dr Shrikanth Srinivasan MD,DNB,FNB,EDIC Consultant, Critical Care Medicine Medanta, The Medicity

Basics of Mechanical Ventilation. Dr Shrikanth Srinivasan MD,DNB,FNB,EDIC Consultant, Critical Care Medicine Medanta, The Medicity Basics of Mechanical Ventilation Dr Shrikanth Srinivasan MD,DNB,FNB,EDIC Consultant, Critical Care Medicine Medanta, The Medicity Overview of topics 1. Goals 2. Settings 3. Modes 4. Advantages and disadvantages

More information

INTRODUCTION TO BI-VENT (APRV) INTRODUCTION TO BI-VENT (APRV) PROGRAM OBJECTIVES

INTRODUCTION TO BI-VENT (APRV) INTRODUCTION TO BI-VENT (APRV) PROGRAM OBJECTIVES INTRODUCTION TO BI-VENT (APRV) INTRODUCTION TO BI-VENT (APRV) PROGRAM OBJECTIVES PROVIDE THE DEFINITION FOR BI-VENT EXPLAIN THE BENEFITS OF BI-VENT EXPLAIN SET PARAMETERS IDENTIFY RECRUITMENT IN APRV USING

More information

Principles of mechanical ventilation. Anton van Kaam, MD, PhD Emma Children s Hospital AMC Amsterdam, The Netherlands

Principles of mechanical ventilation. Anton van Kaam, MD, PhD Emma Children s Hospital AMC Amsterdam, The Netherlands Principles of mechanical ventilation Anton van Kaam, MD, PhD Emma Children s Hospital AMC Amsterdam, The Netherlands Disclosure Research grant Chiesi Pharmaceuticals Research grant CareFusion GA: 27 weeks,

More information

Pressure Controlled Modes of Mechanical Ventilation

Pressure Controlled Modes of Mechanical Ventilation Pressure Controlled Modes of Mechanical Ventilation Christopher Junker Department of Anesthesiology & Critical Care Medicine George Washington University Saturday, August 20, 2011 Assist Control Hypoxemic

More information

Initiation and Management of Airway Pressure Release Ventilation (APRV)

Initiation and Management of Airway Pressure Release Ventilation (APRV) Initiation and Management of Airway Pressure Release Ventilation (APRV) Eric Kriner RRT Pulmonary Critical Care Clinical Specialist Pulmonary Services Department Medstar Washington Hospital Center Disclosures

More information

Accumulation of EEV Barotrauma Affect hemodynamic Hypoxemia Hypercapnia Increase WOB Unable to trigger MV

Accumulation of EEV Barotrauma Affect hemodynamic Hypoxemia Hypercapnia Increase WOB Unable to trigger MV Complicated cases during mechanical ventilation Pongdhep Theerawit M.D. Pulmonary and Critical Care Division Ramathibodi Hospital Case I Presentation Male COPD 50 YO, respiratory failure, on mechanical

More information

excellence in care Procedure Management of patients with difficult oxygenation. For Review Aug 2015

excellence in care Procedure Management of patients with difficult oxygenation. For Review Aug 2015 Difficult Oxygenation HELI.CLI.12 Purpose This procedure describes the processes and procedures for a lung protective strategy in the mechanical ventilation of patients that are difficult to oxygenate

More information

The Basics of Ventilator Management. Overview. How we breath 3/23/2019

The Basics of Ventilator Management. Overview. How we breath 3/23/2019 The Basics of Ventilator Management What are we really trying to do here Peter Lutz, MD Pulmonary and Critical Care Medicine Pulmonary Associates, Mobile, Al Overview Approach to the physiology of the

More information

NOTE: If not used, provider must document reason(s) for deferring mechanical ventilation in a patient with an advanced airway

NOTE: If not used, provider must document reason(s) for deferring mechanical ventilation in a patient with an advanced airway APPENDIX: TITLE: Mechanical Ventilator Use REVISED: November 1, 2017 I. Introduction: Mechanical Ventilation is the use of an automated device to deliver positive pressure ventilation to a patient. Proper

More information

Difficult Oxygenation Distribution: Sydney X Illawarra X Orange X

Difficult Oxygenation Distribution: Sydney X Illawarra X Orange X HELICOPTER OPERATING PROCEDURE HOP No: C/12 Issued: May 2011 Page: 1 of 5 Revision No: Original Difficult Oxygenation Distribution: Sydney X Illawarra X Orange X TRIM No: 09/300 Document No: D10/9973 X

More information

Selecting the Ventilator and the Mode. Chapter 6

Selecting the Ventilator and the Mode. Chapter 6 Selecting the Ventilator and the Mode Chapter 6 Criteria for Ventilator Selection Why does the patient need ventilatory support? Does the ventilation problem require a special mode? What therapeutic goals

More information

Mechanical Ventilation

Mechanical Ventilation Mechanical Ventilation Chapter 4 Mechanical Ventilation Equipment When providing mechanical ventilation for pediatric casualties, it is important to select the appropriately sized bag-valve mask or endotracheal

More information

Mechanical Ventilation. Which of the following is true regarding ventilation? Basics of Ventilation

Mechanical Ventilation. Which of the following is true regarding ventilation? Basics of Ventilation Mechanical Ventilation Jeffrey L. Wilt, MD, FACP, FCCP Associate Professor of Medicine Michigan State University Associate Program Director MSU-Grand Rapids Internal Medicine Residency Which of the following

More information

Mechanical Ventilation. Flow-Triggering. Flow-Triggering. Advanced Concepts. Advanced Concepts in Mechanical Ventilation

Mechanical Ventilation. Flow-Triggering. Flow-Triggering. Advanced Concepts. Advanced Concepts in Mechanical Ventilation Mechanical Ventilation Advanced Concepts in Mechanical Ventilation Flow-Triggering Trigger = the variable that causes the vent to begin the inspiratory phase Common triggers 1-2- 3- Effort required to

More information

Indications for Mechanical Ventilation. Mechanical Ventilation. Indications for Mechanical Ventilation. Modes. Modes: Volume cycled

Indications for Mechanical Ventilation. Mechanical Ventilation. Indications for Mechanical Ventilation. Modes. Modes: Volume cycled Mechanical Ventilation Eric A. Libré, MD VCU School of Medicine Inova Fairfax Hospital and VHC Indications for Mechanical Ventilation Inadequate ventilatory effort Rising pco2 with resp acidosis (7.25)

More information

EMS INTER-FACILITY TRANSPORT WITH MECHANICAL VENTILATOR COURSE OBJECTIVES

EMS INTER-FACILITY TRANSPORT WITH MECHANICAL VENTILATOR COURSE OBJECTIVES GENERAL PROVISIONS: EMS INTER-FACILITY TRANSPORT WITH MECHANICAL VENTILATOR COURSE OBJECTIVES Individuals providing Inter-facility transport with Mechanical Ventilator must have successfully completed

More information

Driving Pressure. What is it, and why should you care?

Driving Pressure. What is it, and why should you care? Driving Pressure What is it, and why should you care? Jonathan Pak MD March 2, 2017 Lancet 1967; 290: 319-323 Traditional Ventilation in ARDS Tidal Volume (V T ) = 10-15 ml/kg PBW PEEP = 5-12 cm H 2 O

More information

RESPIRATORY PHYSIOLOGY. Anaesthesiology Block 18 (GNK 586) Prof Pierre Fourie

RESPIRATORY PHYSIOLOGY. Anaesthesiology Block 18 (GNK 586) Prof Pierre Fourie RESPIRATORY PHYSIOLOGY Anaesthesiology Block 18 (GNK 586) Prof Pierre Fourie Outline Ventilation Diffusion Perfusion Ventilation-Perfusion relationship Work of breathing Control of Ventilation 2 This image

More information

Objectives. Respiratory Failure : Challenging Cases in Mechanical Ventilation. EM Knows Respiratory Failure!

Objectives. Respiratory Failure : Challenging Cases in Mechanical Ventilation. EM Knows Respiratory Failure! Respiratory Failure : Challenging Cases in Mechanical Ventilation Peter DeBlieux, MD, FAAEM, FACEP LSUHSC University Hospital Pulmonary and Critical Care Medicine Emergency Medicine pdebli@lsuhsc.edu Objectives

More information

Neonatal tidal volume targeted ventilation

Neonatal tidal volume targeted ventilation Neonatal tidal volume targeted ventilation Colin Morley Retired Professor of Neonatal Medicine, Royal Women s Hospital, Melbourne, Australia. Honorary Visiting Fellow, Dept Obstetrics and Gynaecology,

More information

Neonatal Assisted Ventilation. Haresh Modi, M.D. Aspirus Wausau Hospital, Wausau, WI.

Neonatal Assisted Ventilation. Haresh Modi, M.D. Aspirus Wausau Hospital, Wausau, WI. Neonatal Assisted Ventilation Haresh Modi, M.D. Aspirus Wausau Hospital, Wausau, WI. History of Assisted Ventilation Negative pressure : Spirophore developed in 1876 with manual device to create negative

More information

Introduction. Respiration. Chapter 10. Objectives. Objectives. The Respiratory System

Introduction. Respiration. Chapter 10. Objectives. Objectives. The Respiratory System Introduction Respiration Chapter 10 The Respiratory System Provides a means of gas exchange between the environment and the body Plays a role in the regulation of acidbase balance during exercise Objectives

More information

Notes on BIPAP/CPAP. M.Berry Emergency physician St Vincent s Hospital, Sydney

Notes on BIPAP/CPAP. M.Berry Emergency physician St Vincent s Hospital, Sydney Notes on BIPAP/CPAP M.Berry Emergency physician St Vincent s Hospital, Sydney 2 DEFINITIONS Non-Invasive Positive Pressure Ventilation (NIPPV) Encompasses both CPAP and BiPAP Offers ventilation support

More information

Technical Data and Specifications

Technical Data and Specifications Technical Data and Specifications INTENDED USE Ventilator designed to provide Invasive and Non-invasive ventilation for the critical care management of adult, pediatric and neonate-infant (including premature)

More information

PERFORMANCE EVALUATION #34 NAME: 7200 Ventilator Set Up DATE: INSTRUCTOR:

PERFORMANCE EVALUATION #34 NAME: 7200 Ventilator Set Up DATE: INSTRUCTOR: PERFORMANCE EVALUATION #34 NAME: 7200 Ventilator Set Up DATE: 1. **Identify and name the filters on the 7200ae. 2. **Explain how each filter is sterilized. 3. **Trace the gas flow through the ventilator

More information

Using Common Ventilator Graphics to Provide Optimal Ventilation

Using Common Ventilator Graphics to Provide Optimal Ventilation 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 Disclosure

More information

Mechanical Ventilation

Mechanical Ventilation Mechanical Ventilation Understanding Modes Rob Chatburn, RRT-NPS, FAARC Research Manager Respiratory Therapy Cleveland Clinic Associate Professor Case Western Reserve University 1 Overview Characteristics

More information

Automatic Transport Ventilator

Automatic Transport Ventilator Automatic Transport Ventilator David M. Landsberg, MD, FACP, FCCP, EMT-P Luke J. Gasowski, RRT, NPS, ACCS, CCP-C, FP-C Christopher J. Fullagar, MD, FACEP, EMT-P Stan Goettel, MS, EMT-P Author credits /

More information

Chapter 4: Ventilation Test Bank MULTIPLE CHOICE

Chapter 4: Ventilation Test Bank MULTIPLE CHOICE Instant download and all chapters Test Bank Respiratory Care Anatomy and Physiology Foundations for Clinical Practice 3rd Edition Will Beachey https://testbanklab.com/download/test-bank-respiratory-care-anatomy-physiologyfoundations-clinical-practice-3rd-edition-will-beachey/

More information

Advanced Ventilator Modes. Shekhar T. Venkataraman M.D. Professor Critical Care Medicine and Pediatrics University of Pittsburgh School of Medicine

Advanced Ventilator Modes. Shekhar T. Venkataraman M.D. Professor Critical Care Medicine and Pediatrics University of Pittsburgh School of Medicine Advanced Ventilator Modes Shekhar T. Venkataraman M.D. Shekhar T. Venkataraman M.D. Professor Critical Care Medicine and Pediatrics University of Pittsburgh School of Medicine Advanced modes Pressure-Regulated

More information

Respiratory Physiology. Adeyomoye O.I

Respiratory Physiology. Adeyomoye O.I Respiratory Physiology By Adeyomoye O.I Outline Introduction Hypoxia Dyspnea Control of breathing Ventilation/perfusion ratios Respiratory/barometric changes in exercise Intra-pulmonary & intra-pleural

More information

Mechanical Ventilation. Mechanical Ventilation is a Drug!!! is a drug. MV: Indications for use. MV as a Drug: Outline. MV: Indications for use

Mechanical Ventilation. Mechanical Ventilation is a Drug!!! is a drug. MV: Indications for use. MV as a Drug: Outline. MV: Indications for use Mechanical Ventilation is a Drug!!! Mechanical Ventilation is a drug I am an employee of Philips Healthcare Hospital Respiratory Care Group and they help me pay for my kids education Jim Laging, RRT, RCP

More information

UNDERSTANDING NEONATAL WAVEFORM GRAPHICS. Brandon Kuehne, MBA, RRT-NPS, RPFT Director- Neonatal Respiratory Services

UNDERSTANDING NEONATAL WAVEFORM GRAPHICS. Brandon Kuehne, MBA, RRT-NPS, RPFT Director- Neonatal Respiratory Services UNDERSTANDING NEONATAL WAVEFORM GRAPHICS Brandon Kuehne, MBA, RRT-NPS, RPFT Director- Neonatal Respiratory Services Disclosures Purpose: To enhance bedside staff s knowledge of ventilation and oxygenation

More information

PART EIGHT HIGH FREQUENCY PERCUSSIVE OSCILLATION (HFPOV )

PART EIGHT HIGH FREQUENCY PERCUSSIVE OSCILLATION (HFPOV ) PART EIGHT HIGH FREQUENCY PERCUSSIVE OSCILLATION (HFPOV ) Note: For maximal comparative understanding, FIRST read PART SEVEN which defines the concept of High Frequency Oscillatory Ventilation (HFOV).

More information

mechanical ventilation Arjun Srinivasan

mechanical ventilation Arjun Srinivasan Respiratory mechanics in mechanical ventilation Arjun Srinivasan Introduction Mechanics during ventilation PV curves Application in health & disease Difficulties & pitfalls The future. Monitoring Mechanics

More information

Bunnell LifePulse HFV Quick Reference Guide # Bunnell Incorporated

Bunnell LifePulse HFV Quick Reference Guide # Bunnell Incorporated Bunnell Incorporated n www.bunl.com n 800-800-4358 (HFJV) n info@bunl.com 436 Lawndale Drive n Salt Lake City, Utah 84115 n intl 801-467-0800 n f 801-467-0867 Bunnell LifePulse HFV Quick Reference Guide

More information

Collin County Community College. Lung Physiology

Collin County Community College. Lung Physiology Collin County Community College BIOL. 2402 Anatomy & Physiology WEEK 9 Respiratory System 1 Lung Physiology Factors affecting Ventillation 1. Airway resistance Flow = Δ P / R Most resistance is encountered

More information

Capnography in the Veterinary Technician Toolbox. Katie Pinner BS, LVT Bush Advanced Veterinary Imaging Richmond, VA

Capnography in the Veterinary Technician Toolbox. Katie Pinner BS, LVT Bush Advanced Veterinary Imaging Richmond, VA Capnography in the Veterinary Technician Toolbox Katie Pinner BS, LVT Bush Advanced Veterinary Imaging Richmond, VA What are Respiration and Ventilation? Respiration includes all those chemical and physical

More information

VENTILATORS PURPOSE OBJECTIVES

VENTILATORS PURPOSE OBJECTIVES VENTILATORS PURPOSE To familiarize and acquaint the transfer Paramedic with the skills and knowledge necessary to adequately maintain a ventilator in the interfacility transfer environment. COGNITIVE OBJECTIVES

More information

RESPIRATORY PHYSIOLOGY, PHYSICS AND PATHOLOGY IN RELATION TO ANAESTHESIA AND INTENSIVE CARE

RESPIRATORY PHYSIOLOGY, PHYSICS AND PATHOLOGY IN RELATION TO ANAESTHESIA AND INTENSIVE CARE Course n : Course 3 Title: RESPIRATORY PHYSIOLOGY, PHYSICS AND PATHOLOGY IN RELATION TO ANAESTHESIA AND INTENSIVE CARE Sub-category: Intensive Care for Respiratory Distress Topic: Pulmonary Function and

More information

Guide to Understand Mechanical Ventilation Waveforms

Guide to Understand Mechanical Ventilation Waveforms Do No Harm Ventilate Gently Guide to Understand Mechanical Ventilation Waveforms Middle East Critical Care Assembly 1/30/2015 Mazen Kherallah, MD, FCCP http://www.mecriticalcare.net Email: info@mecriticalcare.net

More information

Mechanical Ventilation of the Patient with ARDS

Mechanical Ventilation of the Patient with ARDS 1 Mechanical Ventilation of the Patient with ARDS Dean Hess, PhD, RRT, FAARC Assistant Professor of Anesthesia Harvard Medical School Assistant Director of Respiratory Care Massachusetts General Hospital

More information

OPEN LUNG APPROACH CONCEPT OF MECHANICAL VENTILATION

OPEN LUNG APPROACH CONCEPT OF MECHANICAL VENTILATION OPEN LUNG APPROACH CONCEPT OF MECHANICAL VENTILATION L. Rudo Mathivha Intensive Care Unit Chris Hani Baragwanath Aacademic Hospital & the University of the Witwatersrand OUTLINE Introduction Goals & Indications

More information

Test Bank for Pilbeams Mechanical Ventilation Physiological and Clinical Applications 6th Edition by Cairo

Test Bank for Pilbeams Mechanical Ventilation Physiological and Clinical Applications 6th Edition by Cairo Test Bank for Pilbeams Mechanical Ventilation Physiological and Clinical Applications 6th Edition by Cairo Link full download: http://testbankair.com/download/test-bank-for-pilbeams-mechanicalventilation-physiological-and-clinical-applications-6th-edition-by-cairo/

More information

Invasive Ventilation: State of the Art

Invasive Ventilation: State of the Art ARDSnet NEJM 2000;342:1301 9-30-17 Cox Invasive Ventilation: State of the Art Bob Kacmarek PhD, RRT Harvard Medical School Massachusetts General Hospital Boston, Massachusetts A V T of 6 ml/kg PBW results

More information

Chapter 3: Invasive mechanical ventilation Stephen Lo

Chapter 3: Invasive mechanical ventilation Stephen Lo Chapter 3: Invasive mechanical ventilation Stephen Lo Introduction Conventional mechanical ventilation is the delivery of positive pressure to the airway to allow removal of CO2 and delivery of O2. In

More information

Presentation Overview. Monitoring Strategies for the Mechanically Ventilated Patient. Early Monitoring Strategies. Early Attempts To Monitor WOB

Presentation Overview. Monitoring Strategies for the Mechanically Ventilated Patient. Early Monitoring Strategies. Early Attempts To Monitor WOB Monitoring Strategies for the Mechanically entilated Patient Presentation Overview A look back into the future What works and what may work What s all the hype about the WOB? Are ventilator graphics really

More information

Potential Conflicts of Interest Received research grants from Hamilton, Covidien, Drager, General lel Electric, Newport, and Cardinal Medical Received

Potential Conflicts of Interest Received research grants from Hamilton, Covidien, Drager, General lel Electric, Newport, and Cardinal Medical Received How Does a Mechanical Ventilator t 6-22-10 Spain Work? Bob Kacmarek PhD, RRT Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts Potential Conflicts of Interest Received research

More information

Author: Thomas Sisson, MD, 2009

Author: Thomas Sisson, MD, 2009 Author: Thomas Sisson, MD, 2009 License: Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Non-commercial Share Alike 3.0 License: http://creativecommons.org/licenses/by-nc-sa/3.0/

More information

APRV: Moving beyond ARDSnet

APRV: Moving beyond ARDSnet APRV: Moving beyond ARDSnet Matthew Lissauer, MD Associate Professor of Surgery Medical Director, Surgical Critical Care Rutgers, The State University of New Jersey What is APRV? APRV is different from

More information

Update to RS-232 commands. Changing patient from NIV to INVASIVE Vent Type. SNDF command

Update to RS-232 commands. Changing patient from NIV to INVASIVE Vent Type. SNDF command Changing patient from NIV to INVASIVE Vent Type Table 9 shows automatic settings changes that occur when changing the same patient from NIV to INVASIVE Vent Type. Table 9: Automatic settings changes NIV

More information

Disclosures. The Pediatric Challenge. Topics for Discussion. Traditional Anesthesia Machine. Tidal Volume = mls/kg 2/13/14

Disclosures. The Pediatric Challenge. Topics for Discussion. Traditional Anesthesia Machine. Tidal Volume = mls/kg 2/13/14 2/13/14 Disclosures Optimal Ventilation of the Pediatric Patient in the OR Consulting Draeger Medical Jeffrey M. Feldman, MD, MSE Division Chief, General Anesthesia Dept. of Anesthesiology and Critical

More information

ONLINE DATA SUPPLEMENT. First 24 hours: All patients with ARDS criteria were ventilated during 24 hours with low V T (6-8 ml/kg

ONLINE DATA SUPPLEMENT. First 24 hours: All patients with ARDS criteria were ventilated during 24 hours with low V T (6-8 ml/kg APPENDIX 1 Appendix 1. Complete respiratory protocol. First 24 hours: All patients with ARDS criteria were ventilated during 24 hours with low V T (6-8 ml/kg predicted body weight (PBW)) (NEJM 2000; 342

More information

OXYGEN THERAPY. (Non-invasive O2 therapy in patient >8yrs)

OXYGEN THERAPY. (Non-invasive O2 therapy in patient >8yrs) OXYGEN THERAPY (Non-invasive O2 therapy in patient >8yrs) Learning aims Indications and precautions for O2 therapy Targets of therapy Standard notation O2 delivery devices Taps, tanks and tubing Notation

More information

6 th Accredited Advanced Mechanical Ventilation Course for Anesthesiologists. Course Test Results for the accreditation of the acquired knowledge

6 th Accredited Advanced Mechanical Ventilation Course for Anesthesiologists. Course Test Results for the accreditation of the acquired knowledge 6 th Accredited Advanced Mechanical Ventilation Course for Anesthesiologists Course Test Results for the accreditation of the acquired knowledge Q. Concerning the mechanics of the newborn s respiratory

More information

Oxylog 3000 plus Emergency & Transport Ventilation

Oxylog 3000 plus Emergency & Transport Ventilation Oxylog 3000 plus Emergency & Transport Ventilation Offering high ventilation performance with features such as AutoFlow, integrated capnography and non-invasive Ventilation, the compact and robust Oxylog

More information

MEDICAL EQUIPMENT IV MECHANICAL VENTILATORS. Prof. Yasser Mostafa Kadah

MEDICAL EQUIPMENT IV MECHANICAL VENTILATORS. Prof. Yasser Mostafa Kadah MEDICAL EQUIPMENT IV - 2013 MECHANICAL VENTILATORS Prof. Yasser Mostafa Kadah Mechanical Ventilator A ventilator is a machine, a system of related elements designed to alter, transmit, and direct energy

More information

Completed downloadable Test Bank for Pilbeams Mechanical Ventilation Physiological and Clinical Applications 5th Edition by Cairo

Completed downloadable Test Bank for Pilbeams Mechanical Ventilation Physiological and Clinical Applications 5th Edition by Cairo Completed downloadable Test Bank for Pilbeams Mechanical Ventilation Physiological and Clinical Applications 5th Edition by Cairo Link full download: http://testbankcollection.com/download/pilbeams-mechanicalventilation-physiological-and-clinical-applications-5th-edition-test-bank-cairo

More information

The physiological functions of respiration and circulation. Mechanics. exercise 7. Respiratory Volumes. Objectives

The physiological functions of respiration and circulation. Mechanics. exercise 7. Respiratory Volumes. Objectives exercise 7 Respiratory System Mechanics Objectives 1. To explain how the respiratory and circulatory systems work together to enable gas exchange among the lungs, blood, and body tissues 2. To define respiration,

More information

http://www.priory.com/cmol/hfov.htm INTRODUCTION The vast majority of patients who are admitted to an Intensive Care Unit (ICU) will need artificial ventilation (Jones et al 1998). The usual means through

More information

Physiological Basis of Mechanical Ventilation

Physiological Basis of Mechanical Ventilation Physiological Basis of Mechanical Ventilation Wally Carlo, M.D. University of Alabama at Birmingham Department of Pediatrics Division of Neonatology wcarlo@peds.uab.edu Fine Tuning Mechanical Ventilation

More information

Ventilators. Dr Simon Walton Consultant Anaesthetist Eastbourne DGH KSS Basic Science Course

Ventilators. Dr Simon Walton Consultant Anaesthetist Eastbourne DGH KSS Basic Science Course Ventilators Dr Simon Walton Consultant Anaesthetist Eastbourne DGH KSS Basic Science Course Objectives Discuss Classification/ terminology Look at Modes of ventilation How some specific ventilators work

More information

Mechanical power and opening pressure. Fellowship training program Intensive Care Radboudumc, Nijmegen

Mechanical power and opening pressure. Fellowship training program Intensive Care Radboudumc, Nijmegen Mechanical power and opening pressure Fellowship training program Intensive Care Radboudumc, Nijmegen Mechanical power Energy applied to the lung: Ptp * V (Joule) Power = Energy per minute (J/min) Power

More information

3100A Competency Exam

3100A Competency Exam NAME DATE (Circle the appropriate answer) 3100A Competency Exam 1. Of the following, which best describes the mechanics of ventilation used by the 3100A? a. Active inspiration with passive exhalation b.

More information

RESPIRATORY CARE POLICY AND PROCEDURE MANUAL. a) Persistent hypoxemia despite improved ventilatory pattern and elevated Fl02

RESPIRATORY CARE POLICY AND PROCEDURE MANUAL. a) Persistent hypoxemia despite improved ventilatory pattern and elevated Fl02 The University of Mississippi AND PROCEDURE MANUAL Effective Date: June 30, 1990 Revised Date: December 2009 MANUAL CODE Page 1 of 5 PREPARED BY: Respiratory Care Policy and Procedure Review Committee

More information

Section Two Diffusion of gases

Section Two Diffusion of gases Section Two Diffusion of gases Lecture 5: Partial pressure and the composition of gasses in air. Factors affecting diffusion of gases. Ventilation perfusion ratio effect on alveolar gas concentration.

More information

Monitoring, Ventilation & Capnography

Monitoring, Ventilation & Capnography Why do we need to monitor? Monitoring, Ventilation & Capnography Keith Simpson BVSc MRCVS MIET(Electronics) Torquay, Devon. Under anaesthesia animals no longer have the ability to adequately control their

More information

PICU Resident Self-Study Tutorial The Basic Physics of Oxygen Transport. I was told that there would be no math!

PICU Resident Self-Study Tutorial The Basic Physics of Oxygen Transport. I was told that there would be no math! Physiology of Oxygen Transport PICU Resident Self-Study Tutorial I was told that there would be no math! INTRODUCTION Christopher Carroll, MD Although cells rely on oxygen for aerobic metabolism and viability,

More information

O-Two Self-Study Guide. e600 Transport Ventilator Ventilation Modes

O-Two Self-Study Guide. e600 Transport Ventilator Ventilation Modes O-Two Self-Study Guide e600 Transport Ventilator Ventilation Modes e600 VENTILATION MODES The e600 ventilator has 13 ventilation modes: Manual Ventilation, Controlled Mandatory Ventilation (CMV), Assist

More information

Prof. Javier García Fernández MD, Ph.D, MBA.

Prof. Javier García Fernández MD, Ph.D, MBA. Prof. Javier García Fernández MD, Ph.D, MBA. Chairman of Anesthesia & Perioperative Medicine Department Puerta de Hierro Universitary Hospital Prof. of Anaesthesia and Perioperative Medicine. Autonoma

More information

How does HFOV work? John F Mills MBBS, FRACP, M Med Sc, PhD Neonatologist Royal Children s Hospital. Synopsis

How does HFOV work? John F Mills MBBS, FRACP, M Med Sc, PhD Neonatologist Royal Children s Hospital. Synopsis How does HFOV work? John F Mills MBBS, FRACP, M Med Sc, PhD Neonatologist Royal Children s Hospital Synopsis Definition of an oscillator Historical perspective Differences between HFOV and CMV Determinants

More information

Mechanical Ventilation Guided by Esophageal Pressure in Acute Lung Injury *

Mechanical Ventilation Guided by Esophageal Pressure in Acute Lung Injury * A teaching hospital of Harvard Medical School Mechanical Ventilation Guided by Esophageal Pressure in Acute Lung Injury * Ray Ritz BA RRT FAARC Beth Israel Deaconess Medical Center Boston MA * n engl j

More information

New Frontiers in Anesthesia Ventilation. Brent Dunworth, MSN, CRNA. Anesthesia Ventilation. New Frontiers in. The amount of gas delivered can be

New Frontiers in Anesthesia Ventilation. Brent Dunworth, MSN, CRNA. Anesthesia Ventilation. New Frontiers in. The amount of gas delivered can be New Frontiers in Anesthesia Ventilation Senior Director, Nurse Anesthesia Department of Anesthesiology University of Pittsburgh Medical Center Content Outline 1 2 Anesthesia Evolution Anesthesia Evolution

More information

PROBLEM SET 9. SOLUTIONS April 23, 2004

PROBLEM SET 9. SOLUTIONS April 23, 2004 Harvard-MIT Division of Health Sciences and Technology HST.542J: Quantitative Physiology: Organ Transport Systems Instructors: Roger Mark and Jose Venegas MASSACHUSETTS INSTITUTE OF TECHNOLOGY Departments

More information

Physiological based management of hypoxaemic respiratory failure

Physiological based management of hypoxaemic respiratory failure Physiological based management of hypoxaemic respiratory failure David Tingay 1. Neonatal Research, Murdoch Children s Research Institute, Melbourne 2. Neonatology, Royal Children s Hospital 3. Dept of

More information

Introduction to Conventional Ventilation

Introduction to Conventional Ventilation Introduction to Conventional Ventilation Dr Julian Eason Consultant Neonatologist Derriford Hospital Mechanics Inspiration diaphragm lowers and thorax expands Negative intrathoracic/intrapleural pressure

More information

Respiratory System. Prepared by: Dorota Marczuk-Krynicka, MD, PhD

Respiratory System. Prepared by: Dorota Marczuk-Krynicka, MD, PhD Respiratory System Prepared by: Dorota Marczuk-Krynicka, MD, PhD Lungs: Ventilation Perfusion Gas Exchange - Diffusion 1. Airways and Airway Resistance (AWR) 2. Mechanics of Breathing and Lung (Elastic)

More information

RSPT 1060 OBJECTIVES OBJECTIVES OBJECTIVES EQUATION OF MOTION. MODULE C Applied Physics Lesson #1 - Mechanics. Ventilation vs.

RSPT 1060 OBJECTIVES OBJECTIVES OBJECTIVES EQUATION OF MOTION. MODULE C Applied Physics Lesson #1 - Mechanics. Ventilation vs. RSPT 1060 MODULE C Applied Physics Lesson #1 - Mechanics OBJECTIVES At the end of this module, the student should be able to define the terms and abbreviations used in the module. draw & explain the equation

More information

Flight Medical presents the F60

Flight Medical presents the F60 Flight Medical presents the F60 Reliable Ventilation Across the Spectrum of Care Adult & Pediatric Pressure/Volume Control Basic/Advanced Modes Invasive/NIV High Pressure/Low Flow O2 Up to 12 hours batteries

More information

Module Two. Objectives: Objectives cont. Objectives cont. Objectives cont.

Module Two. Objectives: Objectives cont. Objectives cont. Objectives cont. Transition to the New National EMS Education Standards: EMT-B B to EMT Module Two Objectives: Upon completion, each participant will do the following to a degree of accuracy that meets the Ntl EMS Education

More information

Unit 15 Manual Resuscitators

Unit 15 Manual Resuscitators 15-1 Unit 15 Manual Resuscitators GOAL On completion of this unit, the student should comprehend the proper operation of self-inflating resuscitation bags, flow-inflating resuscitation bags and gas-powered

More information

Classification of Mechanical Ventilators

Classification of Mechanical Ventilators Classification of Mechanical Ventilators Kacmarek s 12 Point Classification Positive/Negative Pressure Powering Mechanism Driving Mechanism Single or Double Circuited Modes of Ventilation Cycling Parameter

More information

Physiology (3) Pulmonary Function Test:

Physiology (3) Pulmonary Function Test: Pulmonary Function Test: Today we will continue with the pulmonary function test, and the question is: why do we do pulmonary function tests for patients? Can pulmonary function tests tell us what type

More information

Ventilating the Sick Lung Mike Dougherty RRT-NPS

Ventilating the Sick Lung Mike Dougherty RRT-NPS Ventilating the Sick Lung 2018 Mike Dougherty RRT-NPS Goals and Objectives Discuss some Core Principles of Ventilation relevant to mechanical ventilation moving forward. Compare and Contrast High MAP strategies

More information

Respiratory Anatomy and Physiology. Respiratory Anatomy. Function of the Respiratory System

Respiratory Anatomy and Physiology. Respiratory Anatomy. Function of the Respiratory System Respiratory Anatomy and Physiology Michaela Dixon Clinical Development Nurse PICU BRHFC Respiratory Anatomy Function of the Respiratory System - In conjunction with the cardiovascular system, to supply

More information

Rodney Shandukani 14/03/2012

Rodney Shandukani 14/03/2012 Rodney Shandukani 14/03/2012 OXYGEN THERAPY Aerobic metabolism accounts for 90% of Oxygen consumption by tissues. generates ATP by oxidative phosphorylation. Oxygen cascade: Oxygen exerts a partial pressure,

More information

Respiratory Failure & Mechanical Ventilation. Denver Health Medical Center Department of Surgery and the University Of Colorado Denver

Respiratory Failure & Mechanical Ventilation. Denver Health Medical Center Department of Surgery and the University Of Colorado Denver Respiratory Failure & Mechanical Ventilation Denver Health Medical Center Department of Surgery and the University Of Colorado Denver + + Failure of the Respiratory Pump 1. Lack of patent airway 2. Bronchospasm

More information

Operating Instructions for Microprocessor Controlled Ventilators

Operating Instructions for Microprocessor Controlled Ventilators Page 1 of 5 Operating Instructions for Microprocessor Controlled Ventilators Purpose Audience Scope Physician's Order To provide guidelines for the procedure for the use of microprocessor controlled ventilators.

More information

What is Lung Protective Ventilation? NBART 2016

What is Lung Protective Ventilation? NBART 2016 What is Lung Protective Ventilation? NBART 2016 Disclosure Full time employee of Draeger Outline 1. Why talk about Lung Protective Ventilation? 2. What is Lung Protective Ventilation? 3. How to apply Lung

More information

Mechanical Ventilation

Mechanical Ventilation PROCEDURE - Page 1 of 5 Purpose Scope Physician's Order Indications Procedure Mechanical Artificial Ventilation refers to any methods to deliver volumes of gas into a patient's lungs over an extended period

More information

Mechanical ven3la3on. Neonatal Mechanical Ven3la3on. Mechanical ven3la3on. Mechanical ven3la3on. Mechanical ven3la3on 8/25/11. What we need to do"

Mechanical ven3la3on. Neonatal Mechanical Ven3la3on. Mechanical ven3la3on. Mechanical ven3la3on. Mechanical ven3la3on 8/25/11. What we need to do 8/25/11 Mechanical ven3la3on Neonatal Mechanical Ven3la3on Support oxygen delivery, CO2 elimination" Prevent added injury, decrease ongoing injury" Enhance normal development" Mark C Mammel, MD University

More information

VT PLUS HF performance verification of Bunnell Life-Pulse HFJV (High Frequency Jet Ventilator)

VT PLUS HF performance verification of Bunnell Life-Pulse HFJV (High Frequency Jet Ventilator) VT PLUS HF performance verification of Bunnell Life-Pulse HFJV (High Frequency Jet Ventilator) VT PLUS HF provides a special mode for evaluating the performance of high frequency ventilators while connected

More information

RESPIRATORY REGULATION DURING EXERCISE

RESPIRATORY REGULATION DURING EXERCISE RESPIRATORY REGULATION DURING EXERCISE Respiration Respiration delivery of oxygen to and removal of carbon dioxide from the tissue External respiration ventilation and exchange of gases in the lung Internal

More information

Respiratory Physiology. ED Primary Teaching

Respiratory Physiology. ED Primary Teaching Respiratory Physiology ED Primary Teaching Functions of the respiratory system Gas exchange with O2 and CO2 Surfactant production Defence - IgA and macrophages Filer - pollutants and thromboembolism Metabolises

More information

AUTOVENT 4000 VENTILATOR

AUTOVENT 4000 VENTILATOR OVERVIEW AUTOVENT 4000 Only properly trained and approved Escambia County Bureau of Public Safety Paramedics are to use the AutoVent 4000 ventilator manufactured by LSP to transport patients already on

More information

Respiration - Human 1

Respiration - Human 1 Respiration - Human 1 At the end of the lectures on respiration you should be able to, 1. Describe events in the respiratory processes 2. Discuss the mechanism of lung ventilation in human 3. Discuss the

More information

Volume Targeted Ventilation on the Neonatal Unit

Volume Targeted Ventilation on the Neonatal Unit This guidance does not override the individual responsibility of health professionals to make appropriate decision according to the circumstances of the individual patient in consultation with the patient

More information

Respiration (revised 2006) Pulmonary Mechanics

Respiration (revised 2006) Pulmonary Mechanics Respiration (revised 2006) Pulmonary Mechanics PUL 1. Diagram how pleural pressure, alveolar pressure, airflow, and lung volume change during a normal quiet breathing cycle. Identify on the figure the

More information

Inspiration 7i Ventilator

Inspiration 7i Ventilator Inspiration 7i Ventilator Clinician Focused Products is not just a tag line, rather a belief system. Low cost of ownership High performance PSOL and active exhalation Comprehensive graphics and trending

More information