Medical Ventilators. Presented by: Edwin Lim

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1 Medical Ventilators Presented by: Edwin Lim 1

2 Presentation Outline Respiration and You Medical Ventilators: Why? How? Current Medical Ventilators The Future 2

3 The Importance of Oxygen People can survive for a few weeks without food, a few days without water, but not much longer than 2 minutes without oxygen Oxygen is almost solely required for cellular respiration Main source of oxygen is the air around us, ingested through the respiratory system While vastly important, too much can kill you Oxygen poisoning: oxygen free radicals formed damage tissues 3

4 Zones of Interest Can be divided into 2 parts Conduction Zone (mouth, nose, sinuses, pharynx, trachea, bronchi, bronchioles) Filter Warm/Humidify Moves Air to respiratory zone Respiration Zone (respiratory bronchioles, alveoli, alveolar sacs) Gas Exchange 4

5 Lung Properties Compliance Governs expansion of lungs Normally 100 times more distensible than balloon Elasticity Returns lungs to original state after expansion Surface Tension Surfactant prevents alveoli from collapsing upon themselves during exhalation 5

6 Ventilation Process of moving of air into and out of the lungs 2 Stages: Inspiration Thoracic Diaphragm (major) and External Intercostals contract to expand the thoracic cavity Decreased pressure in lungs causes air to move in Expiration Thoracic Diaphragm relaxes, Internal Intercostals contract to decrease volume of thoracic cavity Increased pressure in lungs causes air to move out 6

7 Lung Volumes Total Lung Capacity Total amount of air in lungs after forced inspiration Tidal Volume amount of air moved in and out during normal ventilation Vital Capacity amount of air that can be forcefully expired after forced inspiration Residual Volume (Dead Space) amount of air left in lungs after forced expiration Minimum alveolar volume for an average adult: 350mL However the person s dead space (roughly 150mL for average adult) would prevent some of the gas from reaching the alveoli Also dead space from equipment that is being used too (air might stay in masks or tubes, etc.) Thus to save a person a minimum volume of 600mL tidal volume must be provided by the equipment Most people trained to give a minimum of 800mL (greater margin of safety, also causes patient s chest to rise, the only indication to the initial rescuer that adequate ventilation is being received 7

8 What is a Medical Ventilator? Aids the breathing of a patient Can range from a simple mask attached to a bag to a giant machine carefully calibrated to provide the appropriate amount of air to the patient 8

9 Why Use Medical Ventilators? General Anesthesia during operations Breathing Trouble Treatment of obstructive sleep apnea (airway constricts during sleep, causing person to wake up due to lack of oxygen during sleep) Injury/disease Drowning or compressive asphyxiation Note: obstructions to airways should be removed first or medical ventilation is futile 9

10 Manual Ventilators Can be small, simple bags attached to a mask and possibly a pump depending on implementation Usually cheaper, more readily available and quickly accessible than mechanical Largely dependent on person providing treatment Rescuer may fatigue from pumping or breathing into device 10

11 Cardiopulmonary Respiration Contrary to its name, CPR is highly unlikely to restart a patient s heart Main purpose to maintain flow of oxygenated blood to brain and heart to delay tissue death before help arrives Performed by ventilating the patient s lungs with rescuer s lungs, and compressing the chest in order to keep blood flowing through the body Pros: Usually much more readily available option than other forms of ventilation Cons: Not nearly as effective as other ventilation methods Relies on a person trained to use it to be effective as well as their breathing capacity Can never reach maximum ventilation capacity as this would cause the rescuer to become dizzy or even lose consciousness from hyperventilation 11

12 Mouth-to-Mask Essentially the same as mouth-to-mouth except instead of directly breathing onto the person s mouth, a mask is positioned so that direct contact is not required Developed to prevent exchange of communicable diseases by contact with patient May also have one-way valve to vent patient s expired air to further prevent exchange of communicable diseases 12

13 Bag-Valve Mask A bag, connected to a valve, connected to a mask Mask goes over mouth, bag is squeezed, increasing pressure at mouth, causing air to go through to the lungs Rescuer may fatigue over long periods of time Hand-size and technique affect effectiveness A person with larger hands will be able to squeeze the bag more Different techniques of squeezing the bag aid also increase effectiveness 13

14 Mechanical Ventilators Machines used to pump air in and out of lungs through positive or negative pressure Can usually be set to automatically allow set amounts of air to enter a person s airways Generally very large, restrictive machines In long-term, use may cause respiratory muscles to atrophy if patient becomes too reliant upon ventilator Least amount of ventilator support as possible is supplied 14

15 Negative Pressure Ventilators Negative pressure is applied to chest, causing it to expand, causing air to move into lungs Expiration is generally passive Advantages: Eliminates the need for tracheal intubation of patient Sterile Allows for communication Disadvantages: Devices normally cover entire chest area at least, restricting access to patient May cause some discomfort Patients without limited control of upper airway may ingest gastric contents Not as much air provided as positive pressure ventilation Effectiveness greatly affected by patient s elastance/compliance 15

16 Iron Lung Developed in the early 1900s, original manufacturer: Phillip Drinker Most commonly known for its use to combat the polio virus in the mid 1900s Patient placed in a large, steel, cylindrical chamber Pumps control the air pressure inside the chamber Decreased pressure expands chest Increased pressure compresses chest 16

17 Biphasic Cuirass Ventilator Like its namesake, only covers the thorax region of the body Similar function to iron lung Usually more comfortable than iron lung, allows for more freedom of movement Must be sealed properly for proper function Cannot generate as much pressure, and therefore generates lower tidal volume than iron lung 17

18 Positive Pressure Ventilators Presently most commonly used method of medical ventilation Many different models, but largely follow 2 basic methods Method 1: Patient intubated through the trachea (tracheotomy) Oxygen sent down tube Expiration generally passive Method 2: Patient wears tight-fitted mask Oxygen sent through mask to patient Expiration generally passive Not as greatly affected by compliance/elastance Non-invasive designs will cause less discomfort, but invasive ones will cause a lot more discomfort Invasive designs must have the tube kept sterile or there is risk of infection, also air bypasses many of defenses body has to clean air Tube must be carefully inserted or there may be airway obstruction 18

19 Positive Airway Pressure (PAP) Ventilator Largely used to treat sleep apnea Non-invasive More affected by compliance/elastance than other positive pressure ventilators 19

20 Intensive Care Unit (ICU) Not really just a ventilator, contains many other life support systems Come in many types depending upon the condition or patient designed to be treated (i.e. neonatal, burn victim, etc.) Usually follows intubation method (invasive) Large and expensive to manufacture Has many features to control rate of breathing or how breathing aid is administered 20

21 Modes of Ventilation for an ICU Breath Termination (when to terminate a breath) Ventilator provides oxygen until a target volume is met, and then terminates provision until next cycle Breath Initiation (when to start a breath) Ventilator assists patient when an attempt to inspire is made Adaptive Support Ventilation Frequency and tidal volume of breaths adjusted to meet patient s needs 21

22 Future Improvements to Medical Ventilators The ideal future would not require assisted breathing at all, however this is likely to be a far and distant future (possibly aided by the invention of an artificial lung?) Even with artificial lungs, ventilation still required for anesthesia or on-site treatment In the near future however: Portability: with advancements in science/technology, etc. miniaturization of medical ventilators could allow more sophisticated medical ventilators to be more easily moved onto the field 22

23 Future Improvements Cont. Neurally adjusted ventilatory assist (NAVA): Attempt to inspire is picked up by patient s neural signal as opposed to pressure increase that comes with inspiration Refinement of manufacturing methods: decreased cost of production would help make better medical ventilators, more readily available 23

24 Fin Questions? 24

25 Bibliography Blanchard, Susan M., John D. Enderle, and Joseph D. Bronzino. Introduction to Biomedical Engineering. New York: Academic P, "Cardiopulmonary Rescusitation." Wikipedia. 2 Nov Wikimedia Foundation Inc. 2 Nov < Chang, David W. Clinical Application of Mechanical Ventilation. Belmont: Cengage Delmar Learning, Cushman, Donnell. "Portable Home Ventilators." Respiratory Care Consulting Services, Inc. 28 Oct Respiratory Care Consulting Services, Inc. 2 Nov < "Iron Lung." Wikipedia. 30 Oct Wikimedia Foundation Inc. 2 Nov < "Mechanical Ventilation." Wikipedia. 25 Oct Wikimedia Foundation, Inc. 2 Nov < "Positive Airway Pressure." Wikipedia. 2 Nov Wikimedia Foundation, Inc. 2 Nov < Rattenborg, Christen C. Clinical Use of Mechanical Ventilation. St. Louis: Mosby, Sinclair, Alex, and Sean Wright. User Guidelines for Respiratory Assist Devices. Canada. Health and Welfare Canada. Bureau of Radiation and Medical Devices. Ottawa, ON: CHA P,

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