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Modes of Mechanical Ventilation

Modes of Mechanical Ventilation. Points of Discussions. Advanced Basics: Flow and Time Limit and cycling Rise Time Volume vs Pressure Control Mandatory Modes of Ventilation Controlled Mandatory Ventilation (CMV or IPPV) Triggered Modes of Ventilation

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Modes of Mechanical Ventilation

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  1. Modes of Mechanical Ventilation

  2. Points of Discussions • Advanced Basics: • Flow and Time • Limit and cycling • Rise Time • Volume vs Pressure Control • Mandatory Modes of Ventilation • Controlled Mandatory Ventilation (CMV or IPPV) • Triggered Modes of Ventilation • Continuous Positive Airway Pressure (CPAP) • Pressure Support Ventilation (PSV) • Hybrid Modes of Ventilation • Assist Control Mode (A/C) • Synchronized Intermittent Mandatory Ventilation (SIMV)

  3. Respiratory Cycle Transition=Expiratory Cycling Inspiration Transition=Inspiratory Cycling Expiration

  4. Mandatory, Spontaneous and Triggered Inspiratory Cycling M M M M M M S S S M M Tsupp Tsupp Tsupp Tsynch M Tsupp Tsupp Tsupp

  5. Pressure Limited Breath Volume Pressure Limit Time

  6. Expiratory Flow Cycling Flow 100% Flow Cycling 50% Time

  7. Volume Controlled Inflation Pressure Flow Tidal Volume Volume Time TI TE

  8. P aw cmH 0 2 Volume Control Breaths 50 Decreased Compliance SEC 1 2 3 4 5 6 -20 120 INSP Flow SEC 1 2 3 4 5 6 L/min 120 EXH If compliance decreases the pressure increases to maintain the same Vt

  9. Pressure Controlled Inflation Rise Time Pressure Peak Inspiratory Flow Flow Tidal Volume Volume Time TI TE

  10. Paw Paw Volume/Flow Control Pressure Control Inspiration Expiration Inspiration Expiration 20 20 Pressure 0 0 2 2 1 0 1 20 20 Volume 0 0 2 2 0 1 0 1 3 3 Flow Time (s) Time (s) 0 0 -3 -3

  11. Rise Time Pressure Flow Volume Time TI TE

  12. Volume Control with End-Inspiratory Pause End Inspiratory Pause Pressure Flow Tidal Volume Volume Time TI TE

  13. Relationship between Tidal Volume, Inspiratory Time and Flow Volume VT 3 Exp Insp Flow= 37.5 L/min VT 1 Flow= 30 L/min VT 2 Flow= 15 L/min Time Ti a

  14. Relationship between Tidal Volume, Inspiratory Time and Flow Volume Insp Insp Insp Exp Exp Flow= 60 L/min Flow= 30 L/min VT 1 Flow= 20 L/min Ti b Ti c Time Ti a

  15. CPAP and PSVV Triggered Modes of Ventilation

  16. Spontaneous Breathing Pressure (cm H2O) Flow (L/m) Volume (mL) Time (sec)

  17. Continuous Positive Airway Pressure(CPAP) Pressure (cm H2O) CPAP Level Flow (L/m) Volume (mL) Time (sec)

  18. Pressure Support Ventilation(PSV) Set PS Level Pressure (cm H2O) Flow Cycling Better Efforts Longer Inspiration Flow (L/m) Volume (mL) Time (sec) Patient Triggered, Flow Cycled, Pressure limited Mode

  19. CPAP+PSV Set PS Level Pressure (cm H2O) CPAP Level Flow Cycling Flow (L/m) Volume (mL) Time (sec) Patient Triggered, Flow Cycled, Pressure limited Mode

  20. Triggered Modes of VentilationPressure Support Ventilation Patient Triggered Flow Cycled Ventilation

  21. CMV or IPPV Mandatory Modes of Ventilation

  22. Mandatory Modes of VentilationCMV Time Triggered Time Cycled Ventilation

  23. Control Mode (Pressure-Targeted Ventilation) Time Cycling Set PC Level Pressure (cm H2O) Flow (L/m) Volume (mL) Time (sec) Time Triggered, Pressure Limited, Time Cycled Ventilation

  24. Control Mode(Volume-Targeted Ventilation) Time Cycling Pressure (cm H2O) Dependent on CL & Raw Flow (L/m) Preset VT Volume Cycling Volume (mL) Time (sec) Time Triggered, Flow Limited, Volume Cycled Ventilation

  25. SIMV and A/C Hybrid Modes of Ventilation

  26. Hybrid Modes of VentilationA/C Time or PatientTriggered Time Cycled Ventilation

  27. Assisted Mode(Volume-Targeted Ventilation) Time Cycling Pressure (cm H2O) Preset peak Flow Flow (L/m) Volume (mL) Time (sec) Patient Triggered, Flow limited, Volume Cycled Ventilation

  28. Assisted Mode (Pressure-Targeted Ventilation) Time Cycling Set PC Level Pressure (cm H2O) Flow (L/m) Volume (mL) Time (sec) Patient Triggered, Pressure Limited, Time Cycled Ventilation

  29. Hybrid Modes of VentilationSIMV/PS

  30. SIMV(Volume Targeted Ventilation) Pressure (cm H2O) M M M Spontaneous Breaths Flow (L/m) Volume (mL) Time (sec)

  31. SIMV+PS(Volume Targeted Ventilation) Set PS Level Tsupp Tsynch M Pressure (cm H2O) Flow-cycled Flow (L/m) Volume (mL) Time (sec)

  32. SIMV + PS (Pressure-Targeted Ventilation) Tsynch Tsynch Tsupp Pressure (cm H2O) Set PC Level Set PS Level Time Cycled Flow-cycled Flow (L/m) Volume (mL) Time (sec)

  33. Hybrid Mode Ventilation: Suppression Tsupp Tsupp Pressure (cm H2O) Tsupp Tsupp M M M Flow (L/m) Cycles M M Time (sec)

  34. Hybrid Mode Ventilation: Synchronization(SIMV+PSV) M Tsynch Tsynch Tsupp Tsupp M Pressure (cm H2O) Flow (L/m) Mandatory Cycle Time Cycles Time (sec) Triggered window for supported breaths Triggered window for synchronized breaths

  35. All Modes tables

  36. Thank You

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