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Efficiency

How to set Ventilation Parameters?. Efficiency. Comfort. Safety. Versatility. Prediction. S/T mode - Titration. Ask the patient to sit or lay comfortably Adjust the mask Initial settings IPAP = 8-10 cmH 2 O EPAP = 4 cmH 2 O Respiratory rate = 4-8 BPM Ti = 1 sec. Look at the patient!.

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Efficiency

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  1. How to set Ventilation Parameters? Efficiency Comfort Safety Versatility Prediction

  2. S/T mode - Titration • Ask the patient to sit or lay comfortably • Adjust the mask • Initial settings • IPAP = 8-10 cmH2O • EPAP = 4 cmH2O • Respiratory rate = 4-8 BPM • Ti = 1 sec. • Look at the patient!

  3. Titration – Set IPAP O2 saturation (< 90%) due to hypoventilation events Increase IPAP PaCO2 > objective Patient Vt < target (7–12 ml/Kg) Patient wants more air • IPAP objective: • COPD patients •  Ventilation to avoid hypoventilation at night •  PaCO2 (« realistic ») • Restrictive patients • Provide the right patient Vt (8-12 ml/Kg) • Guarantee a minimum ventilation

  4. Titration – Set EPAP Patient uses his respiratory muscles Patient hardly triggers to inspiration Increase EPAP Expiratory time too long Obstructive apnea events • EPAP objective: • Remove obstructive apnea events and reduce arousals • Compensate intrinsic PEEP to reduce respiratory work • Increase alveoli recruitment (for COPD) to improve oxygenation

  5. Titration – Set Respiratory Rate and Ti • Respiratory rate back up objective: • Maintain efficient ventilation during central episodes • Decrease respiratory work: the patient tends to rely on his ventilator at night Set back up rate 2 to 3 breaths below patient spontaneous breathing Obstructive Patient Ti from 25 to 33% Restrictive Patient Ti from 33 to 50% Ti (Second) = (60 / RR) x % Ti

  6. Ti Setting

  7. Titration – Set Rise Time • Rise time: time from EPAP to IPAP • Obstructive patients : prefer short rise time from 100ms to 400ms (from 1 to 4) • Restrictive patients: prefer longer rise time from 300ms to 600ms (from 3 to 6) • Warning: long rise time with high respiratory rate may be not compatible IPAP EPAP

  8. Titration – Ramp • Ramp: comfort feature to progressively provide pressure to the patient • Starting pressure: EPAP starts at the set starting pressure and IPAP at set starting pressure + 2 cmH2O • Time • EPAP and IPAP gradually increase up to the prescription during the set time.

  9. Titration – Set Alarms • Alarms: • For more safety, a disconnection alarm and a minimum minute ventilation alarm can be set (usually for dependant patients) • Apnea Alarm: to detect when patient does not trigger. When a safety respiratory rate is set, then the ventilator controls patient ventilation • With AVAPS, an additional alarm on the tidal volume can be turned on.

  10. Titration Guidelines

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