Mechanical Ventilator Supervisied by : Dr.huda Wahid

8/14/2019 Mechanical Ventilator Supervisied by : Dr.huda Wahid

1/32

Mechanical ventilatorechanical ventilatorSupervisied By : Dr.Huda Wahid

Prepared By : Mohammed Ibrahim Ali

Obied.

ID:24883


2/32

Indications forndications forMechanical Ventilationechanical Ventilation Severe Hypoxemia-Severe Hypoxemia- present when a patient haspresent when a patient has

a PaOa PaO22less than 60mmHg onless than 60mmHg on 50% oxygen or less 50% oxygen or less

than 40 mmHg on any FiOthan 40 mmHg on any FiO22..

Prophylactic Ventilatory Support-Prophylactic Ventilatory Support- ProvidedProvidedin clinical conditions in which the risk of pulmonaryin clinical conditions in which the risk of pulmonary

complications, ventilatory failure or oxygenation failurecomplications, ventilatory failure or oxygenation failureis high.is high.


3/32

Indications forndications forMechanical Ventilationechanical Ventilation PostoperativelyPostoperatively

Oversedation/paralyticsOversedation/paralytics Pain ControlPain Control

Proper ImmobilizationProper Immobilization


4/32

Key Terms iney Terms inMechanical Ventilationechanical Ventilation Tidal Volume (Vt)Tidal Volume (Vt)

The volume of air inhaled and exhaled fromThe volume of air inhaled and exhaled from

the lungs.the lungs. Breaths per Minute (RR,Breaths per Minute (RR, f)f)

Also known as frequency.Also known as frequency.

Positive End Expiratory Pressure (PEEP)Positive End Expiratory Pressure (PEEP) Defined as the pressure in the alveoli at endDefined as the pressure in the alveoli at end

expiration.expiration.


5/32

Key Terms iney Terms inMechanical Ventilationechanical Ventilation Minute Ventilation (VE)Minute Ventilation (VE)

The total amount of volume moving in andThe total amount of volume moving in and

out of the lung in one minute.out of the lung in one minute. Fractional Inspired Oxygen (FiO2)Fractional Inspired Oxygen (FiO2)

Correctly written with decimal place (21%)Correctly written with decimal place (21%)

Inspiratory:Expiratory Ratio (I:E ratio)Inspiratory:Expiratory Ratio (I:E ratio)

Normal I:E ratio 1:2-3Normal I:E ratio 1:2-3


6/32

Negative Pressureegative PressureVentilationentilation Rarely Used; Currently used for patientsRarely Used; Currently used for patients

with neuromuscular diseases.with neuromuscular diseases.

Thoracic cage is encased where negativeThoracic cage is encased where negativepressure is applied across the chest wall.pressure is applied across the chest wall.

During exhalation, negative pressure isDuring exhalation, negative pressure isreplace by atmospheric pressure allowingreplace by atmospheric pressure allowingthe lungs to deflate.the lungs to deflate.


7/32

Negative Pressureegative PressureVentilationentilation

Types of Negative Pressure VentilatorsTypes of Negative Pressure Ventilators


8/32

Iron Lung circa 1950sron Lung circa 1950s


9/32

Modern(ized) Iron Lungodern(ized) Iron Lung


10/32

Chest Cuirasshest Cuirass


11/32

Complications withomplications withNegative Pressureegative PressureVentilationentilation

Limited access for patient care.Limited access for patient care.

Inability to properly monitor pulmonaryInability to properly monitor pulmonary

mechanics.mechanics. Patient discomfort.Patient discomfort.


12/32

Positive Pressureositive PressureVentilationentilation

Basically broken into twoBasically broken into twocategories:categories:

Control Modes.Control Modes. Supportive Modes.Supportive Modes.


13/32

Control Modes ofontrol Modes ofVentilationentilation

Assist/Control (usually abbreviated A/CAssist/Control (usually abbreviated A/Calso known as Volume Control VC).also known as Volume Control VC).

Tidal Volume is set and remains constant.Tidal Volume is set and remains constant. Respiratory Rate is set.Respiratory Rate is set.

Airway Pressure will vary according to lungAirway Pressure will vary according to lungcompliance.compliance.

Ventilator will deliver set volume whetherVentilator will deliver set volume whetherpatient triggers a breath or mandatory breathpatient triggers a breath or mandatory breathis being delivered.is being delivered.


14/32


Pressure Control Ventilation :Pressure Control Ventilation :

Upper Airway Pressure Level is set and remainsUpper Airway Pressure Level is set and remainsconstant.constant.

Respiratory Rate is set.Respiratory Rate is set.

Tidal volumes will vary according to lungTidal volumes will vary according to lungcompliance.compliance.

Ventilator will deliver set pressure level whetherVentilator will deliver set pressure level whetherpatient triggers a breath or mandatory breath ispatient triggers a breath or mandatory breath isbeing delivered.being delivered.


15/32


Pressure Regulated Volume ControlPressure Regulated Volume Control(usually abbreviated PRVC).(usually abbreviated PRVC).

Tidal Volume is set, however may or mayTidal Volume is set, however may or maynot remain constant.not remain constant.


Ventilator will deliver volume howeverVentilator will deliver volume however

volume may decrease according to patientsvolume may decrease according to patientslung compliance.lung compliance.

A lung protective mode.A lung protective mode.


16/32

Supportive Modes ofupportive Modes ofVentilationentilation

Synchronized Intermittent MandatorySynchronized Intermittent Mandatory

Ventilation (usually abbreviated SIMV).Ventilation (usually abbreviated SIMV).

Tidal Volume is set and delivered on eachTidal Volume is set and delivered on eachmandatory breath.mandatory breath.


When a patient triggers the ventilatorWhen a patient triggers the ventilatorspontaneously , the patient receives aspontaneously , the patient receives a

Pressure Supported breath.Pressure Supported breath.


17/32


Pressure Support Ventilation (PSV)Pressure Support Ventilation (PSV) Is a strictly patient dependant mode; patientIs a strictly patient dependant mode; patient

must be breathing spontaneously.must be breathing spontaneously. An upper (inspiratory) pressure level isAn upper (inspiratory) pressure level is

adjusted to provide adequate tidal volumesadjusted to provide adequate tidal volumesfor each patient triggered breath.for each patient triggered breath.

PEEP is also adjusted as an independentPEEP is also adjusted as an independentpressure from the upper pressure level andpressure from the upper pressure level andis active during expiration.is active during expiration.

PSV is a weaning mode.PSV is a weaning mode.


18/32


Volume Support (VS)Volume Support (VS)

Is a strictly patient dependant mode; patientIs a strictly patient dependant mode; patient

must be breathing spontaneously.must be breathing spontaneously. Tidal Volume is set.Tidal Volume is set.

Each spontaneous breath is supported withEach spontaneous breath is supported with

dialed volume.dialed volume.


19/32


Continuous (Constant) Positive AirwayContinuous (Constant) Positive AirwayPressure (CPAP)Pressure (CPAP)

Is a strictly patient dependant mode; patientIs a strictly patient dependant mode; patientmust be breathing spontaneously.must be breathing spontaneously.

Closely resembles Pressure Support,Closely resembles Pressure Support,however CPAP is a constant set pressurehowever CPAP is a constant set pressure

that does not change during inspiration orthat does not change during inspiration orexpiration.expiration.

CPAP is a weaning mode.CPAP is a weaning mode.


20/32

Drager Evita IIrager Evita II


21/32

Puritan Bennett 840uritan Bennett 840


22/32

Servo 900cervo 900c


23/32

Servo 300aervo 300a


24/32

Servoervo ii


25/32

Complications toomplications toMechanical Ventilationechanical Ventilation Ventilator Induced Lung Injury (VILI)Ventilator Induced Lung Injury (VILI)

Induced by excessive pressureInduced by excessive pressure

(barotrauma)(barotrauma) Induced by excessive VolumeInduced by excessive Volume

(volutrauma)(volutrauma)


26/32

Complications toomplications toMechanical Ventilationechanical Ventilation Nosocomial Infection: Most infections ofNosocomial Infection: Most infections of

the body will travel to the lungs and resultthe body will travel to the lungs and result

in a pneumonia. These are referred to asin a pneumonia. These are referred to asVentilator Associated Pneumonia (VAP)Ventilator Associated Pneumonia (VAP)


27/32

Complications toomplications toMechanical Ventilationechanical Ventilation

Decreased Cardiac Output and Blood PressureDecreased Cardiac Output and Blood Pressure

pressure in the lungs=pressure in the lungs= pressurepressure

surrounding the heartsurrounding the heart

and major vesselsand major vessels

results in decreasedresults in decreased

CO/BPCO/BP


28/32

Weaning fromeaning fromVentilatory Supportentilatory Support

Weaning MethodsWeaning Methods

Rapid Weaning: Post SurgeryRapid Weaning: Post Surgery

Routine Weaning:Routine Weaning: Gradual Weaning: T-collar trialsGradual Weaning: T-collar trials

Ventilator Dependent patientsVentilator Dependent patients


29/32

VentilatoryentilatoryDiscontinuanceiscontinuance

Success in discontinuing ventilatorySuccess in discontinuing ventilatory

support is related to the patientssupport is related to the patients

conditions in four main areas:conditions in four main areas: Ventilatory workloadVentilatory workload

Oxygenation statusOxygenation status

Cardiovascular functionCardiovascular function Psychological factors.Psychological factors.


30/32

Standard criteria for initiating weaning:1) Clinically and radiologically resolving lung

disease

2) FiO2 10ml/kg

7) NIF (negative inspiratory force) > -20cm H20


31/32

Questions?uestions?


32/32

Documents

Mechanical Ventilator Supervisied by : Dr.huda Wahid