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Introduction to Mechanical Ventilation

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... of volume moving in and out of the lung in one minute. ... Iron Lung circa 1950's. Modern(ized) Iron Lung ... will vary according to lung compliance. ... – PowerPoint PPT presentation

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Title: Introduction to Mechanical Ventilation


1
Introduction to Mechanical Ventilation
  • Craig A. Hawkins BS RRT RCP
  • Respiratory Therapy Supervisor
  • Presbyterian Hospital

2
Indications for Mechanical Ventilation
  • Impending Respiratory Failure
  • Acute Respiratory Failure/Arrest
  • Post-Operatively

3
Indications for Mechanical Ventilation
  • Impending Respiratory Failure
  • Progressively worsening clinical appearance.
  • Worsening CXR.
  • Hypoxemic Respiratory Failure.
  • Hypercapnic Respiratory Failure.

4
Indications for Mechanical Ventilation
  • Acute Respiratory Failure/Arrest
  • Acute change in ABG results
  • Respiratory Arrest/Status Post CPR
  • Acute epiglottitis/anaphylaxis

5
Indications for Mechanical Ventilation
  • Postoperatively
  • Oversedation/paralytics
  • Pain Control
  • Proper Immobilization

6
Key Terms in Mechanical Ventilation
  • Tidal Volume (Vt)
  • The volume of air inhaled and exhaled from the
    lungs.
  • Breaths per Minute (RR, f)
  • Also known as frequency.
  • Positive End Expiratory Pressure (PEEP)
  • Maintenance of above atmospheric pressure at the
    airway throughout exp. phase.

7
Key Terms in Mechanical Ventilation
  • Minute Ventilation (VE)
  • The total amount of volume moving in and out of
    the lung in one minute.
  • Fractional Inspired Oxygen (FiO2)
  • Correctly written with decimal place (21-0.21
    100-1.0)
  • InspiratoryExpiratory Ratio (IE ratio)
  • Normal IE ratio 12-3

8
Negative Pressure Ventilation
  • Rarely Used Currently used for patients with
    neuromuscular diseases.
  • Thoracic cage is encased where negative pressure
    is applied across the chest wall.
  • Generates subatmospheric pressures creating a
    difference in pressure gradients.
  • During exhalation, negative pressure is replace
    by atmospheric pressure allowing the lungs to
    deflate.

9
Negative Pressure Ventilation
  • Types of Negative Pressure Ventilators

10
Iron Lung circa 1950s
11
Modern(ized) Iron Lung
12
Chest Cuirass
13
Complications with Negative Pressure Ventilation
  • Limited access for patient care.
  • Inability to properly monitor pulmonary
    mechanics.
  • Patient discomfort.

14
Positive Pressure Ventilation
  • Defined as the application of pressure to the
    lungs in order to improve gas exchange.
  • The Lungs are physically filled/ventilated with
    air using machinery.
  • Multiple modes, methods, and theory.

15
Positive Pressure Ventilation
  • Basically broken into two categories
  • Control Modes.
  • Supportive Modes.

16
Control Modes of Ventilation
  • Assist/Control (usually abbreviated A/C also
    known as Volume Control VC).
  • Tidal Volume is set and remains constant.
  • Respiratory Rate is set.
  • Airway Pressure will vary according to lung
    compliance.
  • Ventilator will deliver set volume whether
    patient triggers a breath or mandatory breath is
    being delivered.

17
Control Modes of Ventilation
  • Pressure Control Ventilation (usually abbreviated
    PCV or sometimes PCIRV).
  • Upper Airway Pressure Level is set and remains
    constant.
  • Respiratory Rate is set.
  • Tidal volumes will vary according to lung
    compliance.
  • Ventilator will deliver set pressure level
    whether patient triggers a breath or mandatory
    breath is being delivered.

18
Control Modes of Ventilation
  • Pressure Regulated Volume Control (usually
    abbreviated PRVC).
  • Tidal Volume is set, however may or may not
    remain constant.
  • Respiratory Rate is set.
  • Ventilator will deliver volume however volume may
    decrease according to patients lung compliance.
  • A lung protective mode.

19
Supportive Modes of Ventilation
  • Synchronized Intermittent Mandatory Ventilation
    (usually abbreviated SIMV).
  • Tidal Volume is set and delivered on each
    mandatory breath.
  • Respiratory Rate is set.
  • When a patient triggers the ventilator
    spontaneously , the patient receives a Pressure
    Supported breath.

20
Supportive Modes of Ventilation
  • Pressure Support Ventilation (PSV)
  • Is a strictly patient dependant mode patient
    must be breathing spontaneously.
  • An upper (inspiratory) pressure level is adjusted
    to provide adequate tidal volumes for each
    patient triggered breath.
  • PEEP is also adjusted as an independent pressure
    from the upper pressure level and is active
    during expiration.
  • PSV is a weaning mode.

21
Supportive Modes of Ventilation
  • Volume Support (VS)
  • Is a strictly patient dependant mode patient
    must be breathing spontaneously.
  • Tidal Volume is set.
  • Each spontaneous breath is supported with dialed
    volume.

22
Supportive Modes of Ventilation
  • Continuous (Constant) Positive Airway Pressure
    (CPAP)
  • Is a strictly patient dependant mode patient
    must be breathing spontaneously.
  • Closely resembles Pressure Support, however CPAP
    is a constant set pressure that does not change
    during inspiration or expiration.
  • CPAP is a weaning mode.

23
Drager Evita II
24
Puritan Bennett 840
25
Servo 900c
26
Servo 300a
27
Servo i
28
One of the Most Famous Ventilators
29
Complications to Mechanical Ventilation
  • Ventilator Induced Lung Injury (VILI)
  • Induced by excessive pressure (barotrauma)
  • Induced by excessive Volume (volutrauma)
  • Ventilator Associated Pneumonia (VAP)
  • Most commonly Pseudomonas, Gram Negative Bacilli,
    and staphylococci.

30
Ventilatory Discontinuance
  • Weaning
  • Process of discontinuing ventilatory support,
    regardless of the time frame involved.
  • Categories
  • Quick removal routine
  • More gradual reduction in support (trach collar
    trials)
  • Ventilator dependent patients

31
Ventilatory Discontinuance
  • Success in discontinuing ventilatory support is
    related to the patients conditions in four main
    areas
  • Ventilatory workload
  • Oxygenation status
  • Cardiovascular function
  • Psychological factors.

32
Ventilatory Discontinuance
  • Common indices in successful weaning

FiO2 lt 0.4-0.5 PaO2 gt 60 PaO2/FiO2 ratio gt
200 PaCO2 lt 50 pH gt 7.35 RSBI lt 100
33
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