Assist-Control Mode

Adhrie Sugiarto
What is a breath?
• A breath is one cycle of positive flow (inspiration) and negative flow
(expiration)

1 breath cycle
Types of breath
• Spontaneous breath arises without apparent external cause. It is
patient triggered and patient cycled
• Mandatory breaths, are breaths with machine involvement in
triggering or cycling
• A breath is assisted if pressure rises above baseline during inspiration
or falls during expiration. A ventilator assists breathing by doing some
portion of the work of breathing.
Assist-Control Mode
• Mode for which the ventilator controls the timing, the cycling, the
tidal volume, or the inspiratory pressure
Assist-Control Mode
Assist-Control Mode
Volume Control
Volume Control
• The volume A/ C mode is intended for ventilated patients who are
passive or partially active
• The volume assist/ control mode allows the operator to directly
control tidal volume, rate, and Ti for a desired minute volume
Volume Control
In this mode, the operator sets:
a. Tidal volume
b. Rate
c. Ti (or I:E ratio or peak flow)
d. Patient trigger type and sensitivity
e. PEEP (positive end- expiratory pressure)
f. FiO2
g. Flow pattern (possibly).
Tidal volume and Respiratory rate
• Based on predicted body weight (PBW)
• Males = 50 + 2.3 [height (inches) - 60]
• Females = 45.5 + 2.3 [height (inches) -60]
• Tidal volume 6-8 ml/kg PBW

• Respiratory rate adjusted to achieve Minute Volume (MV) of 100

ml/kg PBW
Setting I:E, inspiratory flow time,
pause time
• Nomenclature
Volume

Time
Setting I:E, inspiratory flow time,
pause time
• Nomenclature
Inspiratory flow time
Volume

Time
Setting I:E, inspiratory flow time,
pause time
• Nomenclature
Inspiratory pause time
Volume

Time
Setting I:E, inspiratory flow time,
pause time
• Nomenclature
Inspiratory time
Volume

Time
Setting I:E, inspiratory flow time,
pause time
• Nomenclature
Inspiratory time Expiratory time
Volume

Time
Setting I:E, inspiratory flow time,
pause time
• Nomenclature
Respiratory cycle time
Volume

Time
I:E as a ratio & inspiratory pause
time as a percentage
6 secs

2 secs 4 secs

10%
Volume

Time Set: RR, I:E, Pause time %

I:E as a ratio & inspiratory pause
time as a percentage
3 secs

1 2
 Respiratory rate
10%
Volume

 Inspiratory flow

Time Set: RR, I:E, Pause time %

 Absolute inspiratory time,
inspiratory flow time as a function
of flow rate 6 secs
2 secs 4 secs

0.5 s
Volume

Time Set: RR, Insp Time, Flow rate

 Absolute inspiratory time,
inspiratory flow time as a function
of flow3 rate
secs

2 secs 1 sec  Respiratory rate without

changing Inspiratory time or
0.5 s inspiratory flow
Volume

Time Set: RR, Insp Time, Flow rate

 Absolute inspiratory time,
inspiratory flow time as a function
of flow3 rate
secs

2 secs 1 sec  inspiratory flow

1.5 s
Volume

Time Set: RR, Insp Time, Flow rate

 Absolute inspiratory time,
inspiratory flow time as a function
of flow3 rate
secs

1 sec 2 sec  Absolute inspiratory time

0.5 s
Volume

Time Set: RR, Insp Time, Flow rate

 Inspiratory flow time as a function
of flow rate, absolute pause time
6 secs

2 sec 4 sec

0.5 s
Volume

Time Set: RR, Insp flow rate, Pause time

 Inspiratory flow time as a function
of flow rate, absolute pause time
3 secs

2 secs 1 sec  Respiratory rate without

changing inspiratory flow or
0.5 s inspiratory pause time
Volume

Time Set: RR, Insp flow rate, Pause time

 Inspiratory flow time as a function
of flow rate, absolute pause time
3 secs
 inspiratory flow
1 sec 2 sec
 inspiratory pause time

0.3 s
Volume

Time Set: RR, Insp flow rate, Pause time

 Inspiratory flow time as a function
of flow rate, absolute pause time

Volume  Tidal volume

Time Set: RR, Insp flow rate, Pause time

Increased spontaneous breathing
Expiratory time
Volume

Time
Increased spontaneous breathing
Exp
time
Volume Inverse ratio

Time
Calculating adequate flow

• preset tidal volume = 500 ml

• preset ventilatory rate = 20
– respiratory cycle time = 3 secs
• I:E ratio 1:2
– inspiratory time=1 sec
– inspiratory flow=30L/min
Calculating adequate flow

• preset tidal volume = 500 ml

• preset ventilatory rate = 10
– respiratory cycle time = 6 secs
• I:E ratio 1:2
– inspiratory time=2 sec
– inspiratory flow=15L/min
Disadvantages of Volume Control
• There is a high incidence of patient- ventilator asynchrony in active
patients with a strong drive.
• The resultant peak airway pressure can be uncomfortably high.
Therefore, it is important to set the upper limit of the airway pressure
alarm to avoid resultant barotrauma.
Caution: In some ventilators, the set alarm limit is used for pressure
cycling
• In this mode, leakage compensation is impossible.
Pressure Control
Pressure Control
• The pressure A/ C mode is suitable for passive or partially active
patients
• It can also be used in active patients with weak respiratory drive,
because this mode allows the patient to influence rate, inspiratory
flow, and tidal volume
• Compared to the volume assist/ control mode, pressure assist/
control has a considerably lower incidence of patient- ventilator
asynchrony
• Another advantage of pressure assist/ control is that this mode
enables the ventilator to compensate for moderate levels of gas
leakage
Pressure Control
Pressure Control
In this mode, the operator sets:
• Inspiratory pressure (often called pressure control)
• Rate
• Ti (or I:E)
• Patient trigger type and sensitivity
• PEEP
• FiO2
• Rise time (possibly).
Inspiratory pressure/pressure control

Pressure above PEEP Total/Peak Inspiratory Pressure

Inspiratory time
• Flow is not an issue
• I:E or inspiratory time set
 “Ideal” “Short” “Long”

Pressure

Flow

Volume

Time
Disadvantages of Pressure Control
• The perceived disadvantage of this mode is that an operator cannot
directly control tidal volume.
• The resultant tidal volume may be unstable when the patient’s
breathing effort and/ or respiratory mechanics change. Therefore, you
should carefully set the upper and lower limits of the tidal volume
alarm
Assist-Control Mode
Thank You