NORMAL SCALARS ON VENTILATORY

INTERFACE
 Initiation of Mechanical Ventilation

Volume Ventilation Pressure Ventilation

Dual Modes
 Volume Ventilation
(Control Variable is Volume)
Clinician Sets

Tidal volume (VT) Respiratory Inspiratory Flowrate

or Minute volume Frequency (f) or Inspiratory Time (TI)
( VE ) or TI % or I:E ratio
 Pressure Ventilation
(Control Variable is Pressure)
Clinician Sets

Pressure Level Respiratory Inspiratory Time (TI)

< 30 cm H2O Frequency (f) or TI %
or I:E ratio
 Commonly used Ventilatory Modes
Volume Ventilation Pressure Ventilation

Control Mode Control Mode

Assisted mode Assisted mode

SIMV SIMV

SIMV + PSV SIMV + PSV

SIMV + PSV + CPAP SIMV + PSV + CPAP

 Controlled Mode
(Volume- Targeted Ventilation)
Time triggered, Flow Limited, Volume Cycled Ventilation
Preset Peak Flow

Flow
L/m

Dependent on
Pressure CL & Raw
cm H2O

Preset VT
Volume Volume Cycling
mL

Fig 7.6 Time (sec)

 CONTROLLED VENTILATION

 Operator sets the rate, VT and Inspiratory Flow rate

 Technically, sensitivity is “OFF”
 No WOB for the patient
 CONTROLLED VENTILATION

Cautions:
 Patient “FIGHTING” the ventilator
 Inadequate flow
 Improper rate setting
 Assisted Mode
(Volume-Targeted Ventilation)
Patient triggered, Flow limited, Volume cycled Ventilation

Flow
L/m

Pressure
cm H2O

Preset VT
Volume Volume Cycling

mL
Time (sec)
 ASSISTED VENTILATION

 Minimum back up rate and VT set

 Patient sets the total ventilator rate
 Sensitivity adjusted to –1 to –2 cmH2O
 Every breath is initiated by the patient
 Every breath is a positive pressure breath.
Volume Targeted Ventilation
 Key Alarms

 High Pressure Alarm

Set at 10-15 cm H2O above
the ventilating pressure

 Low Pressure Alarm

Set at 10-15 cm H2O below
the ventilating pressure
 Controlled Mode
(Pressure-Targeted Ventilation)
Time Triggered, Pressure Limited, Time Cycled Ventilation

Time-Cycled
Flow
(L/min)

Set PC level
Pressure
(cm H2O)

Volume
(ml)

Time (sec)
 Assisted Mode
(Pressure-Targeted Ventilation)
Patient Triggered, Pressure Limited, Time Cycled Ventilation

Time-Cycled
Flow
(L/min)

Set PC level
Pressure
(cm H2O)

Volume
(ml)

Time (sec)
Pressure Targeted Ventilation

 Key Alarms

 Low VOLUME Alarm

 Set at ~ 100-200 ml below

the initial ventilating volume
 IMV or SIMV

 IMV: Spontaneous breaths interposed between Controlled

Mandatory breaths
 SIMV: Spontaneous breaths interposed between Assisted
Mandatory breaths
 Used as one of the weaning method
 A PRESSURE SUPPORT MUST BE ADDED to enhance
spontaneous breaths
 SIMV Mode
(Volume Ventilation)

Flow
L/m

Pressure
cm H2O

Volume
mL

Spontaneous Breaths
 SIMV Mode
(Pressure Ventilation)

Flow
(L/min)

Set PC level
Pressure
(cm H2O)

Volume
(ml)

Time (sec)
Fig 7.19 Spontaneous Breath
 SIMV + PS
(Pressure-Targeted Ventilation)
Time-Cycled Flow-Cycled

Flow
(L/min)

Set PC level
Pressure Set PS level
(cm H2O)

Volume
(ml)

Time (sec)
Fig 7.21 PS Breath
 Pressure Support Ventilation
( PSV )

 Strictly an assist form of mechanical ventilation

 Augments spontaneous tidal volume with a preselected
level of positive inspiratory pressure
 Overcomes imposed work of breathing due to :
 Artificial Airways
 Demand valve system
 Ventilator circuitry

 Classified as a Pressure-limited, flow-cycled, assisted

ventilation

Fig 7.22
 Delivery of PSV
The Expiratory Phase :

 When the inspiratory flow decreases to a system

specific minimal level ( 25% of the peak flow), or the
pressure increases to a system specific level , the
inspiratory phase is terminated and the exhalation
valve opens.
 Flow cycled mode.

Fig 7.24
 PSV
Patient Triggered, Flow Cycled, Pressure limited Mode

Flow Flow Cycling

L/m

Set PS
level
Pressure
cm H2O

Volume
mL
Time (sec)
Fig 7.25
 Pressure Support Ventilation
The Tidal Volume depends on:

 The Set Pressure ( PSV)

 Airway Resistance (Raw)
 Lung Compliance ( CL)
 Patient Effort

Fig 7.26
 CPAP

Flow
L/m

Pressure
cm H2O CPAP level

Volume
mL
Time (sec)

Fig 7.28
 SIMV + PS + CPAP
(Pressure Ventilation)

Flow
(L/min)

Set PC level
Pressure Set PS level
(cm H2O)

CPAP level

Volume
(ml)

Time (sec)
Fig 7.29
 SIMV+PS + CPAP
(Volume Ventilation)

Flow
(L/min)

Set PS Level
Pressure
(cm H2O)

CPAP level

Volume
(ml)

Time (sec)
Fig 7.30
 CPAP + PSV ( BiPAP )

Flow Cycling

Flow
L/m

Set PS level
Pressure
cm H2O
CPAP level

Volume
mL

Time (sec)
 NPPV
Noninvasive Positive Pressure Ventilation

20

15

IPAP
Pressure 10
PS PS

5
CPAP (EPAP)
0
Time
Bi-level Positive Airway Pressure
THANK YOU