Modes of Mechanical Ventilation determined by pts WOB

Volume Modes

Pressure Modes

Control Ventilation(CV) or Controlled Mandatory Ventilation (CMV) Assist Control (AC) or Assisted Mandatory Ventilation (AMV) Intermittent Mandatory Ventilation (IMV) and Synchronized Intermittent Mandatory Ventilation (SIMV)

Pressure Support Ventilation (PSV) Pressure-Controlled Inverse Ratio Ventilation (PC-IRV)

Volume Modes cont

CMV:

CMV (Controlled Mandatory Ventilation)

Preset Volume and Rate Independent of Pts efforts/Machine does all the work Pt can NOT initiate breathing due to anesthesia or paralysis

Breaths delivered at preset rate and a preset tidal volume INDEPENDENT of pts ventilation efforts Indicated for patients with paralysis or patients under anesthesia.

Volume Modes cont

AMV: Pt CAN initiate breath spontaneously Ventilator delivers Preset Volume at Preset Frequency and when Pt initiates a spontaneous breath Danger of hyperventilation! b/c ventilator delivers preset volume at preset rate plus every time Pt breaths ventilator delivers preset volume again

AMV (Assist Control/Assisted Mandatory Ventilation)

Preset Tidal Volume Preset Frequency Volume delivered when pt initiates spontaneous breath Indicated for patients with pulmonary edema, neuromuscular disorders and acute respiratory failure.

SIMV:

Volume Modes Cont

Pt CAN breathe spontaneously Ventilator delivers Preset Volume at Preset Frequency but in synchrony with Pts own breathing: if Pt initiates a spontaneous breath b/n ventilators breaths, those spontaneous breath will have Pts own rate an volume

SIMV (Synchronized Intermittent Mandatory Ventilation)

Preset tidal volume Preset frequency in synchrony with patients breathing. Pt is able to breathe spontaneously between ventilator delivered breaths * Indicated for patients being weaned from the ventilator and for continuous ventilation

SIMV is used during CONTINOUS ventilation and when WEANING from the ventilator.

PSV: Pt CAN breathe spontaneously Preset Pressureapplied d/g Pts spontaneous respirations (inspirations) and PEEP d/g expiration Pt will determine volume, rate and length of inspirations Used in Continuous ventilation and Weaning

Pressure Modes

PSV (Pressure Support Ventilation)

Preset level of Positive pressure applied during inspiration used in conjunction with patients spontaneous respirations. Pt must be able to spontaneously initiate a breath Pt determines inspiratory length, tidal volume, respiratory rate. Used in continuous ventilation and weaning

PC-IRV: PROLONGED positive pressure is applied d/g INSPIRATION, increasing inspiratory time Progressively expands collapsed alveoli

Pressure Modes cont

PC-IVR (Pressure Controlled-Inverse Ratio Ventilation

Pt requires SEDATION with or without paralysis Used in ARDS if Pt doesnt respond to high PEEP

Combines pressure limited ventilation with an inverse ratio of inspiration and expiration With IRV a prolonged positive pressure is applied for inspiration, increasing inspiratory time and shortening expiratory time. Pt requires sedation Used often when increasing PEEP is not enough

CONTINUOUS, NON-INVASIVE

CPAP and BIPAP

CPAP(Continuous Positive Airway Pressure)

BIPAP (Bi-level Positive Airway Pressure)

Can be administered Non-Invasively Pressure delivered continuously during spontaneous breathing Commonly used in sleep apnea

Can be delivered noninvasively Higher inspiratory positive airway pressure and lower expiratory positive airway pressure