Newer Modes of

Mechanical Ventilation
Timothy A. Morris, M.D.
Division of Pulmonary and Critical Care Medicine
Medical Director, Respiratory Care
University of California, San Diego
 How to Assess Ventilator
Modes

● Inhalation

» what is controlled during the breath

» what is targeted (how much is enough?)

» how does it adjust to changes

 How to Assess Ventilator
Modes

● Exhalation

» what is controlled

» when does it end

» how does it adjust

 How to Assess Ventilator
Modes

● Inhalation

» what is controlled

» what is targeted

» how does it adjust

Simple Pressure System

Pressure 20 cm H2O
Pressure
20 cm H2O
 Time Constant

● time it takes to get 1/2 way to

equilibrium

● total resistance x total compliance

Increased Compliance

Pressure 20 cm H2O

Pressure
20 cm H2O
Increased Resistance

Obstruction

Pressure 20 cm H2O
Pressure
20 cm H2O
Simple Volume System

Volume 500 ml Volume 500 ml

Pressure 3500 cm H20
 Simple Volume
System

Pop!
Volume 2000 ml
Pressure 3500 cm H20
 Big Secret!

● Ventilator modes are simulations

» pressure control
» volume control

● Microprocessors control the simulation

Dadmobile
Minivan Tire
High Pressure Pump
Filling the Tire
Tire Pressure
Toy Balloon: deflated
Toy Balloon: inflated
Toy Balloon: popped
Flow Control
Control of Resistor
 High Pressure
System

valve

Pressure 3500 cm H20 Pressure 35 cm H20

Tidal volume 500 ml
 Volume Control
Deflated Volume Inflated Volume
 Pressure Control
Deflated Pressure Inflated Pressure
What controls the
adjustments?

Volume?
(flow control)

Pressure?
 Microprocessor
Control
Microprocessor

solenoid exhale
valve

Inhalatio
n
valve
(resistor
Pressure 3500 cm H20
) Tidal volume 500 ml
Pressure 35 cm H20
 Quality of the control

● hardware:
» how frequently is the flow/pressure
measured
» how rapidly are adjustments made
» how are adjustments made
● software
» timing and patterns of control
 How to Assess Ventilator
Modes

● Inhalation

» what is controlled

» what is targeted

» how does it adjust

 Targeting

● How much breath is enough?

 Targeting

Control Target

Volume
● Flow ● Time
control

● Pressure ● Pressure

● Volume
 Targeting

Control Target

Time-cycled
● Flow ● Time
pressure
control
● Pressure ● Pressure

● Volume
 Targeting

Control Target

● Flow ● Time

● Pressure ● Pressure
Volume
● Volume targeted
pressure
control
 How to Assess Ventilator
Modes

● Inhalation

» what is controlled

» what is targeted

» how does it adjust

 Patients generate
pressures

● Negative pressure
» inhalation efforts

● Positive pressure
» “bucking”
 Negative pressure:
Adjustments

● No adjustment

● Increase in pressure/flow to match

demand

● Decrease in pressure/flow to foster

weaning
 Positive pressure:
Adjustments

● No adjustment

● End inhalation, open exhalatory

valve

● Adjust inspiratory and expiratory

valves to maintain control
 How to Assess Ventilator
Modes

● Exhalation
» next year
Coming up next...

Reality