MECANICAL VENTILATOR

Presented by
sangeethasasidharan

Overview of topics
INTRODUCTION
TYPES OF MEDICAL VENTILATOR
MODES OF MECHANICAL VENTILATION
VENTILATOR ALARMS
GUIDE LINES FOR VENTILATOR SETTING

INTRODUCTION

Helps patients breathe by assisting the inhalation of oxygen

into the lungs and the exhalation of carbon dioxide.
Depending on the patients condition, mechanical
ventilation can help support or completely control
breathing.

VENTILATOR TYPES
The two main categories of ventilators include:
Noninvasive ventilators
These devices provide breathing support through an external
interface, such as a mask or nasal prongs.
Invasive ventilators
Patients on long-term ventilation may require ventilation
through an endotracheal tube inserted through the mouth or
nose, or through a tracheostomy tube inserted into an incision
in the in the neck.

VENTILATOR TERMS
RATE
VOLUME
SENSITIVITY
FLOW
LIMITS
MEASURES OF BREATHING

VENTILATOR SETTINGS
FiO2
Rate
Tidal volume
Sensitivity
Peak flow
Inspiratory and expiratory times
Cycling
limit

VENTILATOR MODES
ASSIST CONTROL (AC)
Continuous positive airway pressure
ventilation(CPAP)
Synchronized intermitted mandatory
ventilation(SIMV)
Pressure control ventilation(PCV)
Pressure support ventilation(PSV or PS)
Positive end expiratory pressure(PEEP)

ASSIST CONTROL

All breaths delivered by the ventilator will

control either volume or pressure. The
ventilator delivers the same measured
breath every time, whether the breath is
patient initiated or ventilator initiated,
based on the rate setting.

CONTINUOUS POSITIVE AIRWAY

PRESSURE VENTILATION

This mode also allows the patient to breathe

at a continuous, elevated airway pressure
that can improve oxygenation

The ventilator can also apply positive

pressure during spontaneous inspirations
taken during CPAP mode to reduce the
patients work to breathe.

SYNCHRONISED INTERMITTED
MANDATORY VENTILATION

The ventilator synchronizes machine breath

delivery with the patients spontaneous
breath efforts. This mode is a combination
of set mandatory machine breaths
synchronized with the patients own
spontaneous breaths.

PRESSURE CONTROL
VENTILATION

This is a type of mandatory breath that can

be used in either A/C or SIMV modes and
targets a specific pressure during
inspiration. The delivered flow rate varies
according to the patients demand and own
lung characteristics, such as lung
compliance and airway resistance.

PRESSURE SUPPORT

This is a type of spontaneous breath that

can be used in either CPAP or SIMV modes
and targets a set inspiratory pressure, much
like PC. But the PS inspiration ends as the
lung gets full and the delivered flow
decreases to a specific valve set by the
clinician. The patient decides the
respiratory rate and inspiratory time as well
as the flow rate and tidal volume.

POSITIVE END EXPIRATORY

PRESSURE

Mechanical positive pressure is applied at

the end of exhalation to prevent the lungs
from emptying completely and returning to
a zero reading. The benefit of positive
pressure at the end of exhalation is
increased lung volume for improved
oxygenation.

VENTILATOR ALARMS
High airway pressure alarms
Low airway pressure alarms
High and low rate alarms
High and low volume alarms

GUIDE LINES FOR VENTILATOR

SETTING
Mode of ventilation
Tidal volume
Respiratory rate
Supplemented Oxygen therapy
I:E ratio
Inspiratory flow rate
Peep
sensitivity

Mode of ventilation

SIMV and A/C are versatile modes that can

be used for initial settings. In patients with a
good respiratory drive and mild-tomoderate respiratory failure, PSV is a good
initial choice.

Tidal volume
An initial TV of 5-8 mL/kg of ideal body
weight is generally indicated.
the lowest values recommended in the
presence of obstructive airway disease
andARDS

Respiratory rate

A respiratory rate (RR) of 8-12 breaths per

minute is recommended for patients not
requiring hyperventilation for the treatment
of toxic or metabolic acidosis, or intracranial
injury. High rates allow less time for
exhalation, increase mean airway pressure,
and cause air trapping in patients with
obstructive airway disease. The initial rate
may be as low as 5-6 breaths per minute in
asthmatic patients when using a permissive
hypercapnic technique.

Supplemental oxygen
therapy

The lowest FiO2that produces an arterial

oxygen saturation (SaO2) greater than 90%
and a PaO2greater than 60 mm Hg is
recommended. No data indicate that
prolonged use of an FiO2less than 0.4
damages parenchymal cells.

I:E RATIO

The normal inspiration/expiration (I/E) ratio

to start is 1:2. This is reduced to 1:4 or 1:5
in the presence of obstructive airway
disease in order to avoid air-trapping
(breath stacking) and auto-PEEP or intrinsic
PEEP (iPEEP). Use of inverse I/E may be
appropriate in certain patients with complex
compliance problems in the setting of
ARDS.

INSPIRATORY FLOW RATE

Inspiratory flow rates are a function of the

TV, I/E ratio, and RR and may be controlled
internally by the ventilator via these other
settings. If flow rates are set explicitly, 60
L/min is typically used. This may be
increased to 100 L/min to deliver TVs
quickly and allow for prolonged expiration in
the presence of obstructive airway disease.

PEEP

Applying physiologic PEEP of 3-5 cm H 2O is

common to prevent decreases in functional
residual capacity in those with normal lungs.
The reasoning for increasing levels of PEEP in
critically ill patients is to provide acceptable
oxygenation and to reduce the FiO 2to
nontoxic levels (FiO2< 0.5). The level of PEEP
must be balanced such that excessive
intrathoracic pressure (with a resultant
decrease in venous return and risk of
barotrauma) does not occur.

SENSITIVITY

With assisted ventilation, the sensitivity

typically is set at -1 to -2 cm H2O. The
development of iPEEP increases the
difficulty in generating a negative
inspiratory force sufficient to overcome
iPEEP and the set sensitivity. Newer
ventilators offer the ability to sense by
inspiratory flow instead of negative force.
Flow sensing, if available, may lower the
work of breathing associated with ventilator
triggering.

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