advanced modes of mechanical ventilation
DESCRIPTION
Advanced Modes of Mechanical Ventilation. Points of Discussion. Triggered Modes of Ventilation Volume Support (VS) Proportional Assist Ventilation (PAV or PPS) Hybrid Modes of Ventilation Volume Assured Pressure Support Pressure Regulated Volume Control (PRVC) Auto mode: VS and PRVC - PowerPoint PPT PresentationTRANSCRIPT
![Page 1: Advanced Modes of Mechanical Ventilation](https://reader034.vdocuments.us/reader034/viewer/2022050709/5681678c550346895ddcae40/html5/thumbnails/1.jpg)
Advanced Modes of Mechanical Ventilation
![Page 2: Advanced Modes of Mechanical Ventilation](https://reader034.vdocuments.us/reader034/viewer/2022050709/5681678c550346895ddcae40/html5/thumbnails/2.jpg)
POINTS OF DISCUSSION Triggered Modes of Ventilation
Volume Support (VS) Proportional Assist Ventilation (PAV or PPS)
Hybrid Modes of Ventilation Volume Assured Pressure Support Pressure Regulated Volume Control (PRVC) Auto mode: VS and PRVC Adaptive Support Ventilation: ASV Bi-level Ventilation (APRV and Bi-vent) Mandatory Minute Ventilation (MMV)
![Page 3: Advanced Modes of Mechanical Ventilation](https://reader034.vdocuments.us/reader034/viewer/2022050709/5681678c550346895ddcae40/html5/thumbnails/3.jpg)
DUAL CONTROL BREATH-TO-BREATHPRESSURE-LIMITED FLOW-CYCLED VENTILATIONVOLUME SUPPORT
Control Trigger Limit Target CyclePressure Patient Pressure Volume Flow
Pressure Limited Flow Cycled Ventilation
![Page 4: Advanced Modes of Mechanical Ventilation](https://reader034.vdocuments.us/reader034/viewer/2022050709/5681678c550346895ddcae40/html5/thumbnails/4.jpg)
VS (VOLUME SUPPORT)
(1), VS test breath (5 cm H2O); (2), pressure is increased slowly until target volume is achieved; (3), maximum available pressure is 5 cm H2O below upper pressure limit; (4), VT higher than set VT delivered results in lower pressure; (5), patient can trigger breath; (6) if
apnea alarm is detected, ventilator switches to PRVC
1 2 3 4 5 6
Pressure Upper Pressure limit
5 cm H2O
Flow
Apnea5 cm H2O
Constant exp. Flow
![Page 5: Advanced Modes of Mechanical Ventilation](https://reader034.vdocuments.us/reader034/viewer/2022050709/5681678c550346895ddcae40/html5/thumbnails/5.jpg)
Volume fromVentilator=
Set tidal volume
Pressure limitBased on VT/C Cycle off
Calculatecompliance
Calculate newPressure limit
no
yes
yes
no
Control logic for volume support mode of the servo 300
Trigger Flow= 5% ofPeak flow
![Page 6: Advanced Modes of Mechanical Ventilation](https://reader034.vdocuments.us/reader034/viewer/2022050709/5681678c550346895ddcae40/html5/thumbnails/6.jpg)
DUAL CONTROL BREATH TO BREATH:PROPORTIONAL ASSIST VENTILATION(PAS)/PROPORTIONAL PRESSURE SUPPORT (PPS)
Control Trigger Limit Target CyclePressure Patient Pressure Volume Flow
Pressure Limited Flow Cycled Ventilation
![Page 7: Advanced Modes of Mechanical Ventilation](https://reader034.vdocuments.us/reader034/viewer/2022050709/5681678c550346895ddcae40/html5/thumbnails/7.jpg)
PROPORTIONAL ASSIST VENTILATION (PAV)
Pressure
Flow
Time
Time
Rregulates the pressure output of the ventilator moment by moment in accord with the patient’s demands for flow and volume.Thus, when the patient wants more, (s)he gets more help; when less, (s)he gets less. The timing and power synchrony are therefore nearly optimal—at least in concept.
Changing pressure support based on patient’s efforts
![Page 8: Advanced Modes of Mechanical Ventilation](https://reader034.vdocuments.us/reader034/viewer/2022050709/5681678c550346895ddcae40/html5/thumbnails/8.jpg)
PROPORTIONAL ASSIST AMPLIFIES MUSCULAR EFFORT
Muscular effort (Pmus) and airway pressure assistance (Paw) are better matched for Proportional Assist (PAV) than for Pressure Support (PSV).
![Page 9: Advanced Modes of Mechanical Ventilation](https://reader034.vdocuments.us/reader034/viewer/2022050709/5681678c550346895ddcae40/html5/thumbnails/9.jpg)
![Page 10: Advanced Modes of Mechanical Ventilation](https://reader034.vdocuments.us/reader034/viewer/2022050709/5681678c550346895ddcae40/html5/thumbnails/10.jpg)
DUAL CONTROL WITHIN A BREATHVOLUME-ASSURED PRESSURE SUPPORT
Control Trigger Limit Target CycleDual
Pressure/Volume
Patient Pressure Volume Flow or volume
Volume Assured Pressure Support Ventilation
![Page 11: Advanced Modes of Mechanical Ventilation](https://reader034.vdocuments.us/reader034/viewer/2022050709/5681678c550346895ddcae40/html5/thumbnails/11.jpg)
PPawawcmHcmH2200
6060
-20-20
6060
FlowFlowL/minL/min
VolumeVolume
Set flow
Set tidal volume cycle threshold
Set pressure limit
Tidal volume met
Tidal volume not met
Switch from Pressure control toVolume/flow control
Inspiratory flowgreater than set flow
Flow cycleInspiratory flowequals set flow
Pressure limitoverridden
LL
0
0.6
4040
![Page 12: Advanced Modes of Mechanical Ventilation](https://reader034.vdocuments.us/reader034/viewer/2022050709/5681678c550346895ddcae40/html5/thumbnails/12.jpg)
Pressure at Pressure support
delivered VT
≥ set VT
flow= 25% peak
Cycle offinspiration Insp flow
> Set flow
PAW <PSVsetting
delivered VT
= set VT
Switch to flow controlat peak flow setting
Trigger
yes
no
no
no
no
no
yes
yes
yes
Control logic for volume-assured pressure-support mode
yes
![Page 13: Advanced Modes of Mechanical Ventilation](https://reader034.vdocuments.us/reader034/viewer/2022050709/5681678c550346895ddcae40/html5/thumbnails/13.jpg)
DUAL CONTROL BREATH-TO-BREATHPRESSURE REGULATED VOLUME CONTROL
Control Trigger Limit Target CycleVolume Patient or
TimePressure Lowest
pressurefor set volume
Time
Pressure-limited Time-cycled Ventilation
![Page 14: Advanced Modes of Mechanical Ventilation](https://reader034.vdocuments.us/reader034/viewer/2022050709/5681678c550346895ddcae40/html5/thumbnails/14.jpg)
PRVC (PRESSURE REGULATED VOLUME CONTROL)
PRVC. (1), Test breath (5 cm H2O); (2) pressure is increased to deliver set volume; (3), maximum available pressure; (4), breath delivered at preset E, at preset f, and during preset TI; (5), when VT
corresponds to set value, pressure remains constant; (6), if preset volume increases, pressure decreases; the ventilator continually monitors and adapts to the patient’s needs
1 2 3 4 5 6
Upper Pressure Limit5 cm H2OPressure
Floe
Time
Time
![Page 15: Advanced Modes of Mechanical Ventilation](https://reader034.vdocuments.us/reader034/viewer/2022050709/5681678c550346895ddcae40/html5/thumbnails/15.jpg)
PRVC AUTOMATICALLY ADJUSTS TO COMPLIANCE CHANGESPressure control Ventilation PRVC
![Page 16: Advanced Modes of Mechanical Ventilation](https://reader034.vdocuments.us/reader034/viewer/2022050709/5681678c550346895ddcae40/html5/thumbnails/16.jpg)
Volume fromVentilator=
Set tidal volume
Time= setInspiratory time
Pressure limitBased on VT/CTrigger Cycle off
Calculatecompliance
Calculate newPressure limit
no
yes
yes
no
Control logic for pressure-regulated volume control and autoflow
![Page 17: Advanced Modes of Mechanical Ventilation](https://reader034.vdocuments.us/reader034/viewer/2022050709/5681678c550346895ddcae40/html5/thumbnails/17.jpg)
AUTOMODE
Mandatory SpontaneousPRVC VS
Ventilator triggered, pressure controlled and
time cycled; the pressure is adjusted to maintain the
set tidal volume
Patient triggered, pressure limited, and flow cycled.
Apnea for 12 seconds Two consecutive breaths
![Page 18: Advanced Modes of Mechanical Ventilation](https://reader034.vdocuments.us/reader034/viewer/2022050709/5681678c550346895ddcae40/html5/thumbnails/18.jpg)
DUAL CONTROL BREATH-TO-BREATHADAPTIVE SUPPORT VENTILATION
![Page 19: Advanced Modes of Mechanical Ventilation](https://reader034.vdocuments.us/reader034/viewer/2022050709/5681678c550346895ddcae40/html5/thumbnails/19.jpg)
ASV (ADAPTIVE SUPPORT VENTILATION) A dual control mode that uses pressure
ventilation (both PC and PSV) to maintain a set minimum E (volume target) using the least required settings for minimal WOB depending on the patient’s condition and effort It automatically adapts to patient demand by
increasing or decreasing support, depending on the patient’s elastic and resistive loads
![Page 20: Advanced Modes of Mechanical Ventilation](https://reader034.vdocuments.us/reader034/viewer/2022050709/5681678c550346895ddcae40/html5/thumbnails/20.jpg)
ASV (ADAPTIVE SUPPORT VENTILATION) The clinician enters the patient’s IBW, which allows the
ventilator’s algorithm to choose a required E. The ventilator then delivers 100 mL/min/kg.
A series of test breaths measures the system C, resistance and auto-PEEP
If no spontaneous effort occurs, the ventilator determines the appropriate respiratory rate, VT, and pressure limit delivered for the mandatory breaths
I:E ratio and TI of the mandatory breaths are continually being “optimized” by the ventilator to prevent auto-PEEP
If the patient begins having spontaneous breaths, the number of mandatory breaths decrease and the ventilator switches to PS at the same pressure level
Pressure limits for both mandatory and spontaneous breaths are always being automatically adjusted to meet the E target
![Page 21: Advanced Modes of Mechanical Ventilation](https://reader034.vdocuments.us/reader034/viewer/2022050709/5681678c550346895ddcae40/html5/thumbnails/21.jpg)
+
+TargetCurrent
MinVol 7.0 L/min
200
400
600
800
THE SAFETY WINDOW: LOW RATE/VOLUME LIMITS
VmL
10 20 30 40 50 60 fSpont0 b/min
fControl11 b/min
Pinsp18 cmH2O
fb/min
5 b/min
2 * Vd
(Pmax-PEEP)*Cdyn
f=60/[1RCinsp+2RCexp]
![Page 22: Advanced Modes of Mechanical Ventilation](https://reader034.vdocuments.us/reader034/viewer/2022050709/5681678c550346895ddcae40/html5/thumbnails/22.jpg)
MANDATORY MINUTE VENTILATION A minimum minute ventilation is set by the
operator The ventilator monitors the spontaneous MV The part of the pre-selected MV that the
patient is not able to accomplish is provided by the ventilator to make up the difference by automatically changing the breath rate
![Page 23: Advanced Modes of Mechanical Ventilation](https://reader034.vdocuments.us/reader034/viewer/2022050709/5681678c550346895ddcae40/html5/thumbnails/23.jpg)
MMV
time
Min.Vent.MMV
SMV
![Page 24: Advanced Modes of Mechanical Ventilation](https://reader034.vdocuments.us/reader034/viewer/2022050709/5681678c550346895ddcae40/html5/thumbnails/24.jpg)
MMV SETTINGS
time
Min.Vent.
SMVMMV
MMV = 70-90% of SMV
![Page 25: Advanced Modes of Mechanical Ventilation](https://reader034.vdocuments.us/reader034/viewer/2022050709/5681678c550346895ddcae40/html5/thumbnails/25.jpg)
BILEVEL VENTILATION
PEEPPEEPHH
PEEPPEEPLL
Pressure SupportPressure SupportPEEPPEEPHigh High + PS + PS
PPawawcmHcmH2200
6060
-20-201 2 3 4 5 6 7
![Page 26: Advanced Modes of Mechanical Ventilation](https://reader034.vdocuments.us/reader034/viewer/2022050709/5681678c550346895ddcae40/html5/thumbnails/26.jpg)
Thigh
Tlow
Plow
Phigh
Time
Time
Pres
sure
Pres
sure
Psupp
![Page 27: Advanced Modes of Mechanical Ventilation](https://reader034.vdocuments.us/reader034/viewer/2022050709/5681678c550346895ddcae40/html5/thumbnails/27.jpg)
Thigh
Tlow
Plow
Phigh
Time
Time
Pres
sure
Pres
sure
Phigh
Psupp
![Page 28: Advanced Modes of Mechanical Ventilation](https://reader034.vdocuments.us/reader034/viewer/2022050709/5681678c550346895ddcae40/html5/thumbnails/28.jpg)
Thigh
Tlow
Plow
Phigh
Time
Time
Pres
sure
Pres
sure
PhighPsupp
Psupp
![Page 29: Advanced Modes of Mechanical Ventilation](https://reader034.vdocuments.us/reader034/viewer/2022050709/5681678c550346895ddcae40/html5/thumbnails/29.jpg)
AIRWAY PRESSURE RELEASE VENTILATION
Control Trigger Limit CyclePressure Time Pressure Time
Time Triggered Time-cycled Ventilation
![Page 30: Advanced Modes of Mechanical Ventilation](https://reader034.vdocuments.us/reader034/viewer/2022050709/5681678c550346895ddcae40/html5/thumbnails/30.jpg)
AIRWAY PRESSURE RELEASE VENTILATION
PPawawcmHcmH2200
6060
-20-201 2 3 4 5 6 7 8
Spontaneous Breaths
Releases
![Page 31: Advanced Modes of Mechanical Ventilation](https://reader034.vdocuments.us/reader034/viewer/2022050709/5681678c550346895ddcae40/html5/thumbnails/31.jpg)
APRV (AIRWAY PRESSURE RELEASE VENTILATION)
Spontaneous breaths
CPAP Level
CPAP Level 2CPAP Level 1
CPAP ReleasedCPAP Restored
Time
Airw
ay P
ress
ure
![Page 32: Advanced Modes of Mechanical Ventilation](https://reader034.vdocuments.us/reader034/viewer/2022050709/5681678c550346895ddcae40/html5/thumbnails/32.jpg)
![Page 33: Advanced Modes of Mechanical Ventilation](https://reader034.vdocuments.us/reader034/viewer/2022050709/5681678c550346895ddcae40/html5/thumbnails/33.jpg)
QUESTIONS