essentials of ventilator graphics · essentials of ventilator graphics ©2000 respimedu controlled...

Essentials of Ventilator Graphics ©2000 RespiMedu

Developed by:

Ruben D Restrepo, MD, RRT

Vijay M Deshpande, MS, RRT, FAARC

Assistant Professors

Georgia State University

Atlanta, Georgia

ESSENTIALS

OF

VENTILATOR GRAPHICS


Mechanical Ventilation

GraphicsSCALARS LOOPS


SCALARS

Flow/Time

Pressure/Time

Volume/Time


Pressure-Volume Flow-Volume

LOOPS


SCALARS

Flow/TimePressure/Time

Volume/Time


Spontaneous Breath

Time (sec)

Flo

w (

L/m

in) Inspiration

Expiration


Mechanical Breath

Inspiration

Expiration

Flo

w (

L/m

in)

Time (sec)


Typical Flow Patterns

ACCELERATING

DECELERATING

SINE

SQUARE


Inspiratory Flow Pattern

Inspiration

Expiration

Time (sec)

Flo

w (

L/m

in)

Beginning of inspirationexhalation valve closes

Peak inspiratory flow ratePIFR

Beginning of expirationexhalation valve opens

Total cycle timeTCT

Insp. timeTI

Expiratory Time

TE


Expiratory Flow Pattern

Inspiration

Expiration

Time (sec)

Flo

w (

L/m

in)

Beginning of expirationexhalation valve opens

Peak Expiratory Flow RatePEFR

Duration of expiratory flow

Expiratory timeTE


Inadequate Inspiratory Flow

Flow(L/min)

Time (sec)

NormalAbnormal

Active Inspiration or Asynchrony

Patient’s effort


Obstruction vs Active Expiration

Obstruction Active Expiration

Time

(sec)

NormalAbnormal

Flow

(L/min)


Air Trapping

Inspiration

Expiration

NormalPatient

Time (sec)

Flo

w (

L/m

in)

Air TrappingAuto-PEEP

}


Response to Bronchodilator

Before

Time (sec)

Flo

w (

L/m

in)

PEFR

After

Long TE

Higher PEFR

Shorter TE


SCALARS

Flow/TimePressure/Time

Volume/Time


Volume vs Time

Inspiration

Expiration

Time (sec)

Vo

lum

e (

ml)

Inspiratory Tidal Volume

TI


Inspiration

Expiration

Time (sec)

Vo

lum

e (

ml)

Inspiratory Tidal Volume

TI

Volume Ventilation breaths are Volume Cycled

Volume Cycling


Air LeakV

olu

me (

ml)

Time (sec)

Air Leak


Active Exhalation

Volume (ml)

Time (sec)


SCALARS

Flow/Time

Pressure/Time

Volume/Time


Spontaneous BreathP

aw

(cm

H20)

Time (sec)

Inspiration

Expiration


Mechanical Breath

InspirationExpiration

Pa

w(c

m H

2O

)

Time (sec)

}TI

Peak Inspiratory PressurePIP

PEEP

TE


Mechanical

Time (sec)

Pa

w(c

m H

2O

)

Time Triggered Breath

CONTROLLED BREATH(Time Triggered)


Assisted Breath(Patient Triggered)

Mechanical

Time (sec)

Pa

w(c

m H

2O

)

Patient Triggered Breath


Assisted vs Controlled

Time (sec)

Assisted ControlledPressure

(cmH20)


Spontaneous vs. Mechanical

Mechanical

Time (sec)

SpontaneousPaw

(cm H2O)

Inspiration

ExpirationExpiration

Inspiration


Components of Inflation Pressure

Begin Expiration

Pa

w(c

m H

2O

)

Time (sec)

Begin Inspiration

PIP

Pplateau

(Palveolar)

Transairway Pressure (PTA)}Exhalation Valve Opens

Expiration

Inspiratory Pause


Begin InspirationBegin Expiration

Pa

w(c

m H

2O

)

Time (sec)

Distending (Alveolar) Pressure Expiration

Inflation Hold(seconds)

Begin Expiration

Pa

w(c

m H

2O

)

Time (sec)Begin Inspiration

PIP

Pplateau

(Palveolar

Transairway Pressure (PTA)}Exhalation Valve Opens

Expiration

PIP


PIP vs Pplat

Normal High Raw

High Flow Low Compliance

Time (sec)

Paw

(c

m H

2O

)

PIP

PPlat

PIP

PIP PIP

PPlatPPlat

PPlat


Paw

(c

m H

2O

)

Normal

Normal PPlat

(Normal Compliance)

Increased PIP

} Increased PTA

(increased Airway Resistance)

NormalPIP

PPlat

High RawPIP

PPlat

Increased Airway Resistance


Effect of increased Flow

Time (sec)

Pa

w (c

m H

2O

)Normal

PIP

High Flow

PPlat

PIP

Dynamic Inspiratory TimeDecreased Inspiratory Time(Due to High Inspiratory Flow)

Normal

PPlat


DECREASED COMPLIANCE

Time (sec)

Paw

(c

m H

2O

)

Low CompliancePIP

PPlat

Normal

PIP

PPlat

Normal PPlat

(Normal Compliance)

Increased PPlat

(Decreased Compliance)

Normal

PIP



Adequate Flow

Time (sec)

Inadequate Flow

Pa

w

(cm

H2O

)



LOOPS


Pressure-Volume Loop(Type of Breath)

Controlled Assisted Spontaneous

Vo

l (m

l)

Paw

(cm H2O)

I: InspirationE: Expiration

I

E

E

E

II


FRC and PV Loop

FRCVO

LU

ME

TLC

Negative Positive0

DISTENDING PRESSURE

Normal Compliance

FRC


Components of Pressure-Volume Loop

Volume

(mL)

PIP

VT

Paw (cm H2O)


PEEP and P-V Loop

Volume

(mL)

VT

PIPPaw (cm H2O)

PEEP


Work of Breathing

A: Resistive WorkB: Elastic Work

Pressure (cm H2O)

Volume (ml)

B

A


Inflection Points

Pressure (cm H2O)

Volume (mL)

Upper Inflection Point

Lower Inflection Point


Inadequate Sensitivity

Volume

(mL)

Paw (cm H2O)Increased WOB


Air Leak

Volume (ml)

Pressure (cm H2O)

Air Leak



Paw (cm H2O)

Volume (ml)

NormalAbnormal

Active Inspiration

Inappropriate Flow


Increased Raw

Pressure (cm H2O)

Higher PTA

Vol (mL)


Hysteresis

Volume (ml)

Pressure (cm H2O)

Abnormal Hysteresis

Normal Hysteresis


Lung Compliance Changes and the P-V Loop

Volume (mL)

PIP levels

Preset VT

Paw (cm H2O)

COMPLIANCE

IncreasedNormalDecreased

Volume Targeted Ventilation


Lung Compliance Changes and the P-V Loop

Volume (mL)

Preset PIP

VT

le

ve

ls

Paw (cm H2O)

COMPLIANCE

IncreasedNormalDecreased

Pre

ssure

Targ

ete

d V

en

tilatio

n


Overdistension

Vo

lum

e (

ml)

Pressure (cm H2O)

With little or no change in VT

Paw rises

NormalAbnormal



LOOPS


Flow-Volume Loop

Volume (ml)

PEFR

FRC

Inspiration

Expiration

PIFR

VT


Air Leak

Inspiration

Expiration

Volume (ml)

Flow (L/min)

Air Leak in mL

NormalAbnormal


Air TrappingInspiration

Expiration

Volume (ml)

Flow (L/min)

Does not returnto baseline

NormalAbnormal


Increased Airway Resistance

Inspiration

Expiration

Volume (ml)

Flow (L/min)

Decreased PEFR

NormalAbnormal

“Scooped out”pattern


Airway Secretions/Water in the Circuit

Inspiration

Expiration

Volume (ml)

Flow (L/min)

NormalAbnormal


Modes of Ventilation

SpontaneousMechanical

Volume

Targeted

Pressure

Targeted


Spontaneous Breath

Time (sec)

Flow

L/m

Pressure

cm H2O

Volume

mL


CPAP

Time (sec)

CPAP level

Flow

L/m

Pressure

cm H2O

Volume

mL


PSV

Time (sec)

Flow

L/m

Pressure

cm H2O

Volume

mL

Flow Cycling

Set PS level

Patient Triggered, Flow Cycled, Pressure limited Mode


CPAP + PSV

Set PS level

CPAP level

Time (sec)

Flow

L/m

Pressure

cm H2O

Volume

mL

Flow Cycling


Modes of Ventilation

SpontaneousMechanical

Volume

Targeted

Pressure

Targeted


Controlled Mode (Volume- Targeted Ventilation)

Preset VT

Volume Cycling

Dependent on

CL & Raw

Time (sec)

Flow

L/m

Pressure

cm H2O

Volume

mL

Preset Peak Flow

Time triggered, Flow limited, Volume cycled Ventilation


Assisted Mode(Volume-Targeted Ventilation)

Time (sec)

Flow

L/m

Pressure

cm H2O

Volume

mL

Preset VT

Volume Cycling

Patient triggered, Flow limited, Volume cycled Ventilation


SIMV(Volume-Targeted Ventilation)

Spontaneous Breaths

Flow

L/m

Pressure

cm H2O

Volume

mL


Controlled Mode (Pressure-Targeted Ventilation)

Press

ure

Flow

Volume

(L/min)

(cm H2O)

(ml)

Time (sec)

Time-Cycled

Set PC level

Time Triggered, Pressure Limited, Time Cycled Ventilation


Assisted Mode (Pressure-Targeted Ventilation)

Press

ure

Flow

Volume

(L/min)

(cm H2O)

(ml)

Set PC level

Time (sec)

Time-Cycled

Patient Triggered, Pressure Limited, Time Cycled Ventilation


Press

ure

Flow

Volume

(L/min)

(cm H2O)

(ml)

Set PC level

Time (sec)

SIMV Mode (Pressure-Targeted Ventilation)

Spontaneous Breath


Press

ure

Flow

Volume

(L/min)

(cm H2O)

(ml)

SIMV + PS (Pressure-Targeted Ventilation)

PS Breath

Set PS levelSet PC level

Time (sec)

Time-Cycled Flow-Cycled


SIMV+PS(Volume-Targeted Ventilation)

Flow

Pressure

Volume

(L/min)

(cm H2O)

(ml)

Set PS level

PS Breath

Flow-cycled


Press

ure

Flow

Volume

(L/min)

(cm H2O)

(ml)

Set PC level

Time (sec)

SIMV + PS + CPAP (Pressure-Targeted Ventilation)

Set PS level

CPAP level


SIMV+PS + CPAP(Volume-Targeted Ventilation)

Flow

Pressure

Volume

(L/min)

(cm H2O)

(ml)

Set PS level

CPAP level

Time (sec)

essentials of ventilator graphics · essentials of ventilator graphics ©2000 respimedu controlled...

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