essentials of ventilator graphics

Essentials of Ventilator Graphics ©2000 RespiMedu

Developed by:

Ruben D Restrepo, MD, RRTVijay M Deshpande, MS, RRT, FAARC

Assistant ProfessorsGeorgia State University

Atlanta, Georgia

ESSENTIALS ESSENTIALS OF OF

VENTILATOR GRAPHICSVENTILATOR GRAPHICS


COPYRIGHT NOTICECOPYRIGHT NOTICE© 2000 RespiMedu, Inc.© 2000 RespiMedu, Inc.

Essentials of Ventilator Graphics. Essentials of Ventilator Graphics. All rights reserved. All rights reserved.

Except as permitted under the Copyright Except as permitted under the Copyright Act of 1976, no part of this material may Act of 1976, no part of this material may be reproduced in whole or in part in any be reproduced in whole or in part in any

manner without permission in writing from manner without permission in writing from the copyright ownersthe copyright owners. . Printed in the U.S.A.Printed in the U.S.A.


Mechanical Ventilation

GraphicsGraphicsSCALARS LOOPS


SCALARS

Flow/TimePressure/Time

Volume/Time


Pressure-Volume Flow-Volume

LOOPS


SCALARS


Volume/Time


Spontaneous Breath

Time (sec)

Flow

(L/m

in) InspirationInspiration

ExpirationExpiration


Mechanical Breath

Inspiration

Expiration

Flow

(L/m

in)

Time (sec)


Typical Flow Patterns

ACCELERATINGACCELERATING

DECELERATINGDECELERATING

SINESINE

SQUARESQUARE


Inspiratory Flow Pattern

Inspiration

Expiration

Time (sec)

Flow

(L/m

in)

Flow

(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)

Flow

(L/m

in)

Beginning of expirationexhalation valve opens

Peak Expiratory Flow RatePEFR

Duration of expiratory flow

Expiratory time

TE


Inadequate Inspiratory Flow

Flow (L/min)

Time (sec)

NormalAbnormal

Active Inspiration or Active Inspiration or AsynchronyAsynchrony

Patient’s effort


Obstruction vs Active Expiration

Obstruction Active Expiration

Time (sec)

NormalAbnormal

Flow (L/min)


Air TrappingInspiration

Expiration

NormalNormalPatientPatient

Time (sec)

Flow

(L/m

in)

Air TrappingAuto-PEEP

}


Response to Bronchodilator

Before

Time (sec)

Flow

(L/m

in)

PEFR

After

Long TE

Higher PEFR

Shorter TE


SCALARS


Volume/Time


Volume vs Time

InspirationInspiration

Expiration

Time (sec)Time (sec)

Volu

me

(ml)

Volu

me

(ml)

Inspiratory Tidal Volume

TTII


Air LeakVo

lum

e (m

l)Vo

lum

e (m

l)


Air LeakAir Leak


Active Exhalation

Volume (ml)Volume (ml)



SCALARS


Volume/Time


Spontaneous BreathPP awaw

(cm

H (c

m H

220)0)


InspirationInspiration



Mechanical Breath

InspirationExpirationP a

w (

cm H

2O)

Time (sec)

}}TI

Peak Inspiratory PressurePIP

PEEPPEEPTE


Mechanical

Time (sec)

P aw (

cm H

2O)

Time Triggered Breath

CONTROLLED BREATH(Time Triggered)


Assisted Breath(Patient Triggered)

Mechanical

Time (sec)

P aw (

cm H

2O)

Patient Triggered Breath


Assisted vs Controlled

Time (sec)

Assisted ControlledPressure (cmH20)


Spontaneous vs. Mechanical

MechanicalMechanical

Time (sec)

SpontaneousSpontaneousPaw (cm H2O)

Inspiration


Inspiration


Components of Inflation Pressure

Begin Expiration

P aw (

cm H

2O)

Time (sec)

Begin Inspiration

PIPPIP

Pplateau

(Palveolar)

Transairway Pressure (PTA)}}

Exhalation Valve Opens


Inspiratory Pause


Begin Inspiration Begin Expiration

P aw (

cm H

2O)

Time (sec)

Airway

Resistan

ce

Distending (Alveolar) Pressure Expiration

Inflation Hold(seconds)

Begin Expiration

P aw (

cm H

2O))

Time (sec)Begin Inspiration

PIPPIP

Pplateau

(Palveolar

Transairway Pressure (PTransairway Pressure (PTATA))}}Exhalation Valve Opens

Expiration

PIP


PIP vs Pplat

Normal High Raw

High Flow Low Compliance

Time (sec)

Paw

(cm

H2O

)

PIPPIP

PPPlatPlat

PIPPIP

PIPPIP PIPPIP

PPPlatPlatPPPlatPlat

PPlat


Pa

w (

cm H

Paw

(cm

H22O

)O

)

Normal

Normal PPlat(Normal Compliance)

Increased PIP

} Increased PTA(increased Airway Resistance))

NormalNormalPIPPIP

PPPlatPlat

High RHigh RawawPIPPIP

PPPlatPlat

Increased Airway Resistance


Effect of increased Flow

Time (sec)

Paw

(cm

H2O

)NormalNormal

PIPPIPHigh FlowHigh Flow

PPlat

PIPPIP

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

Normal

PPlat


DECREASED COMPLIANCE

Time (sec)

Paw

(cm

H2O

)Low CompliancePIPPPlat

NormalNormalPIP

PPlat

Normal PPlat(Normal Compliance)

Increased PPlat(Decreased Compliance))

Normal

PIP



Adequate Flow

Time (sec)

Inadequate Flow

P aw

(cm

H2O

)



LOOPS


Pressure-Volume Loop

(Type of Breath)

Controlled Assisted Spontaneous

Vol (

ml)

Paw (cm H2O)

I: InspirationE: Expiration

I

E

E

E

II


FRC and PV Loop

FRCVOLU

ME

TLC

Negative Positive0

DISTENDING PRESSURE

Normal Compliance

FRC


Components of Pressure-Volume

Loop

Volume Volume (mL)(mL)

Insp

iratio

n

Expi

ratio

n

PIP

VT

PPawaw (cm H (cm H22O)O)


PEEP and P-V Loop

Volume (mL)

VT

PIPPIPPaw (cm H2O)

PEEP PEEP


Work of Breathing

A: Resistive Work B: Elastic Work

Pressure (cm H2O)

Volume (ml)

BB

AA


Inflection Points

Pressure (cm H2O)

Volume (mL)

Upper Inflection Point

Lower Inflection Point


Inadequate Sensitivity

Volume Volume (mL)(mL)

PPawaw (cm H (cm H22O)O)Increased WOB


Air LeakVolume (ml)

Pressure (cm HPressure (cm H22O)O)

Air Leak



PPaw aw (cm (cm HH22O)O)

Volume Volume (ml)(ml)

NormalAbnormal

Active InspirationActive Inspiration

Inappropriate FlowInappropriate Flow


Increased Raw

Pressure (cm Pressure (cm HH22O)O)

Higher PTA

Normal

Slope

Normal

Slope

Vol (mL)Vol (mL)

Lower Slope

Lower Slope


HysteresisVolume (ml)

Pressure (cm Pressure (cm HH22O)O)

Abnormal Hysteresis

Normal Hysteresis


Lung Compliance Changes and the P-V

Loop

Volume (mL)Volume (mL)

PIP levels

Preset VT


COMPLIANCEIncreasedNormalDecreased

Volume Targeted Ventilation


Lung Compliance Changes and the P-V

Loop

Volume (mL)Volume (mL)

Preset PIP

VT

leve

ls


COMPLIANCEIncreasedNormalDecreased

Pressure Targeted Ventilation


Overdistension

Volu

me

(ml)

Pressure (cm HPressure (cm H22O)O)

With little or no change in VT

Paw rises

NormalAbnormal



LOOPS


Flow-Volume Loop


PEFR

FRC

Inspiration

Expiration

Flo w

(L/

mi n

)Fl

o w (

L/m

i n) PIFR

VT


Air Leak

Inspiration

Expiration

Volume (ml)

Flow Flow (L/min)(L/min)

Air Leak in mL

NormalAbnormal


Air Trapping

Inspiration

Expiration


Flow (L/min)

Does not returnDoes not returnto baselineto baseline

NormalAbnormal


Increased Airway Resistance

Inspiration

Expiration

VolumeVolume (ml) (ml)

Flow (L/min)

Decreased PEFR

NormalNormalAbnormal“Scooped out”

pattern


Airway Secretions/Water in the Circuit

Inspiration

Expiration


Flow (L/min)

NormalAbnormal


Modes of Ventilation

Spontaneous Mechanical

Volume Targeted

PressureTargeted


Spontaneous Breath

Time (sec)

FlowL/m

Pressurecm H2O

VolumemL


CPAP


CPAP level

FlowL/m

Pressurecm H2O

VolumemL


PSV

Time (sec)

FlowL/m

Pressurecm H2O

VolumemL

Flow Cycling

Set PS level

Patient Triggered, Flow Cycled, Pressure limited Mode


CPAP + PSV

Set PS level

CPAP level


FlowL/m

Pressurecm H2O

VolumemL

Flow Cycling


Modes of Ventilation

Spontaneous Mechanical

Volume Targeted

PressureTargeted


Controlled Mode (Volume- Targeted

Ventilation)

Preset VT

Volume Cycling

Dependent onCL & Raw


FlowL/m

Pressurecm H2O

VolumemL

Preset Peak Flow Time triggered, Flow limited, Volume cycled Ventilation


Assisted Mode(Volume-Targeted

Ventilation)


FlowL/m

Pressurecm H2O

VolumemL

Preset VT

Volume Cycling

Patient triggered, Flow limited, Volume cycled Ventilation


SIMV(Volume-Targeted

Ventilation)

Spontaneous Breaths

FlowL/m

Pressurecm H2O

VolumemL


Controlled Mode (Pressure-Targeted

Ventilation)

Pressure

Flow

Volume

(L/min)

(cm H2O)

(ml)Time (sec)Time (sec)

Time-Time-Cycled

Set PC level

Time Triggered, Pressure Limited, Time Cycled Ventilation


Assisted Mode (Pressure-Targeted

Ventilation)

Pressure

Flow

Volume

(L/min)

(cm H2O)

(ml)

Set PC level


Time-Cycled

Patient Triggered, Pressure Limited, Time Cycled Ventilation


Pressure

Flow

Volume

(L/min)

(cm H2O)

(ml)

Set PC levelSet PC level


SIMV Mode (Pressure-Targeted

Ventilation)

Spontaneous Breath


Pressure

Flow

Volume

(L/min)

(cm H2O)

(ml)

SIMV + PS (Pressure-Targeted

Ventilation)

PS Breath

Set PS levelSet PC 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


Pressure

Flow

Volume

(L/min)

(cm H2O)

(ml)

Set PC levelSet PC level


SIMV + PS + CPAP (Pressure-Targeted

Ventilation)

Set PS level

CPAP levelCPAP level


SIMV+PS + CPAP(Volume-Targeted

Ventilation)

Flow

Pressure

Volume

(L/min)

(cm H2O)

(ml)

Set PS level

CPAP levelCPAP level

Time (sec)

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