servo-i ventilator graphics. 09-03-25© maquet3 introduction mcv00009701 reva
TRANSCRIPT
SERVO-i VENTILATOR GRAPHICS
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INTRODUCTION
MCV00009701 REVA
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MEDIASTINUM AND CHEST WALL
INTRODUCTION
MCV00009701 REVA
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AIRWAYS AND ALVEOLI
INTRODUCTION
MCV00009701 REVA
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KEEP IN MIND WHEN EVALUATING VENTILATOR GRAPHICS
What type of ventilation is the patient receiving? What are you looking at? Does it make sense?
INTRODUCTION
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TYPES OF VENTILATOR GRAPHICS
Scalars:
Pressure - Time
Flow - Time
Volume - Time
Loops:
Volume - Pressure
Flow - Volume
INTRODUCTION
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VOLUME VS. PRESSURE VENTILATION - SCALARS
Volume Breath Pressure Breath
Time Time
PAW
Flow
PAW
Flow
INTRODUCTION
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You read a waveform like you read a sentence…from left to right. By the time
you get to the end, you should have a complete thought, just like reading a
sentence.
Determine whether the waveform you are examining
belongs to a constant flow mode or a decelerating flow mode.
That way you will know how the waveform is expected to
behave. Then you can compare the expectation to the actual
behavior as you read from left to right.
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VOLUME VS. PRESSURE VENTILATION - LOOPS
Volume Breath Pressure Breath
INTRODUCTION
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VOLUME VENTILATION
Constant Flow
Pressure
INTRODUCTION
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Decelerating Flow
Pressure
PRESSURE VENTILATION INTRODUCTION
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Inspirationbegins
Inspirationends
Expirationbegins
Expirationends
INSPIRATION AND EXPIRATION INTRODUCTION
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Read waveforms one at a time. Don’t try to assimilate all three at once.
Identify the beginning and end of inspiration and the beginning and end of
expiration.
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MODES OF VENTILATION
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VOLUME CONTROL SCALARS
MODES OF VENTILATION
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Know what kind of waveform you’re reading
and note the value to which the scale is set.
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VOLUME CONTROL LOOPS AND SCALARS
MODES OF VENTILATION
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FLOW-ADAPTIVE VOLUME CONTROLLERTM
Volume controlled ventilation:
MODES OF VENTILATION
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If during a positive pressure breath, the patient makes an inspiratory effort, you may see a “dip” in the pressure curve.
A waveform can change in appearance with a change in the patient’s compliance,
resistance or effort.
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PRESSURE CONTROL SCALARS
MODES OF VENTILATION
MCV00009701 REVA
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PRESSURE CONTROL LOOPS AND SCALARS
MODES OF VENTILATION
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SIMV (PRESSURE) WITH PRESSURE SUPPORT SCALARS
MODES OF VENTILATION
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PRVC START UP PROCESS
MODES OF VENTILATION
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PRVC IN USE: PATIENT‘S ADJUSTMENTS
MODES OF VENTILATION
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PRESSURE SUPPORT SCALARS AND LOOPS
MODES OF VENTILATION
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Time
Flow
25%
Peak Inspiratory Flow
50%
25%50%
FLOW-CYCLING
MODES OF VENTILATION
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100%
INSPIRATORY CYCLE OFF
MODES OF VENTILATION
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INSPIRATORY CYCLE OFF
MODES OF VENTILATION
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INSPIRATORY CYCLE OFF
MODES OF VENTILATION
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INSPIRATORY CYCLE OFF
MODES OF VENTILATION
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If you see a curious aberration on one waveform and you can’t account for it, look at the other waveforms at the same point in time to see if
there is a cause and effect relationship.
If during a positive pressure breath the patient tries to exhale against a closed exhalation valve, you may see a spike in the pressure
curve.
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VOLUME SUPPORT SCALARS
MODES OF VENTILATION
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INSPIRATORY RISE TIME
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INSPIRATORY RISE TIME
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Adjust Inspiratory Rise Time to satisfy the patient’s inspiratory demand without
causing turbulent flow.
Or, adjust the IRT for patient comfort without causing “flow hunger”.
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INSPIRATORY RISE TIME
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LEAKS
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LOOK AT VOLUME
Volume - Time Scalar
Volume - Pressure Loop
Flow - Volume Loop
LEAKS
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VOLUME – TIME SCALAR
Vol
ume
Time
Expiratory
LEAKS
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LEAKS
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LEAKS
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INSPIRATORY CYCLE OFF
2.5 seconds
LEAKS
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Waveforms should start at the baseline and end at the
baseline.
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Time
Flow
25%
Peak Inspiratory Flow
50%
25%50%
FLOW-CYCLING
MODES OF VENTILATION
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INSPIRATORY CYCLE OFF
LEAKS
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The “igloo” or “fish mouth” on the Volume-Time curve is the classic
picture of a leak!
Use the ICO control to deal with leak situations by limiting the
inspiratory time in support modes in the interest of patient comfort.
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AUTO-PEEP
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LOOK AT FLOW
Flow - Time Scalar
Flow - Volume Loop
AUTO-PEEP
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AUTO-PEEP
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13 total pressure
- 5 peep set
= 8 auto peep
AUTO-PEEP
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Waveforms should start at the baseline and end at the baseline.
If the expiratory flow curve does not return to baseline before the next inspiration starts, the patient
is trapping gas.
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AUTO-PEEP
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OTHER ISSUES
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Volume – Constant Flow Pattern Pressure –Decelerating Flow Pattern
OPTIMIZING I-TIME
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Generally speaking, in decelerating flow modes, the Ti
should be set to that the inspiratory flow just reaches the
baseline before expiration starts. By doing so in the PC mode, tidal volume can be maximized for any given pressure level; By doing so in the PRVC mode, PIP can be minimized for any given tidal
volume.
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Volume – Constant Flow Pattern Pressure –Decelerating Flow Pattern
SHORT I-TIME
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Volume – Constant Flow Pattern Pressure –Decelerating Flow Pattern
LONG I-TIME
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Generally speaking, in decelerating flow modes, the Ti
should be set to that the inspiratory flow just reaches the
baseline before expiration starts. By doing so in the PC mode, tidal volume can be maximized for any given pressure level; By doing so in the PRVC mode, PIP can be minimized for any given tidal
volume.
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ASSESSING PLATEAU PRESSURE
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ASSESSING PLATEAU PRESSURE
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TRIGGER AND CYCLE ASYNCHRONY
Mode: PRVC
MONITORING EDI AND NAVA
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PATIENT SWITCHED FROM MONITORING EDI TO NAVA
Mode: NAVA
MONITORING EDI AND NAVA
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EARLY SMALL AIRWAY COLLAPSE
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EARLY SMALL AIRWAY COLLAPSE
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EARLY SMALL AIRWAY COLLAPSE
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THE END