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Ventilator Basics
Ventilator Basics
What is the point? To provide oxygenation and ventilation. Or to reduce work of breathing.
How do you ventilate someone? Put air in their lungs, either a set volume or set pressure.
Vocabulary:
1. Tidal volume
2. Pressure support pressure that augments a spontaneous breath
3. PEEP positive end expiratory pressure. Pressure that is maintained at the end of expiration to
prevent alveolar collapse. This in effect increases compliance, and thus oxygenation.
4. I:E ratio the inspiratory time to expiratory time ratio. Normal is 3:1.
5. 10 over 5 or 10/5 (pressure support) above (PEEP). The assigned pressure support, which
is above and beyond the continuous PEEP, for spontaneous breaths.
Volume-based ventilation:
1. Assist-Control.
a. assist refers to assisting a spontaneous breath
b. control refers to a fully controlled breath without spontaneous effort
c. Result There is a basal rate of full breaths, and each spontaneous breath gets a full
volume.
2. IMV intermittent mandatory ventilation
a. mandatory refers to assigned rate of full mandatory breaths
b. All other breaths are spontaneous or assisted with pressure support
c. synchronized refers to synchronization of mandatory breaths with pts diaphragm
Pressure-based ventilation:
1. Pressure Control
a. Assigned rate of full pressure breaths
b. Volumes will vary.
c. Flow rate will vary.
2. Pressure Support
a. Augments spontaneous breathing. Helps overcome tubing.
3. PRVC pressure regulated volume control
a. Adjusts I:E time and other factors to accomplish a rate with volume minimums and
pressure maximums.
Noninvasive ventilation:
1. CPAP continuous positive airway pressure
a. Tight fitting mask, only temporary, cant eat
b. Stents open alveoli with continuous pressure. No rate, no volume.
2. BiPAP bidirectional positive airway pressure
a. Tight fitting mask, only temporary, cant eat
b. IPAP inspiratory positive airway pressure
c. EPAP expiratory positive airway pressure
d. Can set rate (not that helpful)
e. In BiPAP 10/5, the IPAP is 10, the EPAP is 5. In SIMV 10/5, the IPAP is 15, the EPAP is
5.
1. 60yoM with 50 pack year of tobacco and COPD, presents with increased dry cough and
respiratory difficulty x 2 days. He is mentating well, but is tachypneic and has increased work of
breathing.
37.0, 100, 24, 110/70, 86% on RA.
ABG 7.25/70/50
2. 22yoM college student presents with fever and AMS. He has purpura everywhere and looks
extremely toxic.
40.1, 145, 30, 75/40, 90% on RA.
ABG 7.10/30/60, lactate 7.0, hgb 12.
He gets 6L of NS but is still in shock. Is started on pressors. He can communicate but is
confused.
2 days later the patient develops bilateral pulmonary infiltrates. Ventilated FiO2 is 70%. What
ventilator adjustment do you make?