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Breath Types
This chapter contains information regarding the breath types available on the LTV2 2200/2150
ventilator. It covers how breaths are initiated, limited and cycled, and when each type of breath is given.
The following terms are used in discussing how breaths are given:
Initiate What causes a breath to start? Breaths may be initiated by a patient trigger, a press
of the Manual Breath button, or by the ventilator based on the set breath rate and
ventilation mode.
Limit How the breath is controlled. Breaths may be limited to a maximum circuit pressure
or flow.
Cycle What causes the breath to be cycled from the inspiratory phase to the exhalation
phase? Breaths may be cycled by the ventilator when a set time or delivered
volume has been reached, or when an alarm condition such as a high pressure limit
has been reached. Breaths may also cycle when inspiratory flow begins to slow.
Breaths are defined by how they are initiated, limited and cycled. The breath types are Machine, Assist,
and Patient.

Machine Assist Patient

Initiated by: Ventilator Patient Patient

Limited by: Ventilator Ventilator Ventilator

Cycled by: Ventilator Ventilator Patient

Breaths may be given in any of the following forms: Volume Control, Pressure Control, Pressure
Support and Spontaneous. These breaths are given as described in the sections below.

The following parameters apply to all breaths:

• The minimum inspiratory time is 300 milliseconds.
• The minimum exhalation time is 346 milliseconds.
• Triggered breaths are only detected during exhalation after the minimum exhalation time has expired.

Volume Control Breaths

Volume breaths may be machine or assist type breaths. For volume control breaths, the set tidal volume is
delivered over the set inspiratory time and flow is delivered in a decelerating taper flow waveform. Peak flow is
calculated based on the tidal volume, inspiratory time, and set bias flow. The final flow will be the bias flow or 50%
of the peak flow, whichever is greater.

When the calculated peak flow of a volume type breath is greater than or equal to two times the set bias flow, flow
is decelerated from the calculated peak flow to 50% (±15%) of the calculated peak flow, or 5 lpm, whichever is
greater.
When the calculated peak flow of a volume type breath is between the set bias flow and two times set bias flow,
the waveform is flattened to allow the volume to be delivered in the specified inspiratory time with a final flow of
the set bias flow (±15%).

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Sigh Breaths
A sigh breath is a special breath type available in the volume mode (either assist control or SIMV). Sigh
breaths are typically used when an occasional larger breath is preferred. If enabled, sigh breaths are
delivered every 99 breaths or seven (7) minutes (whichever comes first).
Sigh breaths are different than a typical volume control breath in the following ways:
• Tidal volume: 1.5 times the set tidal volume
• Inspiratory time: 1.5 times the set inspiratory time
• Breath period (total cycle time for one breath): 1.5 times the breath period
• High pressure limit: 1.5 times the set high pressure limit (or 99 cmH2O, whichever is less)
See Sigh on page 10-19 for further information.

Pressure Control Breaths

For Pressure Control breaths, flow is delivered to elevate the circuit pressure to the Pressure Control setting and
maintain it at that pressure for the set Inspiratory Time. Pressure Control breaths may be machine or assist type
breaths. Figure 3-1 shows example flow patterns for two different patient conditions.

Figure 3-1. Pressure Control Breaths

1 Flow delivered to meet the set pressure
2 Breath cycles at the set inspiratory time
3 Flow delivered to meet the set pressure
4 Breath cycles at the set inspiratory time
5 Set pressure
6 Set inspiratory time
7 Set inspiratory time
8 Set pressure

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Pressure Control settings are in addition to PEEP. For example, a Pressure Control setting of 20
cmH2O and a PEEP setting of 10 cmH2O results in a Peak Inspiratory Pressure (PIP) of 30 cmH2O (20
cmH2O over the set PEEP of 10 cmH2O ).
Adjusting the Rise Time Profile changes the flow and pressure waveforms for Pressure Control breaths.

Figure 3-2. Adjusting Rise Time on Pressure Control Breaths

1 Profile #2–faster rise time 3 Profile #9–slower rise time
2 Set pressure 4 Set pressure
Pressure Control breaths have an optional flow termination criteria. If PC Flow Termination is ON
Pressure Control breaths have the additional ability to be flow terminated. If the flow drops to the set
FLOW TERM level before the inspiratory time is completed, the inspiration is cycled.

PC FLOW TERM set to OFF PC FLOW TERM set to ON

Pressure control breath terminates normally Pressure control breath terminates at the same
percentage of peak flow as pressure support breaths
Figure 3-3. PC Flow TERM settings

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1 Peak flow 6 Peak flow

2 Set pressure is maintained and 7 Breath terminates at the set percentage
inspiratory flow goes to zero of peak flow
3 Breath terminates at the set inspiratory 8 Set pressure
time
4 Set pressure 9 Set inspiratory time
5 Set inspiratory time

Pressure Support Breaths

For Pressure Support breaths, flow is delivered to elevate the circuit pressure to the Pressure Support
setting and maintain it at that pressure until the flow drops below a variable (user set) percentage of the
peak flow. Pressure Support breaths may also be cycled by a variable time limit, or by exceeding 2
breath periods. Pressure support breaths are patient type breaths.

Figure 3-4. Pressure Support Breaths

1 Measured peak flow
2 Flow delivered to meet set pressure
3 Breath cycles at set percentage of peak flow (Flow Term)
4 When set % of peak flow is not reached, breath is cycled at set Time Term.
5 Set pressure
6 Set pressure
Pressure Support settings are in addition to PEEP. For example, a Pressure Support setting of 20
cmH2O and a PEEP setting of 10 cmH2O results in an approximate Peak Inspiratory Pressure of 30
cmH2O (20 cmH2O over the set PEEP of 10 cmH2O).
For some patients, it may be useful to adjust the variable flow termination percentage. Adjusting the
FLOW TERM setting between 10% and 70% will change the length, volume and comfort of the
inspiration. A higher flow termination setting will terminate the breath sooner.

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Figure 3-5. Adjusting Flow Term on Pressure Support Breaths

1 Measured peak flow 4 Set pressure
2 Higher percentage of peak flow (40%) 5 Longer inspiratory time
3 Lower percentage of peak flow (10%)

Spontaneous Breaths
For Spontaneous breaths, flow is delivered to meet patient demand and maintain the circuit pressure at
the measured PEEP from the previous breath. The breath is cycled when the flow drops below the
Pressure Support Flow Termination setting, or below 5 lpm. Spontaneous breaths may also be
terminated by exceeding two breath periods. Spontaneous breaths are patient type breaths. Figure 3-6
shows an example flow for two different patient conditions.

Figure 3-6. Spontaneous Breaths

1 Measured peak flow
2 Flow delivered to meet patient demand and maintain PEEP
3 Breath cycles at Pressure Support Flow Termination setting
4 Breath cycles at <5 lpm
5 PEEP
6 Pressure maintained at PEEP

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