Mechanical Ventilator

• The human Respiratory system is critical to

immediate survival.

• It is responsible for providing the oxygen into

the body and elimination of the carbon
dioxide from the body.
• The development of this system begins with the nose
and nasal passages and ends with the laryngotracheal
tube and alveoli within the lungs.
• The organs of respiration are separated into two parts;
conducting, that including the nose, nasal cavities,
pharynx (throat), larynx (voice box), trachea, bronchi
and bronchioles, which are thick-walled and do not
participate in the gas exchange, and respiratory, that
including the lungs, alveoli (alveolar ducts and alveolar
sacs) and lung capillaries, which are thin-walled to
permit gas exchange to the blood.
All these organs perform the mechanics of breathing with the diaphragm
and intercostals chest muscles, ribs and sternum.
• If breathing stops for more than five minutes,
death or permanent damage will almost
certainly occur.

• This may happen in many conditions such as

asphyxia, carbon monoxide poisoning,
drowning and electric shocks, then, artificial
respiration is essentially needed.
 ARTIFICIAL VENTILATION
• Essentially, two respiratory diseases cause respiratory failure that
require artificial respiratory ventilation, these are:
1) Hypoxia, low oxygen content in the blood due to improper
ventilation.
This is caused by pulmonary emphysema (stretch alveoli-loss of
lung elasticity), chronic bronchitis, pulmonary tumors, aspiration
pneumonia, interstitial fibrosis, or pulmonary infraction (tissue
death from lack of blood supply).
• 2) Hypercapnia, poor alveolar ventilation causing an accumulation
of carbon dioxide in the blood.
It results from central venous system disorder, diseases of nerves
and muscle weakness, metabolic diseases, and pulmonary
emphysema, chronic bronchitis, or lung obstruction.
• The goal of an artificial ventilatory control mechanism
(correction of pulmonary abnormalities) is to adjust
alveolar ventilation to changing body needs of oxygen
intake and carbon dioxide removal.
• Alveolar ventilation depends on the relationship
between respiratory rate, tidal volume and dead
space.
• In addition, tracheostomy (surgical practice to
overcome obstructions of the upper respiratory tract)
may be performed to permit prolonged artificial
ventilation.
 Definition
• The ventilator (also known as a respirator) is a
pneumatic and electronics system designed to
monitor, assist, or control pulmonary
ventilation, and respiration intermittently or
continuously. It can also be used to control
human body oxygen levels, for example during
surgery where blood loss can result in hypoxia,
or lack of sufficient oxygen in the patient´s
body; it is best to have less human interaction.
• Automatically timed breathing is usually
provided for patients who cannot breathe on
their own.
– It provides inspiration and expiration at fixed rates
and durations except for periodic sigh; a sigh is a
rest period for the patient.
 RESPIRATORY PARAMETERS
• Lung Compliance;
-The ability of alveoli and lung tissue to expand
on inspiration.
-The lungs are passive but they should stretch
easily to ensure the sufficient intake of the air.
-The compliance of the patient's lung represents
the ratio of pressure drop across the airway to
the resulting flow rate through it.
• Airway Resistance;
-Airway resistance relates to the ease with
which air flows through the tubular
respiratory structures.
-Higher resistances occur in smaller tubes
such as the bronchioles and alveoli that have
not emptied.
• Tidal Volume;
-The depth of breathing that represents the
amount of air a person breathes in/out
(inspired/expired) during each respiratory
cycle, normally, as opposed to a full breath.
• Respiration Rate;
-This is the number of breaths per second of
the person.
 Ventilator Modes of Operation
• The following definitions are commonly used to
describe respirator/ventilator operation:
• CMV Continuous mandatory ventilation: Once
initiated by either the ventilator operator or
the patient, the breath is driven to the patient.

• CPAP Continuous positive airway pressure: Breaths

are spontaneous, unless the operator
intervenes. The spontaneous breaths are
determined entirely by patient effort.
However, the air/oxygen mixture is set by the
ventilator.
 – SIMV Synchronized intermittent mandatory
ventilation: These breaths are initiated by
either the machine, the operator, or the
patient. The breaths may be either
spontaneous or mandatory. That is, if the
patient does not breathe within a preset time
period, the ventilator will deliver a breath.

• PEEP Positive end-expiratory pressure: The

pressure maintained by the ventilator
that the patient must exhale against.
 MEDICAL GASES
• A variety of medical gases, cylinders and
regulating equipment are used by the
respiratory therapists.
• They are dangerous and if mishandled may
result in fire and explosion.
 OXYGEN THERAPY
• Oxygen therapy is the administration of oxygen as
ongoing therapy, either continuously or intermittently, for
the treatment of condition resulting from oxygen
deficiency.
• Oxygen is usually introduced together with medicines,
water vapor, other gases (carbon dioxide or helium) and
anesthetics.
• It is accomplished through the use of special procedures
and equipment such as gas regulator / flow meter control
devices, humidifier / nebulizer conditioning units, and
oxygen mask / tent administering systems.
• Oxygen is most often delivered as continuous gaseous
flow, measured in litres per minute.
• Gas regulators are used to reduce cylinder
pressure to a safer level.
• A flow meter is a device that contains a
calibrated tube to adjust the oxygen flow in
liters per minute with a needle valve to
control the rate of flow.
• It must be in the upright position in order to
obtain an accurate reading.
Air and Oxygen regulators
• Humidifiers add water vapor to medical gases
administered to the patient.
• All humidifiers must be sterilized after each
use.
• There are various devices which used for
administration of oxygen.
-Nasal cannula is a thin tube with two small
nozzles that protrude into the patients
nostrils.
*It is often used in elderly patients, or
patients who can benefit from oxygen
therapy but do not require it to the degree of
wearing an uncomfortable mask.
*Oxygen masks are devices that fit over the
patient's face and allow oxygen to pass to the
nose and mouth.
They are dangerous since suffocation will
result if oxygen is cutoff and the patient can
not remove the mask.
Nevertheless, they are more effective
than the nasal cannulas or nasal catheters.
 VENTILATORS
• When artificial ventilation needs to be maintained for
a long time, a ventilator is used.
• Ventilators are connected to the patient's airway and
are designed to match or replace the human
breathing waveform pattern and also are used during
anesthesia.
• These are sophisticated equipment with a large
number of controls which assist in maintaining proper
and regulated breathing activity.
• They are employed with a mask, endotracheal tube or
tracheostomy tube (through an artificial opening in
the trachea via the throat).
• There are two types of used ventilators;
Anesthesia Ventilators, which are generally
small and simple equipment used to give
regular assisted breathing to the patient
under the operation.
• Intensive Care Ventilators, anasithic device
• It may thus be noted that;
• # an airway pressure higher than the alveolar
pressure characterizes an inspiratory flow.
• # an airway pressure lower than the alveolar
pressure characterizes an expiratory flow.
• It may be observed that it is necessary to
provide for a time delay (pause time) between
the cycling of the ventilator and the change from
inspiratory flow to expiratory flow in the airway.
• During this pause time, the flow becomes zero
when the alveolar pressure equals the airway
pressure and constant volume is maintained in
the lungs.
• Ventilators producing a pause time are preferred
over those without such a pause.
 MODERN VENTILATORS
• Modern ventilator machines consist of two
separate but inter-connected systems; a
pneumatic flow system and an electronic
control system.
 Terminology
 Total Lung Capacity (TLC): The total volume of gas a lung can use.

 Tidal Volume (VT): Total volume of gas used in respiration.

 Residual Volume (VR): The volume of gas left in the lung after forced expiration.

 Inspiratory Pressure (Pinsp): Pressure used to deliver the tidal volume into the
lung.

 PEEP: Positive End Expiratory Pressure.

 Frequency: No. of Breaths per Minute.

 Flow: total volume of gas flowing in and out of the lung in one minute.

 Plateau: Inspiratory pause between inspiration and expiration.

 Apnea: Loss of Breath

The Ventilator-Patient System
• Assist/Control Mode (A/C Mode) •The patient
is responsible for initiating all breaths unless
he fails to breathe above a set rate •The
ventilator assists the patient by delivering a
set volume •The patient determines the
breath rate •If the breath rate falls below the
clinician set minimum, the ventilator assumes
the ‘Control Mode’ and delivers a breath
Assist control mode
Synchronized Intermittent Mandatory Ventilation
Mode Synchronized Intermittent Mandatory
Ventilation (SIMV) •The patient can breathe
spontaneously from the ventilator via a demand valve
•The ventilator has a preset rate in which it functions
as if in the ‘Control Mode’ and delivers that rate to the
patient at a set volume •The ventilator rate is
synchronized with patient breaths to prevent breath
stacking
Sudan
SIMV
• The pneumatic flow system enables the flow of
gas through the ventilator.
• The gases (oxygen and medical grade air) enter
the air / oxygen mixer which they combine at
the required percentage.
• An electronically controlled flow valve
proportion the gas flow from the reservoir tank
to the patient's breathing circuit.
• In some ventilators, an air compressor is used in
place of a compressed air tank.
• The primary objective of the device is to ensure proper
level of oxygen in the inspiratory air and deliver a tidal
volume according to the clinical requirements.
• As the gases leave the ventilator, they pass by an oxygen
analyzer, a safety ambient air inlet valve and a back-up
mechanical over pressure valve.
• The ambient valve provides the patient ability to breathe
room air when the ventilator fails or the pressure in the
patient's circuit drops.
• In the patient breathing circuit is a bi-directional flow
sensor to measure the gas flows.
• The exhaled gases exit through an electronically
controlled exhalation valve located at the ventilator.
• The microprocessor controls each valve to deliver the desired inspiratory
air and oxygen flows for mandatory and spontaneous ventilation.
• A high pressure valve is used to provide safety in case the pressure in the
patient's circuit exceeds the normal value.
• The electronic control system may use one or more microprocessors and
software to perform monitoring and control functions in the ventilator.
• These parameters include setting of the respiratory rate, tidal volume,
oxygen concentration of the delivered breath, peak flow and PEEP.
• The microprocessor utilizes the above parameters to compute the
desired inspiratory flow trajectory.
• The system consists of monitors for the pressure, flow and oxygen
fraction.
• Respiratory monitors typically have meter displays for temperature,
oxygen fraction, tidal volume, minute volume, periodic deep breaths
(sighs), and respiratory rate or high / low pressure alarm settings and
audible tones.
`
• The sensors are located near the exit port of the
device to sense the properties of the inspired
air.
• They are connected to electronic processing
circuits which make the physiological variables
available for digital readouts.
• The signals are also compared with pre-set
alarm levels, so that if they fall outside a pre-
determined normal range, alarms are activated.
• The temperature measurement channel uses a
thermistor as its sensor.
• A bridge circuit converts the resistance signal to a voltage, which
is then amplified through a scaling amplifier.
• The pressure sensors are normally of semiconductor strain gauge
type placed in a bridge configuration.
• The output from the bridge is amplified by a scaling amplifier to
yield an appropriate level for digital conversion by the ADC.
• Digital signals are then stored in a register connected to the digital
display.
• The contents of the register are also compared with preset high
and low alarm limits in the digital comparator circuit.
• If it is found that the signal is out of its acceptable range, the
comparator set off the alarm, which flashes the digital display and
produces an audible beep.
• An alarm may be activated by incorrect settings of ventilation
parameters and alarm limits, by faults or changes in the patient's
condition or by malfunction in the ventilator.

• The function causing the alarm is clearly indicated and therefore it

is usually possible to detect the fault immediately.

• If an alarm is activated, and the fault is not apparent, the first step
to take is to check the patient (general condition, ventilation
movement, color of the skin, pulse, if necessary ECG on a
cardioscope).

• If the patient's general condition is satisfactory, fault finding may

start while the patient is connected to the ventilator.
• If it is apparent that the patient does not
receive adequate ventilation, the ventilator
should be disconnected and the patient be
allowed to breath spontaneously, or
alternatively be ventilated by a resuscitator
which should be available.
• Appropriate troubleshooting should be
performed to fix the existed faults.
 TYPICAL FAULTS AND
TROUBLESHOOTING

• Ventilators are life saving equipment and

therefore, need regular maintenance and
calibration which should be carried out as per
the instructions of the manufacturers.
• In general, air tubes and their connections cause
considerable difficulty. This can be minimized by frequent
inspections, especially prior to patient use.
• Humidifiers and nebulizers frequently become clogged but
constant cleaning reduces this occurrences.
• Leaks in compressed gas (oxygenated helium) cylinders
and ventilator systems do occur despite attentive
inspections. Obviously, leaks reduce gas pressure and
volume delivered to the patient. Un-tightened, non
twisted and bent valves, bellows and connections are the
main reason for such leaking problems.
• Also, the flow and pressure transducers should be checked
to be inserted correctly within the apparatus.
• Routine preventive maintenance consists of
periodic inspections of system connections and
functional operation and calibration.
• The applicable operation and maintenance
manual should always be consulted for
instructions.
• Thus, guessing can be dangerous to the patient.
Intake and patient air line filters must be
cleaned or replaced periodically depending on
the use and patient infection.
• This assures proper air flow to the patient.
• Electrical components that require routine
replacement include lamps, switches,
actuating devices, motors and heaters.
• Electrical problems such as faulty capacitors,
diodes, transistors and integrated circuits are
relatively few.
• Faulty power supply may be due to a broken
fuse or a bad connection the power cable and
the main wall socket.
• Sterilization of respiratory therapy equipment is a process of
cleaning deposits and destroying microorganisms and their
spores.
• This is necessary because gases carrying bacteria and viruses into
the patient's lungs can cause severe lung damage to infection.
• The effect of respiratory treatment is then reduced and in the
extreme the patient may die.
• Good sterilization is accomplished by using an autoclave by steam
treatment at temperature higher than (200 °C) which is capable
for killing fungi, bacteria and most viruses.
• All gas conveying devices are either autoclavable or disposable
except the electronic transducers which are protected against
contamination by using of bacterial proof replaceable filters.
Ventilators, Transport
Ventilators, Portable