RespiMedU Graphics

ESSENTIALS
OF
VENTILATOR GRAPHICS
Developed by:
Ruben D Restrepo, MD, RRT

Vijay M Deshpande, MS, RRT, FAARC
Assistant Professors
Georgia State University
Atlanta, Georgia
Essentials of Ventilator Graphics ©2000 RespiMedu
COPYRIGHT NOTICE
© 2000 RespiMedu, Inc.
Essentials of Ventilator Graphics.
All rights reserved.
Except as permitted under the Copyright Act of
1976, no part of this material may be
reproduced in whole or in part in any manner
without permission in writing from the copyright
owners.
Printed in the U.S.A.

Mechanical Ventilation
SCALARS LOOPS
Graphics

SCALARS
Flow/Time
Pressure/Time
Volume/Time
LOOPS
Pressure-Volume Flow-Volume

SCALARS
Flow/Time
Pressure/Time
Volume/Time
Spontaneous Breath
Inspiration
Flow (L/min)
Time (sec)
Expiration

Mechanical Breath
Inspiration
Flow (L/min)
Time (sec)
Expiration

Typical Flow Patterns
SQUARE DECELERATING
ACCELERATING SINE

Inspiratory Flow Pattern
Beginning of expiration
Peak inspiratory flow rate exhalation valve opens
PIFR
Inspiration
Flow (L/min)
Insp. time Expiratory Time

TI TE
Time (sec)
Beginning of inspiration Total cycle time

exhalation valve closes Expiration TCT

Expiratory Flow Pattern
Beginning of expiration
exhalation valve opens
Inspiration
Expiratory time
TE
Flow (L/min)
Time (sec)
Duration of
expiratory flow
Expiration
Peak Expiratory Flow Rate

Essentials of Ventilator Graphics PEFR ©2000 RespiMedu
Inadequate Inspiratory Flow
Active Inspiration or Asynchrony
Patient’s effort
Normal
Abnormal
Time (sec)
Flow
(L/min)

Obstruction vs Active Expiration
Obstruction Active Expiration
Time
Flow (sec)
(L/min)
Normal
Abnormal

Air Trapping
Inspiration
Normal
Patient
Flow (L/min)
Time (sec)
}
Air Trapping
Auto-PEEP
Expiration

Response to Bronchodilator
Before After
Flow (L/min)
Time (sec)
Long TE
PEFR
Shorter TE
Higher
PEFR
SCALARS
Flow/Time
Pressure/Time
Volume/Time
Volume vs Time
Inspiratory Tidal Volume

Volume (ml)
Inspiration
Expiration
TI
Time (sec)
Air Leak
Volume (ml)
Air Leak
Time (sec)

Active Exhalation
Volume (ml)
Time (sec)

SCALARS
Flow/Time
Pressure/Time
Volume/Time
Spontaneous Breath
Expiration
Paw (cm H20)
Time (sec)
Inspiration

Mechanical Breath
Peak Inspiratory Pressure

PIP
Paw (cm H2O)
Inspiration
Expiration
TI TE
} PEEP
Time (sec)

CONTROLLED BREATH
(Time Triggered)
Mechanical
Paw (cm H2O)
Time (sec)
Time Triggered Breath

Assisted Breath
(Patient Triggered)
Mechanical
Paw (cm H2O)
Time (sec)
Patient Triggered Breath

Assisted vs Controlled
Pressure Assisted Controlled

(cmH20)
Time (sec)

Spontaneous vs. Mechanical
Mechanical
Inspiration
Paw Spontaneous
(cm H2O)
Expiration
Expiration
Inspiration
Time (sec)

Components of
Inflation Pressure
PIP
}
Paw (cm H2O)
Transairway Pressure (PTA)

Exhalation Valve Opens
Pplateau
Inspiratory Pause
(Palveolar)
Expiration
Time (sec)
Begin Inspiration Begin Expiration

PIP
Paw (cm H2O)

} Transairway Pressure (PTA)
Exhalation Valve Opens
Pplateau
(Palveolar
Expiration
Time (sec)
Begin Inspiration Begin Expiration
PIP Inflation Hold

(seconds)
Paw (cm H2O)
Distending
(Alveolar)
Pressure Expiration
Time (sec)
Begin Inspiration
Begin Expiration
PIP vs Pplat
Normal PIP
High Raw
PIP
PPlat PPlat
Paw (cm H2O)
PIP
High Flow PIP Low Compliance
PPlat
PPlat
Essentials of Ventilator Graphics

Time (sec) ©2000 RespiMedu
Increased Airway Resistance
Normal
PIP High Raw
PIP
PPlat PPlat
Paw (cm H2O)
Increased PIP
} Increased PTA
(increased Airway Resistance)
Normal PPlat
(Normal Compliance)
Normal

Effect of increased Flow
Normal PIP High Flow
PIP
PPlat
PPlat
Paw (cm H2O)
Normal
Decreased Inspiratory Time Dynamic Inspiratory Time

(Due to High Inspiratory Flow)
Time (sec)
DECREASED COMPLIANCE
Normal Low Compliance
PIP
PPlat
PIP
PPlat
Paw (cm H2O)
PIP Increased PPlat

(Decreased Compliance)
Normal PPlat
Normal
(Normal Compliance)
Time (sec)

Adequate Flow Inadequate Flow

(cm H2O)
Paw
Time (sec)

LOOPS

Pressure-Volume Loop
(Type of Breath)
E
E
Vol (ml)
I E
I I
Paw
(cm H2O)
Controlled Assisted Spontaneous
I: Inspiration
E: Expiration
FRC and PV Loop
Normal Compliance
TLC
VOLUME
FRC FRC
Negative 0 Positive
DISTENDING PRESSURE
Components of
Pressure-Volume Loop
VT
Volume
(mL)
Paw (cm H2O) PIP

PEEP and P-V Loop
VT
Volume
(mL)
PEEP
Paw (cm H2O) PIP

Work of Breathing
Volume (ml)
A: Resistive Work
B: Elastic Work
A
Pressure (cm H2O)

Inflection Points
Upper Inflection Point
Volume (mL)
Lower Inflection Point
Pressure (cm H2O)

Inadequate Sensitivity
Volume
(mL)
Paw (cm H2O)

Increased WOB

Air Leak
Volume (ml)
Air Leak
Pressure (cm H2O)

Volume
(ml)
Active Inspiration
Inappropriate Flow
Normal
Abnormal
Paw (cm H2O)

Increased Raw
Higher PTA
Vol (mL)
Pressure (cm H2O)

Hysteresis
Volume (ml)
Normal Hysteresis
Abnormal Hysteresis
Pressure (cm H2O)

Lung Compliance Changes
and the P-V Loop
Volume Targeted Ventilation
Preset VT
COMPLIANCE
Increased
Normal
Decreased
Volume (mL)
Paw (cm H2O)

PIP levels

Lung Compliance Changes
and the P-V Loop
COMPLIANCE
VT levels
Pressure Targeted Ventilation

Increased
Normal
Decreased
Volume (mL)
Paw (cm H2O) Preset PIP

Overdistension
With little or no change in VT
Normal
Abnormal
Volume (ml)
Pressure (cm H2O) Paw rises

LOOPS

Flow-Volume Loop
Inspiration
PIFR
Volume (ml)
FRC VT
PEFR
Expiration
Air Leak
Inspiration
Flow
(L/min)
Volume (ml)
Air Leak in mL
Normal
Abnormal
Expiration
Air Trapping
Inspiration
Flow
(L/min)
Does not return

to baseline
Volume (ml)
Normal
Abnormal
Expiration
Increased Airway Resistance
Inspiration
Flow
(L/min)
Volume (ml)
“Scooped out”
Normal
pattern Abnormal
Decreased PEFR
Expiration
Airway Secretions/
Water in the Circuit
Inspiration
Flow
(L/min)
Volume (ml)
Normal
Abnormal
Expiration
Modes of Ventilation
Mechanical
Spontaneous
Volume Pressure
Targeted Targeted

Mechanical
Spontaneous
Volume Pressure
Targeted Targeted

Spontaneous Breath
Flow
L/m
Pressure
cm H2O
Volume
mL
Flow
L/m
Pressure
cm H2O CPAP level
Volume
mL
Time (sec)
Patient Triggered, Flow Cycled, Pressure limited Mode
Flow Flow Cycling

L/m
Set PS
level
Pressure
cm H2O
Volume
mL
Time (sec)
CPAP + PSV
Flow Cycling
Flow
L/m
Set PS level
Pressure
cm H2O
CPAP level
Volume
mL
Time (sec)
Mechanical
Spontaneous
Volume Pressure
Targeted Targeted

Controlled Mode
(Volume- Targeted Ventilation)
Time triggered, Flow limited, Volume cycled Ventilation
Preset Peak Flow
Flow
L/m
Dependent on
Pressure CL & Raw
cm H2O
Preset VT
Volume Volume Cycling
mL
Essentials of Ventilator Graphics Time (sec) ©2000 RespiMedu

Assisted Mode
(Volume-Targeted Ventilation)
Patient triggered, Flow limited, Volume cycled Ventilation
Flow
L/m
Pressure
cm H2O
Preset VT
Volume Volume Cycling
mL
Time (sec)
SIMV
Flow
L/m
Pressure
cm H2O
Volume
mL
Essentials of Ventilator Graphics Spontaneous Breaths ©2000 RespiMedu

Controlled Mode
(Pressure-Targeted Ventilation)
Time Triggered, Pressure Limited, Time Cycled Ventilation
Time-Cycled
Flow
(L/min)
Set PC level
Press
(cm H2O)
ure
Volume
(ml)

Assisted Mode
Patient Triggered, Pressure Limited, Time Cycled Ventilation
Time-Cycled
Flow
(L/min)
Set PC level
Press
(cm H2O)
ure
Volume
(ml)

SIMV Mode
Flow
(L/min)
Set PC level
Press
(cm H2O)
ure
Volume
(ml)
Time (sec)
Essentials of Ventilator Graphics Spontaneous Breath ©2000 RespiMedu
SIMV + PS
Time-Cycled Flow-Cycled
Flow
(L/min)
Set PC level
Press Set PS level
(cm H2O)
ure
Volume
(ml)
Time (sec)
Essentials of Ventilator Graphics PS Breath ©2000 RespiMedu
SIMV+PS
Flow-cycled
Flow
(L/min)
Set PS level
Pressure
(cm H2O)
Volume
(ml)
Essentials of Ventilator Graphics PS Breath ©2000 RespiMedu

SIMV + PS + CPAP
Flow
(L/min)
Set PC level
Press Set PS level
(cm H2O)
ure
CPAP level
Volume
(ml)
Time (sec)
SIMV+PS + CPAP
Flow
(L/min)
Set PS level
Pressure
(cm H2O)
CPAP level
Volume
(ml)
Time (sec)

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ESSENTIALS

Ruben D Restrepo, MD, RRT

Essentials of Ventilator Graphics ©2000 RespiMedu

Essentials of Ventilator Graphics ©2000 RespiMedu

Essentials of Ventilator Graphics ©2000 RespiMedu

Essentials of Ventilator Graphics ©2000 RespiMedu

Essentials of Ventilator Graphics ©2000 RespiMedu

Essentials of Ventilator Graphics ©2000 RespiMedu

Insp. time Expiratory Time

Beginning of inspiration Total cycle time

Essentials of Ventilator Graphics ©2000 RespiMedu

Peak Expiratory Flow Rate

Essentials of Ventilator Graphics ©2000 RespiMedu

Obstruction Active Expiration

Essentials of Ventilator Graphics ©2000 RespiMedu

Essentials of Ventilator Graphics ©2000 RespiMedu

Inspiratory Tidal Volume

Essentials of Ventilator Graphics ©2000 RespiMedu

Essentials of Ventilator Graphics ©2000 RespiMedu

Essentials of Ventilator Graphics ©2000 RespiMedu

Peak Inspiratory Pressure

Essentials of Ventilator Graphics ©2000 RespiMedu

Essentials of Ventilator Graphics ©2000 RespiMedu

Patient Triggered Breath

Pressure Assisted Controlled

Essentials of Ventilator Graphics ©2000 RespiMedu

Essentials of Ventilator Graphics ©2000 RespiMedu

Transairway Pressure (PTA)

Essentials of Ventilator Graphics ©2000 RespiMedu

Paw (cm H2O)

PIP Inflation Hold

Essentials of Ventilator Graphics

Essentials of Ventilator Graphics ©2000 RespiMedu

Decreased Inspiratory Time Dynamic Inspiratory Time

PIP Increased PPlat

Essentials of Ventilator Graphics ©2000 RespiMedu

Adequate Flow Inadequate Flow

Essentials of Ventilator Graphics ©2000 RespiMedu

Essentials of Ventilator Graphics ©2000 RespiMedu

Controlled Assisted Spontaneous

Paw (cm H2O) PIP

Essentials of Ventilator Graphics ©2000 RespiMedu

Paw (cm H2O) PIP

Essentials of Ventilator Graphics ©2000 RespiMedu

Pressure (cm H2O)

Essentials of Ventilator Graphics ©2000 RespiMedu

Upper Inflection Point

Lower Inflection Point

Pressure (cm H2O)

Paw (cm H2O)

Essentials of Ventilator Graphics ©2000 RespiMedu

Pressure (cm H2O)

Essentials of Ventilator Graphics ©2000 RespiMedu

Paw (cm H2O)

Essentials of Ventilator Graphics ©2000 RespiMedu

Pressure (cm H2O)

Essentials of Ventilator Graphics ©2000 RespiMedu

Pressure (cm H2O)

Essentials of Ventilator Graphics ©2000 RespiMedu

Paw (cm H2O)

Essentials of Ventilator Graphics ©2000 RespiMedu

Pressure Targeted Ventilation

Paw (cm H2O) Preset PIP

Essentials of Ventilator Graphics ©2000 RespiMedu