Modes of ventilation

and
Ventilator graphics

Presenter: Dr. Abraar Sheriff

Moderator: Prof. Narayanan P
06.03.2019
 Macquet Bella Vista Puritan Bennett

Drager Hamilton Avea SLE

BASIC VENTILATOR PARAMETERS

v Tidal volume
v Frequency/ Rate
v PIP
v PEEP
v Inspiratory Time/ Expiratory time/ I:E Ratio
v FiO2
 Tidal volume

• Volume of breath inspired/expired (VTe / Vti)

• VTi > VTe in case of circuit leak/ peritubal

leak

• Determines the ventilation (MV = TV × Rate)

 Frequency/ Rate

• No of breath per minute

• Determines Ventilation (MV = TV × Rate)

• Initial rates are set as per age

• Neonate: 30-50
• Younger children: 20-30
• Older children: 15-25
 PIP

• Pressure which expands the lungs during inspiration

• PIP - PEEP (ΔP) determines ventilation

• PIP also affects oxygenation by increasing MAP

 PEEP
• Prevents closure or collapse of recruited alveoli during
expiration
• Increases FRC, thereby improves V/Q mismatch
• Improves Oxygenation
• Should be more than lower infection point, to avoid
atelectotrauma
• Higher PEEP is set in case of parenchymal lung disease
• Lower PEEP is set in obstructive airway disease
• Too much PEEP can cause
- Overdistension and gas trapping
- Decrease venous return and precipitate hypotension
 FiO2

• Influences Oxygenation

• Too much FiO2 can cause

- Absorption atelectasis
- Oxygen free radical injury
- Tracheo-bronchitis
 Inspiratory/ expiratory (I:E) ratio

• Ratio of inspiratory time to Expiratory time of one breath

cycle

• Usually kept at 1:2

• Lower in bronchospasm/asthma
• Higher in ARDS

• Ti increases MAP & hence, the oxygenation

Each breath, either spontaneous or mechanical,
consists of 4 phases:
1. Initiation of inspiration
2. Inspiration
3. End of inspiration
4. Expiration

Phase variables: Parameters that are measured and

utilized to initiate, sustain, or terminate some phase of
the ventilatory cycle
Phase Variables: Trigger, Limit and Cycling
Trigger Limit Cycling

Ø Patient Ø Patient Ø Patient- Flow

üFlow Ø Machine Ø Machine

üPressure üPressure üTime

Ø Machine- Time üVolume üVolume

 Types of Breaths
Breath type Trigger Cycling Limit

Mandatory M M M

Assisted P M M

Supported P P M

Spontaneous P P P
 Ventilator Modes
vIMV- PC/VC

vACV- PC/VC

vSIMV- PC/VC

vPSV/VSV

vHybrid modes
 Ventilator graphics
• Graphics are waveforms that reflect the mechanics of
ventilation

• Purpose of monitoring graphics:

– Monitoring patient’s disease status (C and Raw)
– Calculate respiratory mechanics
– Assesses patient response to therapy
– Monitor ventilator function
– Allow fine tuning of ventilator to decrease WOB and
optimize ventilation
– Allow users to interpret, evaluate, and troubleshoot
ventilator
 Graphics
Scalars Loops

Pressure-
Flow/Time Pressure/Time Volume/Time Flow-Volume
Volume
 Types of waveforms
1. Rectangular: square wave or constant waveform

2. Ascending ramp: accelerating ramp

3. Descending ramp: decelerating ramp

4. Sinusoidal: sine wave

5. Exponential rising

6. Exponential decaying
Flow-Time scalar
Volume-Time scalar
Pressure-Time scalar
In Volume control mode
Pressure-Volume loop
Flow-Volume loop
Modes of ventilation on
scalar graphics
THANK YOU
 Use of Flow-Time scalars
Patient Ventilator Pt-Vent Interaction

• Air trapping • Breath types • Asynchrony

• Airway • Flow waveform • Triggering effort
obstruction shape
• Active • Flow starvation
exhalation • Adjustment of
• Bronchodilator Inspiratory time
response
 Use of Volume-Time scalars
Patient Ventilator Pt-Vent
Interaction
• Air trapping • Tidal volume • Asynchrony
(auto-PEEP) • Volume
• Active waveform
exhalation shape
• Leaks
 Use of Pressure-Time scalars
Patient Ventilator Pt-Vent Interaction

• Air trapping • Breath type • Asynchrony

(auto-PEEP) • PIP and plateau • Triggering effort
• Airway • PEEP/CPAP
obstruction • It/Et (I:E ratio)
• Bronchodilator
response
 Use of PV Loops
Patient Ventilator Pt-Vent
Interaction
• Airway obstrn • Flow • Triggering
• Bronchodilator starvation effort
response • Leaks
• Lung over-
distension
• WOB
 Use of FV Loops
Patient Ventilator Pt-Vent
Interaction
•Air trapping •Flow starvation •Asynchrony
•Airway obst •Tidal volume
•Airway •Leaks
resistance •Water or
•Bronchodilator secretion build-
response up