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Basics of Waveform Interpretation: RET 2284 Principles of Mechanical Ventilation
Basics of Waveform Interpretation: RET 2284 Principles of Mechanical Ventilation
INTERPRETATION
RET 2284
Principles of Mechanical Ventilation
Objectives
Identify graphic display options
provided by mechanical ventilators.
Describe how to use graphics to
more appropriately adjust the patient
ventilator interface.
Introduction
Monitoring and analysis of graphic display
of curves and loops during mechanical
ventilation has become a useful way to
determine not only how patient are being
ventilated but also a way to assess
problems occurring during ventilation.
Detect auto-PEEP
Determine patient-ventilator synchrony
Assess and adjust trigger levels
Measure the work of breathing
Adjust tidal volume and minimize overdistension
Assess the effect of bronchodilator administration
Detect equipment malfunctions
Determine appropriate PEEP level
Measured Parameters
Flow
Pressure
Volume
Time
C
PIP
Baseline
P
aw
cmH O
Sec
1
-10
Pressure-Time Curve
20
Volume Ventilation
Pressure Ventilation
Paw
cmH2O
Sec
Patient Triggering
30
P
aw
cmH O
Sec
1
-10
Adequate flow
Paw
cmH2O
1
-10
Time (s)
30
Adequate flow
Paw
cmH2O
1
-10
Time (s)
Patient/Ventilator Synchrony
Volume Ventilator Delivering a Preset Flow and Volume
Adequate Flow
Paw
Sec
cmH2O
1
-20
Patient/Ventilator Synchrony
The Patient Outbreathing the Set Flow
Air Starvation
Paw
Sec
cmH2O
1
-20
Plateau Time
30
Paw
cmH2O
-20
SEC
Plateau Time
30
Paw
cmH2O
-20
SEC
Inspiration
.
V
LPM
120
SEC
EXH
Inspiration
.
V
LPM
SEC
Expiration
120
EXH
Constant Flow
Descending Ramp
INSP
Inspiration
.
V
LPM
120
SEC
EXH
Flow-Time Curve
120
INSP
Insp. Pause
LPM
SEC
Expiration
120
EXH
Inspiratory Time
Short Normal Long
SEC
LPM
-120
SEC
LPM
120
Obstructed Lung
20
Volume Ventilation
Paw
Expiration
cmH2O
Sec
V.
Volume Ventilation
Paw
Expiration
Inspiration
cmH2O
Sec
V.
20
Pressure Ventilation
Volume Ventilation
Inspiratory Time
Paw
cmH2O
Sec
V.
Rise Time
How quickly set pressure is reached
P
Slow rise
Moderate rise
Fast rise
.
V
Pressure Relief
Time
Adequate Flow
Paw
Sec
cmH2O
1
-20
30
Air Starvation
Paw
Sec
cmH2O
1
-20
.
V
SEC
LPM
-120
.
V
SEC
LPM
-120
.
V
SEC
LPM
-120
Detecting Auto-PEEP
120
.
V
SEC
LPM
Detecting Auto-PEEP
120
.
V
SEC
LPM
120
Inspiration
VT
SEC
Expiration
VT
SEC
1.2
A
VT
Liters
SEC
-0.4
A = inspiratory volume
B = expiratory volume
Leaks
1.2
A
VT
Liters
SEC
-0.4
A = exhalation that does not return to zero
450 cc
VT
SEC
120
.
V
LPM
SEC
1
120
450 cc
VT
500 cc
SEC
120
.
V
LPM
Lost VT
SEC
1
120
Loops
Pressure-Volume Loops
Flow-Volume Loops
Pressure-Volume Loop
VT
LITERS
0.6
0.4
0.2
Paw
cmH2O -60
40
20
20
40
60
Mandatory Breath
VT
LITERS
0.6
0.4
Inspiration
0.2
Paw
cmH2O -60
40
20
20
40
60
Mandatory Breath
VT
Counterclockwise
LITERS
0.6
Expiration
0.4
Inspiration
0.2
Paw
cmH2O -60
40
20
20
40
60
Spontaneous Breath
VT
Clockwise
LITERS
0.6
0.4
Inspiration
0.2
Paw
cmH2O -60
40
20
20
40
60
Spontaneous Breath
VT
Clockwise
LITERS
0.6
0.4
Inspiration
Expiration
0.2
Paw
cmH2O -60
40
20
20
40
60
Work of Breathing
VT
LITERS
0.6
0.4
0.2
Paw
cmH2O
-60
-40
-20
20
40
60
Assisted Breath
VT
LITERS
0.6
0.4
Assisted
Breath
0.2
Paw
cmH2O -60
40
20
20
40
60
Assisted Breath
VT
LITERS
0.6
0.4
Assisted
Breath
0.2
Inspiration
Paw
cmH2O -60
40
20
20
40
60
Assisted Breath
VT
Clockwise to Counterclockwise
LITERS
0.6
Expiration
0.4
Assisted
Breath
0.2
Inspiration
Paw
cmH2O -60
40
20
20
40
60
0.6
0.4
0.2
Paw
cmH2O
-60
-40
-20
20
40
60
Changes in Compliances
VT
LITERS
0.6
0.4
0.2
Paw
cmH2O
-60
40
20
20
40
60
Overdistension
VT
A = inspiratory pressure
LITERS
0.6
0.2
Paw
cmH2O
C
-60
-40
-20
20
40
60
Lung Overdistension
Flow
Tidal Volume
Inspiration
Volume
Expiration
Flow
Inspiration
Volume
Expiration
Obstructive Pattern
Bronchodilator Response
BEFORE
3
2
V
LPS
1
2
3
V
LPS
Bronchodilator Response
BEFORE
AFTER
Worse
V
LPS
V
LPS
Bronchodilator Response
BEFORE
AFTER
Better
Worse
3
3
INSP
V
LPS
V
LPS
V
LPS
VT
EXH
Remember!
Waveforms and loops are graphical representation of the
data generated by the ventilator.
Typical Tracings
Pressure-time,
Flow-time,
Volume -time
Loops
Pressure-Volume
Flow-Volume