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1) Basics On Mechanical Ventilation
1) Basics On Mechanical Ventilation
Peter C. Rimensberger
Pressure
PressureDifference
Difference
Gas
GasFlow
Flow
Time
Time
Volume
VolumeChange
Change
Compliance
V
C = P
Volume
V
P
Pressure
Airway Resistance
The Feature of the Tube
R=
P1
P
Flow
P2
Mechanical response to
positive pressure application
Active inspiration
Passive exhalation
Mechanical response to
positive pressure application
Compliance:
pressure - volume
C=V/P
Resistance:
(L/cmH2O)
pressure - flow
.
R = P / V (cmH2O/L/s)
P = ( 1 / Crs ) x V + Rrs x V
Pressure
PressureDifference
Difference
Gas
GasFlow
Flow
Time
Time
Volume
VolumeChange
Change
flow
insuflation
time
auto-PEEP
exhalation
PEEPi
Trapped
volume
1) Correct Te
2) Unnecessary long Ti
2) Too short Ti
Vt 120 ml
Vt 160 ml
Vt 137 ml
Alveolar Pressure
Cave!
Flow
Ti settings in presence of an
endotracheal tube leak
The only solution in presence
of an important leak:
Look how the thorax moves
Leak
Time
Volume
Leak
Time
Compliance
Compliance
Pressure Ventilation
Volume Ventilation
Increased Pressure
Volume
Volume
Decreased Pressure
Pressure
Pressure
and do not forget, the time constant (T = Crs x Rrs) will change too!
Compliance decrease
52 cmH2O
33 cmH2O
0.4 (s)
0.65 (s)
0.35 (s)
0.5 (s)
Volume
pre
PEEP
PIP
PEEP
PIP
Pressure
Pressure
Ventilation
- Waveforms
Inspiratory
time or cycle
off criteria
Peak
Flow
25%
Flow
PI P
Ti Tinsp.
set
Ti given by the
cycle off criteria
Pressure
Pressure Control
Pressure Support
Nilsestuen J
Nilsestuen J
Respir Care 2005
Leak
TS 30%
TS 5%
Time
Tinsp. (eff.)
Set (max)
Tinsp.
Etot = EL + Ecw
Pairways (cmH2O)
Ppleural (cmH2O)
Ptranspulmonary (cmH2O)
stiff
Etot = EL + Ecw
Gattinoni L
Critical Care
2004, 8:350-355
EL = Ecw
Ecw/ Etot = 0.5 and EL/ Etot = 0.5
PTP ~ 50% of Paw applied
In ARDS:
In primary ARDS:
EL > Ecw
(EL / Etot > 0.5)
PTP > 50 % of Paw applied
In secondary ARDS:
Soft lung, stiff thorax
EL < Ecw
(EL / Etot < 0.5)
PTP < 50 % of Paw applied
transpulmonary pressure
Grasso S
By 9-12 months CW = CL
In infant RDS (HMD):
Stiff lung, very soft thorax
By 9-12 months CW = CL
Dynamic FRC in awake, spontaneously ventilating infants is maintained
near values seen in older children and adults because of
1. continued diaphragmatic activity in early expiratory phase
2. intrinsic PEEP (relative tachypnea with start of inspiration
before end of preceding expiration)
3. sustained tonic activity of inspiratory muscles (incl. diaphragma)
(probably most important)
By 1 year of age, relaxed end-expiratory volume predominates
Pplat = Palv;
Pplat = Transpulmonary Pressure ?
transpulmonary
pressure = 15 cm H2O
+15 cm H2O
Pplat 30 cm H2O
Pplat = Palv;
Pplat = Transpulmonary Pressure ?
-15 cm H2O
transpulmonary
pressure = 45 cm H2O
PCV 20 cm H2O,
PEEP 10 cm
H2O; Pplat 30 cm
H2O
Pplat = Palv;
Pplat = Transpulmonary Pressure?
Pplat 30 cm H2O,
PCV
Pplat 30 cm H2O,
PCV
Pplat 30 cm H2O,
PCV (PSV)
t
Curves
.V or V
.V / P / V
Residual Flows
Airway
Pressure