‫‪MECHANICAL VENTILATOR‬‬

‫طارق عبداللطيف عمران‬

‫حمزة عبدالكريم الرفاعي‬
‫عبدالرحمن ناصر المقرمي‬
‫محمد زكريا الكحيلي‬
‫محمد نصر قحطان‬
AGENDA
• Abstract .
• Objective .
• Introduction / Medical background .
• History .
• Principle operation .
• The component of mechanical ventilator .
• Hardware Design
• Types of mechanical ventilator .
• Diseases that can be diagnosed using mechanical ventilator .
• Advantages and disadvantages of mechanical ventilator .
• Conclusion .
ABSTRACT:

A mechanical ventilator is a machine that helps a patient breathe (ventilate) when they are having
surgery or cannot breathe on their own due to a critical illness. The patient is connected to the ventilator
with a hollow tube (artificial airway) that goes in their mouth and down into their main airway or trachea.
They remain on the ventilator until they improve enough to breathe on their own.

A mechanical ventilator is used to decrease the work of breathing until patients improve enough to no
longer need it. The machine makes sure that the body receives adequate oxygen and that carbon dioxide is
removed. This is necessary when certain illnesses prevent normal breathing.
OBJECTIVE:

Upon completion of this module, the learner will be able to:

 Identify types of airways and indications and precautions of each.
 Identify common modes of ventilation and be able to describe the assistance each
mode provides.
 Interpret common alarms associated with mechanical ventilation and indicate an
action for each.
 Describe possible complications associated with mechanical ventilation.
 Discuss and synthesize common weaning parameters and methods.
 MEDICAL BACKGROUND:
 The increasing worldwide life expectancy results in high prevalence of patients suffering from chronic diseases and related “chronic
critical illness.
 Up to 20 million people annually require Intensive Care Units (ICUs) admission and mechanical ventilation (MV).
 The progresses in management of these patients has improved their short-term survival at the price of a growing population of
patients with partial or complete dependence on MV.
 The prevalence of these ventilator assisted individuals (VAIs) ranges from 6.6 to 23 per 100,000 resulting in difficult clinical and
organizational problems for patients, caregivers and health services, as well as in high human and financial resources consumption,
despite poor long-term outcomes.
 In order to minimize the VAI prevalence an effort should be made to improve the management of patients needing weaning from
prolonged MV (PMV).
 This narrative review of available literature summarizes the main concepts in this field with the aim to update the knowledge of
professionals caring respiratory patients on this emerging problem.
INTRODUCTION:

Mechanical ventilation is the process of using positive pressure devices to provide O 2 and CO2 transport

between the environment and the pulmonary capillary bed. The desired effect of mechanical ventilation is

to maintain adequate levels of PO2 and PCO2 in arterial blood, while also unloading the inspiratory muscles.

At the same time, this process should be done in a manner that avoids injury to the lungs and other organ

systems. Ventilator-induced lung injury , infection , and the need for potentially harmful

sedatives/neuromuscular blockers , all underscore the need to assure that initiation of mechanical

ventilatory support is worth these risks.

 HISTORY
 Throughout the 19th century and the first half of the 20th century the negative-pressure ventilator was the
predominant device used to provide ventilatory assistance.

 This “tank ventilator” was first described by the Scottish physician John Dalziel in 1838.1 It consisted of an air-tight
box, with the patient maintained in the sitting position. Negative pressure was established by manually pumping air
into and out of the box (Fig (4 . 1) ).

 In 1904 Sauerbrach even developed a negative-pressure operating chamber (Fig (4 . 2) ) The patient's body, except for
the head, was maintained inside the chamber. The chamber was large enough so that the surgeon was able to perform
surgery while also in the chamber. The patient's lower body was encased in a flexible sack so that positive pressure
could be applied to this part of the body, preventing blood from accumulating in the abdomen and lower extremities,
causing what was referred to as “tank shock’’ .
(Fig 4. 1) (Fig 4. 2)
 (Fig 4. 3) (Fig 4. 4)
Poliomyelitis epidemic patients at Ranchos Los Multi-person negative-pressure ventilator at
Amigos Hospital, California, 1953 . Boston Children's Hospita 1950.
PRINCIPLE OF OPERATION

The principle of operation of the ventilator is based on the difference in gas pressure.
When humans inhale air into the lungs, the respiratory muscles contract, the size of the
chest increases, the alveoli expand to form a decrease in pressure, and air is drawn from
the outside. During exhalation, the respiratory muscles relax, the alveoli contract for
flexibility, and the pressure in the lungs increases, and the air is exhaled to the outside.
The ventilator uses a mechanical method to achieve this pressure difference, which helps
to achieve forced artificial respiration.
COMPONENTS HARDWARE DESIGN
 System definition: An electronics system for a medical respirator can be complex because of the variety of
components and functions that must be accurate.
• It must have the following modules:
o Power supply—This PCB : must power the microcontroller, sensors, display and switch four 200 mA valve,
and a 12 A air compressor at different voltages.
o Communications (USB)—System : requires a channel for connectivity with other controlling or monitoring
devices to exchange data and provide complete control, for example, anesthetic controllers.
o Signals treatment and measuring from sensors—Reliable measurement: is a critical factor for this application.
Signal treatment and decoupling are important factors to consider.
o Human Interface—This system : is able to support some operational modes with different parameter values.
o Actuators controlling—System : requires controlling several electromechanical actuators that demand high
current consumption and generates electrical noise to the system by EMI.
COMPONENTS HARDWARE DESIGN

Figure (6.1) is the medical ventilator block diagram.

 COMPONENTS HARDWARE DESIGN

1) Microcontroller.
• One of the more critical modules for this
application is signal treatment and measuring, this
is because the respirator acts according to the data
acquired.
• If this data is not reliable, the ventilator may do
incorrect operations that can risk the patient’s
health.
• It is important to select the appropriate MCU and
sensors for instrumentation applications.
• Freescale offers reliable MCUs for medical
instrumentation.
Two examples are theMC9S08MM (8-bit MCU) and
the MCF51MM (32-bit MCU). For this reference
design the MCU chosen was the MCF51MM256.
Figure (6.2) MCF51MM Block diagram
 COMPONENTS HARDWARE DESIGN

2) Pressure sensors.
• To measure accurately the control system, it is
important to have the correct sensors.
• The following pressure sensors are used:
 MPXv5050GP—0 to 50 kPa integrated
silicon pressure sensor, temperature
compensated, and calibrated
• Key features:
• 2.5 % maximum error over 0° to +85°C
• Ideally suited for microprocessor or microcontroller-
based systems
• Temperature compensated over -40°C to +125°C
• One analog output voltage (0 - 3.3 V), CASE 1369-
01.
Figure (6.3)MPXV5050GP output vs. pressure
signal waveform.
 COMPONENTS HARDWARE DESIGN

2) Pressure sensors.
 MPXv5100GP— 0 to 100 kPa integrated
silicon pressure sensor, temperature
compensated, and calibrated
Key features:
• 2.5% maximum error over 0° to +85°C
• Ideally suited for microprocessor or microcontroller-
based systems
• Temperature compensated over -40°C to +125°C
• One analog output voltage (0 - 3.3 V), CASE 1369-
01

Figure (6.4)MPXV5100GP output vs. pressure

signal waveform
 COMPONENTS HARDWARE DESIGN

2) Pressure sensors.
 MPXV7002DP— –2 to 0 and 0 to 2 kPa
integrated silicon differential pressure
sensor, temperature compensated, and calibrated
Key features
• .0% maximum error over 0° to 85°C
• Temperature compensated over 10° to 60°C
• Available in differential and gauge configurations
• One analog output voltage (0 - 5 V), CASE 1351-01

Figure (6.5)MPXV7002DP output vs. pressure

signal waveform
 COMPONENTS HARDWARE DESIGN

3) Power supply.
• The entire ventilator system is powered by a 12 V
15 A power supply connected to a120/220 V AC
power line that may be switched according to the
power supply.
• This power supply powers the 12 V 10 A air
compressor with the 5 V coil relay. The system also
will have the L78S05CV 5 V regulator at 2 A used
to drive four 200 mA electrovalves, a temperature
sensor, switch the 5 V coil of relay, and a
differential pressure(flow) sensor.
• And finally, a TLV2217-33KCSE3 a 3 V at 500
mA regulator to power the MCF51MM MCU, an
80mA buzzer, and the pressure sensor.
Table (6.1)Voltage supply requirements
 COMPONENTS HARDWARE DESIGN

4) Analog To Digital Converter (ADC) :

• To measure sensor analog signals for pressure calculating, the system needs an accurate
ADC. The MM MCU has 24 ports with 16-bit ADC that can be used to read different
sensors.
5) Keyboard Interruptions (KBI) :
• The use of KBIs for the interface buttons eliminates the necessity for extra components
due to the internal pull-ups, and simplifying code by directly turning on interrupts.
6) Universal Serial Bus (USB) :
USB is a commonly used communication channel for medical applications. Medical
standards are moving to create its own USB class and subclasses (PHDC) to create major
medical device environments that can offer the user better health care services.
7) General Purpose Input Outputs (GPIO) :
The system needs GPIOs to control the LCD display, switch valves, and the compressor.
The MCU has the Drive Strength feature to provide more current when needed, for
example for the actuators.
 COMPONENTS HARDWARE DESIGN
 Bill Of Materials (BOM):
• A list of all the components for this demo are shown in the table below.

Table (6.2) Bill Of Materials

 COMPONENTS HARDWARE DESIGN

 Schematics.
• In this section electrical connections are presented by schematic blocks.
1) MCU block.
• The following figure shows the MCU connection tags.
2) Power supply.
• Power supply connections will have some decoupling capacitors, separated 3.3 V for the
microcontroller, and a separated ground for analog ground. It is protected against inverse current and
transients with a diode and a TVS diode.
• It is important have test points and LEDs for debugging the power supply.
• Be sure of current capabilities for voltage regulators, to support the entire system.
COMPONENTS HARDWARE DESIGN

Figure (6.6)Power supply

COMPONENTS HARDWARE DESIGN
3) BDM and Reset.
• Background Debug Mode (BDM) and reset are fundamental signals for an appropriate circuit using
Freescale microcontrollers.
• The BDM is needed to re‐flash program memory and continue with system developing.
• And reset helps the user in case of some issues like exceptions or like a fast restarting program in an
emergency case.

Figure (6.7)BDM and reset

 COMPONENTS HARDWARE DESIGN

4) USB and Clock.

• The figure below shows USB connections for device mode: It is designed to eliminate electrical noise, for layout it is important that
the USB data routes have similar distances and a close distance because they are differential signals.
• These constraints are helpful for signal integrity. For a correct USB function, the MCU must have an external clock with a
recommended frequency of 16 MHZ, if this external clock is not used the USB communication can have synchronization issues and
frequently disconnect..

Figure (6.8)BDM and reset

COMPONENTS HARDWARE DESIGN
5) Actuators switching.
• Power stages for actuator switching :
o For the air compressor MCU :
1) first switch a transistor based optoisolator (4N27M) to separate grounds.
2) Then switch therelay coil with 5 V, this coil needs 100 mA to switch, the relay then provides 15 A at 12V
for the air compressor.

Figure (6.9)Actuators switching

COMPONENTS HARDWARE DESIGN
6) Alarms.
• This system has two types of alarms for the patient, visual, and audio :
1) Visual is a brightLED, and audio is the buzzer, which uses the same switching circuit as valves to ensure
correct working.
2) This device can be switched with the PWM or IO with timers.

Figure (6.10)Alarms
COMPONENTS HARDWARE DESIGN
7) Sensors.
• Figure 11, shows single decoupled sensor diagram connections.
• Its output is connected with internal Op Amps for amplification and isolation of current consumption after
voltage dividers.

Figure (6.11 )Sensors

COMPONENTS HARDWARE DESIGN
8) Human Machine Inteface (HMI).
• The human machine interface system has four buttons and a 20 x 4 characters LCD.
• For button connections there are no external pull-ups, they can be enabled by the software.
• The LCD has a four parallel channel configuration.

Figure (6.12). Human Machine Interface

COMPONENTS HARDWARE DESIGN

 Layout :
- Correct PCB layout maintains signal integration, see the section (3.1.3) Power Supply.
 The pad stack chosen:
• Top—Ground plane and routing 1.
• Inner 1—3.3 V and MCU 3.3 Planes, and air compressor switching plane 1.
• Inner 2—5 V and air compressor switching plane 2.
• Bottom—Ground plane and routing 2.
COMPONENTS HARDWARE DESIGN

1)Layout design : The layout design created on the Allegro PCB editor program.

2) Physical PCB: After the PCB is manufactured according to gerber files.

3) Ventilator Suitcase:After the PCB is properly working , both systems (pneumatic and electrical) are
integrated.
-The demo suitcase shows the complete function of the system and Freescale component capabilities.
COMPONENTS HARDWARE DESIGN

Figure(6.13).Ventilator bottom panel

 TYPES OF MECHANICAL VENTILATOR

 Negative-pressure ventilators.

 Positive-pressure ventilators.
NEGATIVE-PRESSURE VENTILATORS

 Early negative-pressure ventilators were known as “iron lungs.”

 The patient’s body was encased in an iron cylinder and negative pressure was generated
.

 The iron lung are still occasionally used today.

NEGATIVE-PRESSURE VENTILATORS

Fig (7.1)
 NEGATIVE-PRESSURE VENTILATORS

 Intermittent short-term negative-pressure ventilation is sometimes used in patients with

chronic diseases.

 The use of negative-pressure ventilators is restricted in clinical practice, however,

because they limit positioning and movement and they lack adaptability to large or small
body torsos (chests) .

• Our focus will be on the positive-pressure ventilators.

 POSITIVE-PRESASURE VENTILATORS

 Positive-pressure ventilators deliver gas to the patient under positive pressure, during
the inspiratory phase.

Fig (7.2)
 TYPES OF POSITIVE-PRESSURE VENTILATORS

1. Volume Ventilators.

2. Pressure Ventilators.

3. High-Frequency Ventilators.
 1- VOLUME VENTILATORS

 The volume ventilator is commonly used in critical care settings.

 The basic principle of this ventilator is that a designated volume of air is delivered with
each breath.
 The amount of pressure required to deliver the set volume depends on :-
- Patient’s lung compliance.
- Patient–ventilator resistance factors.
 Therefore, peak inspiratory pressure (PIP ) must be monitored in volume modes
because it varies from breath to breath.

 With this mode of ventilation, a respiratory rate, inspiratory time, and tidal volume
are selected for the mechanical breaths.
 2- PRESSURE VENTILATORS

 The use of pressure ventilators is increasing in critical care units.

 A typical pressure mode delivers a selected gas pressure to the patient early in
inspiration, and sustains the pressure throughout the inspiratory phase.

 By meeting the patient’s inspiratory flow demand throughout inspiration, patient effort
is reduced and comfort increased.
 Although pressure is consistent with these modes, volume is not.
 Volume will change with changes in resistance or compliance,
 Therefore, exhaled tidal volume is the variable to monitor closely.
 With pressure modes, the pressure level to be delivered is selected, and with some
mode options (i.e., pressure controlled [PC], described later), rate and inspiratory time
are preset as well.
3- HIGH-FREQUENCY VENTILATORS

 High-frequency ventilators use small tidal volumes (1 to 3 mL/kg) at frequencies

greater than 100 breaths/minute.

 The high-frequency ventilator accomplishes oxygenation by the diffusion of oxygen

and carbon dioxide from high to low gradients of concentration.
 This diffusion movement is increased if the kinetic energy of the gas molecules is
increased.

 A high-frequency ventilator would be used to achieve lower peak ventilator pressures,

thereby lowering the risk of barotrauma.
DISEASES THAT CAN BE DIAGNOSED USING MECHANICAL
VENTILATOR :

 Situations that require artificial respiration:

 A therapeutic artificial respiration:
1) In cases of loss of consciousness, cardio-thoracic resuscitation.
2) In cases of shock, respiratory and cardiac arrest.
3) In cases of diseases of the musculoskeletal system, such as cases of myasthenia gravis.
4) In the event of a defect in the nervous system, such as injury to the brain and spinal cord, and therefore,
it affects the respiratory center in the brain.
5) In cases of spinal injury.
6) In cases of respiratory diseases that lead to a lack of oxygen, such as: COBD&pulmonary edema&RDS.
7) In cases of heart diseases such as cardiogenic shock and cases of CONGESTIVE HEART Failure.
 Mandatory artificial respiration:
1) After surgeries such as open heart surgeries and operations that require long anaesthesia.
2) In cases of head injuries, due to the influence of the respiratory center in the brain.
MECHANICAL HOME VENTILATION SYSTEMS
 Also known as forced ventilation, mechanical ventilation refers to air driven by mechanical means in a
desired direction. This is accomplished with devices like ceiling and standalone fans and vented exhaust
fans.
 Mechanical ventilation systems are necessary in rooms where humidity and odors tend to build up. This
includes exhaust fans in bathrooms, kitchens and attics. Ventilation systems are also useful in other areas
of the home, such as a ceiling fan in the living room, den or bedroom.
 In bathrooms, mechanical ventilation is generally installed in or near the ceiling to remove moist air that
could build up due to bathing or showering. A variety of bathroom exhaust fans are available at Home
Depot, Walmart and Amazon.
 Mechanical ventilation is found in the form of vented hood exhaust fans over kitchen stovetops. This
helps ensure that food odors that result from cooking are forced out of the home, as well as water
vapors. You can find many range hood exhaust fan options at Amazon, Home Depot and Walmart.
 Mechanical ventilation systems are also installed in attics to expel stale indoor air that may create
moisture buildup. This helps reduce the chances of mold in the attic or home in general. Such fans may
also be installed to remove hot air.
 ADVANTAGE OF MECHANICAL VENTILATOR :
 In addition to replacing stale air with fresh oxygenated air, mechanical ventilation systems serve a
variety of other functions. They help regulate the temperature in your home. For instance, an attic fan
can pull hot air out of your home, resulting in cooler temperatures within your living space.

 Mechanical home ventilation systems also help to moderate humidity. This is the case with exhaust
fans in the kitchen, bathroom and anywhere else where humidity may build up, such as the laundry
area.

 Odors are greatly reduced with mechanical ventilation. Fresh air is exchanged with internal air. This
results in the reduction of the smell of smoke and cooked foods. Additionally, mechanical ventilation
can help improve safety by removing air containing dust, bacteria and trace amounts of carbon dioxide.

 Forced air mechanical ventilation also makes your home interior more comfortable. For instance, the
air movement created by a ceiling or standalone fan can be refreshing.
DISADVANTAGE OF MECHANICAL VENTILATOR :
 While ventilation is a positive in most homes, consider that the more you ventilate
your home, the harder your heating and cooling system must work. Bringing the
outdoor air indoors can increase the work required of your HVAC system.
 Because of the airtight nature of many of today's homes, mechanical ventilation can
also depressurize your home. This can cause issues with appliances that vent naturally,
such as a furnace and water heater. Rather than expelling the harmful gasses outdoors
that are created when your water heater and furnace operate, the gases may linger in
your indoor environment. This creates unhealthy, even dangerous, air.
CONCLUSION:

 Ventilator modes are simple.

 Ventilator modes do not determine outcome.
 You should know how a mode you are using triggers, cycles and limits each
breath.
 Avoid high stretch and high pressure on the lung.
 Regular spontaneous breathing trials improve outcome.
 Prone ventilation and other recruitment maneuvers improve hypoxia but may
not improve outcome.