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Modes of Ventilation PowerPoint Presentation

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Description : Check out this medical PowerPoint presentation titled "Modes of Ventilation" by Prof. Ravi Kant.

This medical PowerPoint presentation talks about ventilation, the process of moving air in and out of the lungs. There are several modes of ventilation that can be used to support breathing in patients who are unable to breathe effectively on their own. Some of the most common modes of ventilation include Assist-Control (AC) Mode, Synchronized Intermittent Mandatory Ventilation (SIMV) Mode, Pressure Support (PS) Mode, Continuous Positive Airway Pressure (CPAP) Mode, and Bi-level Positive Airway Pressure (BiPAP) Mode.

Tags : Modes of Ventilation, ventilation, Assist-Control (AC) Mode, Synchronized Intermittent Mandatory Ventilation (SIMV) Mode, Pressure Support (PS) Mode, Continuous Positive Airway Pressure (CPAP) Mode, Bi-level Positive Airway Pressure (BiPAP) Mode.

Published on : Mar 31, 2023 | Views : 3029 | Downloads : 10

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Slide 1-

Modes of Ventilation
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To be able to demonstrate essential knowledge of the care and management of the patient requiring mechanical ventilation Aims
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Explore the indications and contra-indications Overview of the modes of ventilation Be familiar with normal parameters of ventilation Discuss the indications for weaning and extubation Objectives
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Respiratory Failure Cardiopulmonary arrest Trauma Events Cardiovascular impairment Neurological impairment Pulmonary impairment Procedures requiring sedation/paralysis Indications
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Goals Treat hypoxemia/hypercapnia Relieve respiratory distress/reverse fatigue Decrease Myocardial O2 demand Prevention or reversal of atelectasis Breath for the sedated/paralysed patient Stabilise the chest wall
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Risks outweigh benefits, for example Neutropenia Non-invasive deemed preferable to invasive ventilation Invasive ventilation considered medically futile Contrary to the expressed wishes of the patient Contra-Indications
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Ventilation
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A machine that generates a controlled flow of blended air and oxygen into a patient’s airway. Ventilators
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Two categories Volume or Pressure This refers to the mode of breath delivery rather than the mode itself Ventilation
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In volume category modes of ventilation the machine generates flow to achieve a set volume known as TIDAL VOLUME Volume
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Tidal Volume VT Definition – ‘the volume of air that is inspired or expired in a single breath during regular breathing’
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Volume Modes Advantages Guaranteed Minute Ventilation (Mv). Disadvantages Increased monitoring of airway pressures. Airway pressures will increase if lung compliance decreases. Risk of barotrauma.
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Minute Ventilation MV Definition – ‘the total volume of gas in litres expelled from the lungs per minute’
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In pressure modes of ventilation a pressure limit is set, the machine generates flow until the peak pressure limit is achieved- PAP or PIP Peak Airway (inspiratory) Pressures Pressure
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Peak Airway (Inspiratory) Pressures Pip Pap Ppeak Definition – ‘is the highest level of pressure applied to the lungs during inhalation expressed in cmh2o’
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Pressure Modes Advantages Greater control of airway pressure. Less risk of barotrauma. Disadvantages No guaranteed minute ventilation. Increased monitoring of VT required. Rapid changes in the compliance can cause hypoventilation/hypoxia.
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FLOW TRIGGER - a breath is generated when the patient’s respiratory effort causes flow to reach a set level. PRESSURE TRIGGER - a breath is generated by measuring pressure and starting assisted ventilation when pressure reaches a given level. TIME TRIGGER - a breath is generated by measuring frequency of respirations and starting ventilation when respirations frequency is at a given. Inspiration
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TIME CYCLED - such in in pressure controlled ventilation FLOW CYCLED - such as in pressure support VOLUME CYCLED - the ventilator cycles to expiration once a set tidal volume has been delivered: this occurs in volume controlled ventilation. Expiration
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Mandatory Modes of Ventilation
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Intermittent Positive Pressure Ventilation IPPV
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IPPV Set: TV, rate, Fi02, PEEP, No capacity for the patient to trigger a breath Uncomfortable if patient not fully sedated &/ paralysed Suitable only for patients who have no ability to breathe spontaneously
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Mandatory Assist Modes of Ventilation
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SIMV Synchronized Intermittent Mandatory Ventilation
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Provides a set TIDAL VOLUME at a set RATE (F) Patient can breathe in-between mandatory ventilation Spontaneous breaths are supported with pressure support Ventilator synchronises mandatory breaths and spontaneous breaths for increased patient comfort NB Usually volume targeted but some machines offer SIMV(pc) SIMV
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SIMV Advantages Guaranteed Minute Ventilation Disadvantages Increased monitoring of airway pressures. Airway pressures will increase if lung compliance decreases. Risk of barotrauma.
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Bilevel Positive Airway Pressure BiPAP
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Provides a set P-insp at a set RATE (F) Patient can breathe in-between mandatory ventilation Spontaneous breaths are supported with pressure support Pt can breathe at any point of respiratory cycle, not just between breaths Breathing takes between two levels Pinsp and PEEP BiPAP
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BiPAP Advantages Increased patient comfort Can limit high airway pressures Reduce risk of barotrauma Disadvantages No guaranteed Minute Ventilation Increased monitoring of Tidal Volumes Patient may hypo-ventilate and become hypoxic if lung compliance changes suddenly
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Spontaneous Modes of Ventilation
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Spontaneous Modes of Ventilation Spontaneous modes are- Triggered Cycled -By the patient
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The patient triggers the ventilator and receives a supported breath at a pre-set pressure. This helps overcome the increased work of breathing or resistance of breathing through an endotracheal tube. Pressure Support or ASB
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Complications of invasive ventilation Airway: Aspiration pneumonia Trauma to trachea during intubation Hypoxia prior to / during intubation Laryngeal oedema Occlusion of blood supply to trachea (if cuff pressures to high) Sinus infection
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Complications of invasive ventilation Mechanical: Ventilator malfunction. Ventilator circuit: occlusion, kinks, bronchospasm, disconnection & biting. Barotrauma / Volutrauma can rupture alveoli, causing pneumothorax.
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Complications of invasive ventilation Decreased cardiac output: Induction agents Changes intrathoracic pressure & reduces venous return Cardiac output falls, BP drops CVP and LV preload rise This has implications for the perfusion of all vital organs: brain, kidneys, GI tract
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Complications
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PEEP Maintains pressure within the breathing circuit at a pre-set level at the end of expiration When used during spontaneous respiration it is called CPAP A degree of PEEP should be applied on all ventilation modes to minimise risk of atelectasis
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Other settings to consider:
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Inspiration time : Expiration time I:E ratio is 1:2 Can be reversed – 1:1 or less: 2:1 Some machines automatically alter I:E ratios when the set resp rate is altered.
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Reversing the I:E Ratio Disadvantages Air trapping from increased intrathoracic pressure Hypercarbia ( Î C02) Breath stacking Extreme discomfort for the pt Reduction in cardiac return Advantages Advantages or reversing the I:E ratio: Alveolar recruitment Reduced alveolar collapse due to shorter expiratory times Increased mean airway pressure without increasing PAP