Documente Academic
Documente Profesional
Documente Cultură
A Beginner's Guide
www.philippelefevre.com
PaO2
PaCO2
PaO2
FiO2
PaCO2
PaO2
FiO2
Alveolar Ventilation
PaCO2
PaO2
FiO2
Alveolar Ventilation
Shunt / VQ mismatch
PaCO2
PaO2
FiO2
Alveolar Ventilation
Shunt / VQ mismatch
PaCO2
Metabolic Rate
PaO2
PaCO2
FiO2
Metabolic Rate
Alveolar Ventilation
Alveolar Ventilation
Shunt / VQ mismatch
Respiratory Failure
Type 1
O2
Type 2
O2
CO2
O2
Pneumonia
Bronchiolitis
Contusions
Atelectasis
Pulmonary oedema
ARDS
PE
Type 1
O2
CO2
CNS depression
Neuromuscular disorders
Pulmonary fibrosis
COPD
Asthma
Airway obstruction
Type 2
O2
Pneumonia
Bronchiolitis
Contusions
Atelectasis
Pulmonary oedema
ARDS
PE
Type 1
O2
CO2
CNS depression
Neuromuscular disorders
Pulmonary fibrosis
COPD
Asthma
Airway obstruction
Type 2
Modes of Ventilation
Modes of Ventilation
Types of Breath
Mandatory
Spontaneous
Assisted
Modes of Ventilation
Types of Breath
Mandatory
Spontaneous
Assisted
Trigger
Flow
Pressure
Neuromuscular
impulse
Modes of Ventilation
Types of Breath
Mandatory
Trigger
Spontaneous
Flow
Assisted
Pressure
Limit (cycle)
Volume
Pressure
(time)
Neuromuscular
impulse
Neuromuscular
impulse
Ventilation Limit
Ventilation Limit
Volume
Ventilation Limit
Volume
Pressure
Ventilation Limit
Volume
Pressure
Neuromuscular impulse
Modes
Modes
Continuous Mandatory Ventilation (CMV)
Modes
Continuous Mandatory Ventilation (CMV)
Assist Control (AC)
Modes
Continuous Mandatory Ventilation (CMV)
Assist Control (AC)
Intermittent Mandatory Ventilation (IMV)
Modes
Continuous Mandatory Ventilation (CMV)
Assist Control (AC)
Intermittent Mandatory Ventilation (IMV)
SIMV
Modes
Continuous Mandatory Ventilation (CMV)
Assist Control (AC)
Intermittent Mandatory Ventilation (IMV)
Modes
Continuous Mandatory Ventilation (CMV)
Assist Control (AC)
Intermittent Mandatory Ventilation (IMV)
Synchronised Intermittent Mandatory Ventilation (SIMV)
Modes
Continuous Mandatory Ventilation (CMV)
Assist Control (AC)
Intermittent Mandatory Ventilation (IMV)
Synchronised Intermittent Mandatory Ventilation (SIMV)
Synchronised Intermittent Mandatory Ventilation with PSV (SIMV + PSV)
Modes
Continuous Mandatory Ventilation (CMV)
Assist Control (AC)
Intermittent Mandatory Ventilation (IMV)
Synchronised Intermittent Mandatory Ventilation (SIMV)
Synchronised Intermittent Mandatory Ventilation with PSV (SIMV + PSV)
Modes
Continuous Mandatory Ventilation (CMV)
Assist Control (AC)
Intermittent Mandatory Ventilation (IMV)
Synchronised Intermittent Mandatory Ventilation (SIMV)
Synchronised Intermittent Mandatory Ventilation with PSV (SIMV + PSV)
Pressure Support
Modes
Continuous Mandatory Ventilation (CMV)
Assist Control (AC)
Intermittent Mandatory Ventilation (IMV)
Synchronised Intermittent Mandatory Ventilation (SIMV)
Synchronised Intermittent Mandatory Ventilation with PSV (SIMV + PSV)
Pressure Support
Neurally Adjusted Ventilatory Assist
Modes of Ventilation
Modes of Ventilation
Assist Control
(Pressure Control)
SIMV + PS
(volume control)
Pressure Support
Weaning
NAVA
Weaning
Modes of Ventilation
Assist Control
(Pressure Control)
SIMV + PS
(volume control)
Pressure Support
Weaning
NAVA
Weaning
Modes of Ventilation
Assist Control
(Pressure Control)
SIMV + PS
(volume control)
Pressure Support
Weaning
NAVA
Weaning
Modes of Ventilation
Assist Control
(Pressure Control)
SIMV + PS
(volume control)
Pressure Support
Weaning
NAVA
Weaning
Modes of Ventilation
Assist Control
(Pressure Control)
SIMV + PS
(volume control)
Pressure Support
Weaning
NAVA
Weaning
Modes of Ventilation
Assist Control
(Pressure Control)
SIMV + PS
(volume control)
Pressure Support
Weaning
NAVA
Weaning
Modes of Ventilation
Assist Control
(Pressure Control)
SIMV + PS
(volume control)
Pressure Support
Weaning
NAVA
Weaning
Modes of Ventilation
Assist Control
(Pressure Control)
SIMV + PS
(volume control)
Pressure Support
Weaning
NAVA
Weaning
Oxygen Toxicity
Biotrauma
Volutrauma
Tidal Volume
Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute
lung injury and the acute respiratory distress syndrome. The Acute Respiratory Distress
Syndrome Network. N. Engl. J. Med. 2000 May 4;342(18):13018
PEEP
Brower RG, Lanken PN, MacIntyre N, Matthay MA, Morris A, Ancukiewicz M, et al. Higher
versus lower positive end-expiratory pressures in patients with the acute respiratory
distress syndrome. N. Engl. J. Med. 2004 Jul. 22;351(4):32736
PEEP
Briel M, Meade M, Mercat A, Brower RG, Talmor D, Walter SD, et al. Higher vs lower positive
end-expiratory pressure in patients with acute lung injury and acute respiratory distress
syndrome: systematic review and meta-analysis. JAMA. 2010 Mar. 3;303(9):86573
PEEP
PEEP (cmH2O)
Low
High
0.3
12
0.4
14
0.5
10
16
0.6
12
18
0.7
14
20
0.8
14
22
0.9
18
22
1.0
20
24
30
High PEEP
Low PEEP
25
20
PEEP cmH20
FiO2
15
10
0.3
0.4
0.5
0.6
0.7
FiO2
0.8
0.9
Oxygen Toxicity
Biotrauma
Volutrauma
Atelectatrauma
Healthy Lung
Volume
Pressure
Healthy Lung
Volume
PEEP
PIP
Pressure
Volume
PEEP
PIP
Pressure
Volume
PEEP
PIP
Pressure
Heterogeneous Lung
Volume
PEEP
PIP
Pressure
Heterogeneous Lung
Volume
PEEP PIP
Pressure
f
Vt
Mean
Airway Pressure
3 - 10 Hz
(180 - 600 breaths per minute)
5 - 30 ml
35 - 45 mmHg
f
Vt
Mean
Airway Pressure
3 - 10 Hz
(180 - 600 breaths per minute)
5 - 30 ml
35 - 45 mmHg
f
Vt
Mean
Airway Pressure
3 - 10 Hz
(180 - 600 breaths per minute)
5 - 30 ml
35 - 45 mmHg
f
Vt
Mean
Airway Pressure
3 - 10 Hz
(180 - 600 breaths per minute)
5 - 30 ml
35 - 45 mmHg
f
Vt
Mean
Airway Pressure
3 - 10 Hz
(180 - 600 breaths per minute)
5 - 30 ml
35 - 45 mmHg
f
Vt
Mean
Airway Pressure
3 - 10 Hz
(180 - 600 breaths per minute)
5 - 30 ml
35 - 45 mmHg
Pillow et al.
Crit Care Med 2005 Vol. 33
Key Points
Understand the nature of your patients respiratory failure
Choose the mode of ventilation appropriate for your patient
Vt 6 ml/Kg (ideal body weight)
Titrate PEEP to FiO2 or recruit and use the open lung tool