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Basic Ventilator

Hendry – PT Covidien Indonesia

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Negative Pressure Ventilator

1. Implication on Ventilator
(when to use Ventilator)

Hendry – PT Covidien Indonesia

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 Basic Ventilator Basic Ventilator
Why do mechanical ventilation Classification of Respiratory Dysfunction

• Elective
• To allow for sedation and paralysis during major surgery 1. Obstructive Disease
• Therapeutic • Reduce airflow through airways
• Inadequate Alveolar Ventilation • Reduced elastic recoil of lungs
• Apnea, Respiratory failure, Impending Respiratory failure, Resuscitation
• Neuromuscular disorders, CNS disorders 2. Restrictive Disease
• Chest wall diseases (Kyphoscoliosis ) • Reduced lung capacity
• Excessive work of Breathing • Increased elastic recoil of lungs
• Acute Airway Obstruction (COPD, severe Asthma, Excessive Secretions)
• Intra-thorax (pleural disease) Obstruction to airflow increases work of breathing, increasing O2 consumption
• Refractory Hypoxemia And CO2 production.
• Pneumonia
• Atelectasis (collapse), Pulmonary Edema, ARDS
• Airway protection (Indication for intubation)
• Inadequate cough, Tracheal obstruction, Severe Allergic Reactions

Basic Ventilator Basic Ventilator

Respiratory Pathophysiology Disease
Asthma
Obstructive Diseases
Normal Lungs
Emphysema
• Asthma Chronic
• Chronic Obstructive Pulmonary Disease (COPD) Bronchitis
• Emphysema

Sign and symptoms Asthma :

• Periodic narrowing of the conducting airways (bronchospasm)
• Increased mucus production
• Frequently referred to as “reactive airway disease”
• Asthmatics often complain that “it’s easy to get the air in but difficult to get the air out.

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Asthma Chronic Bronchitis

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Emphysema Respiratory Pathophysiology Disease

Restrictive Disease
• Kyphoscoliosis

• Pleural Effusion

• Pneumothorax

• Pulmonary Edema

• ARDS (Acute Respiratory Disease Syndrome)

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Kyphoscoliosis with atelectasis Atelactasis

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Pleural effusion Pneumothorax

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Pulmonary edema TBC

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Pneumonia Fungal infection

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Smoke inhalation and thermal Acute Respiratory
injuries Distress Syndrome
(ARDS)

Basic Ventilator
Indication Respiratory Failure

Respiratory Rate >35/minute

Tidal Volume <2mL/kg

Minute Ventilation <5L/minute or > 12L/minute

Vital Capacity <10mL/kg (N=65/75)

Negative Inspiratory <20cmH20
Force

Vd / Vt 0.60 (N=0.3) 2. Trigger Type and How mode depicted

PaC02 >10 above baseline

pH <7.30 with increased C02

HR and BP > 20% baseline

Hendry – PT Covidien Indonesia

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Part A: How breaths begins… Basic Ventilator
Pressure Trigger
Triggering
As the patient draws gas from the circuit,
Airway pressure drops below baseline pressure

When airway pressure drops below baseline

by the value selected for pressure sensitivity,
The ventilator initiates a patient-triggered
inspiration

Timed

Basic Ventilator Basic Ventilator

Trigger Depict
Flow Trigger flow
flow
The ventilator triggers a breath when the trigger
A
Difference between inspiratory and expiratory
Flow increases to a value that is at beginning of
Least the value selected for flow sensitivity patient effort pressure

flow

beginning of
patient effort pressure

B pressure
trigger

A-Flow trigger, B-Pressure Trigger

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5 Basic Parameters Flow (Ltrs/sec)
•Flow (Ltrs/sec)
•Volume (Ltrs)
•Pressure (CmH2O)
•Compliance (ml/CmH2O)
•Resistance (CmH2O/ltrs/sec)

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Volume (Ltrs) Pressure (CmH2O)

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 Compliance (ml/CmH2O) Resistance (CmH2O/Ltrs/sec)

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Controlled versus assisted breath

Part B : How modes depicted…
There are 3 fundamental Modes according Human Breaths:

a) Controlled
Deliver gas to the patient according to the control variable set by the operator. C
b) Assisted
Either replace or be in addition to controlled breaths. An assisted breath is
Initiated when the patient’s inspiratory effort is equal to the sensitivity setting

c) Spontaneous
A
Based on the patient demand, when the patient inspiratory effort is equal to
the sensitivity, the flow or volume from the ventilator is delivered

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 3. Volume Based (CMV, SIMV)

Hendry – PT.Covidien Indonesia

CMV (Control Mandatory Ventilation) or

A/C - VC
Volume vs. Time Curve

500

Volume
What parameter to setting :
Ventilation

VT
(mL) Sec
1 2 3 4 5 6

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 SIMV (Synchronize Intermittent Mandatory
Mandatory Breath Ventilation)

VT
LITERS
Counterclockwise
0.6
Expiration What parameter to setting :
0.4

Inspiration
0.2

Paw
cmH2O -60 40 20 0 20 40 60

Assisted Breath
(Pressure vs Volume Loop)
VT Clockwise to
LITERS Counterclockwise
0.6

Expiration
0.4

Assisted Breath 0.2

Inspiration 4. Pressure Based (PCV,PSIMV, PS)
Paw
cmH2O -60 40 20 0 20 40 60

Hendry – PT.Covidien Indonesia

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PCV (Pressure Control Ventilation) Pressure vs. Time Curve

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Pressure Ventilation
What parameter to setting :

Paw
cmH2O Sec
1 2 3 4 5 6

Flow-Time Curve P SIMV (Pressure Synchronize Intermitten

Mandatory Ventilation)

120

What parameter to setting :

.
V
LPM 1 4 2 3 4 5 6

Time

120

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 CPAP-PS (Continuous Positive Airway
Pressure – Pressure Support) PS (Pressure Support)

What parameter to setting :

Airway Pressure limited
Pressure
(cm H2O)

Flow Triggered Time (sec)

Flow Adequacy during VCV

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Adequate flow

5. Waveform and Loops Changes P aw

Flow set too low
cmH2O
1 2 3
Time
(s)
-10

Hendry – PT.Covidien Indonesia

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 Flow Acceleration
% Rise Time Setting Appropriate I-Time
Minimal Pressure Overshoot

600 cc
450 cc 500 cc
VT
P

Slow rise Moderate rise Fast rise 0 1 2 3 4 5 6

120
Lost VT
.
. V
V LPM 1 2 3 4 5 6

Time
120
Pressure Relief

Time

A Higher Expiratory Flow Rate and a Decreased

Expiratory Time Denote a Lower Expiratory Volume vs. Time Curve
Resistance
Leaks
120

1.2

A
.
V
LPM
1 2 3 4 5 6 VT
Liters
Time 1 2 3 4 5 6
-0.4
Time

A = exhalation that does not return to zero

120

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 Changes in Compliances Overdistension
Indicates a drop in compliance
VT (higher pressure for the same VT
LITERS volume) LITERS

0.6 0.
6

0.4 0.4

0.2 0.2

Paw Paw
-60 40 20 0 20 40 60 -60 -40 -20 0 20 40 60
cmH2O cmH2O

Flow -Volume Loops

Volume Control
Tidal Volume
Peak Inspiratory Flow
Peak Expiratory Flow

Inspiration
Thank You
Volume

Expiration

Hendry – PT.Covidien Indonesia

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