MODES OF MECHANICAL VENTILATION

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Ahmad Irfan & Fahrur Razi

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Assist Volume Control Delivers volume-limited

breaths triggered by the patient or ventilator Breaths may be assisted, unassisted, or a combination backup rate is set to ensure a minimal number of ventilator breaths An inspiratory hold can be performed to obtain the plateau pressure that approximates the alveolar pressure
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APC controlled ventilation

Assist Pressure ventilation is a partial ventilatorControl

mode similar to

AVC

provides pressure-limited, time-cycled breaths on the basis of set applied pressure limits and inspiratory time The tidal volumes delivered can vary according to the set pressure, the compliance of the lungs and chest wall, and patient effort
5/5/12 monitoring

is

necessary

because

SIMV
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Permits the spontaneously

patient

to

breathe

May reduce the need for sedation or analgesic agents Created to allow the weaning of patients from mechanical ventilation when the only other modes that existed were CMV and assist control The combination of PSV and SIMV allows spontaneous breaths to be 5/5/12

Pressure-Regulated Volume Control A variant on APC ventilation whereby

the pressure is allowed to go up or down within set limits to achieve a targeted tidal volume
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This is achieved by adjusting the ventilator system pressure up or down (within preset limits) to achieve the desired tidal volume This mode allows use of a pressure control breath
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Reduce breathing in the SIMV mode

Pressure Support Ventilation the work of spontaneous

Commonly used as the sole method of ventilation support It cannot be used in patients with respiratory drive suppression not ideal for patients with bronchospasm, excessive bronchial secretions because of the frequently changing airway resistance and lung 5/5/12

Controlled Mechanical Ventilation mechanical Patient has no influence on

ventilation For stabilizing patients with severest respiratory compromise the

The duration of CMV can vary depending on the nature of the lung injury Instituting heavy sedation or paralysis
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OTHERS MODES OF MECHANICAL VENTILATION

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Bilevel Ventilation characterized by ventilating,

over time, from two system pressures, (Phigh) and (Plow) = airway pressure release ventilation (APRV).[ can be used with two different conceptual applications and settings intended to elicit diaphragm activity and increase dependent lung ventilation and therefore oxygen ation in the area where shunt and low / is marked
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Proportional Assist Ventilation Proportional assist ventilation

varies inspiratory support with each mechanical breath on the basis of a patient's inspiratory effort may allow the patient to feel more comfortable with mechanical ventilation based on the assumption that the patient will respond in an appropriate manner to determine the optimal type of inspiratory effort, rate, and 5/5/12 frequency that should be employed

Volume-Assisted Pressure Support Pressure support ventilation can

be delivered by volume-assisted pressure support This form of ventilation ensures a minimum PSV-delivered tidal volume It is achieved by having two ventilators, working in parallel, within one device has been demonstrated to be well tolerated

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High-Frequency Ventilation employs positive-pressure ventilation

with VT smaller than or equal to the anatomic dead space typical respiratory frequencies of 60 to 150 breaths per minute or more In a theoretical model, demonstrated that at these frequencies and velocities, augmented diffusion would play a significant role in achieving gas transport
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it has not been shown to be superior to

Inverse Ratio Ventilation positive-pressure ventilation with an I :

E greater than 1, has been advocated for use in patients with ARDS IRV can be achieved volume-cycled or ventilation with either time-cycled

Patients with significant airflow obstruction should not be treated with this mode Prolonged I : E ratios may raise the 5/5/12 rate of pneumothorax

Continuous Positive Airway Pressure and Positive EndExpiratory Pressure CPAP is not a mode of MV because

no positive pressure above baseline system pressure is applied during inspiration provides a supply of fresh gas during weaning trials, CPAP allows application of PEEP PEEP prevents atelectasis, increases functional residual capacity (FRC), and improves oxygenation
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POTENTIAL FUTURE MODES Greater knowledge of the mechanisms

that determine respiratory failure has led to the development of new technologies aimed at improving ventilatory treatment
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The main difference between modes is essentially the manner in which positive pressure is applied to the airway the amount of support provided should instantaneously correspond to the 5/5/12

Neurally Adjusted Ventilatory Assist an experimental mode in which the

ventilator assistance is titrated in proportion to the electrical activity of the diaphragm (EAdi) during assisted ventilation
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The amount of ventilatory assistance for a given level of EAdi depends on a user-adjustable proportionality factor has the capability to dramatically enhance the coordination between mechanical ventilation and respiratory 5/5/12 muscle activity, thereby improving

Biologically Variable (or Fractal) Ventilation that mimics spontaneous a mode

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breath-to-breath variability, incorporating natural variable noise into a volume-targeted, controlled mode The ventilator is programmed to modulate RR and TV while maintaining a fixed minute ventilation on the basis of a previously generated data file

in animal models support the validity of the mathematical model that 5/5/12