Mechanical Ventilation I
MVA
Objectives
Describe types of breaths and modes of
mechanical ventilation
Describe interactions between ventilatory
parameters and modifications needed to
avoid harmful effects
MVA
Indications for
Mechanical Ventilation
Ventilation abnormalities
Respiratory muscle dysfunction
Respiratory muscle fatigue
Chest wall abnormalities
Neuromuscular disease
Decreased ventilatory drive
Increased airway resistance and/or
obstruction
MVA
Indications for
Mechanical Ventilation
Oxygenation abnormalities
Refractory hypoxemia
Need for positive end-expiratory
pressure (PEEP)
Excessive work of breathing
MVA
Types of Ventilator Breaths
Volume-cycled breath
Volume breath
Preset tidal volume
Time-cycled breath
Pressure control breath
Constant pressure for preset time
Flow-cycled breath
Pressure support breath
Constant pressure during inspiration
MVA
Modes of Mechanical
Ventilation
Consider trial of NPPV
Determine patient needs
Goals of mechanical ventilation
Adequate ventilation and oxygenation
Decreased work of breathing
Patient comfort and synchrony
MVA
Modes of Mechanical Ventilation
Point of Reference:
Spontaneous Ventilation
MVA
Continuous Positive Airway
Pressure (CPAP)
No machine breaths delivered
Allows spontaneous breathing at elevated
baseline pressure
Patient controls rate and tidal volume
MVA
Assist-Control Ventilation
Volume or time-cycled breaths + minimal ventilator
rate
Additional breaths delivered with inspiratory effort
Advantages: reduced work of breathing; allows
patient to modify minute ventilation
Disadvantages: potential adverse hemodynamic
effects or inappropriate hyperventilation
MVA
Pressure-Support Ventilation
Pressure assist during spontaneous inspiration
with flow-cycled breath
Pressure assist continues until inspiratory effort
decreases
Delivered tidal volume dependent on inspiratory
effort and resistance/compliance of lung/thorax
MVA
Pressure-Support Ventilation
Potential advantages
Patient comfort
Decreased work of breathing
May enhance patient-ventilator synchrony
Used with SIMV to support spontaneous breaths
MVA
Pressure-Support
Ventilation
Potential disadvantages
Variable tidal volume if pulmonary
resistance/compliance changes rapidly
If sole mode of ventilation, apnea alarm mode
may be only backup
Gas leak from circuit may interfere with cycling
MVA
Synchronized Intermittent
Mandatory Ventilation (SIMV)
Volume or time-cycled breaths at a preset
rate
Additional spontaneous breaths at tidal
volume and rate determined by patient
Used with pressure support
MVA
Synchronized Intermittent
Mandatory Ventilation
(SIMV)
Potential advantages
More comfortable for some patients
Less hemodynamic effects
Potential disadvantages
Increased work of breathing
MVA
Controlled Mechanical
Ventilation
Preset rate with volume or time-cycled breaths
No patient interaction with ventilator
Advantages: rests muscles of respiration
Disadvantages: requires sedation/neuro-muscular
blockade, potential adverse hemodynamic effects
MVA
Inspiratory Plateau Pressure
(IPP)
Airway pressure measured at end of inspiration with
no gas flow present
Estimates alveolar pressure at end-inspiration
Indirect indicator of alveolar distension
PIP
Plateau pressure
Inspiration
Peak pressure
Expiration
MVA
Plateau pressure
Inspiratory Plateau Pressure
High inspiratory plateau pressure
Barotrauma
Volutrauma
Decreased cardiac output
Methods to decrease IPP
Decrease PEEP
Decrease tidal volume
MVA
Inspiratory Time: Expiratory
Time Relationship (I:E ratio)
Spontaneous breathing I:E = 1:2
Inspiratory time determinants with volume
breaths
Tidal volume
Gas flow rate
Respiratory rate
Inspiratory pause
Expiratory time passively determined
MVA
I:E Ratio during Mechanical
Ventilation
Expiratory time too short for exhalation
Breath stacking
Auto-PEEP
Reduce auto-PEEP by shortening
inspiratory time
Decrease respiratory rate
Decrease tidal volume
Increase gas flow rate
MVA
Auto-PEEP
Can be measured on some ventilators
Increases peak, plateau, and mean airway
pressures
Potential harmful physiologic effects
MVA
Auto-PEEP
Can be measured on some ventilators
Increases peak, plateau, and mean airway
pressures
Potential harmful physiologic effects
MVA
Key Points
MVA
