Types of Assisted Ventilation Jerry Goure

Ventilator Option Indications Contraindications Advantages Notes

Controlled Mandatory • No respiratory drive or • Hypovolemia • • Delivers preset volume at a preset rate.
Ventilation (CMV) effort
Assist Control Ventilation • Neuromuscular disorders • Hypovolemia • Allows spontaneous • Positive pressure during entire breath,
(ACV) (Guillain-Barré) breaths between ventilator- spontaneous or not.
• Pulmonary edema delivered breaths. • Delivers preset volume at a preset rate.
• Acute respiratory failure • When a spontaneous breath is detected,
the ventilator “pushes” the entire preset
volume into the patient.
Synchronized Intermittent • Weaning • Hypovolemia • Allows spontaneous • Delivers preset volume at a preset rate.
Mandatory Ventilation breaths between ventilator- • During a spontaneous breath, the pa-
(SIMV) delivered breaths. tient determines the volume delivered.
• Improved synchrony • The ventilator will “push” a minim-
between patient & ventilat- um volume into the patient, but the
or. patient can breathe deeper.
• Prevents atrophy of respir- • ↑ work of breathing for patient.
atory muscles. • Most common type of ventilation.
• Lower mean airway pres-
sure.
Pressure Support • Weaning (with SIMV) • Hypovolemia • Helps ↓ work of breathing • Patient controls the length of each
Ventilation (PSV) • Sole ventilatory and O2 demand. breath, the tidal volume, and the respir-
support for acute • ↑ endurance conditioning. atory rate.
respiratory failure. • Prevents atrophy of respir- • Delivers each breath with a preset (pos-
atory muscles. itive) pressure.
Pressure Controlled • ARDS • Hypovolemia • Keeps alveoli open longer. • I:E ratio is usually set to 2:1.
Inverse Ratio (PCIR) • Prolonged inspiratory time • Unnatural breathing pattern requires
may → “auto-PEEP.” sedation and/or paralysis.
Positive End-Expiratory • ARDS? • Hypovolemia • Keeps alveoli open during • Positive pressure applied to airway dur-
Pressure (PEEP) expiration. ing expiration.
• Limits O2 toxicity. • Mechanical equivalent to pursed-lip
breathing.
Continuous Positive • Apnea • Hypovolemia • • Positive pressure applied to airway dur-
Airway Pressure (CPAP) ing the entire breath.
• Mask must be tight-fitting over face.
• ↑ work of breathing for patient.