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Volume?
(flow control)
Pressure?
Targeting
Control Target
z Flow z Time
Volume
control
z Pressure z Pressure
z Volume
Targeting
Control Target
z Flow z Time
Time-cycled
pressure
z Pressure z Pressure control
z Volume
Targeting
Control Target
z Flow z Time
z Pressure z Pressure
z Volume Volume
targeted
pressure
control
Microprocessor Control
Microprocessor
solenoid exhale
valve
Inhalatio
n
valve
(resisto
r) Tidal volume 500 ml
Pressure 3500 cm H20 Pressure 35 cm H20
Goals of Mechanical Ventilation
zVolutrauma
zAtelectrauma: Even the best possible lung
protective strategy may cause injury to
some of lung units (due to heterogenous
involvement)
zBarotrauma
zBiotrauma: majority of deaths in ARDS are
not because of oxygenation failure but
because of MODS
Lung Protective Strategy
zRR
zPeak flow (flow if TV<Target)
zPEEP
zFiO2
zTrigger sensitivity
zMinimum desired Vt
zPressure support setting = plateau
pressure obtained during a volume-
controlled breath at the desired Vt
VAPS
zAssist-control ventilation
zPressure control titrated to a set TV
zTime cycled
Synonyms of PRVC
hypoxemia
PRVC
@ Particular RR
@ very high RR
↓
overcome the flow-resistance
↓
↑WOB
↓
Maintaining MV
Adaptive Support Ventilation (ASV)
zRR: Respiratory
rate
zRC: Respiratory
time constant
zVA: Alveolar
ventilation
z VD: Dead space
volume
ASV Input
zIdeal body weight: determines dead
space
zHigh-pressure alarm: 5 cm H2 O above
PEEP to 10 cm H2 O below set Pmax
zMandatory RR
zPEEP
zFiO2
zInsp time (0.5–2 secs), exp time (3 ×
RCe to 12 secs)
ASV
Adjusts
¾inspiratory pressure
¾I:E ratio,
¾mandatory respiratory rate
↓
zmaintain the target MV (according to IBW)
and RR, to avoid both rapid shallow
breathing and excessive inflation volumes
ASV
Outcome: same
Anaethesia Analgesia. 2003 Dec
ASV Evidence
zPressure control
zPatient triggered
zPressure limited
zFlow cycled
PAV
z Pediatric
z Broncho-pleural fistula
Partial Liquid Ventilation
zVolume-targeted
zControlled ventilation
zAimed at improving oxygenation
zIncorporates the breath-to-breath
variability that characterizes a natural
breathing pattern
Summary
Conventional & New Modes
Mode Mand Assist Support Spont Condn
Variable
× × × Cy:F
×
ASV Tr: T, L:Pr Tr: Pt, L:Pr, Pt effort
Cy: T
× Cy:F
× impedenc
changes
Synonyms Causing Confusion: Drager