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MECHANICAL VENTILATIOR:

MODES

NISHA KAUSHIK
MSC NURSING 1ST YEAR
MEDICAL SURGICAL NURSING

INTRODUCTION
Over 60% of patients appropriately admitted to ICU require
endotracheal intubation and mechanical ventilation.

Mechanical ventilator is a machine designed to mechanically


move breatheable air into and out of the lungs, to provide the
mechanism of breathing for a patient who is physically unable
to breathe, or breathing insufficiently.
Mechanical ventiation is ventilation of the lungs by artificial
means usually by a ventialtor.

INDICATION OF MECHANICAL
VENTILATOR
Respiratory failure
Pneumonia, ARDS, COPD, acute severe asthma, aspiration
Circulatory failure
Cardiac arrest, pulmonary edema
Neurological disease
Coma, status epilepticus, drug overdose, head injury
Multiple trauma

CLASSIFICATION OF MECHANICAL
VENTILATORS

MECHANICAL
VENTILATION
NON
INVASIVE

INVASIVE
FULL
SUPPORT
CMV

VOLUME
CONTRO
L

PRESS
URE
CONTR
OL

PARTIAL
SUPPORT
SIMV
PSV
BiPAP

POSITIVE
PRESSURE
CPA
P
BiPA
P
NIPP
V

NEGATIVE
PRESSURE

CUIRASS
TANK"
iron lung
rocking
bed

ABBREVATIONS USED
CMV -Continuous mandatory ventilation
SIMV Synchronized intermittent
mandatory ventilation
PSV Pressure support ventilation
BIPAP-Bi level positive airway pressure
CPAP- Continuous positive airway
pressure
NIPPV- Non invasive intermittent positive
pressure ventilation

MODES OF VENTILATORS
The variable method by which the patient and the ventilator
interact to deliver effective ventilation are called MODES.
The ventilator mode selected is based on how much work of
breathing (WOB) the patient ought to or can perform
OR
Mode of ventilator is determined by the patients ventilatory
status, respiratory drive and ABGs values.

MODES OF MECHANICAL
VENTILATION

Invasive Mechanical Ventilator

Intermittent positive pressure ventilation


- Full support
- CMV (controlled mechanical ventilation)

- Partial support
- SIMV, PSV, BiPAP

Non Invasive Mechanical Ventilator

Positive pressure
CPAP, BiPAP, NIPPV

Negative pressure
Cuirass Tank iron lung Rocking bed

CONTROLLED MANDATORY
VENTILATION(CMV)

Pre-set rate and tidal volume.


Independent of patients ventilatory efforts.
It is used when patient has no drive to breath.

SYNCHRONIZED INTERMITTENT
MANDATORY
VENTILATION (SIMV)
Pre-set of mandatory breaths with pre-set tidal volume.
Allows spontaneous breaths between mandatory breaths.
Allows patient to settle on ventilator with less sedation.

PRESSURE SUPPORT VENTILATION


(PSV)
Breaths are triggered by patient.
Provide positive pressure to augment patients breaths.
Useful for weaning.
Usually combined with CPAP; may be combined with SIMV

POSITIVE END EXPIRATORY


PRESSURE (PEEP)
Positive airway pressure applied during expiratory
phase in patients receiving mechanical ventilation.
Improves oxygenation by recruiting atelectatic or
odematous lung.

CONTINUOUS POSITIVE AIRWAY


PRESSURE (CPAP)
Positive airway pressure applied throughout the respiratory
cycle, via either an endotracheal tube or a tight fitting facemask.
Deliver only one level of air pressure.
Helps in breathing by applying continuous pressure to the
airways.
CPAP machine demand extra effort from the patient to get in
and out of the air.

BI- LEVEL POSITIVE AIRWAY


PRESSURE(BiPAP)
Deliver two different levels of air pressure.
BiPAP exerts high pressure when the patient breath in and
deliver low pressure when they breathe out.
BiPAP machine comes with dual pressure adjustments, it helps
patients to get more air in and out without much effort.

NON INVASIVE INTERMITTENT


POSITIVE PRESSURE VENTILATION
(NIPPV)
Most modes of ventilation may be applied via a facemask or
nasal mask.
Usually PSV/BiPAP (typically 15-20 cmH2O) often with
back-up mandatory rate.
Indications include acute exacerbations of COPD.

CUIRASS TANK IRON LUNG ROCKING


BED

CUIRASS TANK IRON LUNG ROCKING


BED
Early negative pressure ventilators were known as iron lungs.
The patients body was encased in an iron cylinder and negative
pressure is generated.
The use of negative-pressure ventilators is restricted in clinical
practice.

INNOVATION IN
MECHANICAL
VENTILATION MODES

HIGH FREQUENCY VENTILATION


HFV involves delivery of a small tidal volume(usually 1 to 5
ml per kg of body weight)at rapid respiratory rates(100 to 300
breaths per minute) in an effort to recruit and maintain lung
volume and reduce intrapulmonary shunting.
It is used in patients with acute respiratory distress syndrome.

PARTIAL LIQUID VENTILATION


Currently, clinical trials are investigating the use of
perflurocarbon(Liqui vent) in partial liquid ventilation for
patients with ARDS.
Perflurocarbon is trickled down a specially designed ET tube
through a side port into the lungs of mechanically ventilated
patient.
The amount used is usually equivalent to a patients functional
residual capacity.

PARTIAL LIQUID VENTILATION


Perflurocarbon evaporates quickly and must be
replaced to maintain a constant level during the
therapy(usually 3 to 5 days).
Patients receiving PLV need close observation.
Frequent assessment of vital signs ,ABGs , and
continuous SpO2 monitoring are required before,
during and after PLV.

SUMMARY
Mechanical ventilation is ventilation of the lungs by artificial
means usually by a ventilator.
Indication are pneumonia,COPD,ARDS,coma,head injury etc.
Ventilator are of two types :invasive and non invasive.
The variable method by which the patient and the ventilator
interact to deliver effective ventilation are called MODES.
Modes are CMV,SIMV,BIPAP,CPAP,PEEP,PSV,PLV and HFV.

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