Mechanical ventilation workshop

Basic Principles:Establish Synchronization PATIENT DEMAND... Basic Principles:Know the Modes SIMV... Basic Principles:Know the Modes SIMV + PRESSURE SUPPORT SIMV... Basic Principles:Know

Mechanical Ventilation Workshop

J Christopher Farmer

“Play by the Rules”

Basic Principles:

Establish Harm-Free Goals

1 SaO2 85-90% with certain exceptions

2 Follow pH not PaCO2

3 VT: ARDS versus other lung conditions

4 Paw: ARDS versus other lung conditions

5 Avoid drugs that may prolong weaning

(sedatives, neuromuscular blockers)

Better is the enemy of good…

Basic Principles:

Establish Synchronization

PATIENT DEMAND

Basic Principles:

The Target Zone

Basic Principles:

Lung immobilization = healing

Basic Principles:

Know the Modes

CPAP

Basic Principles:

Know the Modes

SIMV

Basic Principles:

Know the Modes

SIMV + PRESSURE SUPPORT SIMV

Basic Principles:

Know the Modes

ASSIST CONTROL (CMV)

Basic Principles:

Know the Modes

CMV versus PC

Basic Principles:

Know the Modes

APRV

Basic Principles:

Know the Waveforms

Basic Principles:

Know the Waveforms

What is the flow pattern?

Basic Principles:

Know the Waveforms

Is this a pressure supported or SIMV or VAC breath?

Basic Principles:

Know the Waveforms

Is this pressure support or pressure control?

Basic Principles:

Know the Waveforms

Inspiratory effort: patient work with pressure versus flow triggering

VENTILATOR

PATIENT

VENTILATOR TUBING CIRCUIT LENGTH

“Diagnosing the problem”

Flow Starvation

CMV, Volume Cycled Inspiratory Flow Starvation

the pre-set (fixed)

ventilator flow rate

waveform

Adjust Peak Flow to Meet

Patient Inspiratory Demand

TURBULENT

Outflow obstruction

Auto-Minimizing the Impact of Outflow Obstruction

rate

Inflow Obstruction

RESISTANCE

Increased P aw :

Resistance versus Compliance

Identifying the Cause of Inflow Obstruction

 “Kink” in the ET tube

 Secretions or mucous plugging

 Bronchospasm

Disorders of Pressure

 Reduced lung compliance

 Excess tidal volume (VT)

Reduced Lung Compliance

(alveolar flooding)

Peak versus Plateau Pressure

Excess V T :

↑P aw Overdistension and Barotrauma

Inappropriate I-Time (Dyssynchrony)

Patient Perceives

“Insufficient” V T

“DOUBLE TRIGGERING”

MACHINE T I PATIENT T I

1 Know the waveforms!

2 Synchronize the machine to the patient

3 “Seek” the cause of the problem by

analysis techniques shown here today

4 Use sedation only after you have

accomplished 1-3 (or in ARDS patients with  VT