Interactions among clinician, patient, and ventilator.

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New Modes in Mechanical Ventilation Manish Tandon Hartford Hospital July 10, 2013.

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Newer modes of ventilation

The patient is being ventilated with 2 types of breaths.

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Airway pressure and flow waveforms during constant flow volume control ventilation, illustrating the effect of an end-inspiratory breath-hold. Airway pressure.

Trigger pressure-time product (PTP) with zero pressure support, with no leak, medium leak, and large leak. Trigger pressure-time product (PTP) with zero.

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Air flow during ventilator-supported speech production.

Lung simulator diagram of airway pressure release ventilation (APRV): volume (yellow), lung pressure (white), and flow (orange)/time curve. Lung simulator.

Shape-signal method of triggering combines shape signal (A) and volume (B) methods of triggering. Shape-signal method of triggering combines shape signal.

Running title: NAVA may reduce weaning duration from mechanical ventilation A randomized controlled trial to compare Neurally adjusted ventilatory assist.

Even though this patient is undergoing positive-pressure mechanical ventilation, the first 4 breaths have a relatively negative pressure (ie, pressure.

Noninvasive ventilation-neurally adjusted ventilatory assist (NIV-NAVA) where each patient effort is captured but support is insufficient (maximum electrical.

An example of delayed cycling during pressure-support ventilation of a patient with COPD, on a Puritan Bennett 7200 ventilator, which has a flow-termination.

The third breath has a negative deflection (ie, below PEEP) at the end of the mechanical breath (arrow A) associated with a flow increase (arrow B), indicating.

Asynchrony index at baseline and following optimization of pressure support (PS) level (A), and following optimization of mechanical inspiratory time (mechanical.

Example airway pressure and rib-cage impedance in a premature infant supported with the biphasic mode of SiPAP (“sigh” positive airway pressure) from the.

Simulated screenshot of flow starvation in volume control continuous mandatory ventilation. Simulated screenshot of flow starvation in volume control continuous.

Characteristics of a pressure-supported breath.

The peak flows (60 L/min) and flow patterns are the same for all the breaths. The peak flows (60 L/min) and flow patterns are the same for all the breaths.

During this tracing of 30 seconds, the ventilator displays that the patient rate is 16 breaths/min. During this tracing of 30 seconds, the ventilator displays.

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Trigger and synchronization windows.

Top: Stress index (SI) in a patient early in the course of ARDS

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Pressure, flow, volume, and electrical activity of the diaphragm (EAdi) waveforms from a patient on pressure support ventilation, and the presumed pressure.

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Control circuit for set-point or dual targeting schemes.

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Components of a patient-triggered mechanical breath.

FEV1 and FVC for the control group (without noninvasive ventilation [NIV]), NIV with an inspiratory pressure (IPAP) of 15 cm H2O and expiratory pressure.

Determinants of patient-ventilator interaction.

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Airway pressure and flow graphics illustrate delayed cycling.

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Tidal volume (VT) error (% difference between set and actual values) was determined for each ventilator at VT of 300, 500, and 700 mL. Tidal volume (VT)

The changes in peak flow and inspiratory time between a minimum rise time (first 2 breaths) and a maximum rise time (last 2 breaths), with the Servo-i.

Experimental setup. Experimental setup. Each tested ventilator was connected to the TTL test lung via a ventilator circuit. An oxygen analyzer, a pressure.

Efficiency of aerosol bronchodilator delivery during continuous high-flow system at different CPAP and flow levels. Efficiency of aerosol bronchodilator.

Enhancing flow synchrony with a variable flow, pressure-targeted breath. Enhancing flow synchrony with a variable flow, pressure-targeted breath. In the.

Difference between mid-frequency ventilation (MFV), volume control continuous mandatory ventilation (VC-CMV), and pressure control CMV (PC-CMV) when frequency.

Fentenyl and lorazepam use for the first 5 d of ventilatory support are presented. Fentenyl and lorazepam use for the first 5 d of ventilatory support.

Mean ± SD PEEP requirements from randomized clinical trials of lung-protective ventilation whereby PEEP and FIO2 were titrated to maintain PaO2

Coefficients of variation across ventilation modes and ARDS categories for each combination of effort and breathing frequency. Coefficients of variation.

Minute-by-minute means of breathing variables during the spontaneous breathing trial for the groups of subjects with trial success (n = 32) and failure.

Effects of an automated endotracheal-tube-compensation system on a pressure-support breath. Effects of an automated endotracheal-tube-compensation system.

Presentation transcript:

Interactions among clinician, patient, and ventilator. Interactions among clinician, patient, and ventilator. The clinician is key in the interaction. The clinician can improve patient-ventilator interaction, for instance, by administering a bronchodilator to decrease intrinsic PEEP, or by applying appropriate ventilator settings (eg, applied PEEP, VT, flow) or specific ventilatory modes (eg, proportional assist ventilation [PAV], or neurally adjusted ventilatory assist [NAVA]). On the other hand, the clinician can worsen the interaction, for example, by administering heavy sedation. A bidirectional interaction between patient and ventilator occurs with automation (eg, with SmartCare, a pressure-support mode that uses artificial intelligence for weaning). Catherine SH Sassoon Respir Care 2011;56:39-51 (c) 2012 by Daedalus Enterprises, Inc.