Newer Modes of Mechanical Ventilation Timothy A. Morris, M.D. Division of Pulmonary and Critical Care Medicine Medical Director, Respiratory Care University.

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Presentation transcript:

Newer Modes of Mechanical Ventilation Timothy A. Morris, M.D. Division of Pulmonary and Critical Care Medicine Medical Director, Respiratory Care University of California, San Diego

How to Assess Ventilator Modes l Inhalation »what is controlled during the breath »what is targeted (how much is enough?) »how does it adjust to changes

How to Assess Ventilator Modes l Exhalation »what is controlled »when does it end »how does it adjust

How to Assess Ventilator Modes l Inhalation »what is controlled »what is targeted »how does it adjust

Simple Pressure System Pressure 20 cm H 2 O Pressure 20 cm H 2 O

Time Constant l time it takes to get 1/2 way to equilibrium l total resistance x total compliance

Increased Compliance Pressure 20 cm H 2 O Pressure 20 cm H 2 O

Increased Resistance Pressure 20 cm H 2 O Pressure 20 cm H 2 O Obstruction

Volume 500 ml Pressure 3500 cm H 2 0 Simple Volume System Volume 500 ml

Volume 2000 ml Pressure 3500 cm H 2 0 Pop! Simple Volume System

Big Secret! l Ventilator modes are simulations »pressure control »volume control l Microprocessors control the simulation

Dadmobile

Minivan Tire

High Pressure Pump

Filling the Tire

Tire Pressure

Toy Balloon: deflated

Toy Balloon: inflated

Toy Balloon: popped

Flow Control

Control of Resistor

Pressure 3500 cm H 2 0 High Pressure System valve Pressure 35 cm H 2 0 Tidal volume 500 ml

Volume Control Deflated Volume Inflated Volume

Pressure Control Deflated PressureInflated Pressure

What controls the adjustments? Volume? (flow control) Pressure?

Pressure 3500 cm H 2 0 Microprocessor Control Inhalation valve (resistor) solenoid Microprocessor exhale valve Tidal volume 500 ml Pressure 35 cm H 2 0

Quality of the control l hardware: »how frequently is the flow/pressure measured »how rapidly are adjustments made »how are adjustments made l software »timing and patterns of control

How to Assess Ventilator Modes l Inhalation »what is controlled »what is targeted »how does it adjust

Targeting l How much breath is enough?

Targeting Control l Flow l Pressure Target l Time l Pressure l Volume Volume control

Targeting Control l Flow l Pressure Target l Time l Pressure l Volume Time-cycled pressure control

Targeting Control l Flow l Pressure Target l Time l Pressure l Volume Volume targeted pressure control

How to Assess Ventilator Modes l Inhalation »what is controlled »what is targeted »how does it adjust

Patients generate pressures l Negative pressure »inhalation efforts l Positive pressure »“bucking”

Negative pressure: Adjustments l No adjustment l Increase in pressure/flow to match demand l Decrease in pressure/flow to foster weaning

Positive pressure: Adjustments l No adjustment l End inhalation, open exhalatory valve l Adjust inspiratory and expiratory valves to maintain control

How to Assess Ventilator Modes l Exhalation »next year

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