ESSENTIALS OF VENTILATOR GRAPHICS RespiMedu 2000 c o ESSENTIALS OF VENTILATOR GRAPHICS Developed by: Ruben D Restrepo, MD, RRT Vijay M Deshpande, MS, RRT, FAARC Assistant Professors Georgia State University Atlanta, Georgia

Essentials of Ventilator Graphics. COPYRIGHT NOTICE © 2000 RespiMedu, Inc. Essentials of Ventilator Graphics. All rights reserved. Except as permitted under the Copyright Act of 1976, no part of this material may be reproduced in whole or in part in any manner without permission in writing from the copyright owners. Printed in the U.S.A.

Mechanical Ventilation SCALARS LOOPS Graphics

SCALARS Flow/Time Pressure/Time Volume/Time

LOOPS Pressure-Volume Flow-Volume

SCALARS Flow/Time Pressure/Time Volume/Time

Spontaneous Breath Inspiration Time (sec) Flow (L/min) Expiration

Mechanical Breath Inspiration Time (sec) Flow (L/min) Expiration

Typical Flow Patterns SQUARE DECELERATING ACCELERATING SINE

Inspiratory Flow Pattern Beginning of expiration exhalation valve opens Peak inspiratory flow rate PIFR Inspiration Insp. time TI Expiratory Time TE Flow (L/min) Total cycle time TCT Time (sec) Beginning of inspiration exhalation valve closes Expiration

Expiratory Flow Pattern Beginning of expiration exhalation valve opens Inspiration Expiratory time TE Time (sec) Flow (L/min) Duration of expiratory flow Expiration Peak Expiratory Flow Rate PEFR

Inadequate Inspiratory Flow Active Inspiration or Asynchrony Patient’s effort Normal Abnormal Time (sec) Flow (L/min)

Obstruction vs Active Expiration Time (sec) Flow (L/min) Normal Abnormal

Air Trapping Inspiration Normal Patient Time (sec) Flow (L/min) } Auto-PEEP Expiration

Response to Bronchodilator Before After Time (sec) Flow (L/min) Long TE PEFR Shorter TE Higher PEFR

SCALARS Flow/Time Pressure/Time Volume/Time

Inspiratory Tidal Volume Volume vs Time Inspiratory Tidal Volume Volume (ml) Inspiration Expiration TI Time (sec)

Air Leak Volume (ml) Air Leak Time (sec)

Active Exhalation Volume (ml) Time (sec)

SCALARS Flow/Time Pressure/Time Volume/Time

Spontaneous Breath Expiration Paw (cm H20) Time (sec) Inspiration

Peak Inspiratory Pressure Mechanical Breath Peak Inspiratory Pressure PIP Paw (cm H2O) Inspiration Expiration TI TE } PEEP Time (sec)

CONTROLLED BREATH (Time Triggered) Mechanical Paw (cm H2O) Time (sec) Time Triggered Breath

Assisted Breath (Patient Triggered) Mechanical Paw (cm H2O) Time (sec) Patient Triggered Breath

Assisted vs Controlled Pressure (cmH20) Time (sec)

Spontaneous vs. Mechanical Inspiration Spontaneous Paw (cm H2O) Expiration Expiration Inspiration Time (sec)

Components of Inflation Pressure PIP } Transairway Pressure (PTA) Paw (cm H2O) Exhalation Valve Opens Pplateau (Palveolar) Inspiratory Pause Expiration Begin Inspiration Time (sec) Begin Expiration

Transairway Pressure (PTA) Exhalation Valve Opens Begin Expiration Paw (cm H2O) Time (sec) Begin Inspiration PIP Pplateau (Palveolar Transairway Pressure (PTA) } Exhalation Valve Opens Expiration Paw (cm H2O) Time (sec) PIP Inflation Hold (seconds) Airway Resistance Distending (Alveolar) Pressure Expiration Begin Inspiration Begin Expiration

PIP vs Pplat High Raw Normal Paw (cm H2O) High Flow Low Compliance Time (sec)

Increased Airway Resistance (increased Airway Resistance) High Raw PIP PPlat Normal PIP PPlat Paw (cm H2O) Increased PIP } Increased PTA (increased Airway Resistance) Normal Normal PPlat (Normal Compliance)

Effect of increased Flow Normal PIP High Flow PPlat PIP PPlat Paw (cm H2O) Normal Decreased Inspiratory Time (Due to High Inspiratory Flow) Dynamic Inspiratory Time Time (sec)

(Decreased Compliance) Low Compliance PIP PPlat Normal PIP PPlat Paw (cm H2O) PIP Increased PPlat (Decreased Compliance) Normal PPlat (Normal Compliance) Normal Time (sec)

Inadequate Inspiratory Flow Inadequate Flow Adequate Flow (cm H2O) Paw Time (sec)

LOOPS Pressure-Volume Flow-Volume

Pressure-Volume Loop (Type of Breath) Vol (ml) I E I I Paw (cm H2O) Controlled Assisted Spontaneous I: Inspiration E: Expiration

FRC and PV Loop Normal Compliance TLC VOLUME FRC FRC Negative Positive DISTENDING PRESSURE Normal Compliance FRC FRC

Components of Pressure-Volume Loop VT Expiration Volume (mL) Inspiration PIP Paw (cm H2O)

PEEP and P-V Loop VT PIP Volume (mL) PEEP Paw (cm H2O)

Work of Breathing B A: Resistive Work B: Elastic Work A Volume (ml) Pressure (cm H2O)

Inflection Points Upper Inflection Point Lower Inflection Point Volume (mL) Lower Inflection Point Pressure (cm H2O)

Inadequate Sensitivity Volume (mL) Paw (cm H2O) Increased WOB

Air Leak Volume (ml) Air Leak Pressure (cm H2O)

Inadequate Inspiratory Flow Volume (ml) Active Inspiration Inappropriate Flow Normal Abnormal Paw (cm H2O)

Increased Raw Higher PTA Normal Slope Lower Slope Pressure (cm H2O) Vol (mL) Normal Slope Lower Slope Pressure (cm H2O)

Hysteresis Normal Hysteresis Abnormal Hysteresis Volume (ml) Pressure (cm H2O)

Lung Compliance Changes and the P-V Loop Volume Targeted Ventilation Preset VT COMPLIANCE Increased Normal Decreased Volume (mL) Paw (cm H2O) PIP levels

Lung Compliance Changes and the P-V Loop Increased Normal Decreased VT levels Pressure Targeted Ventilation Volume (mL) Paw (cm H2O) Preset PIP

With little or no change in VT Overdistension With little or no change in VT Normal Abnormal Volume (ml) Pressure (cm H2O) Paw rises

LOOPS Pressure-Volume Flow-Volume

Flow-Volume Loop Inspiration PIFR FRC VT PEFR Expiration Flow (L/min) Volume (ml) FRC VT Flow (L/min) PEFR Expiration

Air Leak Normal Abnormal Inspiration Expiration Volume (ml) Flow (L/min) Volume (ml) Air Leak in mL Normal Abnormal Expiration

Air Trapping Normal Abnormal Inspiration Expiration Flow (L/min) Does not return to baseline Volume (ml) Normal Abnormal Expiration

Increased Airway Resistance Inspiration Flow (L/min) Volume (ml) Normal Abnormal “Scooped out” pattern Decreased PEFR Expiration

Airway Secretions/ Water in the Circuit Inspiration Flow (L/min) Volume (ml) Normal Abnormal Expiration

Modes of Ventilation Mechanical Spontaneous Volume Targeted Pressure

Modes of Ventilation Mechanical Spontaneous Volume Targeted Pressure

Spontaneous Breath Flow L/m Pressure cm H2O Volume mL Time (sec)

CPAP Flow L/m Pressure cm H2O CPAP level Volume mL Time (sec)

PSV Patient Triggered, Flow Cycled, Pressure limited Mode Flow L/m Flow Cycling Set PS level Pressure cm H2O Volume mL Time (sec)

CPAP + PSV Flow Cycling Flow L/m Pressure cm H2O Volume mL Time (sec) Set PS level Pressure cm H2O CPAP level Volume mL Time (sec)

Modes of Ventilation Mechanical Spontaneous Volume Targeted Pressure

Controlled Mode (Volume- Targeted Ventilation) Time triggered, Flow limited, Volume cycled Ventilation Preset Peak Flow Flow L/m Dependent on CL & Raw Pressure cm H2O Preset VT Volume Cycling Volume mL Time (sec)

Assisted Mode (Volume-Targeted Ventilation) Patient triggered, Flow limited, Volume cycled Ventilation Flow L/m Pressure cm H2O Preset VT Volume Cycling Volume mL Time (sec)

SIMV (Volume-Targeted Ventilation) Flow L/m Pressure cm H2O Volume mL Spontaneous Breaths

Controlled Mode (Pressure-Targeted Ventilation) Time Triggered, Pressure Limited, Time Cycled Ventilation Time-Cycled Pressure Flow Volume (L/min) (cm H2O) (ml) Set PC level Time (sec)

Assisted Mode (Pressure-Targeted Ventilation) Patient Triggered, Pressure Limited, Time Cycled Ventilation Time-Cycled Pressure Flow Volume (L/min) (cm H2O) (ml) Set PC level Time (sec)

SIMV Mode (Pressure-Targeted Ventilation) Flow Volume (L/min) (cm H2O) (ml) Set PC level Time (sec) Spontaneous Breath

SIMV + PS (Pressure-Targeted Ventilation) Time-Cycled Flow-Cycled Pressure Flow Volume (L/min) (cm H2O) (ml) Set PC level Set PS level Time (sec) PS Breath

SIMV+PS (Volume-Targeted Ventilation) Flow-cycled Flow Pressure Volume (L/min) (cm H2O) (ml) Set PS level PS Breath

SIMV + PS + CPAP (Pressure-Targeted Ventilation) Flow Volume (L/min) (cm H2O) (ml) Set PC level Set PS level CPAP level Time (sec)

SIMV+PS + CPAP (Volume-Targeted Ventilation) Flow Pressure Volume (L/min) (cm H2O) (ml) Set PS level CPAP level Time (sec)