1. Principles of Mechanical Ventilation Magdy M Khalil, MD, EDIC Prof. Pulmonary& Critical Care Medicine

2. MV: Indications Acute hypercapneic respiratory failure Acute hypoxemic respiratory failure Assistance of respiratory muscles

3. MV: The machine Negative-pressure ventilation Positive-pressure ventilation

4. MV: Modes Controlled ▫Volume- targeted ▫Pressure- targeted Assisted spontaneous-breathing ▫Volume- targeted ▫Pressure- targeted

5. Conventional modes

6. MV: Settings FiO2 (fraction of inspired oxygen) Vt (tidal volume)+ RR (respiratory rate)= [MV] or IP (inspiratory pressure) PEEP (positive expiratory pressure) I/E (inspiration/expiration ratio) Trigger Inspiratory flow

7. MV: Monitoring Effectiveness ▫ABGs/SpO2/capnography Safety ▫Airway pressures  peak airway pressure (limited)  end-inspiratory pressure (<25-30 cmHO2) Comfort ▫Patient-ventilator synchrony Imaging ▫CXR/US/CT

8. MV: Efficiency algorism

9. MV: The patient! Treatment of underlying disease Communication Sedation/muscle relaxation Care of airways Positioning Care of a critically ill, bed-ridden patient

10. MV: Complications Barotrauma Atelectasis Infection [VAP] Cardiovascular compromise Muscle dysfunction Multiple organ dysfunction Complications related to the airway

11. MV: Weaning Readiness for weaning 1. Reversal or stability of the cause of ARF 2. Adequate gas exchange (PaO2/FiO2 > 150 - 200 at a PEEP-level 5 to 8 cmH2O and pH > 7.25) 3. Cardio-vascular stability 4. Ability to make an inspiratory effort (? minute ventilation, negative inspiratory force and maximal inspiratory pressure) 5. ? Others: stable heart rate, no fever, adequate Hb (>8-10 g/dL), and adequate mental state

12. MV: Spontaneous breathing trial (SBT) Method: T-tube, CPAP, or Low levels of PS (5 and 7 cmH2O) Duration: 30 -120 minutes Monitoring: ▫During the first few minutes rapid shallow breathing index (RR/VT) should be evaluated (<60-105 breaths/L= the patient is allowed to continue the SBT ) ▫Close observation (30 min): respiratory + cardio-vascular + patient’s comfort Successful completion (120 min) = !Successful weaning = ?! Extubation Failure to complete = Daily SBT (provided the patient continues to meet the criteria for attempting weaning) = Correction of cause of failure

13. MV: Modern ventilators Dual-control modes Adaptive Support Ventilation (ASV) Biphasic Positive Airway Pressure (BIPAP) Smart……..?!

14. Other modalities Non invasive ventilation Curass ventilator Extracorporial gas exchange

15. Best wishes dr_mmk2001@yahoo.com