1. MECHANICAL VENTILATION
Seyed Alireza Mahdavi

2. Ventilator settings

3. Ventilator settings Ventilator mode Respiratory rate
Tidal volume or pressure settings
Inspiratory flow
I:E ratio
PEEP
FiO2
Inspiratory trigger

4. CMV

5. A/CV

6. SIMV

7. Concepts and Modes of Mechanical Ventilation
Spontaneous
Breathing
Mechanical
Ventilation
CMV
Pressure
Time
SIMV
Pressure
Time
Bivent
Pressure
Time
APRV
Pressure
Time
CPAP
Pressure
Time

8. Positive End-expiratory Pressure (PEEP)
What is PEEP?
What is the goal of PEEP?
Improve oxygenation
Diminish the work of breathing
Different potential effects

9. PEEP What are the secondary effects of PEEP? Barotrauma
Diminish cardiac output
Regional hypoperfusion
NaCl retention
Augmentation of I.C.P.?
Paradoxal hypoxemia

10. Monitoring of the patient

11. Auto-PEEP or Intrinsic PEEP
What is Auto-PEEP?
Normally, at end expiration, the lung volume is equal to the FRC
When PEEPi occurs, the lung volume at end expiration is greater than the FRC

12. Auto-PEEP or Intrinsic PEEP
Why does hyperinflation occur?
Airflow limitation because of dynamic collapse
No time to expire all the lung volume (high RR or Vt)
Expiratory muscle activity
Lesions that increase expiratory resistance

14. Auto-PEEP or Intrinsic PEEP
Auto-PEEP is measured in a relaxed pt with an end-expiratory hold maneuver on a mechanical ventilator immediately before the onset of the next breath

15. Auto-PEEP or Intrinsic PEEP
Adverse effects:
Predisposes to barotrauma
Predisposes hemodynamic compromises
Diminishes the efficiency of the force generated by respiratory muscles
Augments the work of breathing
Augments the effort to trigger the ventilator

16. Different types of patient

17. COPD and Asthma Goals: Diminish dynamic hyperinflation
Diminish work of breathing
Controlled hypoventilation (permissive hypercapnia)

18. Diminish DHI
Why?

19. Diminish DHI How? Diminish minute ventilation Low Vt (6-8 cc/kg)
Low RR (8-10 b/min)
Maximize expiratory time

20. Diminish work of breathing
How:
Add PEEP (about 85% of PEEPi)
Applicable in COPD and Asthma.

21. Controlled hypercapnia
Why?
Limit high airway pressures and thus diminish the risk of complications

22. Controlled hypercapnia
How?
Control the ventilation to keep adequate pressures up to a PH > 7.20 and/or a PaCO2 of 80 mmHg

23. Controlled hypercapnia
CI:
Head pathologies
Severe HTN
Severe metabolic acidosis
Hypovolemia
Severe refractory hypoxia
Severe pulmonary HTN
Coronary disease

24. Restrictive Pattern Intrapulmonary: Intra-alveolar filling processes
Alterations in lung interstitium
Extrapulmonary
Pleural disease
Chest wall abnormalities
Neuromuscular disease

25. Management of Mechanical Ventilation
Volume
Pressure
I:E ratio
Mode

28. Thank You