1. 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

2. 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.

3. Mechanical Ventilation
SCALARS
LOOPS
Graphics

4. SCALARS
Flow/Time
Pressure/Time
Volume/Time

5. LOOPS
Pressure-Volume
Flow-Volume

6. SCALARS
Flow/Time
Pressure/Time
Volume/Time

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

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

9. Typical Flow Patterns
SQUARE
DECELERATING
ACCELERATING
SINE

10. 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

11. 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

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

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

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

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

16. SCALARS
Flow/Time
Pressure/Time
Volume/Time

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

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

19. Active Exhalation
Volume (ml)
Time (sec)

20. SCALARS
Flow/Time
Pressure/Time
Volume/Time

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

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

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

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

25. Assisted vs Controlled
Pressure (cmH20)
Time (sec)

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

27. 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

28. 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

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

30. 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)

31. 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)

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

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

34. LOOPS
Pressure-Volume
Flow-Volume

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

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

37. Components of Pressure-Volume LoopVT
Expiration
Volume (mL)
Inspiration
PIP
Paw (cm H2O)

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

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

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

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

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

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

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

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

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

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

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

49. LOOPS
Pressure-Volume
Flow-Volume

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

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

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

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

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

55. Modes of Ventilation Mechanical Spontaneous Volume Targeted Pressure

56. Modes of Ventilation Mechanical Spontaneous Volume Targeted Pressure

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

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

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

60. 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)

61. Modes of Ventilation Mechanical Spontaneous Volume Targeted Pressure

62. 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)

63. 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)

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

65. 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)

66. 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)

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

68. 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

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

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

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