1 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use.

2 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Chapter 26 Advanced Modes of Mechanical Ventilation

3 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Control Variable Control variables may include: –Pressure –Volume –Flow –Time

4 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Dual Control Within a Breath During dual control within a breath modes, the ventilator switches from pressure control to volume control. –Establish a high initial inspiratory flow and a taper in flow as the volume target is met.

5 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Dual Control Breath-To-Breath Allows the clinician to set a volume target, and the ventilator delivers pressure- controlled breaths attempting to achieve the desired target tidal volume –Pressure is adjusted in increments between breaths until the maximum pressure is reached or a set level below the upper pressure limit.

6 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Inverse Ratio Ventilation Ventilator modes in which the inspiratory phase is longer than the expiratory phase, exceeding 1:1 –Pressure controlled or volume controlled –Increase mean airway pressures to improve oxygenation in the acute respiratory distress syndrome (ARDS).

7 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Airway Pressure Release Ventilation (APRV) Form of continuous positive airway pressure (CPAP) with two distinct pressure levels –The clinician sets the high and low pressures, and the inspiratory times at each pressure level. –May result in less ventilator lung injury (VLI) –Allows spontaneous ventilation

8 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Intermittent Mandatory Ventilation (IMV) Allows spontaneous breathing between time triggered ventilator breaths –Pressure or volume controlled –Spontaneous breaths may also be augmented using pressure support

9 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Additional Mechanical Ventilation Modes Mandatory Minute Volume (MMV) Automatic Tube Compensation Proportional Assist Ventilation (PAV) Automode

10 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Patient Assessment and Monitoring Ventilation –Rapid shallow breathing index (RSBI) Oxygenation –Pulse oximetry, arterial blood sampling Cardiovascular –Heart rate, blood pressure, ECG Work of breathing –Physical inspection, observation

11 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Setting Ventilator Modes Airway Pressure Release Ventilation Automatic Tube Compensation Automode Synchronized Intermittent Mandatory Ventilation (SMIV) (continues)

12 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Setting Ventilator Modes (continued) Inverse Ratio Ventilation Pressure Regulated Volume Control (PRVC) Proportional Assist Ventilation Volume Support Ventilation (VSV)

13 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Hazards and Precautions Appropriate alarm settings and, when possible, backup ventilation settings are important to alert the clinician to adverse changes in the patient’s condition. –Minute ventilation, tidal volume, and low respiratory rate alarms