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ESSENTIALS OF VENTILATOR GRAPHICS

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Presentation on theme: "ESSENTIALS OF VENTILATOR GRAPHICS"— Presentation transcript:

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 Loop
VT 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)


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