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Resp 2.7 III

basic ventilator PP

Mode How we deliver the breath. How the machine will deliver insp and create expiratory
sensitvity determine ease with which pt can begin inspiration (flow or pressure sensitivity)
Inverse IE ratio pt usually sedated
PIP Peak inspiratory pressure/ MIP Pressure that is required to deliver the set volume on the ventilator. (HOW MUCH PRESSURE YOU NEED TO VENTILATE THE LUNG)
MAP mean airway pressure average airway pressure over a resp cycle an increase in MAP helps with oxygenation. You use it if there is to much dead space (to much pressure)
Negative pressure Creates a negative extrathoracic pressure
Positive pressure creates a positive intrapulmonary pressure
Internal circuit pathway for air inside the machine
external circuit has exhaltion valve which functions to direct the flow of the gas to the pt wye.
External circuit will not function properly without a exhalation valve, machine would not deliver a positive pressure breath
Assist pt initiates all breaths (machine is not set to deliver timed breaths)
control machine is set to deliver ALL breaths based on time, pt CANNOT take assisted breaths
What makes the ventilator begin a breath for the pt time, pressure, flow, volume triggers
Flow triggering used instead of pressure triggering, more senstive to pt effort. Decreased WOB, base flow rate is set through the pt circuit., as pt reduces that flow by an amount (trigger flow) machine delivers pt breath.
The variable that is measured and used to end expiration cycle variable
Pressure cycled inspiration ends when a pre set pressure is reached. pressure stays constant
Volume cycled inspiration ends when a pre set volume is delivered. Volume and flow are constant. Needs to hit Vt to exhale
Time cycled inspiration ends when a set time expired. Pressure is constant.
What effects expiratory time flow, rate, volume
Flow cycled inspiration ends when a min flow is met. Breath in and when you are filled that flow drops (stops) and makes you exhale
Pressure limited/time cycled allows the therapist to preset peak airway pressure and insp ends due to the set time. Tidal volume is variable depending on total system resistance and compliance
How pressure limited/time cycled works ventilator adjusts flow to meet set pressure, flow is tapered or decreased,
IE ratio limit prevents the ventilator from delivering breaths with an IE ratio of less than 1:1
Pressure limit sets a maximum inp pressure that can be delivered to the pt. Stops inspiration, (SAFETY PRESSURE LIMIT WE SET)
Inflation hold (plateau) at peak insp, holds the pressure or volume for a period of time, increase IE ratio.
Pressure limiting relief valve alarm Releases any pressure in the system by venting any volume remaining (ALLOWS VOLUME TO ESCAPE)
PEEP on expiration, pressure is held at an elevated baseline above atmosphere, WORKS BY INCREASING FRC. (RAISE BASELINE,OPENS AIRWAY)
CPAP when used on ventilator, it is same as PEEP except that the pt must be taking only SPONTANEOUS breaths.
Assist/control use when pt is breathing some on their own but not effiecient enough
assist pt must be initiating breaths on their own
control pt cannot initiate breath on their own
IMV/SIMV pt must be breathing spontaneously, used as weaning mode
Pressure support affects spontaneous breath only, used with SIMV or CPAP mode
Pressure control pressure limited, time cycled (USE PRESSURE LIMIT THAT PRESSURE AND TIME CYCLES IT OFF)
IMV ventilator is set to deliver a specific # of breaths at a set volume. In btwen the set # of breaths the pt can take as many additional OWN breaths as they want (whatever volume they get is what they get)
SIMV same as IMV but if pt has started to take OWN breath and it's time for a machine breath the machine will wait and allow pt to take control. (will not stack breaths)
CMV continous mandatory ventilation assist/control mode on some ventilators, each breath delivered to the pt is at the volume set on the machine
PSV pressure support ventilation NO SET, pt has control of RR and volume. FLow is provided at a level necessary to acheive the set pressure. Pressure is then maintained throughout inspiration. Machine cycles off when flow delivered slows down.
IN PSV what effects volume muscle, pressure, flow, compliance and resistance
Flow cycled on PSV machine cycles off when flow slows
Pressure limited on PSV will not go above pressure set
Assisted ventilation on PSV breath only happens when pt triggers machine
On PSV when breath starts it helps push up until it drops (flow drops)
Levels of 7 and below overcome airway resistance and make breathing easier. They will be getting that volume on their own
Levels of 7 and above can add to spontanous tidal volume
Goal of pressure support PSV overcome airway resistance, increase until WOB decreases and ventilatory pattern improves
If you increase pressure you will get close to volume that is set
How does PSV help pt Decrease WOB, increase spontaneous tidal volume, can decrease RR, increase Vt, reduces resp muscle activity, can decrease oxygen consumption (how body is using it)
Pt not breathing on their own (spontaneously) or not strong enough to initiate an assisted breath Use assit/control or CMV
Pt strong enough to assist ventilator in assist/control use SIMV
If pt's tidal volume is large but has low PaO2 use PEEP or CPAP
Pt strong enough to assist ventilator but has low Vt in spontaneous breaths use PSV
When oxygenation is poor and pressure control does not work try inverse ratio ventilation
The key to selecting flow pattern is to select the one that will best ventilate the pt, low peak airway pressure, low mean airway pressure, IE ratio of at least 1:2 or less
On Volume cycled ventilators if you increase the flow decrease I time/increase E time
On volume cycled ventilators if you decrease the flow increase I time/decrease E time
If you increase the volume increase I time/ decrease E time
if you decrease the volume decrease I time/ increase E time
If you the pt fights the machine work of breathing will increase
Created by: TnJFarrington12