Basic Ventilator
Management
PPP Wan Mohd Firdaus Bin Omar
Jabatan Anaesthesiologi & ICU
Hospital Melaka
Table of Content
TOC Introduction
Modes of ventilator
Basic ventilator settings
Presentation title 2
Introduction
• Mechanical ventilation is required for airway protection and impending
or existing respiratory failure
• It is often used to fully or partially replace the functions of spontaneous
breathing by performing the work of breathing and gas exchange
• A predetermined mixture of air (ie: oxygen and other gases) is forced
into the central airways and then flows into the alveoli during
mechanical ventilation
3
Goals of Mechanical Ventilation
• Improve gas exchange
• Oxygenation- support Pao2/ Spo2
• Ventilation- maintain pH
• Patient comfort
• Relieve respiratory distress
• Facilitate weaning- minimize muscle loss, promote readiness to wean from support
4
Anatomy of Airways
5
Presentation title 6
Presentation title 7
Mechanic of Breathing
8
9
Composition of Inhaled Air
10
11
Type of Ventilation
MECHANICAL VENTILATION
Is a method to mechanically assist or
replacing spontaneous breathing by
providing positive pressure ventilation
(PPV) which involves pumping pressure
and flow into patient’s airway to effect the
O2 and CO2 transport to and from the
pulmonary capillary bed
13
Can be divide into two different type of
ventilation
- Non-Invasive Ventilation
- Invasive Ventilation
14
Types of Ventilation
Non-Invasive Ventilation Invasive Ventilation
CPAP Endotracheal Tube
BiPAP Tracheostomy Tube
15
Mode in Ventilator
Invasive Mode Ventilation
• Assist-Control Ventilation Volume Control
• Assist-Control Ventilation Pressure Control
• Pressure Support Ventilation (PSV)
• Synchronized Intermittent Mandatory Ventilation Volume Control (SIMV-
VC)
• Synchronized Intermittent Mandatory Ventilation Pressure Control (SIMV-
PC)
• Airway Pressure Release Ventilation (APRV)
• Adaptive Mechanical Ventilation (AMV) 17
Volume - Control vs Pressure - Control
18
Volume Control
•Set volume delivered with each breath
•Volume delivery fixed, pressure will vary depending upon pulmonary
compliance and airway resistance
•The advantage of volume control is the ability to regulate both tidal
volume and minute ventilation & precise control of Paco2
•Disadvantage: Potential for high airway pressures and acute lung injury
19
Pressure Control
•Involved selection of an inspiratory pressure for each mechanical breath
•Pressure remains constant, volume and minute ventilation may vary
with changes in the patient’s pulmonary compliance or airway resistance
•Advantage is of that the lungs can be protected from excessive pressures,
preventing ventilator induced lung injury
•Disadvantage : hypoventilation secondary to changes in lung compliance
and resistance
20
“ BASIC VENTILATOR
PARAMETERS
”
Basic Ventilator Parameters
• Mode of Ventilation
• Tidal Volume ( Vt )
• Frequency / Rate (RR / f)
• Fraction oxygen ( FiO2 )
• Positive End – Expiratory Pressure ( PEEP )
• Inspiration : Expiration Ratio ( I : E )
22
“ MODE OF VENTILATION
”
Frequently Use Mode of Ventilator during
Transfering Critically Ill Patient
• Assist-Control Ventilation Volume Control
• Assist-Control Ventilation Pressure Control
• Synchronized Intermittent Mandatory Ventilation Volume Control (SIMV-
VC)
• Synchronized Intermittent Mandatory Ventilation Pressure Control (SIMV-
PC)
24
Assist Control
• Vent allow patient to initiate a breath and then vent will deliver a pre-
set tidal volume when there is no respiratory effort from the patient
• Machine set at a minimum rate so apnea will not occur if patients does
not initiate a breath
• Minimal work of breathing and patient controls RR which help
normalize PaCO2
• Disadvantages:
• Hyperventilation if patient has increased respiratory rate ( can lead to
respiratory alkalosis)
25
SIMV
• Similar to A/C, but patients can take own breaths with their
own TV between mechanically assisted breaths
• Provides partial ventilator support
• Delivers a minimum number of supported breaths
synchronized with patient’s efforts
• Can be used as primary mode or a weaning mode
• SIMV= AC when patients are not breathing spontaneously
26
“ TIDAL VOLUME
”
TIDAL VOLUME
• Tidal volume (VT) is the volume of air delivered to lungs by mechanical
ventilator
• How deep or shallow you inhale and exhale
• Initial tidal volume is set between 6-8ml/kg of predicted body weight
• Inhalation is set for ventilator triggered breaths
• Exhalation is measured
• What goes in should come out
• Conditions that may require lower tidal volumes
• Increase of airway pressure requirement: ards, pulmonary edema
• Increase of lung compliance: emphysema
• Decrease of lung volume: pneumonectomy
28
PBW FORMULA
• Predicted body weight = Ideal body weight
• For male
Men IBW (kg) = 22 X ( height in meters ) 2
• For female
Women IBW (kg) = 22 X (height in meters – 10 cm ) 2
29
“ FREQUENCY / RATE
”
FREQUENCY / RATE
• The number of breaths per minute
• Adjusted based on patient’s respiratory rate
• The initial frequency is usually set at 16-20/min
• May be higher in patients with ARDS
32
“ FiO2
”
FiO2
• Amount of oxygen delivered to the patient
• Initial fio2 may be set at 100%
• Should be evaluated by means of abg after stabilization
• Should be adjusted accordingly to maintain a pao2 between 80-100mmHg
• After stabilization of the patient, the fio2 is best kept below 50% to avoid oxygen
induced lung injury
34
“ PEEP
”
PEEP
• Pressure given in expiratory phase to prevent alveoli from collapsing and allow
increased time for O2 exchange
• Reinflates collapsed alveoli and maintains alveolar inflation during exhalation
• Physiologic (normal)~ 5cm H20
• Helps drive oxygen across the alveolar capillary membrane to improve Sa02 and
PaO2
• ARDS treatment up to 15cm H20 and higher in patients with ARDS and covid-19
• Risk: Barotrauma, pneumothorax
36
“ I : E RATIO
”
I : E RATIO
• Is the ratio of duration of inspiratory time to expiratory time
• Usually kept in the range between 1:2 and 1:4
• A large i:e ratio
• Possibility of air trapping
38
Wan Mohamad Firdaus Bin
Thank you Omar
Jab Anestesiologi & ICU
Hospital Melaka