This document discusses analyzing ventilator waveforms to diagnose problems. It covers:
1) Different waveform patterns that indicate issues like airflow obstruction, starvation, and reverse triggering
2) Detection of small and large airflow obstruction using end-expiratory flow, auto-PEEP, and expiratory curve shape
3) Problem-solving approaches like checking circuits, tubes, bronchoscopy, changing tubes
4) Management strategies for different problems like increasing support, rates, volumes or switching modes.
This document discusses analyzing ventilator waveforms to diagnose problems. It covers:
1) Different waveform patterns that indicate issues like airflow obstruction, starvation, and reverse triggering
2) Detection of small and large airflow obstruction using end-expiratory flow, auto-PEEP, and expiratory curve shape
3) Problem-solving approaches like checking circuits, tubes, bronchoscopy, changing tubes
4) Management strategies for different problems like increasing support, rates, volumes or switching modes.
This document discusses analyzing ventilator waveforms to diagnose problems. It covers:
1) Different waveform patterns that indicate issues like airflow obstruction, starvation, and reverse triggering
2) Detection of small and large airflow obstruction using end-expiratory flow, auto-PEEP, and expiratory curve shape
3) Problem-solving approaches like checking circuits, tubes, bronchoscopy, changing tubes
4) Management strategies for different problems like increasing support, rates, volumes or switching modes.
This document discusses analyzing ventilator waveforms to diagnose problems. It covers:
1) Different waveform patterns that indicate issues like airflow obstruction, starvation, and reverse triggering
2) Detection of small and large airflow obstruction using end-expiratory flow, auto-PEEP, and expiratory curve shape
3) Problem-solving approaches like checking circuits, tubes, bronchoscopy, changing tubes
4) Management strategies for different problems like increasing support, rates, volumes or switching modes.
Dept of Intensive Care Alfred Hospital Melbourne, Australia
The Alfred Intensive Care Unit, Melbourne, Australia
1. Early-insp P (VCV, decel flow) Hi flow, small vol - P mainly flow & resistance
2. End-insp P VolHi Control: 12 x flow, max vol - P mainly Vt &450, Vi 50 compliance
3. Exp flow curve
Shallow curve – complete 1-2 sec
4. Pplat
4. auto-PEEP
The Alfred Hospital, Melbourne, Australia
Detection of Airflow Obstruction
1. Persisting end-expiratory flow
2. Auto PEEP
3. Expiratory flow curve shape
The Alfred Hospital, Melbourne, Australia
The Alfred Hospital, Melbourne, Australia The Alfred Hospital, Melbourne, Australia The Alfred Hospital, Melbourne, Australia Vol Control: 14 x 300, Vi 60
The Alfred Hospital, Melbourne, Australia
The Alfred Hospital, Melbourne, Australia P support 12
The Alfred Hospital, Melbourne, Australia
Auto-PEEP UNDERESTIMATES DHI • Airway closure during deflation 9 Auto-PEEP 9 • Most severely obstructed 1st 12 • Multiple high P, non-communicating units 16 • Auto-PEEP measures only Mean Palv 15 communicating units 22
Leatherman & Ravenscraft Crit Care Med 1996; 24: 541-6
The Alfred Hospital, Melbourne, Australia Detection of Airflow Obstruction
1. End-expiratory flow – easily missed
lowest flows = worst AO rate dependent 2. Auto PEEP – must think to do it often can’t be done underestimates problem
3. Exp curve shape – easily missed
no quantification
The Alfred Hospital, Melbourne, Australia
Vol Control: 12 x 450, Vi 50
90% N >80%
The Alfred Hospital, Melbourne, Australia
55% N >80%
The Alfred Hospital, Melbourne, Australia
PEV1 / Vt SD Error bars
>97% normal PEV1/Vt >80%
Good discrimination for mod-severe UAO & LAO
The Alfred (+ mild Hospital, UAO)Australia Melbourne, 72 yo M Known mild COPD
1 wk increasing SOB→fatigue , PCO2, drowsy
CXR unremarkable. Exacerbation COPD
Intubated, ventilated
The Alfred Hospital, Melbourne, Australia
The Alfred Hospital, Melbourne, Australia The Alfred Hospital, Melbourne, Australia The Alfred Hospital, Melbourne, Australia The Alfred Hospital, Melbourne, Australia Discrimination of Exp Flow Shapes
NORMAL LOWER AO UPPER AO
Triangular Deep CCC Horizontal (shallow curve) (concave curve) (or linear slope) >80% 1st sec <80% 1st sec <80% 1st sec N 90% Resistance ↑ Resistance as Lung Vol↓ constant
The Alfred Hospital, Melbourne, Australia
Routine ward round – sedated head injury 6 days
No ventilation problems
The Alfred Hospital, Melbourne, Australia
The Alfred Hospital, Melbourne, Australia Obstructed Waveform
3.Bronch – check it out (trach - remove inner cannula)
4.Change ETT
The Alfred Hospital, Melbourne, Australia
The Alfred Hospital, Melbourne, Australia The Alfred Hospital, Melbourne, Australia The Alfred Hospital, Melbourne, Australia The Alfred Hospital, Melbourne, Australia The Alfred Hospital, Melbourne, Australia Vol Control: 12 x 550, Vi 60
The Alfred Hospital, Melbourne, Australia
The Alfred Hospital, Melbourne, Australia Insp Flow (Vi) Starvation • Usually VCV decel flow – P dip mid-breath – P rise at end-breath when effort finished
Mx • Increase Vi – often decel shape doesn’t suit the patient - ✖︎
• Square wave flow – often this flow doesn’t suit patient - ✖︎
• P control, P supt, VC+ (or ≡) – usually works well, ± Vt↑↑ (?P-SILI)
• Increase support (reduce drive) - RR↑
The Alfred Hospital, Melbourne, Australia
Vol Control: 12 x 550, Vi 85
The Alfred Hospital, Melbourne, Australia
Vt 400 Vt Starvation
The Alfred Hospital, Melbourne, Australia
Vol Starvation • VCV only – P dip to end-breath ± spont breath immed after (Flow starvation also always present)
Mx • Increase Vt (match demand) – but often still flow starvation
