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    Vent Mechanics

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    Matteo Giza
    Mechanical ventilation provides positive pressure to the lungs to assist with ventilation and oxygenation. It aims to maintain adequate minute ventilation and oxygenation through settings like tidal volume, respiratory rate, fraction of inspired oxygen, and positive end-expiratory pressure. Key pressures measured include peak inspiratory pressure and plateau pressure. Common modes include assist-control ventilation and synchronized intermittent mandatory ventilation which provide both mandatory and spontaneous breaths.

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    Vent Mechanics

    Uploaded by

    Matteo Giza
    42 views6 pages
    Mechanical ventilation provides positive pressure to the lungs to assist with ventilation and oxygenation. It aims to maintain adequate minute ventilation and oxygenation through settings like tidal volume, respiratory rate, fraction of inspired oxygen, and positive end-expiratory pressure. Key pressures measured include peak inspiratory pressure and plateau pressure. Common modes include assist-control ventilation and synchronized intermittent mandatory ventilation which provide both mandatory and spontaneous breaths.

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    Mechanical ventilation provides positive pressure to the lungs to assist with ventilation and oxygenation. It aims to maintain adequate minute ventilation and oxygenation through settings like tidal volume, respiratory rate, fraction of inspired oxygen, and positive end-expiratory pressure. Key pressures measured include peak inspiratory pressure and plateau pressure. Common modes include assist-control ventilation and synchronized intermittent mandatory ventilation which provide both mandatory and spontaneous breaths.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    42 views6 pages

    Vent Mechanics

    Uploaded by

    Matteo Giza
    Mechanical ventilation provides positive pressure to the lungs to assist with ventilation and oxygenation. It aims to maintain adequate minute ventilation and oxygenation through settings like tidal volume, respiratory rate, fraction of inspired oxygen, and positive end-expiratory pressure. Key pressures measured include peak inspiratory pressure and plateau pressure. Common modes include assist-control ventilation and synchronized intermittent mandatory ventilation which provide both mandatory and spontaneous breaths.

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    Mechanical Ventilation

    Based on the Law of Motions: Pressure = (Resistance x Flow) + (Elastance x Volume)

    - Resistance: Increased in Asthma Exacerbation, Increases Pressure needed to overcome


    o [Driving pressure divided by flow (P/V)]
    - Elasticity: Decreased during ARDS due to stiffness, Increases Pressure Needed to overcome

    The total pressure generated by the Mech Vent is directly related to resistance and elastance

    Makes use of Positive Pressure

    - high compacted pressure that comes from the Mech Vent enters the trachea into the terminal
    airways eventually reaching the respiratory units the alveoli causing them to open causing active
    expansion of the lungs.

    Main Goals of Mechanical Ventilation

    - Assist with Minute Ventilation to remove CO2


    o MV = TV x RR
    - Provide FiO2 to maintain oxygenation with PEEP to maintain end expiratory lung volume
    (prevent collapse)
    o FiO2 = Fraction of Inspired Oxygen
    o PEEP = Positive End Expiratory Pressure

    ABG Monitoring

    - Ventilation: determined by Minute Ventilation and addresses PaCO2 and can alter pH
    - Oxygenation: determined by FiO2 and PEEP

    Ventilator Basic Terms

    Control (target) variables are targets that are set to a constant value. A couple of the variables that
    could be held constant are pressure or volume.

    Conditional variables are the dependent variables. For example, if volume is the controlled variable,
    pressure would be the conditional variable for ventilation.

    The trigger is the factor that initiates inspiration. A breath can be pressure triggered, flow triggered, or
    time triggered.

    The cycle is the determination of the end of a cycle, and the beginning of an exhalation. A ventilator can
    be volume, pressure, or time cycled.
    PULMONARY MECHANICS

    PEAK INSPIRATORY PRESSURE (PIP)

    - Highest pressure during any breath


    - Influenced by both Resistance and Compliance
    o Resistance: R = (PIP- Pplat) / (TV)
    o Normal airway resistance should be ≤ 5 cmH20

    PLATEAU Pressure (Pplat)

    - Measures COMPLIANCE
    o Compliance = (Delta Volume) / (Delta Pressure)
    o C = (TV) / (Pplat – PEEP)
    o Both Volume and Pressure can be changed in ventilator but will affect the other
    o Ex: Decreased Compliance due to stiffness with require Increased pressure to deliver
    even a smaller volume of oxygen
    - Determined during an inspiratory hold (no flow = no resistance)
    - Target Plateau of 30 or less
    Breath Timing

    The Respiratory Cycle is determined by frequency of Inspiration (active) and Expiration (passive)

    - To determine sufficient expiratory timing, use Inspiratory – Expiratory Ratio (I:E)


    o I:E ratio is not a concern until RR or frequency is > 20 bpm
    o When greater than 20 bpm, ensure I:E ratio is 1-2 or higher

    o Shows air trapping because expiratory flow is not reaching 0


    Hemodynamics

    Effects on Right Ventricle

    - Decreased PRELOAD due to decrease venous return


    - Increased AFTERLOAD due to increased pulmonary vascular resistance (expanded alveoli
    compress capillaries)

    Effects on Left Ventricle

    - Decreased PRELOAD
    - Decreased AFRERLOAD due to positive pressure exertion causing decrease in transmural
    pressure (pressure of vessels in the thorax)

    Mechanical Ventilation Indicators

    1) Peak Circuit Pressure (Ppeak) / Peak Inspiratory Pressure (PIP)


    o Highest proximal airway pressure achieved during inspiration
    2) Peak Mean Pressure (Pmean) / Plateau Pressure (Pplat)
    o Measures compliance or pressure of fully expanded alveoli after inspiration (no more
    flow)
    3) Peak End Expiratory Pressure (PEEP)
    o Pressure applied at the end of expiratory phase to keep alveoli from completely
    collapsing
    4) Inspiratory: Expiratory Ratio (I:E)
    o ratio between the length of time to inhale and exhale
    5) Total Respiratory Rate
    o Minimum amount of breaths patient will be allowed to take (programmed bet. 12 – 18)
    6) Expiratory Tidal Volume (Vte)
    - Amount of air the patient's lungs return to the ventilator with exhalation
    7) Expired Minute Volume
    - Amount of air that entered and exited the lungs in one minute

    Common Mechanical Ventilation Settings

    A. Volume Assist Control


    - Provides a consistent breath-to-breath tidal volume
    o Sets a consistent Tidal Volume to be delivered during each inspiration
     Triggered by either Ventilator or Patient
    - Two Types
    o Assist-Control Ventilation (AC mode)
     Otherwise known as Continuous Mandatory Ventilation (CMV)
     A set tidal volume is delivered after an inspiratory trigger either by the machine
    or the patient
     What you set: FiO2, Tidal Volume, Rate, PEEP
     There is a set minimum number of breaths to be taken in one minute
    (controlled breaths)
     If patient breaths above this set rate all spontaneous (“Assist”) breaths
    are fully supported with the standard Tidal Volume
     If below set rate, ventilator will initiate inspiration and provide Tidal
    volume
     If the patient makes an inspiratory effort, the ventilator senses a decrease in the
    circuit pressure and delivers the preset tidal volume.
     In this way, the patient can dictate a comfortable respiratory pattern
    and may trigger additional machine-assisted breaths above the set rate.
     If the patient does not initiate inspiration, the ventilator automatically
    delivers the preset rate and tidal volume, ensuring minimum minute
    ventilation.

    o Synchronized Intermittent Mandatory Ventilation (SIMV)


     Only set number of controlled breaths are supported
     If set number is 6 breaths and the patient initiates 12 inspirations, only 6
    cycles will be supported with the set Tidal Volume
     What you set: FiO2, Tidal Volume, Rate, PEEP
     The original intent of SIMV was to let the patient's respiratory muscles rest
    during the mandatory breaths and to work during the spontaneous breaths

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