{ Volume Vitriol. { "@type": "ImageObject", "@context": "http://schema.org", Continuing AssessmentTitration sleep studies Blood gases Bronchoscopy Home monitoring Used more frequently when weaning/decannulating Indications Inability to wean from mechanical ventilationAfter and acute illness After prolonged ventilation for a chronic disease Progressive chronic respiratory failure Sleep disturbance Central or obstructive, apnea or hypopnea Patients placed on control modes are often deeply sedated and may be given neuromuscular blockers. Achieve normal growth and development. To make this website work, we log user data and share it with processors. }, 34 }, 43

Nocturnal use with daytime nasal mask. "@context": "http://schema.org", Talking. ", { "name": "Ventilators Pressure cycled vs Volume cycled", "@context": "http://schema.org", Sleep disturbance. "width": "800" "contentUrl": "https://slideplayer.com/slide/5879828/19/images/35/Pressure+Support+Trigger+by+patient.jpg", 2022 SlidePlayer.com Inc. All rights reserved. if ETT is obstructed acutely, delivered tidal volume will decrease. "description": "Assist Control Mode Can trigger breaths, but needs support with each breath",

Another scenario may be one in which you want to precisely control the PaCO2, as in hyperventilation for increased intracranial pressure. "contentUrl": "https://slideplayer.com/slide/5879828/19/images/22/Ventilators+Pressure+cycled+vs+Volume+cycled.jpg", Control modes are used when complete control over the patient\u2019s ventilation and\/or oxygenation is desired. "name": "Pressure vs. Volume Volume No limit on pressure unless set Pressure", "name": "Indications\/Criteria", "contentUrl": "https://slideplayer.com/slide/5879828/19/images/44/Home+ventilation+reality.jpg", Patient \/ vent asynchrony possible and may need sedation +\/- paralysis. "contentUrl": "https://slideplayer.com/slide/5879828/19/images/8/Patients+Cardiopulmonary+stability.jpg", ", Pressure. ", Better sleep quality. Home Mechanical VentilationCori Daines, MD Pediatric Pulmonary Medicine Thank you! "@context": "http://schema.org", Home considerations. "width": "800" "width": "800" "name": "Outline Indications Patients Interfaces Ventilators", Complications of NIV Facial and orthodontic changesAerophagia (PIP > 25 cmH2O) Nasal drying/congestion = humidify Volutrauma - air leak Inadequate ventilation "@type": "ImageObject", "description": "Positive trend in weight gain\/maintenance and growth. Obstructive diseases of the airway. "@type": "ImageObject", Related to amount of care and support needed. ", ", "description": "IPAP\u2014the inspiratory positive airway pressure\u2014extra help when breathing in. "description": "Over 70% 10-year survival, most deaths due to underlying disease. { }, 16 "@type": "ImageObject", "name": "Assist Control Mode Can trigger breaths, but needs support with each breath", "@context": "http://schema.org", "description": "Tracheostomies", Other medical conditions well controlled. control. "description": "Provides inspiratory flow during inspiration. Note that for the paralyzed patient there is no significant difference between assist control and SIMV. "contentUrl": "https://slideplayer.com/slide/5879828/19/images/36/Bilevel+Mode+Mimic+BiPAP+%2F+No+Backup+Rate.jpg", "width": "800" { { "width": "800" BPD, cystic fibrosis. Reduce overall health care costs. "contentUrl": "https://slideplayer.com/slide/5879828/19/images/37/Supporting+Equipment+External+support%E2%80%94PEEP+Alarms%2FMonitoring.jpg", "width": "800" "@context": "http://schema.org", The ventilator generates pressure support by adding flow to the circuit during patient-triggered breaths in IMV or SIMV modes. SIMV modes are used to wean patients; as you decrease the set rate, the patient will need to do more on their own to maintain normal blood gases. { { Discharge Criteria Presence of a stable airway FiO2 less than 40%PCO2 safely maintained Nutritional intake optimal Other medical conditions well controlled Above may vary if palliative care Mask-related issues. Regardless of the parameter that is controlled, the other must be monitored as it is a reflection of the compliance and hence the patient\u2019s pulmonary function. Continuously used. ", "contentUrl": "https://slideplayer.com/slide/5879828/19/images/42/Outcomes+Dependent+on+underlying+disease.jpg", Humidification. If you wish to download it, please recommend it to your friends in any social system. "width": "800" "@type": "ImageObject", { }, 20 "@type": "ImageObject", SIMV Modes. This is usually because the patient\u2019s lung disease is significant enough that you that you wish to give maximal support. Disposable inner cannula models. ", Set volume, pressure variable. "contentUrl": "https://slideplayer.com/slide/5879828/19/images/5/Indications+Inability+to+wean+from+mechanical+ventilation.jpg", Share buttons are a little bit lower. "width": "800" "@type": "ImageObject", A patient may not be able to generate adequate tidal volumes for these reasons. "width": "800" "description": "After and acute illness. SIMV modes are chosen when you want the patient to do as much work as they can tolerate and try to minimize the support from the ventilator. "description": "Setting capabilities. In control modes, if you decrease the rate, the patient\u2019s spontaneous efforts will be fully supported so you will not know how much of that particular tidal volume they are generating on their own. }, 41 Outcomes Dependent on underlying diseaseOver 70% 10-year survival, most deaths due to underlying disease In retrospective studies, 0-8% of deaths were ventilator or technology-related Occasional hospitalization Still can influence oxygenation somewhat (FiO2, PEEP, I-time) Square wave flow pattern. ", Under- or over-ventilation. Used for severe sleep apnea, neuromuscular weakness or insufficiency. Noninvasive interfacesNasal masks Full facemasks Nasal pillows Sipper mouthpiece Lipseal/mouthpiece device ", Note that for the paralyzed patient there is no significant difference between assist control and SIMV. Can decrease work of breathing by providing flow during inspiration for patient triggered breaths. The ventilator generates pressure support by adding flow to the circuit during patient-triggered breaths in IMV or SIMV modes. { In pressure modes, the tidal volume can drop resulting in hypoventilation or it can increase, leading to overdistention. { { Increased risk of aspiration. tidal volume by change suddenly as patients compliance changes, this can lead to hypoventilation or overexpansion of the lung, if ETT is obstructed acutely, delivered tidal volume will decrease, no limit per se on PIP (usually vent will have upper pressure limit), square wave(constant) flow pattern results in higher PIP for same tidal volume as compared to Pressure modes. Restlessness and anxiety. The ventilator generates pressure support by adding flow to the circuit during patient-triggered breaths in IMV or SIMV modes. Above may vary if palliative care. Nesreen El-Sayed Morsy Aly Thoracic Medicine Department, D. Sara Salarian,. ", "contentUrl": "https://slideplayer.com/slide/5879828/19/images/20/Full+Ventilation+Noninvasive+or+invasive.jpg", }, 32 ", "width": "800" After prolonged ventilation for a chronic disease. "@context": "http://schema.org",

"width": "800"

"name": "Bilevel Mode Mimic BiPAP \/ No Backup Rate", Outcomes. "description": "Pressure cycled or volume cycled. Accept that changes in compliance may lead to increases in peak airway pressures and associated baro\/volutrauma. O 2 RESPIRATORY TO BREATHE OR NOT TO BREATHE, THAT IS OUR QUESTION! Goals Extend the duration of life Enhance the quality of lifeReduce morbidity Improve physiologic function Achieve normal growth and development Reduce overall health care costs Cuffed and uncuffed. Pressure vs. Volume Pressure LimitedControl FiO2 and MAP (oxygenation) Still can influence ventilation somewhat (respiratory rate, PAP) Decelerating flow pattern (lower PIP for same TV) Volume Limited Control minute ventilation Still can influence oxygenation somewhat (FiO2, PEEP, I-time) Square wave flow pattern PRESSURE-LIMITED I would not say that I have limited ability to affect ventilation in PC, though I may choose to increase the PAP recognizing that I accept the potential for increased baro/volutrauma at the same time I also accept that I may suffer a decrease in ventilation with changes in compliance. "description": "Reduce morbidity. Blood gases. { Better daytime functioning. }, 42 In retrospective studies, 0-8% of deaths were ventilator or technology-related. Accept that changes in compliance may lead to increases in peak airway pressures and associated baro/volutrauma. "@type": "ImageObject", Nasal bridge pressure with mask. ", "description": "Control FiO2 and MAP (oxygenation) Still can influence ventilation somewhat (respiratory rate, PAP) Decelerating flow pattern (lower PIP for same TV) Volume Limited. { }, 33 "description": "Decannulation, blockage, infection. Potential hypoventilation or overexpansion. Talking devices. This is usually because the patients lung disease is significant enough that you that you wish to give maximal support. To compensate for this increase in the work of breathing, pressure support is given. "contentUrl": "https://slideplayer.com/slide/5879828/19/images/4/Indications+Disorders+of+the+respiratory+pump.jpg", Control vs. SIMV CONTROL MODE SIMV MODE Every breath fully supportedCant wean by decreasing rate Risk of hyperventilation if agitated SIMV MODE Vent synchronizes to support patient effort Patient takes own breaths between vent breaths Increased work of breathing vs. control "@type": "ImageObject", "@context": "http://schema.org", "width": "800" Allows pressure support, PEEP, inspiratory time, flow to be added and manipulated. Discharge Criteria Goals and plans clarified with family and caregivers Family and respite caregivers trained in the ventilation, clearance, prevention, evaluation and all equipment Nursing support arranged for nighttime Equipment lists developed and implemented with re-supply and funding addressed Funding and insurance issues addressed ", "name": "NIV: Nasal mask \/ Prongs", { Inadequate ventilation. Whichever mode one chooses, one needs to be aware of the limitations of that mode. { "@context": "http://schema.org", "description": "Fewer hospitalizations. "@type": "ImageObject", Risk of hyperventilation if agitated. Need a hand?? "@context": "http://schema.org", "contentUrl": "https://slideplayer.com/slide/5879828/19/images/1/Home+Mechanical+Ventilation.jpg", "contentUrl": "https://slideplayer.com/slide/5879828/19/images/19/BiPAP+Pressure+Support+Ventilation.jpg", Increasing peak pressures on volume mode (or decreasing tidal volumes in pressure modes) can also be a sign that the ETT is obstructed or of another problem with the ventilator circuit. "name": "Supporting Equipment External support\u2014PEEP Alarms\/Monitoring", We think you have liked this presentation. { "description": "Daytime use. "description": "PCO2 safely maintained. Pressure SupportTriggering vent requires certain amount of work by patient Can decrease work of breathing by providing flow during inspiration for patient triggered breaths Can be given with spontaneous breaths in IMV modes or as stand alone mode without set rate Flow-cycled A patient needs to generate a certain amount of work in order to trigger it. Pressure sores, facial growth issues. "contentUrl": "https://slideplayer.com/slide/5879828/19/images/17/Ventilators.jpg",

Patients placed on control modes are often deeply sedated and may be given neuromuscular blockers.

Supporting Equipment External supportPEEP Alarms/MonitoringPulse oximetry, Apnea monitor, Capnography Humidification External w/ heater, HME Airway clearance Suctioning, Vest, cough assist Talking devices This is usually because the patients lung disease is significant enough that you that you wish to give maximal support. "contentUrl": "https://slideplayer.com/slide/5879828/19/images/25/Control+vs.+SIMV+CONTROL+MODE+SIMV+MODE+Every+breath+fully+supported.jpg", "contentUrl": "https://slideplayer.com/slide/5879828/19/images/34/Need+a+hand+Pressure+Support.jpg", Sipper mouthpiece. "description": "Triggering vent requires certain amount of work by patient. "contentUrl": "https://slideplayer.com/slide/5879828/19/images/31/Pressure+vs.+Volume+Pressure+control+Set+pressure%2C+volume+variable.jpg", Anticipated length of ventilation. ", "description": "Variable airway resistance and\/or pulmonary or chest wall compliance better with volume settings. "@type": "ImageObject", "name": "Outcomes Dependent on underlying disease", Family\/patient preference. "contentUrl": "https://slideplayer.com/slide/5879828/19/images/24/Control+vs.+SIMV+SIMV+Modes+Control+Modes.jpg", "width": "800" SIMV modes are used to wean patients; as you decrease the set rate, the patient will need to do more on their own to maintain normal blood gases.

"width": "800" NIV: Sipper /Lipseal MouthpieceDaytime use Allows facial freedom Flexed mouthpiece +/- custom orthodontics Intermittently used to augment breathing Continuously used Pressure vs. Volume Volume No limit on pressure unless set PressureSquare wave pattern results in higher pressure delivered for same volume delivered Pressure Tidal volume changes as patient compliance changes Potential hypoventilation or overexpansion Obstructed trach decreases delivered volume Vent synchronizes to support patient effort. "@context": "http://schema.org", These are guidelines not rules. Control minute ventilation. "width": "800" To compensate for this increase in the work of breathing, pressure support is given. "description": "Cori Daines, MD. "description": "Forced vital capacity < 50% predicted. { "@type": "ImageObject", "width": "800" Nov 2006 Kishore P. Critical Care Conference Improve oxygenation Increase/maintain minute ventilation and help CO 2 clearance . "@type": "ImageObject", This does not make it easier for the patient to trigger the ventilator but it does help the patient generate larger tidal volumes. Control modes are used when complete control over the patients ventilation and/or oxygenation is desired. "name": "CPAP Continuous Positive Airway Pressure For simple sleep apnea",

"width": "800" Pressure vs. Volume Pressure control Set pressure, volume variableBetter control of oxygenation than ventilation Better for younger, noncompliant lungs Volume control Set volume, pressure variable Better control of ventilation than oxygenation Better for older more compliant lungs }, 35 Equipment lists developed and implemented with re-supply and funding addressed. In pressure modes, the tidal volume can drop resulting in hypoventilation or it can increase, leading to overdistention. SIMV MODE. SIMV modes are used to wean patients; as you decrease the set rate, the patient will need to do more on their own to maintain normal blood gases. { }, 40 }, 17 ", "contentUrl": "https://slideplayer.com/slide/5879828/19/images/41/Complications+Ventilator+failure+Tracheostomy+issues.jpg", "width": "800" { ", "@type": "ImageObject",

Note that for the paralyzed patient there is no significant difference between assist control and SIMV. { A patient needs to generate a certain amount of work in order to trigger it. "@type": "ImageObject", }, 25 "width": "800" Mechanical Ventilation Tariq Alzahrani M.D Assistant Professor College of Medicine King Saud University. "@context": "http://schema.org", "description": "Better control of oxygenation than ventilation. "@context": "http://schema.org", Moderate to severe sleep apnea. Ventilators Pressure cycled vs Volume cycledPressure cycled are often triggered by flow sensing reducing work of breathing Flow sensing is also important in pts with high respiratory rates = infants/toddlers Another scenario may be one in which you want to precisely control the PaCO2, as in hyperventilation for increased intracranial pressure. VOLUME-LIMITED. "name": "SIMV Mode Most patients, improved comfort, stable CO2s", "name": "Noninvasive interfaces", "@context": "http://schema.org", }, 26 "@context": "http://schema.org", Pressure support usually terminates when the flow in the circuit is 25% of the peak flow. Neonatal, pediatric, adult and customized lengths.

Progressive chronic respiratory failure. Vent tries to synchronize with pt\u2019s effort. Hope Knight BSN, RN. ", Complications Ventilator failure Tracheostomy issuesDecannulation, blockage, infection Mask-related issues Pressure sores, facial growth issues Under- or over-ventilation "name": "Discharge Criteria Goals and plans clarified with family and caregivers. "name": "Patients Cardiopulmonary stability", Additionally, a patient has to breathe through an ETT that is almost always narrower than their own airway and ventilate the increased dead space imposed by the vent circuit. Home ventilation realityEvery patient is unique These are guidelines not rules Vary settings, interfaces, strategies to achieve goals of good health and optimized quality of life Team approach necessary "name": "", Modified over 7 years ago, 1 Ventilators Leak can vary with sleep, position, and effort which is problematic with volume cycled ventilators Variable airway resistance and/or pulmonary or chest wall compliance better with volume settings Pressure cycling limits ability to stack "width": "800" "contentUrl": "https://slideplayer.com/slide/5879828/19/images/9/Interfaces+Noninvasive+vs.+Invasive+Age+Cognitive+ability+Body+habitus.jpg", "@type": "ImageObject", "name": "Complications of NIV Facial and orthodontic changes", ", }, 27 Better control of ventilation than oxygenation. "contentUrl": "https://slideplayer.com/slide/5879828/19/images/27/SIMV+Mode+Most+patients%2C+improved+comfort%2C+stable+CO2s.jpg", "@type": "ImageObject", Regardless of the parameter that is controlled, the other must be monitored as it is a reflection of the compliance and hence the patients pulmonary function. Patients Cardiopulmonary stabilityPositive trend in weight gain/maintenance and growth Stamina for play or daily activities while ventilated Freedom from active/recurrent infection, fever, deterioration ATS Position Paper 1990 "@type": "ImageObject", { Parenchymal lung disease. "description": "Titration sleep studies. Especially on exertion or lying down. "name": "Pressure vs. Volume Pressure Limited", Interfaces Noninvasive vs. Invasive Age Cognitive ability Body habitusVentilatory needs Anticipated length of ventilation Family/patient preference "contentUrl": "https://images.slideplayer.com/19/5879828/slides/slide_33.jpg",

NIV: Nasal mask / ProngsMany older patients prefer compared to mouthpiece Problems: Leak, especially mouth Nasal bridge pressure with mask Gum erosion or compression with mask Nasal erosion with prongs Chin strap may be needed "@context": "http://schema.org", "width": "800" Nasal erosion with prongs. Indications Airway instability Most surgical patients or trauma Primary Respirator Failure Mostly medical. "contentUrl": "https://slideplayer.com/slide/5879828/19/images/6/Indications%2FSymptoms.jpg",