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MV New Modes - NEWER VENTILATORY MODES RATIONALE RATIONALE...

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NEWER VENTILATORY MODES: RATIONALE & CLINICAL APPLICATION Dr. SACHIN KUMAR SENIOR RESIDENT PULMONARY & CRITICAL CARE
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EVOLUTION OF MECHANICAL VENTILATORS VOLUME CONTROL PRESSURE CONTROL/ SUPPORT DUAL MODE
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Classifying Modes of Ventilation A S A. Start Trigger mechanism: h h b h? What starts the breath? B. Limits What is controlled and what is variable? C. End Cycle mechanism: What causes the breath to end?
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Targeting Control Target Flow Time Volume t l Pressure Pressure control Volume
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Targeting Control Target Flow Time Time cycled Pressure Pressure pressure control Volume
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Targeting Control Target Flow Time Pressure Pressure Volume Volume targeted pressure control
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Microprocessor Control Microprocessor solenoid Tidal volume 500 ml Pressure 3500 cm H 2 0 Pressure 35 cm H 2 0
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New Modes of Mechanical Ventilation: Background d f h Introduction of the microprocessor controlled ventilator Better control of flow & exhalation valves Increased monitoring capabilities Increased pt ventilator interaction Increased pt ventilator interaction “Dual modes” of ventilation introduced From Mosby’s R. C. Equip., 6th ed. 1999.
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The Problem: Conventional Ventilation Ideal Mode of Ventilation Delivers a breath that: Synchronizes with the ti t’ t patient’s spontaneous respiratory effort Maintains adequate and consistent tidal volume and minute ventilation at low airway pressures Responds to rapid changes inpulmonary mechanics or patient demand Provides the lowest possible WOB
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Why new modes? C i l d f bl Conventional modes are uncomfortable Need for heavily sedation & paralysis Patients should be awake and interacting with the ventilator To enable patients to allow spontaneous breath on inverse ratio ventilation Lung protective ventilation : VILI Scientific jargon : Number of studies on ventilatory modes exceed the number of patients treated !
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VOLUME VS PRESSURE VOLUME CONTROL PRESSURE CONTROL
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Newer Methods of Ventilatory Support: dual modes 1st generation dual modes: VAPS, Press. Aug., PRVC & VS Allow variable flow delivery and pressure “targeted” ventilation approach targeted ventilation approach Attempt to deliver a set tidal volume (TV) All k i t b th t Allow peak airway pressure to vary breath to breath
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New Modes of Mechanical Ventilation: Examples of the first dual modes Volume Assured Pressure Support (VAPS) & Pressure Augmentation Pressure Regulated Volume Control (PRVC) & similar modes Volume Support Ventilation (VS or VSV) & similar modes
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VAPS : V olume A ssured P ressure S upport Combines volume ventilation & pressure support (for mech., vol. limited breaths only) Uses TV, peak flow, and pressure sup./control settings Targets PS level with at least set peak flow first Continues until flow decreases to set peak flow, then: If TV not delivered, peak flow maintained until vol. limit If TV or more delivered breath ends If TV or more delivered, breath ends
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