Ventilation Modes - New Modes of Ventilation Dr. Zia Hashim...

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New Modes of Ventilation Dr. Zia Hashim
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Mode z Describes the specific combination of: ¾ control ¾ phase ¾ conditional variables z Defined for ¾ spontaneous ¾ mandatory breaths
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Variable z Control variable : Constant throughout inspiration, regardless of changes in respiratory impedance z Trigger variable : For initiating a breath. z Limit variable : Constant throughout inspiration but does not result in the termination of inspiratory time z Cycle variable : Causes inspiration to end z Conditional variable : results in a change in output
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What controls the adjustments? Volume? (flow control) Pressure?
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Targeting Control z Flow z Pressure Target z Time z Pressure z Volume Volume control
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Targeting Control z Flow z Pressure Target z Time z Pressure z Volume Time-cycled pressure control
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Targeting Control z Flow z Pressure Target z Time z Pressure z Volume Volume targeted pressure control
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Pressure 3500 cm H 2 0 Microprocessor Control I n h a la t i o v l e ( r s ) solenoid Microprocessor x le Tidal volume 500 ml Pressure 35 cm H 2 0
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Goals of Mechanical Ventilation z Avoiding extension of lung injury, z O 2 toxicity z Recruiting alveoli by mean Paw by PEEP and/or prolonging inspiration, z Peak Paw z Preventing atelectasis z Using sedation and paralysis judiciously z Better Patient-Ventilator synchrony
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z Volutrauma z Atelectrauma: Even the best possible lung protective strategy may cause injury to some of lung units (due to heterogenous involvement) z Barotrauma z Biotrauma: majority of deaths in ARDS are not because of oxygenation failure but because of MODS
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Lung Protective Strategy z Prevention of overdistension related lung injury by avoiding high transpulmonary pressure z The “open lung” concept: recruitment & maintenance of lung volume z Reduction of FiO 2
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Volume Control: Advantages z Guaranteed tidal volume VT is constant even with variable compliance and resistance. z Less atelectasis compared to PC z VT increase is associated with a linear increase in minute ventilation
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Volume Control: Disadvantages z The limited flow available may not meet the patient’s desired inspiratory flow rate z If the patient continues to inspire vigorously Patient Vent Asynchrony: WOB fatigue z In LPV Acute hypercapnia →↑ WOB z Can cause airway pressure leading to barotrauma, volutrauma, & adverse hemodynamic effects
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Pressure Control: Advantage z Increases mean airway pressure by constant inspiratory pressure. z Limits excessive airway pressure z Improves gas distribution z WOB
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Disadvantage of Pressure Control z Variable VT as pulmonary mechanics change z Potentially excessive VT as compliance improves z Inconsistent changes in VT with changes in PIP and PEEP
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Is Pressure Control Really Better ? z
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Ventilation Modes - New Modes of Ventilation Dr. Zia Hashim...

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