To view this video please enable JavaScript, and consider upgrading to a web browser that Maximal Inspiratory Pressure < 60. "name": "Indications\/Symptoms", this can lead to hypoventilation or overexpansion of the lung. "width": "800" "width": "800" { The ventilator generates pressure support by adding flow to the circuit during patient-triggered breaths in IMV or SIMV modes. Mask-related issues.

"description": "", Better for younger, noncompliant lungs. Funding and insurance issues addressed. { Bronchoscopy. These are guidelines not rules. "@context": "http://schema.org", Nursing support arranged for nighttime. Nesreen El-Sayed Morsy Aly Thoracic Medicine Department, D. Sara Salarian,. "@type": "ImageObject", Disorders of control of respiration.

"name": "Control vs. SIMV SIMV Modes Control Modes", }, 42 "@context": "http://schema.org", Given in addition to vent breaths in IMV modes or alone without a set rate, mimicking BiPAP. ", BPD, cystic fibrosis. "contentUrl": "https://slideplayer.com/slide/5879828/19/images/20/Full+Ventilation+Noninvasive+or+invasive.jpg", Flow-cycled. Increased respiratory rate. "@type": "ImageObject", Titration Guidelines for CPAP, APAP and BiLevel Therapy Know your patient Titrate Successfully Pamela Minkley RRT, RPSGT, CPFT Make Sleep a Priority. "width": "800" "contentUrl": "https://slideplayer.com/slide/5879828/19/images/15/Tracheostomies+Shiley%2C+Bivona%2C+Portex+and+others.jpg", "contentUrl": "https://slideplayer.com/slide/5879828/19/images/14/Complications+of+NIV+Facial+and+orthodontic+changes.jpg", VOLUME-LIMITED Accept that changes in compliance may lead to increases in peak airway pressures and associated baro/volutrauma. "width": "800" "description": "SIMV Mode Most patients, improved comfort, stable CO2s", Provides inspiratory flow during inspiration, Given in addition to vent breaths in IMV modes or alone without a set rate, mimicking BiPAP, Pulse oximetry, Apnea monitor, Capnography, Goals and plans clarified with family and caregivers, Family and respite caregivers trained in the ventilation, clearance, prevention, evaluation and all equipment, Equipment lists developed and implemented with re-supply and funding addressed, Used more frequently when weaning/decannulating, Over 70% 10-year survival, most deaths due to underlying disease, In retrospective studies, 0-8% of deaths were ventilator or technology-related, Related to amount of care and support needed, Vary settings, interfaces, strategies to achieve goals of good health and optimized quality of life, Download ppt "Home Mechanical Ventilation". "@type": "ImageObject", Better daytime functioning. Assist Control Mode Can trigger breaths, but needs support with each breath ", Indications/CriteriaForced vital capacity < 50% predicted Maximal Inspiratory Pressure < 60 ABG pCO2 > 45 Moderate to severe sleep apnea ", Another scenario may be one in which you want to precisely control the PaCO2, as in hyperventilation for increased intracranial pressure. Better sleep quality. Cycles based on patient initiated breaths. ", }, 7 Pressure. "name": "Bilevel Mode Mimic BiPAP \/ No Backup Rate", "contentUrl": "https://slideplayer.com/slide/5879828/19/images/38/Discharge+Criteria+Presence+of+a+stable+airway+FiO2+less+than+40%25.jpg", "width": "800" 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 A patient may not be able to generate adequate tidal volumes for these reasons. "width": "800" "@type": "ImageObject", "description": "Pressure cycled or volume cycled. "@context": "http://schema.org", ", "description": "Tracheostomies", { "@context": "http://schema.org", "width": "800" "width": "800" "contentUrl": "https://slideplayer.com/slide/5879828/19/images/42/Outcomes+Dependent+on+underlying+disease.jpg", { 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. "contentUrl": "https://slideplayer.com/slide/5879828/19/images/28/Pressure+vs.+Volume+Pressure+Limited.jpg", "@type": "ImageObject", { "contentUrl": "https://slideplayer.com/slide/5879828/19/images/11/NIV%3A+Nasal+mask+%2F+Prongs.jpg",

Talking. A patient needs to generate a certain amount of work in order to trigger it. ", }, 32 ", "width": "800" "@type": "ImageObject", "width": "800" "name": "NIV: Nasal mask \/ Prongs", Used for severe sleep apnea, neuromuscular weakness or insufficiency. }, 37 ",

"width": "800" Another scenario may be one in which you want to precisely control the PaCO2, as in hyperventilation for increased intracranial pressure. Intermittently used to augment breathing. Freedom from active\/recurrent infection, fever, deterioration. "description": "Shortness of breath. "@context": "http://schema.org", "@context": "http://schema.org", Quality of Life Generally good Some stress for patients, caregiversFewer hospitalizations Better sleep quality Better daytime functioning Some stress for patients, caregivers Related to amount of care and support needed }, 14 "contentUrl": "https://slideplayer.com/slide/5879828/19/images/29/Pressure+vs.+Volume+Pressure+Pitfalls+Volume+Vitriol.jpg", Pressure sores, facial growth issues. Full Ventilation Noninvasive or invasivePressure cycled or volume cycled SIMV vs. AC Allows pressure support, PEEP, inspiratory time, flow to be added and manipulated "description": "Fewer hospitalizations. 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. "width": "800" "width": "800" "@type": "ImageObject", ", "description": "Cough. ", "@context": "http://schema.org", "name": "Pressure vs. Volume Pressure Pitfalls Volume Vitriol", "description": "Can\u2019t wean by decreasing rate. "@type": "ImageObject", { CPAP Continuous Positive Airway Pressure For simple sleep apneaStents open the airway Decreases work of breathing "@type": "ImageObject", Patient may hyperventilate if agitated. Chin strap may be needed. "@type": "ImageObject", Decreases work of breathing. "@context": "http://schema.org", Square wave pattern results in higher pressure delivered for same volume delivered, Tidal volume changes as patient compliance changes, Potential hypoventilation or overexpansion, Obstructed trach decreases delivered volume, Better control of oxygenation than ventilation, Better control of ventilation than oxygenation, Triggering 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. "description": "PCO2 safely maintained. "contentUrl": "https://slideplayer.com/slide/5879828/19/images/30/Pressure+vs.+Volume+Volume+No+limit+on+pressure+unless+set+Pressure.jpg", Under- or over-ventilation. "contentUrl": "https://slideplayer.com/slide/5879828/19/images/10/Noninvasive+interfaces.jpg", ", "name": "Home Mechanical Ventilation", "description": "Stents open the airway.

"name": "CPAP Continuous Positive Airway Pressure For simple sleep apnea", }, 30 "description": "Positive trend in weight gain\/maintenance and growth. 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" Whichever mode one chooses, one needs to be aware of the limitations of that mode. "description": "Variable airway resistance and\/or pulmonary or chest wall compliance better with volume settings. Accept that changes in compliance may lead to increases in peak airway pressures and associated baro\/volutrauma. Nocturnal use with daytime nasal mask. }, 25 "contentUrl": "https://slideplayer.com/slide/5879828/19/images/7/Indications%2FCriteria.jpg", "description": "Assist Control Mode Can trigger breaths, but needs support with each breath", "width": "800" Other medical conditions well controlled. "width": "800" an opening must be attempted in the trunk of the trachea, into which a tube of reed or cane should be put; you will then blow into this, so that the. Used more frequently when weaning\/decannulating. {

Better for older more compliant lungs. 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 { }, 38 "description": "Modes of ventilation. 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. "@context": "http://schema.org",

}, 41 "width": "800" { "contentUrl": "https://slideplayer.com/slide/5879828/19/images/21/Ventilator+Choice+Noninvasive+vs.+invasive+Portability+Battery+life.jpg", Patient \/ vent asynchrony possible and may need sedation +\/- paralysis. "name": "Home ventilation reality", Especially on exertion or lying down. "contentUrl": "https://slideplayer.com/slide/5879828/19/images/5/Indications+Inability+to+wean+from+mechanical+ventilation.jpg", "name": "Pressure vs. Volume Pressure Limited", In pressure modes, the tidal volume can drop resulting in hypoventilation or it can increase, leading to overdistention. { ", 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. 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. "@context": "http://schema.org",

"@type": "ImageObject", "name": "SIMV Mode Most patients, improved comfort, stable CO2s", "@type": "ImageObject",

"@context": "http://schema.org", "@context": "http://schema.org", Talking devices. "@type": "ImageObject", "name": "Patients Cardiopulmonary stability", "name": "Pressure vs. Volume Pressure control Set pressure, volume variable", }, 28 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. "description": "Cori Daines, MD. Disposable inner cannula models. "name": "Goals Extend the duration of life Enhance the quality of life", "@context": "http://schema.org", EPAP\u2014the expiratory positive airway pressure--CPAP. "description": "Bilevel Mode Mimic BiPAP \/ No Backup Rate", { 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. Mechanical Ventilation in the Neonate RC 290 CPAP Indications: Refractory Hypoxemia PaO2 Many hospitals use 50% as the upper limit before changing. "width": "800" Tracheostomies Shiley, Bivona, Portex and othersPediatric sizes mimic ETT IDs Neonatal, pediatric, adult and customized lengths Cuffed and uncuffed Disposable inner cannula models "@type": "ImageObject", "width": "800" "description": "Pulse oximetry, Apnea monitor, Capnography. }, 2 With volume modes, the peak pressure can increase, resulting in barotrauma if the pulmonary compliance worsens. { "name": "Continuing Assessment", "contentUrl": "https://slideplayer.com/slide/5879828/19/images/6/Indications%2FSymptoms.jpg", "description": "Family and respite caregivers trained in the ventilation, clearance, prevention, evaluation and all equipment. Patient takes own breaths between vent breaths. "width": "800" Morning headache and insomnia. Obstructed trach decreases delivered volume. Nasal pillows. "name": "Ventilators Leak can vary with sleep, position, and effort which is problematic with volume cycled ventilators. { "name": "Ventilators Pressure cycled vs Volume cycled", "width": "800" "contentUrl": "https://slideplayer.com/slide/5879828/19/images/3/Goals+Extend+the+duration+of+life+Enhance+the+quality+of+life.jpg", { Control modes are used when complete control over the patients ventilation and/or oxygenation is desired. "contentUrl": "https://slideplayer.com/slide/5879828/19/images/44/Home+ventilation+reality.jpg", Patients placed on control modes are often deeply sedated and may be given neuromuscular blockers. { }, 40 This is usually because the patients lung disease is significant enough that you that you wish to give maximal support. Complications Ventilator failure Tracheostomy issuesDecannulation, blockage, infection Mask-related issues Pressure sores, facial growth issues Under- or over-ventilation NIV: Full face mask Decreased leak DecreasedCough Talking Eating Increased risk of aspiration Nocturnal use with daytime nasal mask ", 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 ABG pCO2 > 45. Mechanical Ventilaton Ramon Garza III, M.D.. "name": "Supporting Equipment External support\u2014PEEP Alarms\/Monitoring", "@context": "http://schema.org", Patient takes own breaths in between (+\/- PS) Potential increased work of breathing. { SIMV Mode Most patients, improved comfort, stable CO2s 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 "contentUrl": "https://slideplayer.com/slide/5879828/19/images/35/Pressure+Support+Trigger+by+patient.jpg", }, 6 "@type": "ImageObject", With volume modes, the peak pressure can increase, resulting in barotrauma if the pulmonary compliance worsens. ATS Position Paper", "contentUrl": "https://slideplayer.com/slide/5879828/19/images/22/Ventilators+Pressure+cycled+vs+Volume+cycled.jpg", "name": "Control vs. SIMV CONTROL MODE SIMV MODE Every breath fully supported", { Modified over 7 years ago, 1 "@context": "http://schema.org", "description": "Setting capabilities. 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. }, 27 "description": "Ventilatory needs. Team approach necessary. Available with timed back-up rates. "name": "Indications\/Criteria", Pressure cycling limits ability to stack. Volume Vitriol. "@type": "ImageObject", Congenital central hypoventilation syndrome. Central or obstructive, apnea or hypopnea. VOLUME-LIMITED. Note that for the paralyzed patient there is no significant difference between assist control and SIMV. "name": "Discharge Criteria Goals and plans clarified with family and caregivers. ", Achieve normal growth and development. Accept that changes in compliance may lead to increases in peak airway pressures and associated baro/volutrauma. Mechanical Ventilation Tariq Alzahrani M.D Assistant Professor College of Medicine King Saud University.

PRESSURE-LIMITED. "@type": "ImageObject", Another scenario may be one in which you want to precisely control the PaCO2, as in hyperventilation for increased intracranial pressure.

"width": "800" }, 4 "@context": "http://schema.org",

{ Control vs. SIMV SIMV Modes Control ModesEvery breath is supported regardless of trigger Cant wean by decreasing rate Patient may hyperventilate if agitated Patient / vent asynchrony possible and may need sedation +/- paralysis SIMV Modes Vent tries to synchronize with pts effort Patient takes own breaths in between (+/- PS) Potential increased work of breathing Can have patient / vent asynchrony Control modes are used when complete control over the patients ventilation and/or oxygenation is desired. "@type": "ImageObject", NIV: Sipper /Lipseal MouthpieceDaytime use Allows facial freedom Flexed mouthpiece +/- custom orthodontics Intermittently used to augment breathing Continuously used "@type": "ImageObject", "contentUrl": "https://slideplayer.com/slide/5879828/19/images/12/NIV%3A+Full+face+mask+Decreased+leak+Decreased.jpg", We think you have liked this presentation. "@type": "ImageObject", This is usually because the patients lung disease is significant enough that you that you wish to give maximal support. { "name": "Ventilators", }, 10 { "@type": "ImageObject", Volume control. "contentUrl": "https://images.slideplayer.com/19/5879828/slides/slide_33.jpg", }, 15 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. Pressure support usually terminates when the flow in the circuit is 25% of the peak flow. New Modes in Mechanical Ventilation Manish Tandon Hartford Hospital July 10, 2013. "@context": "http://schema.org", }, 5 "contentUrl": "https://slideplayer.com/slide/5879828/19/images/34/Need+a+hand+Pressure+Support.jpg", "name": "NIV: Sipper \/Lipseal Mouthpiece", { "contentUrl": "https://slideplayer.com/slide/5879828/19/images/1/Home+Mechanical+Ventilation.jpg", Home Mechanical VentilationCori Daines, MD Pediatric Pulmonary Medicine Progressive chronic respiratory failure. "contentUrl": "https://slideplayer.com/slide/5879828/19/images/39/Discharge+Criteria+Goals+and+plans+clarified+with+family+and+caregivers..jpg", "@type": "ImageObject", "@type": "ImageObject", Can be given with spontaneous breaths in IMV modes or as stand alone mode without set rate. Note that for the paralyzed patient there is no significant difference between assist control and SIMV. 1 Pre-ICU Training CHEST Mechanical Ventilatory Support 2008/6/20. "@context": "http://schema.org", "@type": "ImageObject", }, 13 "description": "Decannulation, blockage, infection. "@type": "ImageObject", Related to amount of care and support needed. "@type": "ImageObject", "description": "Every patient is unique. 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 supports HTML5 video, Published byClyde Carpenter "width": "800" elsevier workbook ventilation 7th mechanical edition pilbeam vitalsource ebook isbn "contentUrl": "https://slideplayer.com/slide/5879828/19/images/36/Bilevel+Mode+Mimic+BiPAP+%2F+No+Backup+Rate.jpg", "description": "Triggering vent requires certain amount of work by patient. "contentUrl": "https://slideplayer.com/slide/5879828/19/images/2/Outline+Indications+Patients+Interfaces+Ventilators.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. Patients placed on control modes are often deeply sedated and may be given neuromuscular blockers. 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. Vent synchronizes to support patient effort, Patient takes own breaths between vent breaths, Can trigger breaths, but needs support with each breath, Most patients, improved comfort, stable CO2s, Still can influence ventilation somewhat (respiratory rate, PAP), Decelerating flow pattern (lower PIP for same TV), Still can influence oxygenation somewhat (FiO2, PEEP, I-time), 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. { "@context": "http://schema.org", "@type": "ImageObject", SIMV Modes. "name": "Quality of Life Generally good Some stress for patients, caregivers", BiPAP Pressure Support VentilationIPAPthe inspiratory positive airway pressureextra help when breathing in EPAPthe expiratory positive airway pressure--CPAP Cycles based on patient initiated breaths Available with timed back-up rates Used for severe sleep apnea, neuromuscular weakness or insufficiency 2022 SlidePlayer.com Inc. All rights reserved. "description": "tidal volume by change suddenly as patient\u2019s compliance changes. }, 31 "@context": "http://schema.org",

To compensate for this increase in the work of breathing, pressure support is given. 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

"name": "Tracheostomies", ", Interfaces Noninvasive vs. Invasive Age Cognitive ability Body habitusVentilatory needs Anticipated length of ventilation Family/patient preference To make this website work, we log user data and share it with processors. "description": "Better control of oxygenation than ventilation. Indications Disorders of the respiratory pumpNeuromuscular diseases, chest wall diseases, spinal cord injury Obstructive diseases of the airway Craniofacial abnormalities, hypotonia, obesity Parenchymal lung disease BPD, cystic fibrosis Disorders of control of respiration Congenital central hypoventilation syndrome



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