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Nov 2003
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Ventilator Review
This review is geared specifically for those who work with the ventilators at VA Palo Alto, but
also includes information on other ventilators for those who work at other facilities. Emphasis
is on those ventilators and modes of ventilation that are considered the most current and
progressive.
Per VA Palo Alto policy, only RCP’s, Fellows, and Attending physicians can make changes or
adjustments to ventilator parameters. If a Fellow or Attending makes a change they must
notify the RCP immediately. This is due to the variety of ventilators currently on the market
and their very different functioning. Frequently changing one parameter will cause other
parameters to change as well, and which parameters are affected vary from ventilator to
ventilator, and mode to mode. Thus, the safety of the patient is at stake unless a practitioner
fully versed in the specific functioning of each ventilator is responsible for manipulations.
RCP’s receive the same minimum amount of schooling as RN’s, however, their educational
focus is the pulmonary system. RCP’s have several years of respiratory training with
emphasis on ventilator management for optimal patient outcomes, whereas Nursing is more
general, with an overview of all the systems. Both RN’s and RCP’s must pass rigorous
national board exams in addition to qualifying for individual state licensure.
Based on a study conducted by Indiana University, and verified as applicable in the state of California by the Respiratory Care
board, The "mean" time spent teaching "mechanical ventilation" is:
Modes of ventilation are developed and named by the ventilator manufacturer. This means
each ventilator can have a different name for the same mode of ventilation, or a similar mode
of ventilation. This can be especially troublesome for those who work at multiple facilities with
different ventilators in use.
The vent gives a set number of breaths at a set Vt. In between the patient can take breaths on their own at
whatever size tidal volume they want. The pressure it takes to deliver the set VT breaths is variable.
PC – Pressure control
The vent gives a set number of breaths at a set pressure. The Vt is variable – depending on how much air the
vent can push in with the set pressure amount. A decelerating waveform is used.
This mode is for spontaneous breathing. It gives a “boost” of pressure to help the patient’s spontaneous
breathing efforts. Typically this is used to help support the spontaneous breaths due to the extra work involved in
breathing through a small tube.
This is pressure that is always in the airway and is never fully exhaled to zero. So at the end of expiration there
is still a certain air pressure in the lungs. Leaving a certain amount of pressure in the lungs can prevent alveoli
units from completely closing on expiration. This helps with oxygenation status.
The same thing as peep, just a different name. The term CPAP is typically used when it is used completely
alone. The term peep is used when it is coupled with another mode of ventilation.
BIPAP, Bilevel positive airway pressure – European term, Dragers & PB 840
In this case the term is applied to using pressure control and pressure support together – you will frequently see
this usage in European studies and journals. However, PB 840 uses it to refer to APRV also, dependent upon
where you set the upper and lower pressure levels.
IPAP and EPAP – Inspiratory positive airway pressure and Expiratory positive airway pressure
Used exclusively with non-invasive ventilation. The IPAP would correspond to a Pressure support limit, and the
EPAP would correspond to PEEP. The IPAP is the maximum limit of pressure COMBINED with the PEEP,
instead of the amount of positive pressure delivered above the PEEP. So, and IPAP of 10 with an EPAP of 5,
would actually be equivalent to Pressure support of 5 with peep of 5.
AUTOFLOW – Only with Drager ventilators (also see detailed info at the end of this packet)
Two Features:
1. Allows synchronization with patient’s inspiratory and expiratory efforts. Decreases “fighting the vent”.
2. Allows you to set a Vt and deliver it at the very lowest possible pressure via a decelerating waveform (huge
benefit). This feature is referred to as PRVC – pressure regulated volume control, in Siemens Servo
ventilators.
3. Delivers each breath at the plateau pressure level – thus, what you see as the peak pressure reading is
actually the plateau pressure.
With autoflow, The patient can exhale and inhale at any point during the inspiratory or expiratory phase, so there
is complete synchrony. Without autoflow, the patient cannot do this, this causes fighting and ‘bucking’ the vent,
patient anxiety, the feeling of air hunger for the patient. Flow is variable to meet patient demand.
Control Panel
AutoFlow Volume
Ventilation
Pressure Control
Ventilation Flow Waveforms Standard Volume
Ventilation
Volume Ventilation
PIP
Pplateau
P
R
E AutoFlow
S delivers Vt
S
Without With
using the
AutoFlow AutoFlow Pplateau level
of pressure
F
L
O
W
*NOTE: If you see the “VOLUME NOT CONSTANT” alarm/message, it indicates that the PIP has reached 5 cm
H2O of the set pressure limit alarm. Transient decreases in minute ventilation may occur as Autoflow adapts to
these changes.