Ventilator graphics and waveforms

What can we learn?

Anton van Kaam, MD, PhD

Emma Children’s Hospital
Academic Medical Center
Amsterdam, The Netherlands
Neonatal ventilators
The start: just settings
Neonatal ventilators
And then: numbers
 Neonatal ventilators
And then: some basic graphics
Neonatal ventilators
And now: lots of graphics!
 Neonatal ventilators
And now: lots of graphics, but….
 Ventilator graphics
…...
• Ventilator waveforms (vs time):
– Pressure waveform
– Flow waveform
– Volume waveform
• Ventilator loops
– Pressure-volume loop
– Flow-volume loop
 Ventilator graphics
Pressure waveform

PIP PEEP Rise Plateau

Ti Te

Red = inspiration
Blue = expiration
 Ventilator graphics
Pressure waveform: MAwP
Pressure (cm H2O)

1
20
4
1. Increase PIP
2. Increase PEEP
3 3. Increase I-time
10 4. Increase flow

Ti Te Ti
Time (sec)
Ventilator graphics
Pressure waveform
Ventilator graphics
Flow waveform
Ventilator graphics
Flow waveform
Peak Insp flow

Peak Exp. flow

VTin
VTex
Ventilator graphics
Reading flow patterns

Plateau pressure

Decelerating flow

Time cycled
Ventilator graphics
Reading flow patterns

Peak pressure

Block wave flow

Volume cycled
Ventilator graphics
Flow waveform

No plateau
PIP

Insp. flow
not zero

Increase flow
Increase Ti
Ventilator graphics
Flow waveform
 Ventilator graphics
Flow waveform

Insp. flow
not zero

4 VTex not zero

 Ventilator graphics
Flow waveform: autoPEEP

Exp.. flow
not zero

4
 Ventilator graphics
Flow waveform: airway resistance

Resistance low

Resistance high
 Ventilator graphics
Flow waveform: Turbulence

“Noisy” appearance flow waveform

Becker MA, Donn SM. Clin Perinatol 2007

 Ventilator graphics
Pressure-volume loop
Volume
Expiration PIP

Inspiration

Pressure PEEP
Becker MA, Donn SM. Clin Perinatol 2007
 Ventilator graphics
Pressure-volume loop
Volume Compliance = △V/△P

Good compliance will

have a compliance axis
>45° if axes are
properly scaled.

Compliance
line

Pressure
Becker MA, Donn SM. Clin Perinatol 2007
 Ventilator graphics
Pressure-volume loop

Low compliance High compliance

 Ventilator graphics
Pressure-volume loop

High opening pressure Low opening pressure

(increase PEEP)
Sinha SK, Nicks JJ, Donn SM. ADC-FN 1996
Ventilator graphics
Pressure-volume loop
Flattening of the volume curve
indicates:
• The ventilator delivers
volume that is in excess of
lung capacity
• Excessive pressure without
an increase in volume

This can be numerically

depicted by using the C20/C
as shown.

Figure courtesy of Dr. Mark Mammel

 Ventilator graphics
Flow-volume loop
Peak inspiratory flow
Flow

Volume

Peak expiratory flow

Becker MA, Donn SM. Clin Perinatol 2007
 Ventilator graphics
Flow-volume loop

High resistance Low resistance

 Ventilator graphics
Conclusions
• Ventilatory graphics are increasing available
• They provide valuable information:
– to optimize settings
– detect lung pathology
• Measure flow at the Y-piece!
• Use proper scaling!
• Effect on outcome not clear
Thank you!

a.h.vankaam@amc.nl