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A Practical Guide
Ben White
GOALS
- Long
- Interesting
• FiO2
• PEEP
• Rate
• Vt – Tidal Volume
• I-Time
• PS – Pressure Support
• Ramp
VARIABLES
OXYGENATION VENTILATION
• FiO2 • Rate
• PEEP • PIP
• I-time • Volume
• PS (Kinda)
1 y/o w/ RSV
Transferred to PICU, no
improvement on BiPAP so intubated
RATE CO2
PIP
( P E A K I N S P I R ATO RY P R E S S U R E )
• Autoflow
• Turns normal pressure control into volume
targeted mode
• Maintains decelerating flow waveform
• Main benefit = Lower airway pressures
Volume Control Pressure Control
Variables Advantages Disadvantages
• Tv set • Consistent volumes, • Ventilation difficulty with
• PIP varies limiting atelectasis or air leaks
• PS for spontaneous volutrauma
breaths • Autoweaning as
compliance improves
SIMV
(DRAGER FOR SIMV-PRVC)
Variables Advantages Disadvantages
PCV
(DRAGER FOR SIMV-PC)
Variables Advantages Disadvantages
• Tv or PIP set • Rest/Comfort mode • De-conditioning of
• The other varies for pt respiratory muscles?
• Every breath fully • Will need to switch
supported to a weaning mode
CMV
(DRAGER FOR A/C)
Variables Advantages Disadvantages
• PS • Comfortable, pt • No guaranteed MV
• Set backup RR driven ventilation • Risk of insufficient
• Usually used with low • Pt controls i-time ventilation
PEEP and MV
CPAP
(DRAGER FOR PSV)
Variables Advantages Disadvantages
• Minute ventilation • Comfortable • Less control over
• (RR + TV) • Pt has unrestricted ventilation
• PS spontaneous breathing
• Vent delivers breaths if
MV falls below goal
MMV
(MANDATORY MINUTE VENTILATION)
Variables Advantages Disadvantages
• Set P-high and P-low • Comfortable • Vt not controlled
• Set time in each • Pt has unrestricted • Increased WOB?
• Inverse I:E Ratio spont. breathing
• Permits consistent
higher MAP
APRV
(AIRWAY PRESSURE RELEASE VENTILATION)
APRV
(AIRWAY PRESSURE RELEASE VENTILATION)
Variables Advantages Disadvantages
• Tv set • Better synchrony • Ventilation
• PS set with pt controlling difficulty with
• PIP varies I-time air leaks
• I-time variable
PSV-VG
(PSV WITH VOLUME GUARANTEE)
• 1 y/o w/ RSV bronchiolitis intubated on DOI #4
• Worsening hypoxia and hypercapnia
CASE
• Gas: 7.1/74/52/19/-4
• CXR – Significantly increased RLL opacities
OSCILLATOR
33
• Indications
• Hypoxic respiratory failure
• Premature infants
• Rescue ventilation
• Pearls
• Look for bounce
• Hz will depend on age
• Amp should be < 3x MAP
• Some leak is needed
VDR
(VOLUMETRIC DIFFUSIVE
(Ventilator of Death and Regret)
RESPIRATOR)
• Indications
• Secretion management
• Rescue ventilation
VDR
(VOLUMETRIC DIFFUSIVE RESPIRATOR)
JET VENTILATOR
PR CO2
Indications
• Interstitial emphysema
• Rescue ventilator
Notes