Mechanical Ventilation - Amarillo College · Mechanical Ventilation Ventilator Graphics 2 Graphic...
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Transcript of Mechanical Ventilation - Amarillo College · Mechanical Ventilation Ventilator Graphics 2 Graphic...
Graphics
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Mechanical Ventilation
Ventilator Graphics
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Graphic Waveforms• Scalar graphics
• pressure vs. time• flow vs. time• volume vs. time
• Loop graphics• flow vs. volume• pressure vs. volume
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Graphic Waveform Use• Monitor ventilator function• Improve patient/ventilator interaction• Identify autoPEEP• Calculate respiratory mechanics
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Remember! (VC)• vol delivered depends on flow, TI• vol delivery is same each breath• flow waveform is same each breath• flow waveform does not change with
changing CL, RAW• pressure produced varies with CL, RAW,
type of flow waveform
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Pressure vs. Time
F = EEPC = start of pauseX + y = TI
E = early exp pressB = PIPy = pause
D = PplatA = start of inspx = TI
VCSIMV (VC)
z = TE
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F = EEPC = early insp press
E = early exp pressB = PIPz = TE
D = PplatA = start of inspx = TI
Pressure vs. TimePC
SIMV (PC)
Graphics
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Pressure vs. Time
P
tI
E
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Pressure vs. Time
P
t
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Pressure vs. Time
P
t
Graphics
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Pressure vs. Time
P
t
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Pressure vs. Time
P
t
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Pressure vs. Time
P
t
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Pressure vs. Time
“Flow Starvation”
RX -
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Pressure vs. Time• Also examine negative pressure
deflection:
• too deep• lasts too long
⇒ ↑ WOB
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Pressure vs. Time
P
t
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Pressure vs. Time• Summary - Use PT graphics to:
• ID breath type• adjust flow rate• assess work to trigger breath• detect autoPEEP• assess plateau & calculate CS
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I = PEFRX + y = TI
K = end exp flowH = zero flow phasey = pause
J = decelerating exp flowG = PIFRx = TI
Flow vs. TimeVC
SIMV (VC)
z = TE
18I = PEFR
K = end exp flowH = decel insp flowz = TE
J = decelerating exp flowG = PIFRx = TI
Flow vs. TimePC
SIMV (PC)
Graphics
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Flow vs. Time
• rectangular = square• descending = decelerating• ascending = accelerating• sinusoidal = sine
Flow WaveType
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Flow vs. TimeFlow
t
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EXTREMELY IMPORTANT!!
AutoPEEP = air-trapping = hyperinflation⇓
↑ risk of barotrauma↑ mean airway pressure
hemodynamic compromise
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Flow vs. Time• Summary - Use FT graphics to:
• ID breath type• ID waveform type• detect autoPEEP• evaluate TI in PCV
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Volume vs. TimeVC
SIMV (VC)
N = end inspz = TE
P = end expM = delivery of VTy = pause
O = exhalation of VTL = start of inspx = TI
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Volume vs. TimePC
SIMV (PC)
N = end insp
P = end expM = delivery of VTz = TE
O = exhalation of VTL = start of inspx = TI
Graphics
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Volume vs. TimeVT
t
if Insp VT ≠ Exp VT = ?
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Volume vs. Time• Summary - Use VT graphics to:
• ID leaks in the ventilator system• ID air-trapping
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Flow-Volume Loops
D = PEFRB = PIFR
C = end insp/start expA = insp start/end exp
VCSIMV(VC)
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Flow-Volume Loops
D = PEFRB = PIFR
C = end insp/start expA = insp start/end exp
PCSIMV(PC)
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Flow-Volume Loops
Normal Abnormal
•Tracing should start at zero and end at zero
•If not =
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Flow-Volume Loops• Gauge effect of bronchodilator therapy
flow
VT
flow
VT
Before After
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Flow-Volume Loops• Summary - Use FV Loops to:
• ID leaks in the ventilator system• ID air-trapping• Evaluate the effect of bronchodilator
therapy
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Volume-Pressure Loops
AC = CD slope
CDA = expiration
ABC = inspiration
E = vol end insp
D = exp press level
C = end insp/start exp
B = insp press level
A = start insp/end esp
MandatoryVentilatorBreath
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E = expiration
I = inspiration
SpontaneousBreathVT
P
E
I
Volume-Pressure Loops
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Volume-Pressure Loops
VT
P
1
2
1 = normal
2 = slope ↓, shape is same⇓
What happened?
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Volume-Pressure Loops
VT
P
1 2 1 = normal
2 = slope ↓, widens⇓
What happened?
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Volume-Pressure Loops
VT
P
Duck bill thingy(P ↑ w/o change in VT)
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Volume-Pressure Loops
alveolar re-expansion interval
• Re-expansion interval(big press/little vol) -shows high press neededto open alveoli
• Rx?
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Volume-Pressure Loops• Summary - Use VP Loops to:
• ID breath type• Assess work to trigger breath• Assess WOB• Assess CL and RAW• Detect overdistention• Titrate PEEP