Mechanical Ventilation

8/3/2016

1 Comment

Dr. Yamane's Guide to reading and using a vent.

Indications
Parameters
Modes
Reading a Waveform
Discontinuation

Indications for Mechanical Ventilation

GCS/altered mental status
Airway Protection
Respiratory Failure
Anticipated Clinical Course

Ventilator Parameters

Tidal Volume (Vt): Volume of a breath, typically set using ideal body weight
Respiratory Rate: Number of breaths delivered, including spontaneous and mandatory breaths
FiO2: Concentration of inhaled oxygen (0.21-1.0)
Minute Ventilation: Average volume of gas being delivered per minute (Vt * rr)
Peak Flow Rate: Highest speed that the ventilator will deliver to change the inspiratory time.
I/E Ratio: Overall inspiratory vs expriatory time, typically 1:2, 1:3
Peak airway pressure: Total pressure required to deliver the tidal volume, dependent on lung compliance and resistance.
Plateau Pressure: Pressure needed to distend the lung, measured by providing an end-inspiratory pause. A measurement of the alveolar pressure
Peep:
CPAP
Mandatory Breath
Spontaneous Breath

Modes of Ventilation

PSV Pressure Support Ventilation: Only provides breaths in response to patient effort, with a backup pressure control mode in case the patient becomes apneic.
SIMV Synchronized intermittent mandatory ventilation: Combines mandatory and spontaneous breaths, providing an assist-control mandatory breath with pressure controlled voluntary breaths when the patient attempts to breath.
PRVC Pressure regulated volume control: Volume and rate are set, and the ventilator regulates the the pressure being provided based on how the patient responds to the vent. The goal is to prevent high peak airway pressure while delivering a set volume.
A/C Assist/Control ventilation: (VCV, PVC, PRVC) Every breath is a mandatory breath controlled by ventilator.
- Volume Control: Fixed volume delivered by a set volume and rate
- Pressure Control: Breaths are triggered by the patient and augmented by the ventilator to provide a set positive pressure.

Reading a Ventilator Waveform

1. Determine the CPAP Level: This is your baseline pressure before a breath is taken

2. Is the patient triggering breaths? Identify if the patient is overbreathing the vent. Check the set respiratory rate and the actual, and identify any negative deflections in pressure which indicates a patient is attempting to take a breath.

3. What shape is the pressure wave?

4. Is the patient gas trapping?

5. Is the patient synchronizing with the ventilator? If the patient is attempting to take breaths and the vent is not triggering, the sensitivity will need to be decreased until the patient is no longer fighting the ventilator.

Discontinuation of Mechanical Ventilation

Rapid-Shallow Breathing Index: a ratio

Adapted from CCM Tutorial's Guide to Reading a Waveform

reading_a_ventilator_waveform.pdf
File Size:	513 kb
File Type:	pdf

Download File

1 Comment

Heat ventilation in Gaithersburg link

10/9/2019 11:00:41 pm

here are many options, and types of heating systems. While some may not be appropriate, and/ or, available, we will try to briefly, review, some of them. One choice may be electric heat. This choice is often, drier, but also, extremely clear. It often is, the only choice, for certain areas, where a house, doesn't have an oil burner, can't use gas (natural or propane), etc. However, many times, electric heat is a costly option. Years ago, coal - heated many homes, but very few, except for in certain limited regions of this nation, use it, today. In the northeast, oil - heat is often, used, but, with oil prices, fluctuating, and rising, over the years, has become more expensive/ costly. In addition, it requires maintenance, and is, one of the least, clean, forms of energy. We have witnessed, numerous conversions, from oil to gas, because of factors, such as ease of availability (automatically delivered instead of having to be delivered), cleanliness/ cleaner, and, the perception of it, being, less costly. However, many areas, lack access to gas (but can use propane, only), so it's not a possibility! With our additional focus and concern, on clean air, many consumers examine non - fossil fuel, alternatives, such as geo - thermal, and solar heating systems. However, the cost - effectiveness, and feasibility of these, depends on location, etc.