VENTILATOR MODES || VCV, A/PCV, PSV, SIMV, CPAP etc || Alarms and common causes

VENTILATOR MODES

 
Moede refers to the machine will ventilate the patient in relation to the patient’s own respiratory efforts. there is a mode for nearly every patient situation, pluss many can be used in conjunction with each other.

 

 
MODES
 
Volume Control Ventilation ( VCV / CV )
                                               CV delivers the preset volume or  pressure regardless of the patient’s own inspiratory efforts. This mode is used for patients who are unable to initiate a breath. If it is used with spontaneously breathing patients, they must be sedated and/or pharmacologically paralyzed so they don’t breathe out of synchrony with the ventilator. 
 
Assist Control Ventilation (A/PCV )
                                               A/C delivers the preset volume or pressure in response to the patient’s own inspiratory effort but will initiate the breath if the patient does not do so within the set amount of time. This means that any inspiratory attempt by the patient triggers a ventilator breath. The patient may need to be sedated to limit the number of spontaneous breaths since hyperventilation can occur. This mode is used for patients who can inititate a breath but who have weakened respiratory muscles.
 
Synchronous Intermittent Mandatory Ventilation (SIMV)
                                               SIMV was developed as a result of the problem of high respiratory rates associated with A/C. SIMV delivers the preset volume or pressure and rate while allowing the patient to breathe spontaneously in between ventilator breaths. Each ventilator breath is delivered in synchrony with the patient’s breaths, yet the patient is allowed to completely control the spontaneous breaths. SIMV is used as a primary mode of ventilation, as well as a weaning mode. (During weaning, the preset rate is gradually reduced, allowing the patient to slowly regain breathing on his or her own.) The disadvantage of this mode is that it may increase the work of breathing and respiratory muscle fatigue

 

 

 

Pressure Support Ventilation (PSV)

 

                                               PSV is Preset pressure that augments the patient’s spontaneous inspiratory effort and decreases the work of breathing. The patient completely  controls the respiratory rate and tidal volume. PSV is used for patients with a stable respiratory status and is often used with SIMV to overcome the resistance of breathing through ventilator circuits and tubing.

 

 

 

 

Positive End Expiratory Pressure (PEEP)

 

                                               PEEP is positive pressure that is applied by the ventilator at the end of expiration. This mode does not deliver breaths, but is used as an adjunct to CV, A/C, and SIMV to improve oxygenation by opening collapsed alveoli at the end of expiration. Complications from the increased pressure can include decreased cardiac output, pneumothorax, and increased intracranial pressure.
 

 

Constant Positive Airway Pressure (CPAP)
                                               CPAP is similar to PEEP except that it works only for patients who are breathing spontaneously. The effect of both is comparable to inflating a balloon and not letting it completely deflate before inflating it again. The second inflation is easier to perform because resistance is decreased. CPAP can also be administered using a mask and CPAP machine for patients who do not require mechanical ventilation, but who need respiratory support; for example, patients with sleep apnea.

Independent Lung Ventilation (ILV)
                                               This method is used to ventilate each lung separately in patients with unilateral lung disease or with a different disease process ineach lung. It requires a double-lumen endotracheal tube and two ventilators. Sedation and pharmacological paralysis are used to facilitate optimal ventilation and increased comfort for the patient.
 
High Frequency Ventilation (HFV)

                                                HFV delivers a small amount of gas at a rapid rate (as much as 60-100 breaths per minute.) This is used when conventional mechanical ventilation would compromise hemodynamic stability, during short-term procedures, or for patients who are at high risk for pneumothorax. Sedation and pharmacological paralysis are required.

                

Inverse Ratio Ventilation (IRV)
                                                The normal inspiratory:expiratory ratio is 1:2 but this is reversed during IRV to 2:1 or greater (the maximum is 4:1). This mode is used for patients who are still hypoxic even with the use of PEEP. The longer inspiratory time increases the amount of air in the lungs at the end of expiration (the functional residual capacity) and improves oxygenation by reexpanding collapsed alveoli. The shorter expiratory time prevents the alveoli from collapsing again. Sedation and pharmacological paralysis are required since it’s very uncomfortable for the patient.

 

VENTILATOR MODES WITH FUNCTION AND CLINICAL USE
Mode
Function
Clinical Use
Control Ventilation (CV)
Delivers preset volume or pressure regardless of patient’s own inspiratory efforts
Usually used for patients who are
apneic
Assist-Control Ventilation (A/C)
Delivers breath in response to patient effort and if patient fails to do so within preset amount of time
Usually used for spontaneously
breathing patients with weakened
respiratory muscles
Synchronous Intermittent Mandatory Ventilation (SIMV)
Ventilator breaths are synchronized with patient’s respiratory effort
Usually used to wean patients from
mechanical ventilation
Pressure Support Ventilation (PSV)
Preset pressure that augments the patient’s inspiratory effort and decreases the work of breathing
Often used with SIMV during weaning
Positive End Expiratory Pressure (PEEP)
Positive pressure applied at the end of expiration

Used with CV, A/C, and SIMV to improve oxygenation by opening collapsed alveoli

Constant Positive Airway Pressure (CPAP)
Similar to PEEP but used only with spontaneously breathing patients
Maintains constant positive pressure in airways so resistance is decreased
Independent Lung Ventilation (ILV)
Ventilates each lung separately; requires two ventilators and sedation/paralysis
Used for patients with unilateral lung disease or different disease process in each lung

 

High Frequency Ventilation (HFV)
Delivers small amounts of gas at a rapid rate (60-100 breaths/minute); requires sedation/paralysis
Used for hemodynamic instability, during short-term procedures, or if patient is at risk for pneumothorax.

 

Inverse Ratio Ventilation (IRV)
l:E ratio is reversed to allow longer inspiration; requires
sedation /paralysis.
Improves oxygenation in patients who are still hypoxic even with PEEP; keeps
 alveoli from collapsing.
 
 

Alarms and common causes

 

As mentioned earlier, the ventilator is designed to monitor many aspects of the patient’s respiratory status, and there are many different alarms that can be set to warn healthcare providers that the patient isn’t tolerating the mode or settings. The following are common ventilator alarms and their most frequent causes.
 
High Pressure Limit
Low Pressure
High Respiratory Rate
Low Exhaled Volume
➤    Secretions in ETT / Airway or Condensation in tubing.
➤    Kink in ventilator tubing.
➤    Patient Biting on ETT.
➤ Patient coughing, gagging, or trying to talk.
➤    Increased airway pressure from bronchospasm or pneumothorax.
➤    Ventilator tubing not connected.
➤    Displaced ETT or tracheal tube.
➤ Patient anxiety or pain.
➤    Secretions in ETT/airway.
➤    Hypoxia.
➤    Hypercapnia.
➤    Ventilator tubing not connected.
➤    Leak in cuff or inadequate cuff seal.
➤    Occurrence of another alarm preventing full delivery of breath.
 
 

 

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