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Modos ventilatorios convencionales
- 11. Ventilación Espontanea vs. Ventilación Mecánica I E I E Presión Volúmen Espontáneo Presión Positiva I E I E
- 23. Controladores : Volumen vs. Presión VARIABLE VOLUMEN PRESION VOLUMEN TIDAL Seteado por el Médico; permanece constante Cambia con el esfuerzo del paciente y la impedancia del sistema respiratorio PRESION INSPIRATORIA PICO Cambia con el esfuerzo del paciente y la impedancia del sistema respiratorio Seteado por el Médico; permanece constante TIEMPO INSPIRATORIO Fijado directamente o como función del seteo de FR y flujo inspiratorio Seteado por el Médico; permanece constante FLUJO INSPIRATORIO Fijado directamente o como función del seteo de FR y flujo inspiratorio Cambia con el esfuerzo del paciente y la impedancia del sistema respiratorio ONDA DE FLUJO INSPIRATORIO Seteo por el Médico; permanece constante; onda sinusal o desacelerante. Cambia con el esfuerzo del paciente y la impedancia del sistema respiratorio: Onda siempre desacelerante.
- 25. Que estratégia debería utilizar? CMV IPPV SIMV MMV BIPAP CPAP SPONT PCV VCV APRV PLV PS ASB ILV PRVC VAPS PAV Auto Mode AutoFlow PPS VS
- 29. Modos Ventilatorios Convencionales VENTILACION MANDATORIA CONTINUA (CMV)
- 40. Modos Ventilatorios Convencionales VENTILACION MANDATORIA INTERMITENTE ( IMV )
- 43. Modos Ventilatorios Convencionales VENTILACION MANDATORIA INTERMITENTE SINCRONIZADA ( SIMV )
- 47. VENTILACION MANDATORIA INTERMITENTE SINCRONIZADA ( SIMV )
- 55. CPAP
- 65. VPS
Notas del editor
- 40 Many clinicians who are not respiratory therapists are often uncertain of what sensitivity is. Sensitivity is another clinician-set variable. Sensitivity, often referred to as trigger, determines when the ventilator will recognize a patient’s spontaneous effort. When patient effort is recognized, the machine will trigger a response - either to give a mechanical breath or support the spontaneous effort. With spontaneous breaths, this change in pressure may trigger a ventilator breath, compared to mandatory machine breaths where breath delivery begins when a set time interval is reached. With spontaneous efforts, the trigger can be a change in pressure or a change in flow. Let’s take a closer look at sensitivity.
- 41 Recall from our earlier discussions that spontaneous breathing effort begins with contraction of the diaphragm. This effort causes a decrease in intrathoracic pressure. This drop in pressure is transmitted through the closed ventilator system. A ventilator is said to be a closed system when it’s valves shut or close completely during exhalation. To open the valves to allow flow delivery, some variable must trigger the ventilator.
- In pressure triggering, when the pressure drop reaches the clinician-set sensitivity (typically -1 to -3 cm H2O), the ventilator will respond according to other established parameters. If the ventilator is in A/C mode, the ventilator will always trigger a mechanical breath, whenever the sensitivity level is reached. There is typically a lag time between when the patient initiates spontaneous effort to when the ventilator recognizes and delivers the breath. Often referred to as ventilator response time, a prolonged lag time can cause patient discomfort and asynchrony.
- 43 In this pressure-time graph, the sensitivity is set at -2 cm H2O. The first two patient efforts reach the sensitivity level and the ventilator responds by delivering a mechanical breath. Notice that the last breath does not reach the sensitivity level, probably due to poor patient effort. In this example, the ventilator does not recognize the effort, so this spontaneous effort is not supported. I’m sure you can see how important it is to set the sensitivity appropriately. If the sensitivity is too high, patient efforts may go unrecognized. If sensitivity is too low, the machine may trigger a response to patient movement or even the patient’s heart rate! This phenomena is often called auto-cycling. Both situations would cause patient discomfort and patient/ventilator asynchrony.
- 44 In addition to pressure, on some ventilators, flow may also be selected as the sensitivity variable. In flow triggering, the ventilator delivers a low level of flow that constantly circulates. Because of this constant flow, the ventilator is said to have an opened system, meaning that no valves fully close.
- As in pressure triggering, patient effort begins with contraction of the diaphragm. As the patient begins this effort, some of the constant flow in the ventilator circuit is diverted to the patient, so that less flow is returned.
- 46 This small amount of flow that is drawn in by the patient can help satisfy initial inspiratory demand. Once the flow from the ventilator circuit is depleted to the sensitivity setting ( typically 1 to 3 LPM), the machine recognizes the patient effort and responds by delivering a breath. Keep in mind that this is an open system and the ventilator valves remain partially opened, resulting in a fast response time. Compared to pressure triggering, flow triggering has less of a lag time, thus improving patient comfort and ventilator synchrony. Note that on this graphic all patient efforts are clearly depicted by the negative deflection. In actual pressure-time curves, this deflection is often barely visible when flow triggering is set.
- 5 5 5 5 5 12 11 AutoFlow What about new modes? There are so many modes of ventilation out there that it can get a bit confusing. The same mode can even have a different name depending on which manufacture your talking about.