Essentials of Ventilator Graphics

Report
Ruben D Restrepo, MD, RRT, FAARC
Professor
The University of Texas Health Science Center at San Antonio
Essentials of Ventilator Graphics
©2000 RespiMedu
Objectives
 Identify graphic display options
provided by mechanical ventilators.
 Describe how to use graphics to
more appropriately adjust the patient
ventilator interface.
Essentials of Ventilator Graphics
©2000 RespiMedu
Introduction
Monitoring and analysis of graphic
display of curves and loops during
mechanical ventilation has become
critical to determine
how patient is being ventilated
to assess problems occurring during
ventilation
Essentials of Ventilator Graphics
©2000 RespiMedu
Uses of Flow, Volume, and Pressure
Graphic Displays
 Confirm mode functions






Detect auto-PEEP
Determine patient-ventilator synchrony
Assess and adjust trigger levels
Measure the work of breathing
Adjust tidal volume and minimize
overdistension
Assess the effect of bronchodilator
administration
Essentials of Ventilator Graphics
©2000 RespiMedu
Uses of Flow, Volume, and Pressure
Graphic Displays






Detect equipment malfunctions
Determine appropriate PEEP level
Evaluate adequacy of inspiratory time in
pressure control ventilation
Detect the presence and rate of continuous
leaks
Assess inspiratory termination criteria during
Pressure Support Ventilation
Determine appropriate Rise Time
Essentials of Ventilator Graphics
©2000 RespiMedu
SCALARS
Essentials of Ventilator Graphics
Graphics
LOOPS
©2000 RespiMedu
Flow/Time
Pressure/Time
Volume/Time
Essentials of Ventilator Graphics
©2000 RespiMedu
Pressure-Volume
Essentials of Ventilator Graphics
Flow-Volume
©2000 RespiMedu
Flow/Time
Pressure/Time
Volume/Time
Essentials of Ventilator Graphics
©2000 RespiMedu
Flow (L/min)
Spontaneous Breath
Inspiration
Time (sec)
Expiration
Essentials of Ventilator Graphics
©2000 RespiMedu
Mechanical Breath
Flow (L/min)
Inspiration
Time (sec)
Expiration
Essentials of Ventilator Graphics
©2000 RespiMedu
Typical Flow Patterns
SQUARE
ACCELERATING
Essentials of Ventilator Graphics
DECELERATING
SINE
©2000 RespiMedu
Inspiratory Flow Pattern
Peak inspiratory flow rate
PIFR
Beginning of expiration
exhalation valve opens
Flow (L/min)
Inspiration
Insp. time
TI
Expiratory Time
TE
Time (sec)
Beginning of inspiration
exhalation valve closes
Essentials of Ventilator Graphics
Expiration
Total cycle time
TCT
©2000 RespiMedu
Expiratory Flow Pattern
Beginning of expiration
exhalation valve opens
Inspiration
Flow (L/min)
Expiratory time
TE
Essentials of Ventilator Graphics
Time (sec)
Duration of
expiratory flow
Expiration
Peak Expiratory Flow Rate
PEFR
©2000 RespiMedu
Inspiratory Pause
pause
}
Flow (L/min)
Inspiration
Time (sec)
Expiration
Essentials of Ventilator Graphics
©2000 RespiMedu
Inadequate Inspiratory Flow
Patient’s effort
Active Inspiration
Normal
Abnormal
Flow
Time (sec)
(L/min)
Essentials of Ventilator Graphics
©2000 RespiMedu
Air Trapping
Flow (L/min)
Inspiration
Normal
Patient
Time (sec)
}
Air Trapping
Auto-PEEP
Expiration
Essentials of Ventilator Graphics
©2000 RespiMedu
Response to Bronchodilator
After
Flow (L/min)
Before
Time (sec)
PEFR
Long TE
Higher
PEFR
Essentials of Ventilator Graphics
Shorter TE
©2000 RespiMedu
SCALARS
Flow/Time
Pressure/Time
Volume/Time
Essentials of Ventilator Graphics
©2000 RespiMedu
Volume vs Time
Volume (ml)
Inspiratory Tidal Volume
Inspiration
Expiration
TI
Time (sec)
Essentials of Ventilator Graphics
©2000 RespiMedu
Volume (ml)
Air Leak/Air Trapping
Volume lost
Time (sec)
Essentials of Ventilator Graphics
©2000 RespiMedu
SCALARS
Flow/Time
Pressure/Time
Volume/Time
Essentials of Ventilator Graphics
©2000 RespiMedu
Spontaneous Breath
Paw (cm H20)
Expiration
Time (sec)
Inspiration
Essentials of Ventilator Graphics
©2000 RespiMedu
Paw (cm H2O)
Mechanical Breath
Peak Inspiratory Pressure
PIP
Inspiration
Expiration
}
TI
TE
PEEP
Time (sec)
Essentials of Ventilator Graphics
©2000 RespiMedu
CONTROLLED BREATH
Paw (cm H2O)
(Time Triggered)
Mechanical
Time (sec)
Time Triggered Breath
Essentials of Ventilator Graphics
©2000 RespiMedu
Assisted Breath
Paw (cm H2O)
(Patient Triggered)
Mechanical
Time (sec)
Patient Triggered Breath
Essentials of Ventilator Graphics
©2000 RespiMedu
Assisted vs Controlled
Pressure
(cmH20)
Assisted
Controlled
Time (sec)
Essentials of Ventilator Graphics
©2000 RespiMedu
Paw (cm H2O)
Spontaneous vs. Mechanical
Mechanical
Inspiration
Spontaneous
Expiration
Inspiration
Essentials of Ventilator Graphics
Expiration
Time (sec)
©2000 RespiMedu
Paw (cm H2O)
Components of Inflation Pressure
PIP
Pplateau
(Palveolar)
}
Transairway Pressure (PTA)
Exhalation Valve Opens
Inspiratory Pause
Expiration
Time (sec)
Begin Inspiration
Essentials of Ventilator Graphics
Begin Expiration
©2000 RespiMedu
Inadequate Inspiratory Flow
Inadequate Flow
Paw
(cm H2O)
Adequate Flow
Time (sec)
Essentials of Ventilator Graphics
©2000 RespiMedu
LOOPS
Pressure-Volume
Essentials of Ventilator Graphics
Flow-Volume
©2000 RespiMedu
Pressure-Volume Loop
(Type of Breath)
Vol (ml)
E
E
I
I
Controlled
Essentials of Ventilator Graphics
I
E
Paw
(cm H2O)
Assisted
I: Inspiration
E: Expiration
Spontaneous
©2000 RespiMedu
Components of
Pressure-Volume Loop
VT
Volume
(mL)
Paw (cm H2O)
Essentials of Ventilator Graphics
PIP
©2000 RespiMedu
PEEP and P-V Loop
VT
Volume
(mL)
PEEP
Paw (cm H2O)
Essentials of Ventilator Graphics
PIP
©2000 RespiMedu
Work of Breathing
Volume (ml)
B
A
A: Resistive Work
B: Elastic Work
Pressure (cm H2O)
Essentials of Ventilator Graphics
©2000 RespiMedu
Inflection Points
Upper Inflection Points
Volume (mL)
Lower Inflection Point
Pressure (cm H2O)
Essentials of Ventilator Graphics
©2000 RespiMedu
Inadequate Sensitivity
Volume
(mL)
Increased WOB
Essentials of Ventilator Graphics
Paw (cm H2O)
©2000 RespiMedu
Air Leak/Air Trapping
Volume (ml)
Air Leak
Pressure (cm H2O)
Essentials of Ventilator Graphics
©2000 RespiMedu
Inadequate Inspiratory Flow
Volume
(ml)
Active Inspiration
Inappropriate Flow
Normal
Abnormal
Paw (cm H2O)
Essentials of Ventilator Graphics
©2000 RespiMedu
Increased Raw
Higher PTA
Volume
(ml)
Higher PTA
Paw (cm H2O)
Essentials of Ventilator Graphics
©2000 RespiMedu
Hysteresis
Volume (ml)
Normal Hysteresis
Abnormal Hysteresis
Pressure (cm H2O)
Essentials of Ventilator Graphics
©2000 RespiMedu
Lung Compliance Changes and
the P-V Loop
Volume Targeted Ventilation
Preset VT
COMPLIANCE
Increased
Normal
Decreased
Volume (mL)
Paw (cm H2O)
Essentials of Ventilator Graphics
PIP levels
©2000 RespiMedu
Increased
Normal
Decreased
Pressure Targeted Ventilation
COMPLIANCE
VT levels
Lung Compliance Changes and
the P-V Loop
Volume (mL)
Paw (cm H2O)
Essentials of Ventilator Graphics
Preset PIP
©2000 RespiMedu
Overdistension
With little or no change in VT
Volume (ml)
Normal
Abnormal
Pressure (cm H2O)
Essentials of Ventilator Graphics
Paw rises
©2000 RespiMedu
LOOPS
Pressure-Volume
Essentials of Ventilator Graphics
Flow-Volume
©2000 RespiMedu
Flow-Volume Loop
Inspiration
PIFR
FRC
VT
Volume (ml)
PEFR
Expiration
Essentials of Ventilator Graphics
©2000 RespiMedu
Air Leak
Inspiration
Flow
(L/min)
Volume (ml)
Air Leak in mL
Normal
Abnormal
Expiration
Essentials of Ventilator Graphics
©2000 RespiMedu
Air Trapping
Inspiration
Flow
(L/min)
Does not return
to baseline
Volume (ml)
Normal
Abnormal
Expiration
Essentials of Ventilator Graphics
©2000 RespiMedu
Increased Airway Resistance
Inspiration
Flow
(L/min)
Volume (ml)
Normal
Abnormal
“Scooped out”
pattern
Decreased PEFR
Essentials of Ventilator Graphics
Expiration
©2000 RespiMedu
Airway Secretions/
Condensate in the Circuit
Inspiration
Flow
(L/min)
Volume (ml)
Normal
Abnormal
Essentials of Ventilator Graphics
Expiration
©2000 RespiMedu
Essentials of Ventilator Graphics
©2000 RespiMedu
Modes of Ventilation
Spontaneous
Volume
Targeted
Essentials of Ventilator Graphics
Mechanical
Pressure
Targeted
©2000 RespiMedu
Spontaneous Breath
Flow
L/m
Pressure
cm H2O
Volume
mL
Time (sec)
Essentials of Ventilator Graphics
©2000 RespiMedu
CPAP
Flow
L/m
Pressure
cm H2O
CPAP level
Volume
mL
Time (sec)
Essentials of Ventilator Graphics
©2000 RespiMedu
PSV
Patient Triggered, Flow Cycled, Pressure limited Mode
Flow Cycling
Flow
L/m
Pressure
cm H2O
Set PS
level
Volume
mL
Time (sec)
Essentials of Ventilator Graphics
©2000 RespiMedu
CPAP + PSV
Flow Cycling
Flow
L/m
Set PS level
Pressure
cm H2O
CPAP level
Volume
mL
Time (sec)
Essentials of Ventilator Graphics
©2000 RespiMedu
Modes of Ventilation
Mechanical
Spontaneous
Volume
Targeted
Essentials of Ventilator Graphics
Pressure
Targeted
©2000 RespiMedu
Controlled Mode
(Volume- Targeted Ventilation)
Time triggered, Flow limited, Volume cycled Ventilation
Preset Peak Flow
Flow
L/m
Dependent on
CL & Raw
Pressure
cm H2O
Preset VT
Volume Cycling
Volume
mL
Essentials of Ventilator Graphics
Time (sec)
©2000 RespiMedu
Assisted Mode
(Volume-Targeted Ventilation)
Patient triggered, Flow limited, Volume cycled Ventilation
Flow
L/m
Pressure
cm H2O
Preset VT
Volume
mL
Volume Cycling
Time (sec)
Essentials of Ventilator Graphics
©2000 RespiMedu
SIMV
(Volume-Targeted Ventilation)
Flow
(L/min)
Press
(cm H2O)
ure
Volume
(ml)
Spontaneous Breaths
Essentials of Ventilator Graphics
©2000 RespiMedu
Controlled Mode
(Pressure-Targeted Ventilation)
Time Triggered, Pressure Limited, Time Cycled Ventilation
Time-Cycled
Flow
(L/min)
Set PC level
Pressure
(cm H2O)
Volume
(ml)
Time (sec)
Essentials of Ventilator Graphics
©2000 RespiMedu
Assisted Mode
(Pressure-Targeted Ventilation)
Patient Triggered, Pressure Limited, Time Cycled Ventilation
Time-Cycled
Flow
(L/min)
Press
(cm H2O)
ure
Set PC level
Volume
(ml)
Essentials of Ventilator Graphics
Time (sec)
©2000 RespiMedu
SIMV Mode
(Pressure-Targeted Ventilation)
Flow
(L/min)
Press
(cm H2O)
ure
Set PC level
Volume
(ml)
Time (sec)
Spontaneous Breath
Essentials of Ventilator Graphics
©2000 RespiMedu
SIMV + PS
(Pressure-Targeted Ventilation)
Time-Cycled
Flow-Cycled
Flow
(L/min)
Press
(cm H2O)
ure
Set PC level
Set PS level
Volume
(ml)
Time (sec)
Essentials of Ventilator Graphics
PS Breath
©2000 RespiMedu
SIMV+PS
(Volume-Targeted Ventilation)
Flow-cycled
Flow
(L/min)
Pressure
Set PS level
(cm H2O)
Volume
(ml)
Essentials of Ventilator Graphics
PS Breath
©2000 RespiMedu
SIMV + PS + CPAP
(Pressure-Targeted Ventilation)
Flow
(L/min)
Press
(cm H2O)
ure
Set PC level
Set PS level
CPAP level
Volume
(ml)
Time (sec)
Essentials of Ventilator Graphics
©2000 RespiMedu
SIMV+PS + CPAP
(Volume-Targeted Ventilation)
Flow
(L/min)
Set PS level
Pressure
(cm H2O)
CPAP level
Volume
(ml)
Time (sec)
Essentials of Ventilator Graphics
©2000 RespiMedu
THANK YOU NYC

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