home mechanical ventilation ppt

SIMV modes are used to wean patients; as you decrease the set rate, the patient will need to do more on their own to maintain normal blood gases. }, 4 "name": "", NIV: Full face mask Decreased leak DecreasedCough Talking Eating Increased risk of aspiration Nocturnal use with daytime nasal mask SIMV Mode Most patients, improved comfort, stable CO2s }, 22 "description": "Forced vital capacity < 50% predicted. Anticipated length of ventilation. "contentUrl": "https://slideplayer.com/slide/5879828/19/images/29/Pressure+vs.+Volume+Pressure+Pitfalls+Volume+Vitriol.jpg", "description": "tidal volume by change suddenly as patient\u2019s compliance changes. "@context": "http://schema.org", { "@context": "http://schema.org", "@context": "http://schema.org", Provides inspiratory flow during inspiration, Given in addition to vent breaths in IMV modes or alone without a set rate, mimicking BiPAP, Pulse oximetry, Apnea monitor, Capnography, Goals and plans clarified with family and caregivers, Family and respite caregivers trained in the ventilation, clearance, prevention, evaluation and all equipment, Equipment lists developed and implemented with re-supply and funding addressed, Used more frequently when weaning/decannulating, Over 70% 10-year survival, most deaths due to underlying disease, In retrospective studies, 0-8% of deaths were ventilator or technology-related, Related to amount of care and support needed, Vary settings, interfaces, strategies to achieve goals of good health and optimized quality of life, Download ppt "Home Mechanical Ventilation". Noninvasive interfacesNasal masks Full facemasks Nasal pillows Sipper mouthpiece Lipseal/mouthpiece device }, 16 "@type": "ImageObject", Community support. Flexed mouthpiece +\/- custom orthodontics. "contentUrl": "https://slideplayer.com/slide/5879828/19/images/19/BiPAP+Pressure+Support+Ventilation.jpg", Square wave pattern results in higher pressure delivered for same volume delivered, Tidal volume changes as patient compliance changes, Potential hypoventilation or overexpansion, Obstructed trach decreases delivered volume, Better control of oxygenation than ventilation, Better control of ventilation than oxygenation, Triggering vent requires certain amount of work by patient, Can decrease work of breathing by providing flow during inspiration for patient triggered breaths, Can be given with spontaneous breaths in IMV modes or as stand alone mode without set rate. SIMV Modes. "width": "800" "name": "Indications Inability to wean from mechanical ventilation", SIMV modes are chosen when you want the patient to do as much work as they can tolerate and try to minimize the support from the ventilator. }, 25 "name": "Ventilators Pressure cycled vs Volume cycled", ", "contentUrl": "https://slideplayer.com/slide/5879828/19/images/10/Noninvasive+interfaces.jpg", "contentUrl": "https://slideplayer.com/slide/5879828/19/images/6/Indications%2FSymptoms.jpg", Continuously used. ", "width": "800" }, 41 "@type": "ImageObject", "description": "Cori Daines, MD. Supporting Equipment External supportPEEP Alarms/MonitoringPulse oximetry, Apnea monitor, Capnography Humidification External w/ heater, HME Airway clearance Suctioning, Vest, cough assist Talking devices Indications/SymptomsShortness of breath Especially on exertion or lying down Morning headache and insomnia Fatigue and lethargy Increased respiratory rate Restlessness and anxiety Risk of hyperventilation if agitated. { Maximal Inspiratory Pressure < 60. Increasing peak pressures on volume mode (or decreasing tidal volumes in pressure modes) can also be a sign that the ETT is obstructed or of another problem with the ventilator circuit. "@context": "http://schema.org", "description": "Pediatric sizes mimic ETT ID\u2019s. Patient takes own breaths between vent breaths. Another scenario may be one in which you want to precisely control the PaCO2, as in hyperventilation for increased intracranial pressure. }, 33 Another scenario may be one in which you want to precisely control the PaCO2, as in hyperventilation for increased intracranial pressure. Volutrauma - air leak. "width": "800" "width": "800" Home monitoring. "name": "Pressure vs. Volume Pressure control Set pressure, volume variable", ", "description": "SIMV Mode Most patients, improved comfort, stable CO2s", ", Indications Inability to wean from mechanical ventilationAfter and acute illness After prolonged ventilation for a chronic disease Progressive chronic respiratory failure Sleep disturbance Central or obstructive, apnea or hypopnea }, 11 }, 27 Home Mechanical VentilationCori Daines, MD Pediatric Pulmonary Medicine To compensate for this increase in the work of breathing, pressure support is given. "@context": "http://schema.org", Patients Cardiopulmonary stabilityPositive trend in weight gain/maintenance and growth Stamina for play or daily activities while ventilated Freedom from active/recurrent infection, fever, deterioration ATS Position Paper 1990 "width": "800" "description": "PCO2 safely maintained. "name": "Pressure vs. Volume Pressure Pitfalls Volume Vitriol", Nursing support arranged for nighttime. ", If you wish to download it, please recommend it to your friends in any social system. }, Initiation and weaning of mechanical ventilation by Ahmed Mohamed Hassan. "width": "800" With volume modes, the peak pressure can increase, resulting in barotrauma if the pulmonary compliance worsens. Better daytime functioning. Eating. Achieve normal growth and development. Better control of ventilation than oxygenation. Nasal bridge pressure with mask. ", Patient may hyperventilate if agitated. ", Can be given with spontaneous breaths in IMV modes or as stand alone mode without set rate. Note that for the paralyzed patient there is no significant difference between assist control and SIMV. "name": "Complications Ventilator failure Tracheostomy issues", "@type": "ImageObject", This does not make it easier for the patient to trigger the ventilator but it does help the patient generate larger tidal volumes. "width": "800" { Team approach necessary. }, 21 Stamina for play or daily activities while ventilated. Potential hypoventilation or overexpansion. "contentUrl": "https://slideplayer.com/slide/5879828/19/images/36/Bilevel+Mode+Mimic+BiPAP+%2F+No+Backup+Rate.jpg", Intermittently used to augment breathing. "width": "800" Regardless of the parameter that is controlled, the other must be monitored as it is a reflection of the compliance and hence the patients pulmonary function. Full Ventilation Noninvasive or invasivePressure cycled or volume cycled SIMV vs. AC Allows pressure support, PEEP, inspiratory time, flow to be added and manipulated Fatigue and lethargy. "name": "Quality of Life Generally good Some stress for patients, caregivers", "contentUrl": "https://slideplayer.com/slide/5879828/19/images/11/NIV%3A+Nasal+mask+%2F+Prongs.jpg", "name": "Full Ventilation Noninvasive or invasive", "width": "800" { "description": "Pulse oximetry, Apnea monitor, Capnography. ", "description": "Better control of oxygenation than ventilation. In control modes, if you decrease the rate, the patients spontaneous efforts will be fully supported so you will not know how much of that particular tidal volume they are generating on their own. "contentUrl": "https://slideplayer.com/slide/5879828/19/images/44/Home+ventilation+reality.jpg", Talking devices. "contentUrl": "https://slideplayer.com/slide/5879828/19/images/31/Pressure+vs.+Volume+Pressure+control+Set+pressure%2C+volume+variable.jpg", "@type": "ImageObject", "contentUrl": "https://slideplayer.com/slide/5879828/19/images/12/NIV%3A+Full+face+mask+Decreased+leak+Decreased.jpg", ", { ", "@context": "http://schema.org", O 2 RESPIRATORY TO BREATHE OR NOT TO BREATHE, THAT IS OUR QUESTION! { ", "contentUrl": "https://slideplayer.com/slide/5879828/19/images/16/Tracheostomies.jpg", Complications. Home ventilation realityEvery patient is unique These are guidelines not rules Vary settings, interfaces, strategies to achieve goals of good health and optimized quality of life Team approach necessary { ", Pressure vs. Volume Pressure LimitedControl FiO2 and MAP (oxygenation) Still can influence ventilation somewhat (respiratory rate, PAP) Decelerating flow pattern (lower PIP for same TV) Volume Limited Control minute ventilation Still can influence oxygenation somewhat (FiO2, PEEP, I-time) Square wave flow pattern PRESSURE-LIMITED I would not say that I have limited ability to affect ventilation in PC, though I may choose to increase the PAP recognizing that I accept the potential for increased baro/volutrauma at the same time I also accept that I may suffer a decrease in ventilation with changes in compliance. Another scenario may be one in which you want to precisely control the PaCO2, as in hyperventilation for increased intracranial pressure. "contentUrl": "https://slideplayer.com/slide/5879828/19/images/38/Discharge+Criteria+Presence+of+a+stable+airway+FiO2+less+than+40%25.jpg", { "width": "800" Obstructed trach decreases delivered volume. }, 26 "description": "Every breath is supported regardless of trigger Can\u2019t wean by decreasing rate. BiPAP Pressure Support VentilationIPAPthe inspiratory positive airway pressureextra help when breathing in EPAPthe expiratory positive airway pressure--CPAP Cycles based on patient initiated breaths Available with timed back-up rates Used for severe sleep apnea, neuromuscular weakness or insufficiency "@type": "ImageObject", { "contentUrl": "https://slideplayer.com/slide/5879828/19/images/40/Continuing+Assessment.jpg", }, 31 "width": "800" 1 Pre-ICU Training CHEST Mechanical Ventilatory Support 2008/6/20. "width": "800" I also accept that I may suffer a decrease in ventilation with changes in compliance. "contentUrl": "https://slideplayer.com/slide/5879828/19/images/41/Complications+Ventilator+failure+Tracheostomy+issues.jpg", "width": "800" { "description": "Shortness of breath. SIMV vs. AC. Suctioning, Vest, cough assist. "description": "IPAP\u2014the inspiratory positive airway pressure\u2014extra help when breathing in. "name": "BiPAP Pressure Support Ventilation", { { ", }, 24 }, 9 "name": "Ventilators", Accept that changes in compliance may lead to increases in peak airway pressures and associated baro/volutrauma. }, 6 "description": "Pressure cycled are often triggered by flow sensing reducing work of breathing. ", Patients placed on control modes are often deeply sedated and may be given neuromuscular blockers. "contentUrl": "https://slideplayer.com/slide/5879828/19/images/5/Indications+Inability+to+wean+from+mechanical+ventilation.jpg", "@type": "ImageObject", "description": "Titration sleep studies. Neonatal, pediatric, adult and customized lengths. In pressure modes, the tidal volume can drop resulting in hypoventilation or it can increase, leading to overdistention. }, 7 "@context": "http://schema.org", This is usually because the patients lung disease is significant enough that you that you wish to give maximal support. { Increased work of breathing vs. ", Reduce overall health care costs. A patient may not be able to generate adequate tidal volumes for these reasons. Full facemasks. }, 44 ", { Additionally, a patient has to breathe through an ETT that is almost always narrower than their own airway and ventilate the increased dead space imposed by the vent circuit. "@type": "ImageObject", Nasal erosion with prongs. "contentUrl": "https://slideplayer.com/slide/5879828/19/images/28/Pressure+vs.+Volume+Pressure+Limited.jpg", "name": "NIV: Full face mask Decreased leak Decreased", A patient may not be able to generate adequate tidal volumes for these reasons. "description": "Fewer hospitalizations. Patients placed on control modes are often deeply sedated and may be given neuromuscular blockers. "contentUrl": "https://slideplayer.com/slide/5879828/19/images/18/CPAP+Continuous+Positive+Airway+Pressure+For+simple+sleep+apnea.jpg", "@context": "http://schema.org", Used more frequently when weaning\/decannulating. "@context": "http://schema.org", { ", { { "name": "Noninvasive interfaces", "@context": "http://schema.org", To compensate for this increase in the work of breathing, pressure support is given. "description": "Triggering vent requires certain amount of work by patient. "description": "Positive trend in weight gain\/maintenance and growth. "@context": "http://schema.org", "name": "NIV: Nasal mask \/ Prongs", "name": "Assist Control Mode Can trigger breaths, but needs support with each breath", "@type": "ImageObject", PRESSURE-LIMITED. "@type": "ImageObject", }, 36 "@type": "ImageObject", VOLUME-LIMITED Accept that changes in compliance may lead to increases in peak airway pressures and associated baro/volutrauma. A patient may not be able to generate adequate tidal volumes for these reasons. "description": "Ventilatory needs. "width": "800" To compensate for this increase in the work of breathing, pressure support is given. Cuffed and uncuffed. Central or obstructive, apnea or hypopnea. }, 38 "@type": "ImageObject", "contentUrl": "https://slideplayer.com/slide/5879828/19/images/26/Assist+Control+Mode+Can+trigger+breaths%2C+but+needs+support+with+each+breath.jpg", Can have patient \/ vent asynchrony. "width": "800" { ", Indications Airway instability Most surgical patients or trauma Primary Respirator Failure Mostly medical. Pressure vs. Volume Volume No limit on pressure unless set PressureSquare wave pattern results in higher pressure delivered for same volume delivered Pressure Tidal volume changes as patient compliance changes Potential hypoventilation or overexpansion Obstructed trach decreases delivered volume "@context": "http://schema.org", "contentUrl": "https://slideplayer.com/slide/5879828/19/images/2/Outline+Indications+Patients+Interfaces+Ventilators.jpg", Note that for the paralyzed patient there is no significant difference between assist control and SIMV. Need a hand?? { "@type": "ImageObject", Volume Vitriol. "@context": "http://schema.org", "width": "800" "name": "Outline Indications Patients Interfaces Ventilators", "description": "Setting capabilities. "contentUrl": "https://slideplayer.com/slide/5879828/19/images/3/Goals+Extend+the+duration+of+life+Enhance+the+quality+of+life.jpg", ", Other medical conditions well controlled. ATS Position Paper", "@type": "ImageObject", ABG pCO2 > 45. Mechanical Ventilaton Ramon Garza III, M.D.. In control modes, if you decrease the rate, the patient\u2019s spontaneous efforts will be fully supported so you will not know how much of that particular tidal volume they are generating on their own. In control modes, if you decrease the rate, the patients spontaneous efforts will be fully supported so you will not know how much of that particular tidal volume they are generating on their own. Regardless of the parameter that is controlled, the other must be monitored as it is a reflection of the compliance and hence the patients pulmonary function. "@type": "ImageObject", Discharge Criteria Presence of a stable airway FiO2 less than 40%PCO2 safely maintained Nutritional intake optimal Other medical conditions well controlled Above may vary if palliative care "description": "Provides inspiratory flow during inspiration. "description": "Every patient is unique. "contentUrl": "https://slideplayer.com/slide/5879828/19/images/15/Tracheostomies+Shiley%2C+Bivona%2C+Portex+and+others.jpg", "width": "800" "@context": "http://schema.org", ", EPAP\u2014the expiratory positive airway pressure--CPAP. "@type": "ImageObject", Bilevel Mode Mimic BiPAP / No Backup Rate Occasional hospitalization. NIV: Sipper /Lipseal MouthpieceDaytime use Allows facial freedom Flexed mouthpiece +/- custom orthodontics Intermittently used to augment breathing Continuously used "description": "Modes of ventilation. "width": "800" "@type": "ImageObject", "@context": "http://schema.org", Flow sensing is also important in pts with high respiratory rates = infants\/toddlers. Sleep disturbance. "@context": "http://schema.org", { Ventilators Pressure cycled vs Volume cycledPressure cycled are often triggered by flow sensing reducing work of breathing Flow sensing is also important in pts with high respiratory rates = infants/toddlers "name": "NIV: Sipper \/Lipseal Mouthpiece", { "description": "Aerophagia (PIP > 25 cmH2O) Nasal drying\/congestion = humidify. "name": "Indications\/Symptoms", "@context": "http://schema.org", Inadequate ventilation. "@type": "ImageObject", "@context": "http://schema.org", ", Sipper mouthpiece. "@type": "ImageObject", ", Obstructive diseases of the airway. "@type": "ImageObject", 2022 SlidePlayer.com Inc. All rights reserved. "description": "Can\u2019t wean by decreasing rate. SIMV modes are chosen when you want the patient to do as much work as they can tolerate and try to minimize the support from the ventilator. }, 17 "@type": "ImageObject", Patients placed on control modes are often deeply sedated and may be given neuromuscular blockers. "description": "Pressure cycled or volume cycled. "name": "Control vs. SIMV CONTROL MODE SIMV MODE Every breath fully supported", Allows facial freedom. "contentUrl": "https://slideplayer.com/slide/5879828/19/images/39/Discharge+Criteria+Goals+and+plans+clarified+with+family+and+caregivers..jpg", Bronchoscopy. "width": "800" "contentUrl": "https://slideplayer.com/slide/5879828/19/images/37/Supporting+Equipment+External+support%E2%80%94PEEP+Alarms%2FMonitoring.jpg", NIV: Nasal mask / ProngsMany older patients prefer compared to mouthpiece Problems: Leak, especially mouth Nasal bridge pressure with mask Gum erosion or compression with mask Nasal erosion with prongs Chin strap may be needed "width": "800" Funding and insurance issues addressed. { no limit per se on PIP (usually vent will have upper pressure limit) square wave(constant) flow pattern results in higher PIP for same tidal volume as compared to Pressure modes. Progressive chronic respiratory failure. Quality of Life Generally good Some stress for patients, caregiversFewer hospitalizations Better sleep quality Better daytime functioning Some stress for patients, caregivers Related to amount of care and support needed The ventilator generates pressure support by adding flow to the circuit during patient-triggered breaths in IMV or SIMV modes. "width": "800" "@type": "ImageObject", ", "@type": "ImageObject", }, 18 The ventilator generates pressure support by adding flow to the circuit during patient-triggered breaths in IMV or SIMV modes. an opening must be attempted in the trunk of the trachea, into which a tube of reed or cane should be put; you will then blow into this, so that the. "description": "Assist Control Mode Can trigger breaths, but needs support with each breath", }, 5 { "@context": "http://schema.org", We think you have liked this presentation. }, 32 Vary settings, interfaces, strategies to achieve goals of good health and optimized quality of life. Ventilators Leak can vary with sleep, position, and effort which is problematic with volume cycled ventilators Variable airway resistance and/or pulmonary or chest wall compliance better with volume settings Pressure cycling limits ability to stack "name": "Continuing Assessment", Better for younger, noncompliant lungs. { "@context": "http://schema.org", "width": "800" Morning headache and insomnia. Pressure sores, facial growth issues. "@context": "http://schema.org", Still can influence oxygenation somewhat (FiO2, PEEP, I-time) Square wave flow pattern. Control minute ventilation. ", Increasing peak pressures on volume mode (or decreasing tidal volumes in pressure modes) can also be a sign that the ETT is obstructed or of another problem with the ventilator circuit. "@context": "http://schema.org", "@context": "http://schema.org", "name": "Supporting Equipment External support\u2014PEEP Alarms\/Monitoring", "width": "800" Assist Control Mode Can trigger breaths, but needs support with each breath Control vs. SIMV CONTROL MODE SIMV MODE Every breath fully supportedCant wean by decreasing rate Risk of hyperventilation if agitated SIMV MODE Vent synchronizes to support patient effort Patient takes own breaths between vent breaths Increased work of breathing vs. control "@type": "ImageObject", "@context": "http://schema.org", }, 10 "description": "Neuromuscular diseases, chest wall diseases, spinal cord injury. { { }, 29 "width": "800" ", }, 8 Cycles based on patient initiated breaths. Moderate to severe sleep apnea. This does not make it easier for the patient to trigger the ventilator but it does help the patient generate larger tidal volumes. "contentUrl": "https://slideplayer.com/slide/5879828/19/images/35/Pressure+Support+Trigger+by+patient.jpg", "width": "800" "width": "800" "contentUrl": "https://slideplayer.com/slide/5879828/19/images/7/Indications%2FCriteria.jpg", "description": "After and acute illness. ", Nesreen El-Sayed Morsy Aly Thoracic Medicine Department, D. Sara Salarian,. Mechanical Ventilation in the Neonate RC 290 CPAP Indications: Refractory Hypoxemia PaO2 Many hospitals use 50% as the upper limit before changing. In pressure modes, the tidal volume can drop resulting in hypoventilation or it can increase, leading to overdistention. Congenital central hypoventilation syndrome. Thank you! "width": "800" { "name": "Need a hand Pressure Support", SIMV modes are used to wean patients; as you decrease the set rate, the patient will need to do more on their own to maintain normal blood gases. Indications/CriteriaForced vital capacity < 50% predicted Maximal Inspiratory Pressure < 60 ABG pCO2 > 45 Moderate to severe sleep apnea }, 23 "name": "Bilevel Mode Mimic BiPAP \/ No Backup Rate", "name": "Home ventilation reality", "name": "CPAP Continuous Positive Airway Pressure For simple sleep apnea", "@context": "http://schema.org", Continuing AssessmentTitration sleep studies Blood gases Bronchoscopy Home monitoring Used more frequently when weaning/decannulating }, 19 ", "width": "800" Disposable inner cannula models. Nov 2006 Kishore P. Critical Care Conference Improve oxygenation Increase/maintain minute ventilation and help CO 2 clearance . Nasal pillows. "@context": "http://schema.org", { Whichever mode one chooses, one needs to be aware of the limitations of that mode. }, 37 { Reliability. Parenchymal lung disease. Chin strap may be needed. { "@type": "ImageObject", "name": "Control vs. SIMV SIMV Modes Control Modes", "description": "Control FiO2 and MAP (oxygenation) Still can influence ventilation somewhat (respiratory rate, PAP) Decelerating flow pattern (lower PIP for same TV) Volume Limited. Volume control. }, 34 Pressure vs. Volume Pressure control Set pressure, volume variableBetter control of oxygenation than ventilation Better for younger, noncompliant lungs Volume control Set volume, pressure variable Better control of ventilation than oxygenation Better for older more compliant lungs { "@context": "http://schema.org", Tracheostomies New Modes in Mechanical Ventilation Manish Tandon Hartford Hospital July 10, 2013. ", "width": "800" "@context": "http://schema.org", control. "@type": "ImageObject", { ", Share buttons are a little bit lower. ", SIMV MODE. "name": "Indications\/Criteria", this can lead to hypoventilation or overexpansion of the lung. Allows pressure support, PEEP, inspiratory time, flow to be added and manipulated. "name": "Ventilators Leak can vary with sleep, position, and effort which is problematic with volume cycled ventilators. Outcomes Dependent on underlying diseaseOver 70% 10-year survival, most deaths due to underlying disease In retrospective studies, 0-8% of deaths were ventilator or technology-related Occasional hospitalization "@context": "http://schema.org", "@context": "http://schema.org", }, 3 Regardless of the parameter that is controlled, the other must be monitored as it is a reflection of the compliance and hence the patient\u2019s pulmonary function. ", Goals Extend the duration of life Enhance the quality of lifeReduce morbidity Improve physiologic function Achieve normal growth and development Reduce overall health care costs "name": "Ventilator Choice Noninvasive vs. invasive Portability Battery life",

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