Basic Concepts in Adult Mechanical

Ventilation

All names are protected copyrights of

Bird Products, Bear Medical and SensorMedics Inc.
Presentation Copyright 2001

Points of Discussion
1. Basic respiratory dynamics
2. Basic ventilator parameters
3. Control variables: pressure, volume
4. Phase variables: trigger, limit and cycle
5. Conditional variables
6. Breath types

Spontaneous Breathing

Exhalation

Inspiration

Precondition of Inspiration
Pa < Pb
y Pa < Pb

Pb
Gas Flow

y Spontaneous

breath
y Pb > Pa
y Mechanical
ventilation

Pa

Three - Dimensional Spring

Pleural
Pressure

Alveolar Pressure Changes

Pressure

Mechanical Breath

Time

Spontaneous Breath

Inspiration

Spontaneous Inspiration
Volume Change

Pressure Difference
Gas Flow

Mechanical Ventilation
Pressure Difference

Gas Flow

Volume Change

Airway Resistance
The Feature of the Tube

R=

P
F

Pressure Difference = Flow Rate x Resistance of the Tube

Compliance
V
C= P

Volume

V
P
Pressure

Volume Change =
Pressure Difference x Compliance of the Balloon

Compliance
Measures

compliance of the lung and thorax

Tidal volume / Plateau-PEEP
Units = ml/cmH20

Compliance and Resistance

P
R=
F
V
C=
P

Resistance
Measures airway resistance
Length
Viscosity
Flow
Radius4

Peak-plateau / Flowrate
Units = cmH20/Lps

Peak and Plateau Pressures

Peak airway pressure reflects
Baseline (PEEP)
Pressure due to compliance (L+T)
Pressure due to resistance

Plateau pressure (breath hold) reflects

Baseline (PEEP)
Pressure due to compliance (L+T)
(alveolar distending pressure)

Peak Alveolar and Transpulmonary

Pressures
y P(t) = VT/CR+ Flow x RR + PEEP tot

Peak Airway Pressure

Alveolar Pressure
Plateau pressure

_
meanPaw

+
_

Palveolar

Intrinsic PEEP
Ppleural

Ptranspulmonary = Palveolar - Ppleural

External PEEP

Pplat = Maximum Palveolar

Transpulmonary pressure is a key determinant of alveolar distension.

Basic Ventilator Parameters

y FiO2
y Fractional concentration of

inspired oxygen delivered

expressed as a % (21-100)
y Breath Rate (f)
y The number of times over a

one minute period inspiration

is initiated (bpm)

y Tidal volume (VT)

y The amount of gas that is

delivered during inspiration

expressed in mls or Liters.
Inspired or exhaled.
y Flow
y The velocity of gas flow or

volume of gas per minute

Terminology

Terminology: PIP & MAP

Peak Inspiratory Pressure

Pressure

A=A1+A2++An
A
Time

Mean Airway Pressure

Inspiration + Exhalation

Terminology: PEEP, I:E Ratio

Pressure

PIP

Positive End
Expiratory Pr.

PEEP
PIP

T insp.

T exp.

I:E=1:2

PEEP
Time

T insp.

I:E=4:1

Terminology: Flow and Volume

Minute Ventilation = Tidal Volume x Breath Rate
Flow

Tidal Volume

Pressure

Time

Volume = Flow X Time

Time
Flow Rate

Volume

PEEP
y Definition
y Positive end expiratory pressure
y Application of a constant, positive pressure such that at end exhalation,

airway pressure does not return to a 0 baseline

y Used with other mechanical ventilation modes such as A/C, SIMV, or

PCV
y Referred to as CPAP when applied to spontaneous breaths

PEEP
y Increases functional residual capacity (FRC) and improves

oxygenation
y Recruits collapsed alveoli
y Splints and distends patent alveoli
y Redistributes lung fluid from alveoli to perivascular space

5 cm H2O
PEEP

Classification
y Control variable
y Flow (volume)
y Pressure

y Phase variable
y Trigger, limit, cycle, baseline

y Conditional variable
y Patient effort and time

Control Variable
Which parameter remains constant despite
changes in pulmonary mechanics?
Pressure Generated Breath
Pressure

Flow

Time

Control variables
y Volume Ventilation

y Pressure Ventilation

Pressure

Pressure

Flow

time
Flow

time

Volume Control Breath Types

60

Paw

SEC

cmH 20
-20
120

6
INSP

SEC

Flow
L/min

120

6
EXH

If compliance decreases the pressure increases to

maintain the same Vt

Volume Targeted (Pressure Controlled)

As compliance changes - flow and volumes change

New Volume Targeted Breath

Pressure Variability is Controlled

Pressure then raises to assure that the set tidal

volume is delivered

Phase Variables
y A. Trigger mechanism
y What causes the breath to begin?

Patient (assisted)
y Machine (controlled)

y B. Limit variable
y Which parameter is sustained at a

preset level during the breath?

y Flow
y Pressure

y C. Cycle mechanism
y What causes the breath to end?

y Volume
y Time

Trigger Variable- Start of a Breath

y Time - control ventilation
y Pressure - patient assisted
y Flow - patient assisted
y Volume - patient assisted
y Manual - operator control

Inspiratory Trigger Mechanism

y Time
yControlled Mechanical Ventilation
y Pressure
y Flow
y Chest impedance
y Abdominal movement

Inspiratory - delivery limits

y Maximum value that can be reached but will not end the

breathy Volume
y Flow
y Pressure

Breath Types
y Mandatory
y Ventilator does the work
y Ventilator controls start and stop
y Spontaneous
y Patient takes on work
y Patient controls start and stop
y Assisted
y Patients triggers the breath
y The ventilator delivers the breath as per control variable
y Supported
y Patients triggers the breath
y Ventilator delivers pressure support
y Breath cycles at set flow

Thank You