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Mechanical Ventilation
Timothy A. Morris, M.D.
Division of Pulmonary and Critical Care Medicine
Medical Director, Respiratory Care
University of California, San Diego
How to Assess Ventilator
Modes
● Inhalation
● Exhalation
» what is controlled
● Inhalation
» what is controlled
» what is targeted
Pressure 20 cm H2O
Pressure
20 cm H2O
Time Constant
Pressure 20 cm H2O
Pressure
20 cm H2O
Increased Resistance
Obstruction
Pressure 20 cm H2O
Pressure
20 cm H2O
Simple Volume System
Pop!
Volume 2000 ml
Pressure 3500 cm H20
Big Secret!
valve
Volume?
(flow control)
Pressure?
Microprocessor
Control
Microprocessor
solenoid exhale
valve
Inhalatio
n
valve
(resistor
Pressure 3500 cm H20
) Tidal volume 500 ml
Pressure 35 cm H20
Quality of the control
● hardware:
» how frequently is the flow/pressure
measured
» how rapidly are adjustments made
» how are adjustments made
● software
» timing and patterns of control
How to Assess Ventilator
Modes
● Inhalation
» what is controlled
» what is targeted
Control Target
Volume
● Flow ● Time
control
● Pressure ● Pressure
● Volume
Targeting
Control Target
Time-cycled
● Flow ● Time
pressure
control
● Pressure ● Pressure
● Volume
Targeting
Control Target
● Flow ● Time
● Pressure ● Pressure
Volume
● Volume targeted
pressure
control
How to Assess Ventilator
Modes
● Inhalation
» what is controlled
» what is targeted
● Negative pressure
» inhalation efforts
● Positive pressure
» “bucking”
Negative pressure:
Adjustments
● No adjustment
● No adjustment
● Exhalation
» next year
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