know the difference between controlled ventilation and assist/control controlled variables: pc-cmv...
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![Page 1: Know the difference between controlled ventilation and assist/control Controlled variables: PC-CMV vs VC-CMV Phase variables: trigger/limit/cycle](https://reader030.vdocument.in/reader030/viewer/2022032523/56649d835503460f94a69f8e/html5/thumbnails/1.jpg)
CMV Mode Workshop
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Objectives:
Know the difference between controlled ventilation and assist/control
Controlled variables: PC-CMV vs VC-CMV Phase variables: trigger/limit/cycle Know the breath types Know the breath sequence Settings and adjustment Indications, advantages and
disadvantages
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Continuous Mandatory Ventilation
All breaths are mandatory and can be volume or pressure targeted
Controlled Ventilation – when mandatory breaths are time triggered
Assist/Control Ventilation – when mandatory breaths are either time triggered or patient triggered
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Mandatory Modes of VentilationCMV
Control Trigger Limit Target Cycle
PressureOr
Volume
Time Pressure or Volume
Time or Volume
Time Triggered Time Cycled Ventilation
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Controlled Ventilation: Breath Types
All breaths are mandatory breaths Ventilator determines the start time
(time triggered) Ventilator delivers the set control
(volume or pressure target) Te ventilator ends the breath (time- or
volume-cycled)
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Controlled Ventilation: Breath Sequence
All breaths are mandatory breaths
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Controlled Ventilation: Indications
Appropriate when a patient can make no effort to breathe or when ventilation must be completely controlled Drugs Cerebral malfunctions Spinal cord injury Phrenic nerve injury Motor nerve paralysis
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Controlled Ventilation: Indications
In other types of patients, controlled ventilation is difficult to use unless the patient is sedated or paralyzed with medications Seizure activity Tetanic contractions Inverses I:E ratio ventilation Patient is fighting (bucking) the ventilator Crushed chest injury – stabilizes the chest Complete rest for the patient
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Controlled Ventilation: Settings
Adequate alarms must be set to safeguard the patient E.g., disconnection
Sensitivity should be set so that when the patient begins to respond, they can receive gas flow from the patient
Do not lock the patient out of the ventilator!
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Flow(L/m)
Pressure(cm H2O)
Volume(mL)
Time Triggered, Pressure Limited, Time Cycled Ventilation Time (sec)
Time CyclingSet PC Level
Control Mode (Pressure-Targeted Ventilation)
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Flow(L/m)
Pressure(cm H2O)
Volume(mL)
Time Triggered, Flow Limited, Volume Cycled Ventilation Time (sec)
Preset VT
Volume Cycling
Time Cycling
Dependent onCL & Raw
Control Mode(Volume-Targeted Ventilation)
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Pressure Or Volume-Targeted Ventilation
ADVANTAGES
Decreases the work of breathing (WOB)
Helps maintain a normal PaCO2
DISADVANTAGES
Not able to assist the ventilator
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Hybrid Modes of VentilationA/C
Control Trigger Limit Target Cycle
PressureOr
Volume
Time Or
Patient
Pressure or Volume
Time or Volume
Time or PatientTriggered Time Cycled Ventilation
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Assist/Control Ventilation A time or patient triggered CMV mode in which
the operator sets a minimum rate, sensitivity level, type of breath (volume or pressure)
The patient can trigger breaths at a faster rate than the set minimum, but only the set volume or pressure is delivered with each breath
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Volume Controlled-CMV
Time or patient triggered, volume targeted, volume cycled ventilation
Graphic (VC-CMV) Time-triggered,
constant flow, volume-targeted ventilation
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Volume Controlled-CMV
Time or patient triggered, volume targeted, volume cycled ventilation
Graphic (VC-CMV) Time-triggered,
descending-flow, volume-targeted ventilation
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Pressure Controlled-CMV
PC – CMV (AKA – Pressure control ventilation - PCV)
Time or patient triggered, pressure targeted (limited), time cycled ventilation
The operator set the length of inspiration (Ti), the pressure level, and the backup rate of ventilation
VT is based on the compliance and resistance of the patient’s lungs, patient effort, and the set pressure
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Pressure Controlled-CMV
Airway pressure is limited, which may help guard against barotrauma or volume-associated lung injury Maximum inspiratory pressure set at 30 – 35 cm H2O Especially helpful in patients with ALI and ARDS
Allows application of extended inspiratory time, which may benefit patients with severe oxygenation problems
Usually reserved for patient who have poor results with a conventional ventilation strategy of volume ventilation
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Flow(L/m)
Pressure(cm H2O)
Volume(mL)
Patient Triggered, Flow limited, Volume Cycled Ventilation
Time (sec)
Preset peak Flow
Time Cycling
Assisted Mode(Volume-Targeted Ventilation)
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Flow(L/m)
Pressure(cm H2O)
Volume(mL)
Patient Triggered, Pressure Limited, Time Cycled Ventilation
Time (sec)
Time CyclingSet PC Level
Assisted Mode (Pressure-Targeted Ventilation)
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Assist/Control Ventilation Indications
Patients requiring full ventilatory support Patients with stable respiratory drive
Advantages Decreases the work of breathing (WOB) Allows patients to regulate respiratory rate Helps maintain a normal PaCO2
Complications Alveolar hyperventilation
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Thank You