essentials of ventilator graphics ©2000 respimedu ruben d restrepo, md, rrt, faarc professor the...
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Essentials of Ventilator Graphics ©2000 RespiMedu
Ruben D Restrepo, MD, RRT, FAARCProfessor
The University of Texas Health Science Center at San Antonio
Essentials of Ventilator Graphics ©2000 RespiMedu
Objectives
Identify graphic display options Identify graphic display options provided by mechanical ventilators.provided by mechanical ventilators.
Describe how to use graphics toDescribe how to use graphics to more appropriately adjust the patient more appropriately adjust the patient
ventilator interface.ventilator interface.
Essentials of Ventilator Graphics ©2000 RespiMedu
Introduction
Monitoring and analysis of graphic Monitoring and analysis of graphic display of curves and loops during display of curves and loops during mechanical ventilation has become mechanical ventilation has become critical to determine critical to determine how patient is being ventilated how patient is being ventilated to assess problems occurring during to assess problems occurring during
ventilationventilation
Essentials of Ventilator Graphics ©2000 RespiMedu
Uses of Flow, Volume, and Pressure Graphic Displays
Confirm mode functionsConfirm mode functions Detect auto-PEEPDetect auto-PEEP Determine patient-ventilator synchronyDetermine patient-ventilator synchrony Assess and adjust trigger levelsAssess and adjust trigger levels Measure the work of breathingMeasure the work of breathing Adjust tidal volume and minimize overdistension Adjust tidal volume and minimize overdistension
Assess the effect of bronchodilator Assess the effect of bronchodilator
administrationadministration
Essentials of Ventilator Graphics ©2000 RespiMedu
Detect equipment malfunctionsDetect equipment malfunctions Determine appropriate PEEP levelDetermine appropriate PEEP level Evaluate adequacy of inspiratory time in Evaluate adequacy of inspiratory time in
pressure control ventilationpressure control ventilation Detect the presence and rate of continuous Detect the presence and rate of continuous
leaksleaks Assess inspiratory termination criteria during Assess inspiratory termination criteria during
Pressure Support VentilationPressure Support Ventilation Determine appropriate Rise Time Determine appropriate Rise Time
Uses of Flow, Volume, and Pressure Graphic Displays
Essentials of Ventilator Graphics ©2000 RespiMedu
GraphicsGraphicsSCALARS LOOPS
Essentials of Ventilator Graphics ©2000 RespiMedu
Flow/TimePressure/Time
Volume/Time
Essentials of Ventilator Graphics ©2000 RespiMedu
Pressure-Volume Flow-Volume
Essentials of Ventilator Graphics ©2000 RespiMedu
Flow/TimePressure/Time
Volume/Time
Essentials of Ventilator Graphics ©2000 RespiMedu
Spontaneous BreathSpontaneous Breath
Time (sec)
Flow
(L/m
in) InspirationInspiration
ExpirationExpiration
Essentials of Ventilator Graphics ©2000 RespiMedu
Mechanical BreathMechanical Breath
Inspiration
Expiration
Flow
(L/m
in)
Time (sec)
Essentials of Ventilator Graphics ©2000 RespiMedu
Typical Flow PatternsTypical Flow Patterns
ACCELERATINGACCELERATINGACCELERATINGACCELERATING
DECELERATINGDECELERATINGDECELERATINGDECELERATING
SINESINESINESINE
SQUARESQUARESQUARESQUARE
Essentials of Ventilator Graphics ©2000 RespiMedu
Inspiratory Flow Pattern Inspiratory Flow Pattern
Inspiration
Expiration
Time (sec)
Flo
w (
L/m
in)
Flo
w (
L/m
in)
Beginning of inspirationexhalation valve closes
Peak inspiratory flow ratePIFR
Beginning of expirationexhalation valve opens
Total cycle timeTCT
Insp. timeTI
Expiratory Time TE
Essentials of Ventilator Graphics ©2000 RespiMedu
Expiratory Flow PatternExpiratory Flow Pattern
Inspiration
Expiration
Time (sec)
Flo
w (
L/m
in)
Beginning of expirationexhalation valve opens
Peak Expiratory Flow RatePEFR
Duration of expiratory flow
Expiratory time
TE
Essentials of Ventilator Graphics ©2000 RespiMedu
Inspiratory PauseInspiratory Pause
Inspiration
Expiration
Flow
(L/m
in)
Time (sec)}
pause
Essentials of Ventilator Graphics ©2000 RespiMedu
Inadequate Inspiratory FlowInadequate Inspiratory Flow
Flow (L/min)
Time (sec)
NormalAbnormal
Active Active InspirationInspiration
Patient’s effort
Essentials of Ventilator Graphics ©2000 RespiMedu
Air TrappingAir Trapping
Inspiration
Expiration
NormalNormalPatientPatient
Time (sec)
Flo
w (
L/m
in)
Air TrappingAuto-PEEP
}
Essentials of Ventilator Graphics ©2000 RespiMedu
Response to BronchodilatorResponse to Bronchodilator
Before
Time (sec)
Flo
w (
L/m
in)
PEFR
After
Long TE
Higher PEFR
Shorter TE
Essentials of Ventilator Graphics ©2000 RespiMedu
SCALARS
Flow/TimePressure/Time
Volume/Time
Essentials of Ventilator Graphics ©2000 RespiMedu
Volume vs TimeVolume vs Time
InspirationInspiration
Expiration
Time (sec)Time (sec)
Vo
lum
e (m
l)V
olu
me
(ml)
Inspiratory Tidal Volume
TTII
Essentials of Ventilator Graphics ©2000 RespiMedu
Air Leak/Air Trapping
Air Leak/Air Trapping
Vo
lum
e (m
l)V
olu
me
(ml)
Time (sec)Time (sec)
Volume lostVolume lost
Essentials of Ventilator Graphics ©2000 RespiMedu
SCALARS
Flow/TimePressure/Time
Volume/Time
Essentials of Ventilator Graphics ©2000 RespiMedu
Spontaneous BreathSpontaneous BreathPP
awaw (
cm H
(cm
H220
)0)
Time (sec)Time (sec)
InspirationInspiration
ExpirationExpiration
Essentials of Ventilator Graphics ©2000 RespiMedu
Mechanical BreathMechanical Breath
InspirationExpirationP
aw
(cm
H2O
)
Time (sec)
}}TI
Peak Inspiratory PressurePIP
PEEPPEEP
TE
Essentials of Ventilator Graphics ©2000 RespiMedu
Mechanical
Time (sec)
Pa
w
(cm
H2O
)
Time Triggered Breath
CONTROLLED BREATH(Time Triggered)
Essentials of Ventilator Graphics ©2000 RespiMedu
Assisted Breath(Patient Triggered)
Assisted Breath(Patient Triggered)
Mechanical
Time (sec)
Pa
w
(cm
H2O
)
Patient Triggered Breath
Essentials of Ventilator Graphics ©2000 RespiMedu
Assisted vs ControlledAssisted vs Controlled
Time (sec)
Assisted ControlledPressure (cmH20)
Essentials of Ventilator Graphics ©2000 RespiMedu
Spontaneous vs. MechanicalSpontaneous vs. Mechanical
MechanicalMechanical
Time (sec)
SpontaneousSpontaneous
Pa
w (
cm H
2O
)
Inspiration
ExpirationExpiration
Inspiration
Essentials of Ventilator Graphics ©2000 RespiMedu
Components of Inflation PressureComponents of Inflation Pressure
Begin Expiration
Pa
w
(cm
H2O
)
Time (sec)
Begin Inspiration
PIPPIP
Pplateau
(Palveolar)
Transairway Pressure (PTA)}}
Exhalation Valve Opens
ExpirationExpiration
Inspiratory Pause
Essentials of Ventilator Graphics ©2000 RespiMedu
Inadequate Inspiratory Flow
Adequate Flow
Time (sec)
Inadequate Flow
Pa
w
(cm
H2O
)
Essentials of Ventilator Graphics ©2000 RespiMedu
Pressure-Volume Flow-Volume
LOOPS
Essentials of Ventilator Graphics ©2000 RespiMedu
Pressure-Volume Loop
(Type of Breath)
Pressure-Volume Loop
(Type of Breath)
Controlled Assisted Spontaneous
Vol (m
l)
Paw
(cm H2O)
I: InspirationE: Expiration
I
E
E
E
II
Essentials of Ventilator Graphics ©2000 RespiMedu
Components of Pressure-Volume Loop
Components of Pressure-Volume Loop
Volume Volume (mL)(mL)
Insp
irat
ion
Expirat
ion
PIP
VT
PPawaw (cm H (cm H22O)O)
Essentials of Ventilator Graphics ©2000 RespiMedu
PEEP and P-V LoopPEEP and P-V Loop
Volume (mL)
VT
PIPPIPPaw (cm H2O)
PEEP PEEP
Essentials of Ventilator Graphics ©2000 RespiMedu
Work of BreathingWork of Breathing
A: Resistive Work B: Elastic Work A: Resistive Work B: Elastic Work
Pressure (cm H2O)
Volume (ml)
BBBB
AAAA
Essentials of Ventilator Graphics ©2000 RespiMedu
Inflection PointsInflection Points
Pressure (cm H2O)
Volume (mL)
Lower Inflection Point
Upper Inflection Points
Essentials of Ventilator Graphics ©2000 RespiMedu
Inadequate SensitivityInadequate Sensitivity
Volume Volume (mL)(mL)
PPawaw (cm H (cm H22O)O)Increased WOB
Essentials of Ventilator Graphics ©2000 RespiMedu
Air Leak/Air Trapping
Air Leak/Air Trapping
Volume (ml)
Pressure (cm HPressure (cm H22O)O)
Air Leak
Essentials of Ventilator Graphics ©2000 RespiMedu
Inadequate Inspiratory FlowInadequate Inspiratory Flow
PPaw aw (cm (cm HH22O)O)
Volume Volume (ml)(ml)
NormalAbnormal
Active InspirationActive Inspiration
Inappropriate FlowInappropriate Flow
Essentials of Ventilator Graphics ©2000 RespiMedu
PPaw aw (cm (cm HH22O)O)
Volume Volume (ml)(ml)
Higher PTA
Increased RawIncreased Raw
Higher PTA
Essentials of Ventilator Graphics ©2000 RespiMedu
HysteresisHysteresis
Volume (ml)
Pressure (cm Pressure (cm HH22O)O)
Abnormal Hysteresis
Normal Hysteresis
Essentials of Ventilator Graphics ©2000 RespiMedu
Lung Compliance Changes and the P-V Loop
Lung Compliance Changes and the P-V Loop
Volume (mL)Volume (mL)
PIP levels
Preset VT
PPawaw (cm H (cm H22O)O)
COMPLIANCEIncreasedNormalDecreased
COMPLIANCEIncreasedNormalDecreased
Volume Targeted Ventilation
Essentials of Ventilator Graphics ©2000 RespiMedu
Lung Compliance Changes and the P-V Loop
Lung Compliance Changes and the P-V Loop
Volume (mL)Volume (mL)
Preset PIP
VT
levels
PPawaw (cm H (cm H22O)O)
COMPLIANCEIncreasedNormalDecreased
COMPLIANCEIncreasedNormalDecreased
Pre
ssu
re T
arg
ete
d
Ven
tilatio
n
Essentials of Ventilator Graphics ©2000 RespiMedu
OverdistensionOverdistension
Volu
me (
ml)
Pressure (cm HPressure (cm H22O)O)
With little or no change in VTWith little or no change in VT
Paw risesPaw
rises
NormalAbnormal
Essentials of Ventilator Graphics ©2000 RespiMedu
Pressure-Volume Flow-Volume
LOOPS
Essentials of Ventilator Graphics ©2000 RespiMedu
Flow-Volume LoopFlow-Volume Loop
Volume (ml)Volume (ml)
PEFR
FRC
Inspiration
Expiration
Flo
w (
L/m
in)
Flo
w (
L/m
in) PIFR
VT
Essentials of Ventilator Graphics ©2000 RespiMedu
Air LeakAir LeakInspiration
Expiration
Volume (ml)
Flow Flow (L/min)(L/min)
Air Leak in mL
NormalAbnormal
Essentials of Ventilator Graphics ©2000 RespiMedu
Air TrappingAir Trapping
Inspiration
Expiration
Volume (ml)Volume (ml)
Flow (L/min)
Does not returnDoes not returnto baselineto baseline
NormalAbnormal
Essentials of Ventilator Graphics ©2000 RespiMedu
Increased Airway ResistanceIncreased Airway Resistance
Inspiration
Expiration
VolumeVolume (ml) (ml)
Flow (L/min)
Decreased PEFR
NormalNormalAbnormal
“Scooped out” pattern
Essentials of Ventilator Graphics ©2000 RespiMedu
Airway Secretions/Condensate in the Circuit
Airway Secretions/Condensate in the Circuit
Inspiration
Expiration
Volume (ml)Volume (ml)
Flow (L/min)
NormalAbnormal
Essentials of Ventilator Graphics ©2000 RespiMedu
Essentials of Ventilator Graphics ©2000 RespiMedu
Modes of Ventilation
SpontaneousMechanical
Volume Targeted
PressureTargeted
Essentials of Ventilator Graphics ©2000 RespiMedu
Spontaneous Breath
Time (sec)
FlowL/m
Pressurecm H2O
VolumemL
Essentials of Ventilator Graphics ©2000 RespiMedu
CPAPCPAP
Time (sec)Time (sec)
CPAP level
FlowL/m
Pressurecm H2O
VolumemL
Essentials of Ventilator Graphics ©2000 RespiMedu
PSVPSV
Time (sec)
FlowL/m
Pressurecm H2O
VolumemL
Flow CyclingFlow Cycling
Set PS level
Set PS level
Patient Triggered, Flow Cycled, Pressure limited Mode
Essentials of Ventilator Graphics ©2000 RespiMedu
CPAP + PSV CPAP + PSV
Set PS level
CPAP level
Time (sec)Time (sec)
FlowL/m
Pressurecm H2O
VolumemL
Flow Cycling
Essentials of Ventilator Graphics ©2000 RespiMedu
Modes of Ventilation
Spontaneous Mechanical
Volume Targeted
PressureTargeted
Essentials of Ventilator Graphics ©2000 RespiMedu
Controlled Mode (Volume- Targeted Ventilation)
Controlled Mode (Volume- Targeted Ventilation)
Preset VT
Volume Cycling
Dependent onCL & Raw
Time (sec)Time (sec)
FlowL/m
Pressurecm H2O
VolumemL
Preset Peak Flow
Time triggered, Flow limited, Volume cycled Ventilation
Essentials of Ventilator Graphics ©2000 RespiMedu
Assisted Mode(Volume-Targeted Ventilation)
Assisted Mode(Volume-Targeted Ventilation)
Time (sec)Time (sec)
FlowL/m
Pressurecm H2O
VolumemL
Preset VT
Volume Cycling
Patient triggered, Flow limited, Volume cycled Ventilation
Essentials of Ventilator Graphics ©2000 RespiMedu
SIMV(Volume-Targeted Ventilation)
SIMV(Volume-Targeted Ventilation)
Spontaneous Breaths
Pressure
Flow
Volume
(L/min)
(cm H2O)
(ml)
Essentials of Ventilator Graphics ©2000 RespiMedu
Controlled Mode (Pressure-Targeted Ventilation)
Controlled Mode (Pressure-Targeted Ventilation)
Pressure
Flow
Volume
(L/min)
(cm H2O)
(ml)
Time (sec)Time (sec)
Time-Time-Cycled
Set PC level
Time Triggered, Pressure Limited, Time Cycled Ventilation
Essentials of Ventilator Graphics ©2000 RespiMedu
Assisted Mode (Pressure-Targeted Ventilation)
Assisted Mode (Pressure-Targeted Ventilation)
Pressure
Flow
Volume
(L/min)
(cm H2O)
(ml)
Set PC level
Time (sec)Time (sec)
Time-Cycled
Patient Triggered, Pressure Limited, Time Cycled Ventilation
Essentials of Ventilator Graphics ©2000 RespiMedu
Pressure
Flow
Volume
(L/min)
(cm H2O)
(ml)
Set PC levelSet PC level
Time (sec)Time (sec)
SIMV Mode (Pressure-Targeted Ventilation)
SIMV Mode (Pressure-Targeted Ventilation)
Spontaneous Breath
Essentials of Ventilator Graphics ©2000 RespiMedu
Pressure
Flow
Volume
(L/min)
(cm H2O)
(ml)
SIMV + PS (Pressure-Targeted Ventilation)
SIMV + PS (Pressure-Targeted Ventilation)
PS Breath
Set PS levelSet PC levelSet PC level
Time (sec)
Time-Cycled Flow-Cycled
Essentials of Ventilator Graphics ©2000 RespiMedu
SIMV+PS(Volume-Targeted Ventilation)
SIMV+PS(Volume-Targeted Ventilation)
Flow
Pressure
Volume
(L/min)
(cm H2O)
(ml)
Set PS level
PS Breath
Flow-cycled
Essentials of Ventilator Graphics ©2000 RespiMedu
Pressure
Flow
Volume
(L/min)
(cm H2O)
(ml)
Set PC levelSet PC level
Time (sec)Time (sec)
SIMV + PS + CPAP (Pressure-Targeted Ventilation)
SIMV + PS + CPAP (Pressure-Targeted Ventilation)
Set PS level
CPAP levelCPAP level
Essentials of Ventilator Graphics ©2000 RespiMedu
SIMV+PS + CPAP(Volume-Targeted Ventilation)
SIMV+PS + CPAP(Volume-Targeted Ventilation)
Flow
Pressure
Volume
(L/min)
(cm H2O)
(ml)
Set PS level
CPAP levelCPAP level
Time (sec)
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