Ventilator

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1. VENTILATOR YASH.GIRISHBHAI.PATEL

2. DEFINITION It is piece or equipment whose function is to move gas in and out of lungs. It is a a rtificial supporting system when natural system of respiration aids fail.

3. TYPE TWO TYPE 1) invasive : Full support – CMV (VC, PC) Partial support – IMV, SIMV, PSV, BIPAP

4. TYPE 2) non- invasive : it doesn’t require ETT or Tracheostomy Positive pressure (via face or nasal mask) - CPAP, BiPAP, NIPPV Negative pressure -cuirass tank, iron lung

5. THREE WAYS OF VENTILIATION 1) VOLUME.CYCLE: Cycling to expiration occur after per-selected volume is delivered to patient. 2)PRESSURE CYCLE: Cycle terminates inspiration when development of a preset pressure. 3) TIME CYCLE: Form inspiration phase, cycling to expiration occur after a set length of time.

6. MODES OF VENTILATOR CMV - controlled mechanical It does not allow spontaneous breathing. It requires patient be sedated and paralyzed. The ventilator derive all breath at per-set. Frequency, volume or pressure and flow rate. The patient, can not take spontaneous breath or trigger the machine.

7. INDICATION Initial control of patient with little respiratory drive, severe lung disease, gas traping or circulatory instability.

8. MODES OF VENTILATOR IMV - intermittent mandatory ventilation Pt. is allowed to take spontaneous breaths between cycles of ventilator. The machine gives pre-set no. of breath each minute. But in between these he can breath for himself.

9. SIMV - synchronized intermittent ventilator It improves on that of IMV. Mandatory breaths are delivered in synchrony with the pt’s breathing. When pt. is maintaining creation degree of respiratory effort, that is he can support himself.

10. Mode of weaning Indication : to provide partial ventilator support to the pt. Advantage : Maintains respiratory muscle strength/ avoid muscle atrophy Reduce ventilation- perfusion mismatch. Decrease mean airway pressure.

11. PSV - pressure support ventilation. Breath are initiated or triggered by the pt. but pressure support is provided to augment pt’s own respiration. Use – when pt. controls the frequency, tidal volume, inspiratory time but pressure is not achieved. Used in conjunction with SLMV

12. MODE OF VENTILATOR PEEP - positive end expiratory pressure It increase functional residual capacity by recruiting areas of collapsed/ atelectasis or edema lung and improves o2. CPAP – continuous positive airway It is used when pt. is having spontaneous breathing. It maintain +ve pressure in the circuitry and airway throughout inspiration and expiration.

13. MODES OF VENTILATOR CPAP mask Is a tight fitting mask secured around the pt’s mouth and nose. Pre-set (+ve) pressure and o2 percentage is delivered USE 1) When lung volumes are reduced, in particular the FRC. E.g. sudsegmetal lung collapse, pneumonia and acute respiratory distress syndrome.

14. 2) Improves ventilation/perfusion (V/Q) mismatch. 3) Improves lung compliance so it reduces the work of breathing.

15. MODES OF VENTILATOR BiPAP – bilevel PAP: ( biphasic positive airway pressure) It ranges from purely mechanical ventilation to purely spontaneous breathing. This rang can cover entire course of therapy form intubations to weaning.

16. Ventilator produces +ve pressure and inspiratory muscle -ve pressure.

17. Genuine – BiPAP : Continuous spontaneous breathing at 2 pressure level. CPAP : Continuous spontaneous breathing and both pressure level are equal.

18. It delivers 2 leave of pressure in phase with respiration. The higher pressure provides inspiratory support and augments tidal volume. The low pressure is applied during expiration and increase FRC. May be applied via face or nasal mask.

19. INDICATION Post operative Respiratory Circulatory Neurological Multiple trauma Additional consideration -metabolic factors

20. CLASSIFICATION OF VENTILATORS 1) Inspiratory phase : -ventilators generate either flow or pressure. Pressure generators : expose the lung to a pressure, gas flows into the lung until the pressure within the patient is equal to the ventilator pressure. Flow generators : it expose the lung to a flow of gas, gas enters the lung for as the flow continues, and the pressure and volume raise accordingly.

21. CLASSIFICATION OF VENTILATORS 2) Cycling to expiration: Pressured cycled Volume cycled Time cycled 3) Expiratory phase: Expiration PEEP NEEP ZEEP

22. CLASSIFICATION OF VENTILATORS 4) Cycling to inspiration: machine adjust the expiratory time to fulfill the presser I:E ration

23. ALARM It indicates pt's condition or machine malfunction. It monitors – high and low pressure, Fio2, apnea, disconnection and volume. High pressure alarm signify -Secretion buildup, -Ventilator tube occlusion -Excessive water buildup

24. Low pressure signify -Leak in the ventilator circuitry, -Bad pt connection.

25. HIGH FREQUENCY VENTILATOR It is the type of mechanical ventilation. That employs very high respiratory rate (60bpm) and small tidal volume. It reduces ventilator associated lung injury.

26. The rates depending upon pt. type and dz condition. It generates very low tidal volume that are less than the dead space. Use : hypoxia , sever ARDS, other o2 issues. In these case, normal ventilators are not used. It is 1 line of ventilation in some neonatal pt. -becoz risk of lung injury from conventional ventilation.

27. WEAINNG FORM MECHANICAL VENTILATOR SIMV, PSV, BiPAP , CPAP are the weaning technique used to allow the gradual withdrawal of mechanical support.

28. SIMV : frequency and duration are preset by staff. In PSV : frequency and duration depends in patient.

29. POINTS OF CONSIDERATION FOR WEAANING Pt should not be under the effect of any respiratory depressive drug. The chest x-ray should be cleared. Pt. should not wean off immediately following physiotherapy. Pt’s T.V should approximate that delivered by the ventilator.

30. POINTS OF CONSIDERATION FOR WEAANING Pt should able to generate sufficient intrathorassic pressure (-ve inspiratory pressure) for deep breathing. The arterial blood gases should be relatively normal without the need for high inspired concentration of o2

31. GENERAL STEPS IN WEANING A PT FROM THE MECHANICAL VENTILATION. Period of time are spent off the ventilator and ‘T’ tune that delivers appropriate o2 and humidity. Mornings are often good time. Physical therapist offer support and reassurance and ask pt. to take deep breath. Monitor constantly vital signs and deep breaths. Deterioration in vital sign indicate that we have to return to a ventilator assistant.

32. PARAMETERS TV> 5 ml/k body weight. RR<30/ min Breathing pattern synchronous Compliance>25Ml/cm h2o pao2> 60 mm hg Paco2< 50 mm hg

33. GENERAL STEPS IN WEANING A PT. FROM MECHANICAL VENTILATION Rest period at least of 1 hour. Pt’s having cardiopulmonary disease, who are older, malnourished, older or smoker can be expected to take longer to be completely weaned from the ventilator. Weaning is faster in pts who have required a shorter period of mechanical ventilation.

34. GENERAL STEPS IN WEANING A PT. FROM MECHANICAL VENTILATION Once the pt with tracheostomy tube has ben weaned off the ventilator, the cuff, plastic tube is changed for an unstuffed silver tube which has an inner speaking tube enabling him to talk. Before the removal of this tube, we must to ensure that pt is capable of clearing his own secretion by hufing and cuffing. Then the silver tube will be removed and a dry dressing placed over stoma which will heal in a few days.

35. PHYSIOTHERAPIST ROLE IN WEANING Early assessment of patient rehabilitation potential(strength, endurance be mobility, transfer) Assistance in secretion clearance Respiratory muscle training Identification of readiness or extubation -minimal secretion -Effective cough -Airway reflexes present -Neurological status

36. Facilitation of endotracheal extubation to non invasive ventilation. Assistance with tracheostomy weaning (periods of spontaneous batching interspersed with periods of respiratory muscle rest on mechanical ventilator) Recognizing patients at risk of difficulties in weaning (COPD, heart failure, obesity , renal failure, flial chest.)