ventilator waveforms Dr Sanjay Chugh.pptx

It's about ventilator

1. VENTILATOR WAVEFORM ANALYSIS DR. SANJAY CHUGH MBBS MD FNB CONSULTANT ICU MAHARAJA AGRASEN HOSPITAL

2. Measured Parameters Flow Pressure Volume Time

3. Uses of Flow, Volume, and Pressure Graphic Display Confirm mode Detect auto-PEEP Determine patient-ventilator synchrony Assess and adjust trigger levels Measure the work of breathing Adjust tidal volume and minimize overdistension Assess the effect of bronchodilator administration Detect equipment malfunctions Determine appropriate PEEP level

4. Breath Delivery Four phases of ventilatory cycle trigger flow delivery cycle expiratory phase Breaths described by what determines the above phases

5. MOST COMMONLY USED WAVEFORMS Pressure vs. Time Flow vs. Time Volume vs. Time

6. VCV

7. PCV

8. IFT EPT EFT IPT Inspiratory Phase Expiratory Phase IFT( A - B ): Inspiratory Flow Time/Phase EFT( C - D ): Expiratory Flow Time/Phase IPT( B - C ):Inspiratory Pause Phase EPT( D - A ): Expiratory Pause Phase Inspiratory Time( A - C ): IFT+IPT Expiratory Time( C - A ) EFT+EPT A → (Exp. To Insp.) →Trigger (Time Cycled mostly), Depends on Respiratory Rate C → (Insp.ToExp.) → Volume/ Pressure or Time Cycled A-C : C-A → I:E Ratio ( Normal 1:2 ) A D C B D C B A Respiratory Cycle

9. PRESSURE VS. TIME CURVE Basics Abnormalities Spontaneous Breath Increased Airway Resistance Mechanical Breath Effect of High Inspiratory Flow Controlled vs Assisted Breath Decreased Lung Compliance Components of Inflation Pressure Inadequate Inspiratory Flow

10. PRESSURE VS TIME GRAPH

11. PRESSURE-TIME CURVE 1 2 3 4 5 6 20 Sec P aw cmH 2 O Pressure Ventilation Volume Ventilation

12. PATIENT TRIGGERING 1 2 3 4 5 6 30 Sec P aw cmH 2 O -10

13. ADEQUATE FLOW DURING VOLUME CONTROL VENTILATION 30 Time (s) -10 1 2 aw P cmH 2 O Adequate flow 3

14. INADEQUATE FLOW DURING VOLUME CONTROL VENTILATION 30 Time (s) -10 1 2 aw P cmH 2 O Adequate flow Flow set too low 3

15. Paw (cm H 2 O) Normal PIP P Plat High R aw PIP P Plat Low Compliance PIP P Plat } Increased P TA

16. PEEP

17. FLOW -TIME CURVE Basics of Flow vs. Time Curve Spontaneous Breath Mechanical Breath Typical Flow Patterns Inspiratory Flow Expiratory Flow Recognition of Common Abnormalities Obstruction vs. Active Expiration Response to Bronchodilators Air Trapping/Auto-PEEP

18. FLOW VS.TIME CURVE 1 2 3 4 5 6 SEC 120 120 EXH INSP V . LPM Inspiration

19. FLOW VS.TIME CURVE 1 2 3 4 5 6 SEC 120 120 EXH INSP V . LPM Inspiration Expiration

20. FLOW VS.TIME CURVE 1 2 3 4 5 6 SEC 120 120 EXH INSP Inspiration V . LPM Constant Flow Descending Ramp

21. FLOW-TIME CURVE 1 2 3 4 5 6 SEC 120 120 EXH INSP Insp. Pause Expiration V . LPM

22. PEFR PEFR

23. From ERV: Exp. Reserved Vol.

24. LOOPS Pressure-Volume Loops Flow-Volume Loops

25. FLOW- VOLUME LOOP Recognition of Common Abnormalities Air Leak Auto-PEEP/Air Trapping Increased Airway Resistance Airway Secretions/Accumulation of Condensate

26. AIR TRAPPING/ AUTO PEEP

27. INCREASE AIRWAY RESISTANCE

28. PEEP

29. Active Inspiration

30. AIR LEAK

31. VOLUME CONTROLLED VENTILATION

32. PRESSURE CONTROLLED VENTILATION

33. SPONTANEOUS VS. IPPV

34. CMV VS. ASSIST CONTROL

35. SPONTANEOUS VS. PSV

36. SIMV Vs. SIMV+PS

37. PSV Vs. CPAP

38. TAKE HOME POINTS Ventilator waveform analysis is an integral component in the management of a mechanically ventilated patient Develop a habit of looking at the right waveform for the given mode of patient ventilation Always look at the inspiratory and expiratory components of the flow-time waveform Don’t hesitate to change the scale or speed of the waveform to aid in your interpretation

39. THANK YOU