ventilators
K SUDARSHAN
ASSOCIATE PROFESSOR
DEPT OF CARDIO-PULMONARY
DEFINITION
Ventilators are the devices used for artificial
ventilation.
Mechanical ventilation is the ventilator to
move room air or oxygen enriched air in to
and out of the lungs mechanically to maintain
proper levels of oxygen and carbon dioxide in
the blood.
Indications
Respiratory failure
Crush injuries of the chest
Severe scoliosis or major surgery
Muscular cases like tetanus ,myasthenia
gravis, muscular dystrophy.
Pulmonary:ARDS,COPD,Bronchial asthma
and drowning
CNS: Drugs, Overdose of Morphine,
Poisoning, Epilepsy cerebrovascular accident
and poliomyelitis .
ARDS
TYPES OF VENTILATORS
1)Negative pressure: The whole body kept in a
large negative tank and negative pressure set
in the tank which induces pressure.
2)Positive pressure: Air is sent in to the lungs
with pressure more than atmospheric
pressure ,i.e supra atmospheric pressure is set
up and air is driven through trachea.
3)High frequency positive: This is of two types
a)Jet frequency positive-350 breaths per
minute
b) Oscillator High frequency positive:1300
Negative pressure ventilator
Positive pressure ventilator
Modes of ventilation
This is two types
a) Full ventilatory support
b) Partial ventilatory support
Mixed ventilators
1)Controlled mandatory ventilator:
This is
fixed ventilation for definite time intervals , no
provision for spontaneous ventilatory effort,
limited to intra operative and immediate post
operative ventilation.
2)Assist control mode:
This acts like CMV and
when the patient takes a spontaneous
breathe ,the ventilator is triggered to preset
level of ventilation
Intermittent mandatory ventilator
& synchronized IMV:
In IMV the patients are free to breathe
spontaneously between set ventilator
breathes.
Mandatory breathes may be synchronized
with the patients spontaneous efforts.
Pressure support ventilator
A preset inspiratory pressure is added to the
ventilator circuit during inspiration in
spontaneously breathing patients.
Controlled mechanical ventilator
Tidal volume and respiratory rate are set in
machine
Assisted mechanical ventilator
Tidal volume is set and useful in weaning.
Assisted controlled ventilator
The tidal volume is set and patient is allowed
to respire himself.
Intermittent mandatory ventilator
The patient breathes by himself and in
between breathe rate is calculated. So
machine is set.
Synchronized mandatory ventilator
When patient makes his effort the machine
itself calculates his requirement.
Pressure ratio mandatory ventilator
This sets pressure with inspiration it is sent
in by machine.
Inverse ratio ventilator
Normal inspiration: Expiration ratio is 1:1.5
to 1:2.
So inspiration time is increased a useful in
acute respiratory distress syndrome.
Independent lung ventilator
Bifid endotracheal tubes are used in patient
one side of lung ventilator is more than other.
Advantages
1. Better gas distribution
2. Lower mean airway pressure
3. Less hemodynamic disturbance
4. Less sedation is required
5. Weaning is easier.
Setting up the ventilator
1. Ensure the airway secure
2. Ensure adequate sedation, opioids and
muscle relaxants
3. Tidal volume : Normal(10 ml /kg body
weight)
4. Respiratory rate :14-16/min
5. Fraction of inspired oxygen : Usually 100%
oxygen to start with there decreases slow.
Factors to be observed
1. Vital signs like blood pressure and heart
rate
2. Consciousness of patient
3. Secretions should be removed periodically
4. Checks alarm function of ventilator
5. Oxygen saturation in the blood
Classification of ventilator on phases
Inspiratory phase
Cycling to expiration
Expiratory phase
Cycling to inspiration
Inspiratory phase
this phase has
a. Pressure generators : Exposes the lung to a
pressure
b. Flow generators : Exposes the lung to the
flow of gas
Cycling or change over to expiration
this phase has
a. Pressure-Cycled :this phase presets the
pressure e.g Bird , Blease , Aarlow ,
Cyclator
b. Volume-cycled: This phase pre sets volume
E.g:Bear ,Bennet, Monaghan , Bromptam
c. Time –Cycled: This phase sets the length of
time E.g:Servo , Clape , Phillips , Engstrom
Expiratory phase
PEEP and NEEP allow expiratory restriction
or choice to be used so that expiration is
slowed .
PEEP is positive pressure and NEEP is a
negative pressure .
Cycling to inspiration
• This phase sets function sets independently
without patient so called controlled ventilation.
a. IMV: Intermittent mandatory ventilation: the gas
supplied to the patient so that he can take
whatever sized breathe he wishes and is able to.
b. MMV: Mandatory minute volume : this gives the
patient slight assistance to her own spontaneous
efforts.
c. CPAP: This phase is used in mild to moderate
acute respiratory insufficiency ,median
sternotomy and CABG. This increases FRC and
oxygenation.
Complications
1. Due to endotracheal tube
2. Barotrauma increases pressure- Surgical
emphysema , Pnemothorax.
3. Fluid retention
4. Stress ulcers- Gastric or duodenal
Xavions
Thank you
