Type of Breathing Delivery

Question 1

Type of Breathing Delivery

Answer 1

-Mandatory

	-Ventilator controls: Timing volume or inspiratory pressure

-Spontaneous

	-PT controls: The timing and the tidal volume 	

	-Based on the PTs demand and the PTs lung characteristics

-Assisted

	-Has characteristics of both mandatory and spontaneous

	-All of the breaths are generated by the vent

Question 2

Modes of Ventilation

Answer 2

-Continuous mandatory ventilation (CMV)

-Controlled ventilation

-Assisted ventilation

-Volume targeted CMV or volumes controlled CMV

	-Assisted controlled volume ventilation

-Pressure targeted CMV or pressured controlled CMV

	-Assist controlled pressure controlled ventilation

-Intermittent mandatory ventilation (IMV)

	-SIMV pressure controlled ventilation’

	-SIMV volume ventilation

Question 3

Assist Mode

Answer 3

-Only the PT can initiate ventilation

-Used with IPPB type treatment

-Not recommended for continuous ventilation

Question 4

Control Mode

Answer 4

-machine will self cycle at a reset rate

-Does not allow the PT to initiate ventilation

-Non apneic, non sedated PTs will often fight the vent requiring sedation and or paralyzation

-Locking out a PT by making the vent totally insensitive to PT effort is rarely advised

-Indication for head trauma/ surgery PT (for induced hypocarbia) status asthmaticus, flail chest, ect

Question 5

Assist- control mode

Answer 5

-Allows the PT to set the RR

-The vent will maintain a minimum rate

-May be used with most PTs in most cases

Question 6

-VC- CMV

Assist- control mode

Answer 6

-Assist control

		-A preset volume is set (Vt)

		-All machine breaths rhea the set Vt

		-All assisted (PT triggered) will reach the set Vt

		-In other words, all breaths whether machine or PT will reach Vt

Question 7

-PC-CMV

-Assist control

Answer 7

-A Preset pressure is set (PIP)

		-All machines breaths will reach the set pressure

		-All assisted (PT triggered) will reach the set PIP

		-In other words, all breaths whether machine or PT will reach set PIP

Question 8

Synchronized Intermittent Mandatory Ventilation (SIMV Mode)

Answer 8

-Allows the PT to breath spontaneous

-Ventilator provides a minimum minute ventilation

-Used with COPD PTs to normalize ABGs

-Used with tachypnea (>20 bpm) to avoid hyperventilation (e.g., pulmonary emboli)

-Used for weaning PT from Vent

-Used instead of assist control to reduce barotrauma

-Used with PEEP to reduce barotrauma

-Used when the gail is to have the PT breath spontaneously without receiving a mandatory breath with every effort

Question 9

-VC-CMV

-SIMV

Answer 9

-Has a set VT

-Has a set Rate

-All machine breaths will reach set Vt

-All Spontaneous breaths will reach PT desired Vt (it will vary)

-Machine will synchronize breaths, meaning, if it is time for a machine breath and the PT decides to take a spontaneous breath, the vent will synchronize and allow the PT spontaneous breath instead of the timed machine breath

-Most vents can also provide pressure support for spontaneous breaths

Question 10

-PC-CMV

-SIMV

Answer 10

-Has a set PIP

-Has a set Rate

-All machine breaths will reach set PIP

-All Spontaneous breaths will reach PT desired PIP (it will vary)

-Machine will synchronize breaths, meaning, if it is time for a machine breath and the PT decides to take a spontaneous breath, the vent will synchronize and allow the PT spontaneous breath instead of the timed machine breath

-Most vents can also provide pressure support for spontaneous breaths

Question 11

Pressure Control Ventilation

Answer 11

-Pressure controlled Breaths

-Used when Peak inspiratory pressure (PIP) are very high (>50cmHS2O)

-May improve oxygenation and reduce barotraumas

-Recommended for Pts requiring high FiO2s (>60%) and PEEP (>15cmH2O) high PIP (>50 cmH20) low PaO2’s, and decreased compliance (ARDS)

-Exhaled tidal volume will vary. Adjust inspiratory time or PIP as necessary

Question 12

Spontaneous Modes

Answer 12

-Spontaneous breathing

	-PTs can breathe spontaneously through a ventilator circuit without receiving any mandatory breaths (T-piece)

-Continuous positive airway pressure (CPAP)

	-Helpful for improving oxygenation in PT with refractory hypoxemia and low FRC

-Pressure support Ventilation (PSV)

	-The vent provides a constant pressure during inspiration once it senses that the PT has made an inspiratory effort

Question 13

Pressure Support Ventilation

Answer 13

-Spontaneous ventilation with all the PT spontaneous breaths supported by the vent

-The PTs inspiratory effort is supported by the vent up to a set level of inspiratory pressure

-Pressure support can only be used in SMIV and not Spontaneous mode

-Indications for PSV

	-Spontaneously breathing PT who require additional vent support to help overcome

		-Increased WOB (decreased C or increased RAW)

		-Respiratory muscle weakness

		-Weaning either by itself or in combination with another mode (SIMV, CPAP)

Question 14

Advantages of PSV

Answer 14

-Full to partial vent support

-Supports the PTs spontaneous Vt

-Decreases the PTs WOB by overcoming the resistance of artificial airway, vent circuit, and demand valves

-Allows PT control of the rate and Vt

-There is a set Peak Pressure

-Prevents respiratory muscle atrophy

-Facilitates weaning

-Improves Pts comfort and reduces the need for sudation

-May be applied in any mode that allows spontaneous breathing

Question 15

Disadvantages/ Risk of PSV

Answer 15

-Requires consistency spontaneous ventilation

-Vt is variable and dependent on lung characteristics