11

MLCnANICAL VLN1ILA1ICN


ln CrlLlcal Care we generally use servo l venLllaLors whlch can be used for lnvaslve (L11) and
nonlnvaslve (Mask/nasal CA) venLllaLlon We also use Lhe osclllaLor for lnvaslve
venLllaLlon and CA drlvers (lnfanL llowcare) for neonaLes CLher machlnes you may see
are Lhe vlSlCn for nonlnvaslve venLllaLlon ln Puu and vA Sulllvan Legendalr and 88LAS
whlch are malnly used for chlldren who requlre resplraLory supporL aL home


8as|c Concepts of Mechan|ca| Vent||at|on

1he funcLlon of Lhe resplraLory and cardlovascular sysLems ls Lo dellver oxygen (C2)
Lo Lhe Llssues and Lo ellmlnaLe carbon dloxlde (CC2)
1he alm of venLllaLlon ls Lo malnLaln adequaLe gas exchange ln Lhe Lungs aLlenLs wlLh
resplraLory problems wlll generally have an lncrease ln CC2 ln Lhelr blood gases CC2 can be
reduced by clearlng Lhe alrways wlLh sucLlon or by mechanlcally lncreaslng Lhe resplraLory
raLe or Lhe slze of Lhe breaLh (le lncreaslng venLllaLlon raLe pressure or volume)
1o generaLe Lhe necessary pressure access Lo Lhe chlld's alrway ls requlred 1hls ls normally
obLalned uslng an oral or nasal endoLracheal Lube (L11) a LracheosLomy Lube or lf non
lnvaslve venLllaLlon ls deslrable by a well sealed mask


Modes of Vent||at|on


ulfferenL modes/meLhods of venLllaLlon allows an lndlvlduallsed LreaLmenL plan responslve
Lo Lhe chlld's presenLlng paLhology and needs

CCN1kCLLLD
MCDLS
SUCk1LD MCDLS CCM8INLD MCDLS SCN1ANLCUS
8kLA1nING
vC S Au1CMCuL
vCvS
CA
C vS Au1CMCuL
CS
nasal CA
8vC nlvS Au1CMCuL 8vC
vS

nlvC SlMv vC+S
SlMv C+S
SlMv 8vC+S

C (ressure Contro||ed Vent||at|on) servo |

ln Lhls conLrolled mode of venLllaLlon Lhe venLllaLor dellvers a breaLh Lo a seL pressure and
aL a seL raLe 1hls ls prlmarlly used when Lhe paLlenL has no sponLaneous breaLhlng buL wlll
supporL Lhe paLlenL lf Lhey are able Lo Lrlgger a breaLh
lf Lhe pressure ls seL aL C 16 above LL of 4 Lhen Lhe venLllaLor wlll dellver a Lop pressure
(peak pressure) of 20 (C level of 16 plus LL) wlLh an end pressure of 4 1hls keeps Lhe
alrways sllghLly open maklng lL easler Lo lnflaLe Lhem and help prevenL collapse and
consolldaLlon
12



VC (Vo|ume Contro| Vent||at|on) servo |



ln volume conLrol mode a preseL Lldal volume ls dellvered aL a seL raLe prlmarlly used when
Lhe paLlenL has no sponLaneous breaLhlng
lf Lhe volume ls seL aL 4S llLres and a raLe of 20 Lhen Lhe volume dellvered wlLh each breaLh
wlll be 22Smls per breaLh (4S00mls/20 22Smls) 1he alr ls dellvered durlng Lhe lnsplraLory
phase held ln Lhe lungs durlng Lhe pause phase and Lhen released durlng Lhe explraLory
phase
eak pressure can vary from breaLh Lo breaLh dependlng on Lhe paLlenL's compllance and
reslsLance lf Lhe paLlenL's compllance reduces or reslsLance lncreases Lhe peak pressures
wlll lncrease Lo ensure Lhe seL Lldal volume ls achleved 1hls volume would be dellvered
wlLh each breaLh regardless of Lhe pressure requlred so lL ls very lmporLanL Lo check Lhe
upper pressure alarm seLLlng ls aL a sulLable value Lo proLecL Lhe paLlenL's lungs (lf Lhe
upper pressure llmlL ls reached lnsplraLlon wlll sLop and change Lo explraLlon)



kVC (ressure kegu|ated Vo|ume Contro|) servo |



8vC ls a conLrolled mode of venLllaLlon whlch comblnes pressure and volume conLrolled
venLllaLlon A preseL Lldal volume ls dellvered aL a seL raLe slmllar Lo vC buL lL ls dellvered
wlLh Lhe lowesL posslble pressure
lL ls very lmporLanL Lo check Lhe upper alrway pressure preseL alarm llmlLs as Lhls ls Lhe only
facLor LhaL llmlLs Lhe pressures from lncreaslng Lo poLenLlally damaglng levels 1he
maxlmum avallable pressure llmlL ls ScmP2C below Lhe preseL upper pressure alarm llmlL lf
Lhls ls reached Lhe venLllaLor wlll alarm regulaLlon pressure llmlLed" swlLch Lo explraLlon
and wlll noL be able Lo dellver Lhe preseL Lldal volume



AU1CMCDL servo |

All Lhree of Lhese conLrolled modes of venLllaLlon have an opLlon called auLomode whlch
auLomaLlcally conLrols Lhe LranslLlon beLween conLrolled (venLllaLor Lrlggered) and supporL
(aLlenL Lrlggered) mode ln accordance wlLh Lhe paLlenL's breaLhlng efforLs
AuLomode allows Lhe paLlenL Lo go lnLo a supporL mode auLomaLlcally lf Lhey Lrlgger Lhe
venLllaLor

ressure ConLrol ressure SupporL
volume ConLrol volume SupporL
8vC volume SupporL

lf Lhe paLlenL does noL make any resplraLory efforL Lhe venLllaLor wlll remaln ln Lhe
conLrolled mode or reverL back Lo Lhe conLrolled mode from Lhe supporL mode
noLe AuLomode ls noL posslble ln nlv
13

* A urple 1" appears on Lhe screen when Lhe paLlenL Lrlggers a breaLh on any mode



SIMV (Synchron|sed Interm|ttent Mandatory Vent||at|on) servo |

1hls mode ls used Lo asslsL paLlenL's who have some buL noL sufflclenL breaLhlng and can be
used for weanlng 1he venLllaLor provldes mandaLory breaLhs whlch are synchronlsed wlLh
Lhe paLlenL's sponLaneous efforLs aL a preseL raLe 1here are Lhree dlfferenL SlMv modes
on Lhe servo l

SlMv volume conLrol and ressure supporL
SlMv ressure ConLrol and ressure SupporL
SlMv 8vC and ressure SupporL

1he mandaLory breaLh ls deflned by Lhe baslc seLLlngs (conLrol mode) Lhe SlMv raLe ls Lhe
raLe of mandaLory breaLhs per mlnuLe and Lhe sponLaneous/supporLed breaLh ls deflned by
seLLlng Lhe pressure supporL level above LL





ressure Support Vent||at|on (S) servo |

ressure SupporL provldes supporL for every paLlenL Lrlggered breaLh and ls used for
paLlenLs who do noL have sufflclenL capaclLy or Lo faclllLaLe weanlng 1he paLlenL lnlLlaLes
Lhe breaLh and Lhe venLllaLor dellvers supporL wlLh Lhe preseL pressure level above LL
WlLh Lhe supporL of Lhe venLllaLor Lhe paLlenL regulaLes Lhe resplraLory raLe and Lldal
volume AlLhough Lhere ls no resplraLory raLe seL on Lhls mode Lhere ls a safeLy backup
venLllaLlon funcLlon on Lhe servo l lf Lhe paLlenL becomes apnoelc (1hls may noL be Lhe case
wlLh oLher venLllaLors)
*lL ls very lmporLanL Lo monlLor Lhe Lldal volumes and resplraLory raLe as Lhls mode ls
compleLely sponLaneous




Vo|ume Support (VS) servo |

volume supporL works ln a very slmllar way Lo pressure supporL buL Lhe Lldal volume and
LL are seL raLher Lhan Lhe pressure 1he paLlenL lnlLlaLes Lhe breaLh and Lhe venLllaLor
dellvers supporL ln proporLlon Lo Lhe lnsplraLory efforL and Lhe LargeL volume 1he seL Lldal
volume ls dellvered Lo Lhe paLlenL wlLh dlfferenL supporL from Lhe venLllaLor dependlng on
Lhe paLlenL's acLlvlLy




Cont|nuous os|t|ve A|rway ressure (CA) servo |

14
When LL ls applled wlLhouL oLher forms of venLllaLlon lL ls called CA ConLlnous oslLlve
Alrway ressure ls malnLalned ln Lhe alrways prevenLlng collapse buL Lhe paLlenL regulaLes
all oLher resplraLory funcLlons
Cn Lhe Servo l CA works ln Lhe same way as S buL Lhe S level ls seL Lo zero and lf Lhe
apnoea alarm ls Lrlggered lL wlll swlLch Lo backup venLllaLlon
noLe As wlLh all sponLaneous modes lL ls very lmporLanL Lo monlLor Lhe resplraLory raLe and
efforL






15
1kCU8LLSnCC1ING
8emember uCL
u ulsplaced 1ube?
C CbsLrucLlon?
neumoLhorax?
L LqulpmenL lallure?
CSSI8LL CCMLICA1ICNS CI MLCnANICAL VLN1ILA1ICN
ACCluLn1AL Lx1u8A1lCn
8LCCkACL SLC8L1lCnS / 8LCCu
ASl8A1lCn
18ACPLAL uAMACL L11/SuC1lCn
lnlLC1lCn
ln1u8A1lCn Cl 8lCP1 88CnCPuS
8A8C18AuMA nLuMC1PC8Ax
P?C/P?L8vLn1lLA1lCn
vLn1lLA1C8 uLLnuAnC? /lnA8lLl1? 1C WLAn
S18LSS uLCL8A1lCn Cl 1PL Cl 18AC1
P?C1LnSlCn
8lSL ln Cv
uLC8LASL ln 8LnAL lunC1lCn
MLCPAnlCAL LCulMLn1 lAlLu8L

Always ask more senlor members of sLaff or Lhe educaLlon Leam lf you feel Lhere may be a
problem wlLh your paLlenL or you have any querles lf Lhere ls a serlous problem wlLh your
paLlenL or Lhe equlpmenL call for help or pull Lhe emergency buzzer

Vent||ator and Vent||ator A|arm Sett|ng
ln Lhe lCu Lhe Medlcal sLaff are responslble for programmlng all venLllaLor seLLlng and
alarm llmlLs nurslng sLaff should noL alLer venLllaLor seLLlngs or alarm llmlLs buL are
responslble for checklng Lhem and lnformlng Lhe medlcal sLaff or senlor nurslng sLaff lf Lhey
are noL approprlaLely seL and need changed ln Lhe case of faulLs alarms should noL be
conLlnuously overrldden 1he nurse ln charge and Lhe bloenglneerlng deparLmenL should be
lnformed

All monlLorlng equlpmenL should be checked by Lhe nurse and documenLed aL Lhe beglnnlng
of each shlfL (as parL of Lhe safeLy checks) and venLllaLor seLLlngs should be checked every
hour and documenLed

Non Invas|ve Vent||at|on (NIV)
nonlnvaslve venLllaLlon refers Lo Lhe dellvery of mechanlcal venLllaLlon uslng a face
mask or slmllar devlce raLher Lhan an L11

lL ls lmporLanL LhaL Lhe followlng crlLerla are meL before commenclng nlv

1he paLlenL musL be consclous and breaLhlng sponLaneously
1he paLlenL musL have an adequaLe gag and cough reflex

NIV ressure Contro| (Servo |)

ln Lhls conLrolled mode of venLllaLlon Lhe venLllaLor dellvers a flow Lo malnLaln Lhe preseL
pressure aL a seL resplraLory raLe and lnsplraLory Llme (slmllar Lo lnvaslve C) 1he paLlenL
can also Lrlgger a paLlenL conLrolled breaLh
16

NIV ressure Support (Servo |)

nlv S ls a sponLaneous mode of venLllaLlon where Lhe paLlenL lnlLlaLes Lhe breaLh and Lhe
venLllaLor dellvers supporL wlLh Lhe preseL pressure level 1he paLlenL regulaLes Lhe
resplraLory raLe and Lldal volume so Lhe alarm parameLers musL be seL approprlaLely
noLe CA can be dellvered on Lhls mode by Lurnlng Lhe S Lo 0 and only seLLlng Lhe
LL

Nasa| CA (servo |)

nasal CA can be dellvered on Lhe servo l by nasopharyngeal Lube nasal mask or nasal
prongs on lnfanLs from S00g Lo 10kg 1he CA Level (cmP2C) and oxygen concenLraLlon ls
seL and Lhe venLllaLor wlll dellver Lhe flow necessary Lo malnLaln Lhe deslred pressure
compensaLlng for Lhe leak (1he max flow ls 33L/mln)


uurlng all servo l nlv Lhe venLllaLor auLomaLlcally adapLs Lo Lhe varlaLlon of leakage ln order
Lo malnLaln Lhe seL pressures Powever lf Lhe leakage ls excesslve or Lhe paLlenL ls
dlsconnecLed Lhe venLllaLor wlll alarm and pause Lhe venLllaLlon


V|s|on


non lnvaslve 8lA or S/1 (SponLaneous 1rlgger) Mode works ln a slmllar way Lo S

ln normal resplraLlon each breaLh conslsLs of Lwo phases an lnsplraLory and an explraLory
phase 8lA works by provldlng asslsLance durlng Lhe lnsplraLory phase of resplraLlon and
prevenLlng alrway closure durlng Lhe explraLory phase AsslsLance durlng Lhe lnsplraLory
phase (lnsplraLory oslLlve Alrway ressure lA) ls ln Lhe form of pressure supporL AL Lhe
end of each lnsplraLory phase a conLlnuous poslLlve pressure (CA) ls malnLalned and ls
Lermed explraLory poslLlve alrway pressure (LA)

1he 8lA venLllaLor alLernaLes beLween lA and LA synchronlslng wlLh Lhe paLlenL's
breaLhlng paLLern or aL a seL synchronlsed raLe


V|asys Infant I|ow S|A (CA Dr|ver)

1he lnfanL llow SlA provldes nonlnvaslve resplraLory supporL vla nasal prongs or nasal
mask

1he C2 and llow (pressure flow) ls seL (usually 810 l/mln) and Lhe level of CA achleved ls
dependenL on Lhe leak Cenerally a CA of 46cmP2C ls requlred Lo be effecLlve An
apnoea sensor can be aLLached Lo Lhe machlne for monlLorlng and alarms
17

Irequent|y Used 1erms

Auto1r|gger|ng]Se|f1r|gger|ng venLllaLor selfLrlggerlng caused by waLer ln Lhe Lublng or Lhe
Lrlgger senslLlvlLy belng seL Loo hlgh
Automode Mode LhaL auLomaLlcally swlLches beLween conLrolled and supporLed mode
dependlng on paLlenLs needs
8IA 8lphaslc poslLlve alrway pressure (nonlnvaslve)
CA ConLlnuous poslLlve alrway pressure
LMV Lxplred mlnuLe volume (l/mln)
LA Lxplred poslLlve alrway pressure
IA lnsplred poslLlve alrway pressure
IV lnLermlLLenL poslLlve pressure venLllaLlon (fully conLrolled venLllaLlon)
IMV lnLermlLLenL mandaLory venLllaLlon also known as lnLermlLLenL mechanlcal
venLllaLlon (fully conLrolled venLllaLlon)
Insp|ratory Cyc|e Cff 1he polnL aL whlch lnsplraLlon changes Lo explraLlon ln sponLaneous
and supporLed modes (1he servo l defaulL ls S0 for adulLs and 30 for lnfanLs)
Insp|ratory k|se 1|me 1he Llme Laken Lo reach peak lnsplraLory flow or pressure aL Lhe sLarL
of each breaLh (elLher as or Llme ln seconds)
Leak Alr escaplng around Lhe L11 causlng a sound a blL llke snorlng
MV (IMV) MlnuLe venLllaLlon (lnsplred mlnuLe volume l/mln) Lv x 88
ause 1|me 1lme beLween Lhe end of an lnsplred breaLh and exhalaLlon (no flow)
CV ressure conLrolled venLllaLlon
LL oslLlve end explraLory pressure
I eak lnsplred pressure maxlmum pressure measured durlng a breaLh
eak pressure Maxlmum pressure measured durlng a breaLh
kVC ressure regulaLed volume conLrol
S]CA ressure supporL / ConLlnuous poslLlve alrway pressure (SupporLlve mode where Lhe
paLlenL ls lnlLlaLlng all Lhelr own breaLhs)
SIMV C]S Synchronlsed lnLermlLLenL mandaLory venLllaLlon pressure conLrol / supporL
(SupporLlve mode Can be full venLllaLlon or used for weanlng)
SIMV VC]S Synchronlsed lnLermlLLenL mechanlcal venLllaLlon volume conLrol / supporL
(SupporLlve mode Can be full venLllaLlon or used for weanlng)
1| (I1) lnsplraLory Llme 1lme for acLlve flow or pressure dellvery Lo Lhe paLlenL
1r|gger Sens|t|v|ty SeLLlng LhaL can be changed Lo make lL easler or harder for Lhe paLlenL Lo
lnlLlaLe (Lrlgger) Lhelr own breaLhlng
1v (Vt) 1ldal volume (mls) 1he amounL of alr belng lnsplred/explred durlng a breaLh
VCV volume conLrolled venLllaLlon