Mechanical Ventilation Modes

what's up guys in this video we are going to talk about all of the modes of mechanical ventilation are you ready let's go so first and foremost what is a ventilator mode a ventilator mode is a way to describe how the mechanical ventilator assists a patient with inspiration the characteristics of a particular ventilator mode controls how the Machine functions and assists with the pattern of breathing when selecting a ventilator mode there are two primary control variables and they are volume control and pressure control volume control means that you can set or control the patient's tidal volume so what they set tidal volume and I set respiratory rates this means that there is a known minute ventilation this is good when it comes to making adjustments to achieve a desired paco2 one of the negative aspects of using volume control is that since the tidal volume is preset if the patient's lung compliance were to decrease this could result in high peak pressures another drawback of volume control is patient ventilator to synchrony and then there's pressure control ventilation pressure control means that you can set or control the patient's pressure in order to achieve a desired tidal volume so as with volume control a pressure controlled tidal volume and set rate can help you reach a desired paco2 the main disadvantage of using pressure control is the patient's tidal volumes can potentially be unstable if there are changes in the patient's lung compliance or air weight resistance so again volume control and pressure control those are the two control variables when initiating mechanical ventilation on a patient once you set the can variable now you can choose the actual operational mode that determines the pattern of breathing for the patient understanding the different ventilator modes is one of the most important aspects of mechanical ventilation and luckily for you we are going to walk you through them now is that sound good well if so let's keep going so most importantly what are the primary ventilator modes and again these are the operational modes of the machine now the two primary modes are assist control or AC or simv which stands for synchronous intermittent mandatory ventilation first we will talk about assist control in this mode a minimum number of preset mandatory breaths are delivered by the ventilator but the patient can also trigger assisted breaths the patient makes an effort to breathe and the ventilator assists in delivering the breath with that said just know that the breasts are not spontaneous in this mode the breaths can be patient triggered but they are still delivered by the ventilator that is where it gets its name assist control because the mandatory breaths are preset which means they are controlled but the patient can trigger additional breaths which these are the assisted breaths and when using this mode the sensitivity setting or the sensitivity control can be adjusted to make it easier or harder for the patient to initiate a breath assist control is most often indicated when mechanical ventilation is first initiated for a patient because this mode provides full ventilatory support that is also one of the advantages of using assist control because it keeps the patient's work a breathing requirement very low but one of the major complications of assist control is hyperventilation which this results in respiratory alkalosis this is the result of two mini breasts being giving to the patient whether they are patient triggered or machine triggered and the second primary mode is simv or synchronous intermittent mandatory ventilation now in this mode the ventilator delivers a preset minimum number of mandatory breaths however it also allows the patient to initiate spontaneous breaths in between the mandatory breaths this mode allows the operator which is either the respiratory therapist or the doctor to set either a controlled pressure or a controlled volume the primary indication for simv is when the patient needs partial ventilatory support because since the patient can take spontaneous breaths that means that they can contribute to some of their minute ventilation simv is a mode that is used for weaning as well some of the key advantages of using simv include a sense in this mode the patient can take spontaneous breaths this helps to maintain their respiratory muscle strength and avoid muscular atrophy another advantage is that in general in simv it distributes the tidal volumes evenly throughout the lung fields which this can reduce v/q mismatching and last but not least simv helps to decrease the patient's mean airway pressure as our respiratory therapist or student simv and assist control are the two primary ventilator modes that you should be the most familiar with however it's also important to develop an understanding of some of these secondary modes and the spontaneous modes as well first let's talk about the spontaneous modes of breathing keep in mind that in order to use any of the following modes the patient must be breathing spontaneously so first we will talk about CPAP or a continuous positive airway pressure now in CPAP a continuous pressure that is above atmosphere pressure is delivered and maintained throughout the entire breathing cycle again the patient must be breathing spontaneously to be in this mode because no mandatory breaths are given CPAP is a useful mode for weaning patients off of the ventilator next we have PSV or pressure support ventilation this is a mode of mechanical ventilation in which the patient spontaneous breaths are supported by the ventilator during the Institute of breathing as the patient triggers our breath the ventilator assists by adding pressure to make breathing easier the level of pressure is preset by the operator so you have control over how much support you give the patient for example the higher the level of pressure support that is set the easier it will be for the patient to take a breath in pressure support ventilation the breaths are time cycled and pressure limited pressure support is often used to help the patient overcome the airway resistance that is caused by the endotracheal tube before example let's say that there's a patient who needs to be weaned from the ventilator and they're in the simv mode if the patient's endotracheal tube size is too small the airway resistance would be increased and this would make weaning difficult this is where pressure support would come in handy because it would help the patient overcome the airway resistance so that they can be weaned and extubated from the ventilator and the last spontaneous mode that will mention is volume support or V s this is a mode of mechanical ventilation in which the ventilator delivers a supportive breath to help the patient reach a set tidal volume this mode is totally dependent on the patient's effort meaning that the Machine varies the inspiratory pressure support level with each breath in order to achieve the target volume this mode is not quite as common as some of the others but it's often used to wean patients from anesthesia so now we've talked about the primary modes we've talked about the spontaneous modes now let's talk about the unconventional modes or sometimes referred to as the secondary modes of ventilation first we have control mode ventilation or CMV this is a mode where the ventilator delivers a preset tidal volume at a set time triggered frequency so basically the ventilator controls both the rate and the tidal volume which means that it's in total control of the minute ventilation this mode should only be used on patients who are fully sedated and have been administered neuromuscular blocking agents this is also one of the biggest hazards of using this mode as well because since the patient is fully dependent on the ventilator for ventilation and oxygenation it could be devastating if they were to become disconnected next we have aprv or airway pressure release ventilation this is a mode in which two levels of CPAP are applied with an intermittent release phase for spontaneous breaths so basically in this mode you will set a high pressure low pressure a high time and a low time if that sounds confusing no worries we will go into much more detail in another video but the main thing I want you to remember about aprv is that this mode is often recommended to improve oxygenation and treat refractory hypoxemia which that means that is good to recommend this mode for ARDS or acute respiratory distress syndrome for an acute lung injury and in some cases for add electives next we have mm V or mandatory minute ventilation this is a feature of some ventilators that causes an increase in the mandatory breaths that are delivered when the patient spontaneous breathing level becomes inadequate so basically if the patient spontaneous breathing decreases the ventilator compensates in order to make sure that a safe minimal minute ventilation is delivered mmv is often an additional function of the simv mode and is intended to prevent hypercapnia next we have IR V or inverse ratio ventilation this is a mode that uses an inverse ie ratio to improve oxygenation and gas exchange it's been shown to decrease shunting improve v/q mismatching and decreased dead space ventilation this mode is commonly recommended for patients with acute respiratory distress syndrome aka artes this mode actually causes auto-peep which usually when you think of auto-peep or intrinsic peep that's normally not a good thing right well in this mode the auto peep is actually what helps improve the patient's oxygenation and it reduces shunting so remember that the two modes that are used to treat patient with ARDS or airway pressure release ventilation and inverse ratio ventilation next up we have pressure regulated volume control or a prvc this is a mode of ventilation that provides volume controlled breaths with the lowest pressure possible it does so by altering the flow and inspiratory time this mode is used to keep the peak airway pressure at the lowest possible level this mode is volume cycled and can be patient triggered or a time triggered next we have P AV or proportional assist ventilation this is a mode of ventilation where the Machine uses variable pressure to provide pressure support for the patient spontaneous breaths the level of pressure support is adjusted depending on the patient's work of breathing P AV can either be pressure triggered or flow triggered and the breathing cycle ends once the patient's volume or flow demands are met and one thing to keep in mind about this mode is that if the patient's lungs show rapid improvement over distinction or barrel trauma could occur because too much pressure would be delivered next up we have ASV or adaptive support ventilation this is a mode that changes the number of mandatory breaths and pressure support level according to the patient's breathing pattern next we have a PC or adaptive pressure control this is a pressure controlled mode that utilizes a closed loop control of the pressure setting in order to maintain a minimum delivery tidal volume with that said in this mode the delivery tidal volume will vary depending on the patient's lung compliance next we have valves or volume assured pressure support this is a mode of ventilation that provides a stable tidal volume by incorporating inspiratory pressure support ventilation along with conventional volume assisted cycles this mode is only available on certain ventilators one thing about this mode is that it causes prolonged inspiratory time so patients with an obstructive disease should be monitored closely in order to prevent air trapping or other cardiovascular effects next up we have Nava or newly adjusted ventilatory assist this one's pretty cool it's a mode that uses the patient's electrical activity of the diaphragm to guide the functionality of the ventilator a catheter that has electrodes is positioned in the patient's esophagus at the level of the diaphragm and that is how the electrical activity is picked up from the phrenic nerves then the ventilator uses this information in order to adequately ventilate the patient next up is automatic tube compensation or ATC while technically in my opinion this is not a mode I did want to mention it briefly because this is a setting on some ventilators and it offsets and compensates for the airflow resistance that is imposed by the endotracheal tube or by the artificial airway and last but most certainly not least is high-frequency oscillatory ventilation or a fov this is a mode or a type of mechanical ventilation that delivers very small tidal volumes at an extremely fast rate which minimizes the chances of a lung injury this mode has been shown to improve oxygenation in severe cases such as with refractory hypoxemia now briefly we need to mention the settings for this mode when making adjustments to settings and high-frequency ventilation the ventilation can be increased by increasing the power or amplitude setting or by decreasing the frequency ventilation can be decreased by decreasing the power or amplitude setting or by increasing the frequency oxygenation can be increased by increasing the mean airway pressure setting or by increasing the fio2 and vice-versa if you want to decrease the oxygenation for some reason this mode is also indicated to provide mechanical ventilator support and neonates with conditions such as a congenital diaphragmatic hernia diffuse alveolar disease and pulmonary hypoplasia but we will talk more about that in another video so there you have it now you know all the primary spontaneous and secondary modes of mechanical ventilation hopefully you found this information to be helpful if so and if you want to support the channel be sure to hit that thumbs up button because it actually really helps a lot and while you're here you might as well go ahead and subscribe because we got some more videos on mechanical ventilation that will be coming out very soon and if you want to dive deeper into the - later modes we have a full article on our website that I think will be helpful for you I will drop a link to that down below in the description that's it for this one thanks again for watching and I will see you in the next video and as always breathe easy my friend [Music]

what&#39;s up guys in this video we are going to talk about all of the modes of mechanical ventilation are you ready let&#39;s go so first and foremost what is a ventilator mode a ventilator mode is a way to describe how the mechanical ventilator assists a patient with inspiration the characteristics of a particular ventilator mode controls how the Machine functions and assists with the pattern of breathing when selecting a ventilator mode there are two primary control variables and they are volume control and pressure control volume control means that you can set or control the patient&#39;s tidal volume so what they set tidal volume and I set respiratory rates this means that there is a known minute ventilation this is good when it comes to making adjustments to achieve a desired paco2 one of the negative aspects of using volume control is that since the tidal volume is preset if the patient&#39;s lung compliance were to decrease this could result in high peak pressures another drawback of volume control is patient ventilator to synchrony and then there&#39;s pressure control ventilation pressure control means that you can set or control the patient&#39;s pressure in order to achieve a desired tidal volume so as with volume control a pressure controlled tidal volume and set rate can help you reach a desired paco2 the main disadvantage of using pressure control is the patient&#39;s tidal volumes can potentially be unstable if there are changes in the patient&#39;s lung compliance or air weight resistance so again volume control and pressure control those are the two control variables when initiating mechanical ventilation on a patient once you set the can variable now you can choose the actual operational mode that determines the pattern of breathing for the patient understanding the different ventilator modes is one of the most important aspects of mechanical ventilation and luckily for you we are going to walk you through them now is that sound good well if so let&#39;s keep going so most importantly what are the primary ventilator modes and again these are the operational modes of the machine now the two primary modes are assist control or AC or simv which stands for synchronous intermittent mandatory ventilation first we will talk about assist control in this mode a minimum number of preset mandatory breaths are delivered by the ventilator but the patient can also trigger assisted breaths the patient makes an effort to breathe and the ventilator assists in delivering the breath with that said just know that the breasts are not spontaneous in this mode the breaths can be patient triggered but they are still delivered by the ventilator that is where it gets its name assist control because the mandatory breaths are preset which means they are controlled but the patient can trigger additional breaths which these are the assisted breaths and when using this mode the sensitivity setting or the sensitivity control can be adjusted to make it easier or harder for the patient to initiate a breath assist control is most often indicated when mechanical ventilation is first initiated for a patient because this mode provides full ventilatory support that is also one of the advantages of using assist control because it keeps the patient&#39;s work a breathing requirement very low but one of the major complications of assist control is hyperventilation which this results in respiratory alkalosis this is the result of two mini breasts being giving to the patient whether they are patient triggered or machine triggered and the second primary mode is simv or synchronous intermittent mandatory ventilation now in this mode the ventilator delivers a preset minimum number of mandatory breaths however it also allows the patient to initiate spontaneous breaths in between the mandatory breaths this mode allows the operator which is either the respiratory therapist or the doctor to set either a controlled pressure or a controlled volume the primary indication for simv is when the patient needs partial ventilatory support because since the patient can take spontaneous breaths that means that they can contribute to some of their minute ventilation simv is a mode that is used for weaning as well some of the key advantages of using simv include a sense in this mode the patient can take spontaneous breaths this helps to maintain their respiratory muscle strength and avoid muscular atrophy another advantage is that in general in simv it distributes the tidal volumes evenly throughout the lung fields which this can reduce v/q mismatching and last but not least simv helps to decrease the patient&#39;s mean airway pressure as our respiratory therapist or student simv and assist control are the two primary ventilator modes that you should be the most familiar with however it&#39;s also important to develop an understanding of some of these secondary modes and the spontaneous modes as well first let&#39;s talk about the spontaneous modes of breathing keep in mind that in order to use any of the following modes the patient must be breathing spontaneously so first we will talk about CPAP or a continuous positive airway pressure now in CPAP a continuous pressure that is above atmosphere pressure is delivered and maintained throughout the entire breathing cycle again the patient must be breathing spontaneously to be in this mode because no mandatory breaths are given CPAP is a useful mode for weaning patients off of the ventilator next we have PSV or pressure support ventilation this is a mode of mechanical ventilation in which the patient spontaneous breaths are supported by the ventilator during the Institute of breathing as the patient triggers our breath the ventilator assists by adding pressure to make breathing easier the level of pressure is preset by the operator so you have control over how much support you give the patient for example the higher the level of pressure support that is set the easier it will be for the patient to take a breath in pressure support ventilation the breaths are time cycled and pressure limited pressure support is often used to help the patient overcome the airway resistance that is caused by the endotracheal tube before example let&#39;s say that there&#39;s a patient who needs to be weaned from the ventilator and they&#39;re in the simv mode if the patient&#39;s endotracheal tube size is too small the airway resistance would be increased and this would make weaning difficult this is where pressure support would come in handy because it would help the patient overcome the airway resistance so that they can be weaned and extubated from the ventilator and the last spontaneous mode that will mention is volume support or V s this is a mode of mechanical ventilation in which the ventilator delivers a supportive breath to help the patient reach a set tidal volume this mode is totally dependent on the patient&#39;s effort meaning that the Machine varies the inspiratory pressure support level with each breath in order to achieve the target volume this mode is not quite as common as some of the others but it&#39;s often used to wean patients from anesthesia so now we&#39;ve talked about the primary modes we&#39;ve talked about the spontaneous modes now let&#39;s talk about the unconventional modes or sometimes referred to as the secondary modes of ventilation first we have control mode ventilation or CMV this is a mode where the ventilator delivers a preset tidal volume at a set time triggered frequency so basically the ventilator controls both the rate and the tidal volume which means that it&#39;s in total control of the minute ventilation this mode should only be used on patients who are fully sedated and have been administered neuromuscular blocking agents this is also one of the biggest hazards of using this mode as well because since the patient is fully dependent on the ventilator for ventilation and oxygenation it could be devastating if they were to become disconnected next we have aprv or airway pressure release ventilation this is a mode in which two levels of CPAP are applied with an intermittent release phase for spontaneous breaths so basically in this mode you will set a high pressure low pressure a high time and a low time if that sounds confusing no worries we will go into much more detail in another video but the main thing I want you to remember about aprv is that this mode is often recommended to improve oxygenation and treat refractory hypoxemia which that means that is good to recommend this mode for ARDS or acute respiratory distress syndrome for an acute lung injury and in some cases for add electives next we have mm V or mandatory minute ventilation this is a feature of some ventilators that causes an increase in the mandatory breaths that are delivered when the patient spontaneous breathing level becomes inadequate so basically if the patient spontaneous breathing decreases the ventilator compensates in order to make sure that a safe minimal minute ventilation is delivered mmv is often an additional function of the simv mode and is intended to prevent hypercapnia next we have IR V or inverse ratio ventilation this is a mode that uses an inverse ie ratio to improve oxygenation and gas exchange it&#39;s been shown to decrease shunting improve v/q mismatching and decreased dead space ventilation this mode is commonly recommended for patients with acute respiratory distress syndrome aka artes this mode actually causes auto-peep which usually when you think of auto-peep or intrinsic peep that&#39;s normally not a good thing right well in this mode the auto peep is actually what helps improve the patient&#39;s oxygenation and it reduces shunting so remember that the two modes that are used to treat patient with ARDS or airway pressure release ventilation and inverse ratio ventilation next up we have pressure regulated volume control or a prvc this is a mode of ventilation that provides volume controlled breaths with the lowest pressure possible it does so by altering the flow and inspiratory time this mode is used to keep the peak airway pressure at the lowest possible level this mode is volume cycled and can be patient triggered or a time triggered next we have P AV or proportional assist ventilation this is a mode of ventilation where the Machine uses variable pressure to provide pressure support for the patient spontaneous breaths the level of pressure support is adjusted depending on the patient&#39;s work of breathing P AV can either be pressure triggered or flow triggered and the breathing cycle ends once the patient&#39;s volume or flow demands are met and one thing to keep in mind about this mode is that if the patient&#39;s lungs show rapid improvement over distinction or barrel trauma could occur because too much pressure would be delivered next up we have ASV or adaptive support ventilation this is a mode that changes the number of mandatory breaths and pressure support level according to the patient&#39;s breathing pattern next we have a PC or adaptive pressure control this is a pressure controlled mode that utilizes a closed loop control of the pressure setting in order to maintain a minimum delivery tidal volume with that said in this mode the delivery tidal volume will vary depending on the patient&#39;s lung compliance next we have valves or volume assured pressure support this is a mode of ventilation that provides a stable tidal volume by incorporating inspiratory pressure support ventilation along with conventional volume assisted cycles this mode is only available on certain ventilators one thing about this mode is that it causes prolonged inspiratory time so patients with an obstructive disease should be monitored closely in order to prevent air trapping or other cardiovascular effects next up we have Nava or newly adjusted ventilatory assist this one&#39;s pretty cool it&#39;s a mode that uses the patient&#39;s electrical activity of the diaphragm to guide the functionality of the ventilator a catheter that has electrodes is positioned in the patient&#39;s esophagus at the level of the diaphragm and that is how the electrical activity is picked up from the phrenic nerves then the ventilator uses this information in order to adequately ventilate the patient next up is automatic tube compensation or ATC while technically in my opinion this is not a mode I did want to mention it briefly because this is a setting on some ventilators and it offsets and compensates for the airflow resistance that is imposed by the endotracheal tube or by the artificial airway and last but most certainly not least is high-frequency oscillatory ventilation or a fov this is a mode or a type of mechanical ventilation that delivers very small tidal volumes at an extremely fast rate which minimizes the chances of a lung injury this mode has been shown to improve oxygenation in severe cases such as with refractory hypoxemia now briefly we need to mention the settings for this mode when making adjustments to settings and high-frequency ventilation the ventilation can be increased by increasing the power or amplitude setting or by decreasing the frequency ventilation can be decreased by decreasing the power or amplitude setting or by increasing the frequency oxygenation can be increased by increasing the mean airway pressure setting or by increasing the fio2 and vice-versa if you want to decrease the oxygenation for some reason this mode is also indicated to provide mechanical ventilator support and neonates with conditions such as a congenital diaphragmatic hernia diffuse alveolar disease and pulmonary hypoplasia but we will talk more about that in another video so there you have it now you know all the primary spontaneous and secondary modes of mechanical ventilation hopefully you found this information to be helpful if so and if you want to support the channel be sure to hit that thumbs up button because it actually really helps a lot and while you&#39;re here you might as well go ahead and subscribe because we got some more videos on mechanical ventilation that will be coming out very soon and if you want to dive deeper into the - later modes we have a full article on our website that I think will be helpful for you I will drop a link to that down below in the description that&#39;s it for this one thanks again for watching and I will see you in the next video and as always breathe easy my friend [Music]

Transcript for:Mechanical Ventilation Modes

Transcript for:
Mechanical Ventilation Modes