Ventilators

Tuesday, 20 April 2004

Bill McCulloch

Types of Ventilator
Positive Pressure Ventilators

Gas blown into lungs All Current Itu and Theatre Ventilators Unphysiological but practical Iron Lung Cuirass (breastplate) ventilators Physiological but impractical

Negative Pressure Ventilators

History
Need arose from polio epidemics in 1950s and changes in anaesthetic techniques (muscle relaxants) Originally engineering challenge Inflexible

Classification
Most classifications obsolete but need to be known Based on cycling

Pressure cycling cycles when pressure attained in system

Compensates for leaks Vt changes with changes in compliance

Volume cycling cycles when preset volume delivered

Doesnt compensate for leaks Will generally deliver preset volume (unless limit reached)

Time cycling cycles after given time

Unresponsive to leaks or compliance changes

or Inspiratory flow patterns

Flow generation
High powered ventilator can deliver constant flow through inspiration flow rate unaffected by patient characteristics

Pressure generation
Low powered ventilator delivering decreasing flow through inspiration -

Anaesthetic Ventilators
Need to be capable of being attached to anaesthetic machine and scavenging Less sophisticated / flexible than itu ventilators Nowadays , generally must be usable with circle

Manley Ventilator

Minute Volume divider Vt set by operator. Rate=FGF/Vt Driving Force = Fresh Gas Pressure

Penlon Nuffield

Tubing from ventilator plugs into bag port on bain or circle Uses Fluid Logic (coanda effect) Used in paediatrics (with Newton Valve)

Ohmeda
Bag in bottle Driving gas blown into bottle , compressing bellows (bag) Bellows contain anaesthetic gas Pneumatic bag squeezer Controlled by electronic management of driving gas.

IMV
Originally , entailed attaching a t-piece onto the inspiratory limb of a ventilator Allowed patient access to spontaneous breaths PEEP had to be adjusted to be equal in spont & controlled circuits

sIMV
Allows imv within the normal breathing circuit Breathing cycle ( which will contain 1 mandatory breath) broken into 3 parts

1. Spontaneous breathing allowed 2. Spontaneous breath will trigger the mandatory breath 3. If spontaneous breath not taken in 2 , mandatory breath delivered

Reduction in sIMV rate not considered useful weaning method

Pressure vs volume control

Generally volume control used to initiate ventilation Changed to pressure control where lungs susceptible to damage by high pressures (ards) Volume delivered under pressure control variable

Pressure Support
System for reducing work of breathing Patient inspiration spontaneous but breathes from pressurised reservoir Applied to any breathing mode Gradual reduction of level of pressure support is valid means of weaning

BiLevel (BiPap)
2 levels of peep set Patient can breathe spontaneously at any phase of respiration Change in peep level-> change in volume within lungs