NEWER VENTILATORS

WHAT MAKES THEM

DIFFERENT ?
John Newhart CRTT. RCP.
PURITAN BENNETT MA-1
 Puritan Bennett MA-1

• First released August 1967.

• Simple to use
• Basic IMV system (non-sync).
• Bellows spirometer for exhaled gas
measurement.
SIEMENS 900 C
 SIEMENS 900 B/C

• 900 B available in the USA early 70’s..

• Time limited and minute volume preset.
• Patient or time cycled or SIMV.
• Expiratory flow monitoring.
 BEAR I

• Built in SIMV.
• Monitoring of tidal and minute volume.
• Pneumatically and electrically powered,
electrically controlled volume limited.
• Time or patient cycled, control or
assist/control modes.
PURITAN BENNETT 7200

• Released 1983
• First widely accepted microprocessor
controlled ventilator in USA.
• Software upgradable.
Newer Generation Ventilators
TRANSPORT VENTILATORS
EARLY MODEL
PULMONETIC LTV 1000
 PULMONETIC LTV
Compact lightweight 12.6 lbs.
• Ability to transport more critical patients.
• Internal battery.
• Volume Control, Pressure Control and Pressure Support.
• Volume and pressure alarms and monitoring.
•
Changes in Ventilators Include...

• More sophisticated hardware.

• More compact size.
• Multiple high speed microprocessors.
• Backup battery systems.
• Graphical User Interface (GUI).
• An ever expanding list of modalities.
 Modular Design

◆ Touch Screen Display

– can be mounted
separately

◆ Breath Delivery Unit

– weighs only 40 lbs.
– can be mounted
separately from cart
 New Hardware

• Proportional control valves

• Active Exhalation valves
• Battery backup
• Miniature blower
 Proportional Control Valves

• One or two valves (O2, Air, or both)

proportionally open or close to control the flow of
gas to the patient circuit.
• Responsible for FIO2, Flow rate, Flow waveform.
• Microprocessor controlled.
• Each valve is controllable from 1,000-4,000 steps.
Two Proportional Valve System
NPB 7200-840, DRAGER E2-4, SERVO 300

50 psig
AIR
FLOW SENSOR

To Patient
50 psig
O2
FLOW SENSOR

Each gas has its own solenoid, flow sensor and pressure regulator .
Both valves controlled by microprocessor.
 Single Proportional System
Hamilton Veolar, Bird 6400-8400st

50 psig
AIR PROPORTIONAL VALVE
RESERVOIR
BLENDER To Patient
10-15 PSIG
50 psig
O2

Air and O2 are mixed in a blender, stored as a mixed gas in a

reservoir then pass through a single proportional valve.
Pneumatics Chassis (PB 840)
 Blower with Intragral Digital
Blender

Pulmonetic LTV Turbine/Blender System

O2 Delivery Control
Valve

Blended gas to patient

 Active Exhalation Valves
• The inspiratory and expiratory valves are active during
inspiration to maximize the reproducibility of inspiratory
and expiratory events.
• These valves are critical in newer modes such as APRV,
BiLevel, and ATC.
• With an active exhalation valve, the ventilator moves the
exhalation valve off of its seat during exhalation. With a
non-active valve the patient must push the valve off of its’
seat adding to expiratory resistance and work of breathing.
 Active Exhalation Valve
• During inspiration, the valve is closed with the force of the insp
pressure setting

• Allows coughing or spont breathing at upper pressure level by venting

excess pressure and flow (PCV or BiLevel)

PCV W/O Active Valve PCV with Active Valve

PCIRC 40
30
cmH2O
20
10
0
10 Spontaneous Efforts Spontaneous Efforts
-20
0 2 4 6 8 10 12s
INSP 80
60
40
. 20
V 0
L 20
min
40
60
EXP -80
Two Proportional Valve System
With Active Exhalation Valve

50 psig AIR

50 psig O2 PATIENT

EXH

Air and O2 solenoids combined with active exhalation valve.

 Microprocessor Control

• Each new generation of ventilator incorporates

faster processors.
• Multiple high speed processors improve the
ventilators response to the patients needs.
• Faster processors make more information
available to the clinician.
 MICROPROCESSOR
FUNCTION
• During each breath, the ventilator switches through multiple
algorythims. These determine sensing of patient breath, rise rate of
breath, criteria for patient termination of breath at various points during
the breath, and ventilator initiated termination of breath.
• Monitored data as well as data needed for ventilator function are
constantly being processed in the background.
• Most calculations done by the ventilator are never seen by the user.
• Most modes of ventilation that have come out in the last 15 years
would be impossible without computer control.
 UPGRADABILITY

• Older ventilators frequently required a complete factory

overhaul to have one mode added.
• Upgrading newer ventilators is usually accomplished by
software upgrade. This may be done by changing out the
chip set or uploading software from a PC.
• Adding options/modes typically involves changing a chip
that accesses specific options included in the software, or
entering a code number through a keypad.
 Battery Back-Up

• Is now standard on most ICU ventilators.

• Eliminates interruptions in ventilator function during
flickers or short term failure in A/C power.
• Aids patient safety.
 GUI
Graphical User Interface

• Touch screen technology.

• Becoming the norm for ICU ventilators.
• Replaces traditional knobs, buttons etc.
• Blends graphical displays with controls.
• Easy software upgrades.
• Gives additional information relative to
setting changes.
Ease of Use - Software Controlled Screens
• Only current modes and settings are displayed (ease
of use)

• Information can appear as needed to help make

decisions easier and safer
 Automatic Tube Compensation
• Overcomes the resistance to flow created by an
endotracheal tube or tracheostomy tube.
• Gives the patient the sensation that they are not
intubated.
• Most important during spontaneous breaths.
• May provide a calculated tracheal pressure curve on
the graphics display (E4).
• Can be used to “train” the respiratory muscles.
 ET. Tube Resistance During
Breath Types

• Mandatory breaths from the ventilator

easily overcome the resistance of an ET.
tube.
• Spontaneous breaths are more difficult as a
result of breathing through a relatively
small orifice.
ATC Function During Inspiration

• During inspiration , the ventilator increases

pressure at the top of the ET. tube
proportionate to the inspiratory flow rate.
 Function of ATC during
Exhalation
• During expiration the circuit pressure is
decreased below the PEEP level. The
tracheal pressure is held constant at the
selected PEEP level. This decreases the
work of expiration. The circuit pressure is
calculated from the expiratory flowrate.
ATC with Paw and Ptrach
waveforms displayed
 Pressure Calculation
Using the flow measured by the ventilator, the
difference in pressure at any given time can
be calculated by the following equation:

Pressure = Rtube Coef. X Flow2, where tube

resistance R is itself dependent on the flow.
Difference Between ATC and PS
• PS is a user set, fixed pressure that remains
constant throughout the inspiratory phase
irrespective of the patients flow rate.
• ATC is a user set level of compensation (1-
100%). The driving pressure will vary
according to the E.T. tube size set,
compensation level and inspiratory flow
rate.
 CONCLUSION
Ventilator Design

• The design of ventilators depends increasingly

on the use of microprocessor control and
software.
• The hardware in ventilators is being
continuously miniaturized.
• Move towards ventilator designs that will
ventilate infants through adults.
 CONCLUSION
Modes of Ventilation
• Modes and hardware that minimize the overall work of
breathing.
• Modes that make “decisions” based on both input from
the therapist and patient monitoring.
• Interfaces that display more graphical and numerical
information.
• “Smart Alarms” that look for combinations and severity
of thresholds. The alarm indicates by sound and/or
graphics the seriousness of the condition.