CONTENTS :

 MECHANICS OF RESPIRATION

 ARTIFICIAL VENTILATION

 VENTILATORS

 TYPES OF VENTILATORS

 TERMS RELATED TO VENTILATORS

 CLASSIFICATION OF VENTILATORS

 MODERN VENTILATORS
MECHANICS OF RESPIRATION
 Respiration is the process of supplying oxygen to and removing carbon
dioxide from the tissues.

 The gas exchange in the lungs is called external respiration and the gas
exchange in the tissues is called internal respiration.

 The balance between absorption and excretion of oxygen and carbon dioxide
is maintained by respiration.

 The organs of respiration are divided in to two sections they are:

i) conducting section ii) respiratory section

Nasal cavities, pharynx, Respiratory branchioles,

larynx, trachea, bronchi, alveolar ducts, alveolar
bronchioles sacs.
Contd..,

Organs of respiration Alveolar gas exchange

 The alveoli consists of only two thin layers of cells separate the air from the blood
and gases can diffuse freely between them.

As it transverses the alveolar capillaries, the haemoglobin of the blood takes up
the oxygen and carbon dioxide passes out of the blood in to alveoli spaces.
ARTIFICIAL VENTILATION
 For reduced breathing and respiratory failure (insufficiency) mechanical
devices or respirators are used in hospitals.

 These devices provide artificial ventilation and supply necessary oxygen to

the patient and remove correct amount of carbon dioxide out.
ventilators
 When artificial ventilation need to be maintained for a long time then
ventilators are used.

 The main function of ventilator is to ventilate the lungs in a manner as close

to natural respiration as possible.

 Natural inspiration is a result of negative pressure pleural cavity generated

by the movement of the diaphragm.

 But for designing negative pressure ventilators there are many engineering
and the apparatus and control mechanism is getting complex. So negative
pressure ventilators are designed.

 Most of the ventilators available at present are positive pressure ventilators,

CONTD..,
 The positive pressure ventilators generates the inspiratory flow by applying
positive pressure greater than atmospheric pressure.

Functional block diagram of positive pressure ventilator

 During the inspiration phase the inspiratory flow delivery system creates a
positive pressure in the patient circuit and exhalation control system closes
the valve outlet to the atmosphere.

 During the expiratory phase the inspiratory flow delivery system stops the
positive pressure at the exhalation system and opens the valve to allow the
exhaled air to atmosphere.
CONTD..,
 The positive pressure ventilators can be operated in two modes. They are
i) spontaneous mode ii) mandatory mode

 Spontaneous Mode : In this mode the ventilator responds to the patient’s

effort to breathe independently. Here the patient can control the volume and
rate of inspiration. These mode is used for patients who are on the way to
recover but are not completely able to breathe from the atmosphere with
mechanical assistance.

 Mandatory Mode : In this mode the ventilator controls all the parameters
such as tidal volume, inspiratory flow waveform, respiration rate, oxygen
content of the breathe. These are used for the patients who are in capable of
breathing on their own.
Types of ventilators :
 There are two types of ventilators. They are

i) anaesthesia ventilators ii) intensive care ventilators

 Anaesthesia Ventilators : These are small and simple equipments used to

give regular assisted breathing during operation.

 Intensive care Ventilators : These are more complicated give accurate

control over wide range of parameters often incorporate patient triggering
facility i.e., the ventilators delivers air to the patient when the patient tries to
inhale.
TERMS RELATED TO VENTILATORS :
 Lung Compliance : It is the ratio of volume delivered to the pressure rise
during inspiratory phase in the lung. It is expressed as litres/cm H2O.
It is the ability of the alveoli and lung tissue to expand on inspiration. The
lungs are passive, But they should stretch easily to ensure the sufficient
intake of air.

 Air Way Resistance : Airway resistance relates to the ease with which air
flow through the tubular respiratory structure. High resistance in
bronchioles and alveoli.

 Mean Airway Pressure : An integral taken over one complete cycle

expresses the mean airway pressure.
Contd..,
 Inspiratory Pause Time : When the pressure in the patient circuit and
alveoli is equal, there is a period of no flow. This period is called Inspiratory
Pause Time.

 Inspiratory Flow : Inspiratory flow is represented as a positive flow above

the zero line.

 Expiratory Flow : Expiratory flow is the negative flow below the zero line.
Contd..,

 Tidal Volume : It is the depth of the breathing (or) volume of gas inspired
and expired out during each respiratory cycle.

 Minute Volume : It is the volume of gas exchanged per minute during quiet
breathing. It is the product of tidal volume by breathing rate.

 Respiration Rate : This is the number of breathes per second. It represents

the respiratory rate of the patient.

 Conventional Mechanical Ventilation (CMV) : This provides the force

which determine the total volume (Vt) at a respiratory frequency (f) to
achieve the desired minute ventilation (VE)
VE = VT × f
Contd..,
 Intermittent Mandatory Ventilation (IMV) : This allow the insertion of a
variable time delay between each breathe.

 Inspiratory Expiratory Phase Time Ratio (I : E Ratio) : This signifies

the ratio of inspiratory interval to expiratory interval of a mandatory
breathe.

 Synchronised Intermittent Mandatory Ventilation (SIMV) : It represents

the combination of machine ventilation and spontaneous breathing. SIMV
enables the patient to breathe spontaneously in regular prescribed cycles
with the mechanical mandatory ventilation strokes providing a minimum
ventilation during the remaining cycles.
Contd..,
 Sigh Volume : One sigh breath is 150 % of the set tidal volume.

 Patient Circuit : This includes a set of tools collecting the patient airway to
the outlet of a ventilator.

 Oxygen Percentage (F1O2) : In all ventilatory modes, oxygen is delivered

during the inspiratory phase and the percentage (F1O2) is adjustable from 21
to 90 % .

 Peak airway pressure : It is the highest level of pressure reached over

several breathes.

 Bias Flow : In Bias flow, mixed gas from the mixer is directed through the
patient circuit between mechanical breathes. Bias flow stabilizes the
baseline pressure for spontaneous breathing patients.
Contd..,
 Sensitivity : It is used to detect spontaneous effort by the patient, in order to
trigger mandatory ventilation with the respiration rate.

 Controlled Mandatory Ventilation : This term refers to mandatory

ventilation of patients who are not able to initiate or respire on their own.

 Assisted Spontaneous Breathing : It refers to the pressure support of

insufficient spontaneous breathing.

 Pressure Relief Valve : It determines the maximum pressure that can be

reached in the patient circuit during spontaneous mechanical and manual
ventilation. It is adjustable from 0- 100 cm/H2O and function in all modes.
Classification of ventilators :
 Based on the method of initiating the inspiration phase :
`
Controller: A ventilator which operates independent of the patients
inspiratory effort. The inspiration is controlled w.r.t time, pressure and other
similar factors.

Assistor: Initiates the inspiration in response inspiration effort by the

patient. A pressure sensor detects the negative pressure each time when the
patient attempts to in hale the air. The amount of effort can be adjusted by
using the selective switch on the equipment.

Assistor/Controller: It is the combination of above two. If the patient fails

to inhale within a predetermine time then the ventilator starts inspiration
phase as a controller. Other wise it acts as assistor.
Contd..,
 Based on Power Transmission :

Direct Power Transmission: A ventilator which delivers the gas directly

from the source of compressed gas to patient.

Indirect Power Transmission: A ventilator which has separate power

system. The pressure in the power system determines the flow rate.
Contd..,
 Based on pressure pattern :

Positive – Atmosphere : A ventilator which produces a positive pressure in

the patients lungs during inspiration, with an end expiratory pressure that is
equal to the atmospheric pressure.

Positive – Negative : It provides the positive pressure in the patients lungs

during inspiration and below atmospheric pressure in the airway during part
of expiratory phase.
Contd..,
Positive – Positive: It provides a positive pressure in the patients lung
during inspiration, with an end expiration pressure greater than the
atmospheric pressure.
 Based on Type of Safety :

Volume Limited: A ventilator where pre- determined volume cannot be

exceeded during inspiration. Volume normally refers to Tidal volume.

Pressure Limited: Here ventilator is designed for pre- determined pressure.

Which cannot be exceeded.

Time Limited: A ventilator in which pre- determined phase time cannot be

exceeded. If the patient do not inhale in a in time then it starts inspiration
phase on its own.
 Based on Source of Power :
Pneumatic: A ventilator powered by compressed gas.

Electric: A ventilator powered by an electric device such as electric motor.

Modern ventilators :

Block Diagram of Microprocessor Controlled Ventilator