Mechanical ventilation choosing amongst ventilator modes: Difference between revisions

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== Choosing Amongst Ventilator Modes ==
== Choosing Amongst Ventilator Modes ==
* Choosing amongst the ventilator modes<ref name="urlNew modes of assisted mechanical ventilation. - PubMed - NCBI">{{cite web |url=https://www.ncbi.nlm.nih.gov/pubmed/24507472 |title=New modes of assisted mechanical ventilation. - PubMed - NCBI |format= |work= |accessdate=}}</ref><ref name="urlA rational framework for selecting modes of ventilation. - PubMed - NCBI">{{cite web |url=https://www.ncbi.nlm.nih.gov/pubmed/22710796 |title=A rational framework for selecting modes of ventilation. - PubMed - NCBI |format= |work= |accessdate=}}</ref><ref name="urlEffects of various modes of mechanical ventilation in normal rats. - PubMed - NCBI">{{cite web |url=https://www.ncbi.nlm.nih.gov/pubmed/24270126 |title=Effects of various modes of mechanical ventilation in normal rats. - PubMed - NCBI |format= |work= |accessdate=}}</ref><ref name="urlPressure modes of invasive mechanical ventilation. - PubMed - NCBI">{{cite web |url=https://www.ncbi.nlm.nih.gov/pubmed/21941160 |title=Pressure modes of invasive mechanical ventilation. - PubMed - NCBI |format= |work= |accessdate=}}</ref><ref name="urlEffect of noninvasive positive pressure ventilation on mortality in patients admitted with acute respiratory failure: a meta-analysis. - PubMed - NCBI">{{cite web |url=https://www.ncbi.nlm.nih.gov/pubmed?term=9377883 |title=Effect of noninvasive positive pressure ventilation on mortality in patients admitted with acute respiratory failure: a meta-analysis. - PubMed - NCBI |format= |work= |accessdate=}}</ref><ref name="urlRecent advances in mechanical ventilation. - PubMed - NCBI">{{cite web |url=https://www.ncbi.nlm.nih.gov/pubmed?term=15922687 |title=Recent advances in mechanical ventilation. - PubMed - NCBI |format= |work= |accessdate=}}</ref><ref name="urlTreatment of severe cardiogenic pulmonary edema with continuous positive airway pressure delivered by face mask. - PubMed - NCBI">{{cite web |url=https://www.ncbi.nlm.nih.gov/pubmed?term=1961221 |title=Treatment of severe cardiogenic pulmonary edema with continuous positive airway pressure delivered by face mask. - PubMed - NCBI |format= |work= |accessdate=}}</ref><ref name="urlHow is mechanical ventilation employed in the intensive care unit? An international utilization review. - PubMed - NCBI">{{cite web |url=https://www.ncbi.nlm.nih.gov/pubmed?term=10806138 |title=How is mechanical ventilation employed in the intensive care unit? An international utilization review. - PubMed - NCBI |format= |work= |accessdate=}}</ref><ref name="urlCharacteristics and outcomes in adult patients receiving mechanical ventilation: a 28-day international study. - PubMed - NCBI">{{cite web |url=https://www.ncbi.nlm.nih.gov/pubmed?term=11790214 |title=Characteristics and outcomes in adult patients receiving mechanical ventilation: a 28-day international study. - PubMed - NCBI |format= |work= |accessdate=}}</ref>
Choice of ventilator mode depends upon the clinical condition of the patient. Choice of ventilator mode can be tailored to achieve specific goals of management and set to achieve spontaneous breathing, volume-targeted ventilation, pressure-targeted ventilation, or some combination. In some conditions, for example in case of spontaneously breathing patient, the patient set the respiratory rate and generates their desired flow rate.<ref name="urlTreatment of severe cardiogenic pulmonary edema with continuous positive airway pressure delivered by face mask. - PubMed - NCBI">{{cite web |url=https://www.ncbi.nlm.nih.gov/pubmed?term=1961221 |title=Treatment of severe cardiogenic pulmonary edema with continuous positive airway pressure delivered by face mask. - PubMed - NCBI |format= |work= |accessdate=}}</ref><ref name="urlHow is mechanical ventilation employed in the intensive care unit? An international utilization review. - PubMed - NCBI">{{cite web |url=https://www.ncbi.nlm.nih.gov/pubmed?term=10806138 |title=How is mechanical ventilation employed in the intensive care unit? An international utilization review. - PubMed - NCBI |format= |work= |accessdate=}}</ref><ref name="urlCharacteristics and outcomes in adult patients receiving mechanical ventilation: a 28-day international study. - PubMed - NCBI">{{cite web |url=https://www.ncbi.nlm.nih.gov/pubmed?term=11790214 |title=Characteristics and outcomes in adult patients receiving mechanical ventilation: a 28-day international study. - PubMed - NCBI |format= |work= |accessdate=}}</ref> The following are the various ventilator modes and their features:
* Assist-control mode minimizes patient effort by providing full mechanical support with every breath. 
 
* This is often the initial mode chosen because it provides the greatest degree of support. 
=== Pressure support ventilation (PSV) ===
* In patients with less severe respiratory failure, other modes such as SIMV may be appropriate.
* This mode supports patient initiated breaths with a set inspiratory pressure and positive end expiratory pressure (PEEP)
* Assist-control mode should not be used in those patients with a potential for [[respiratory alkalosis]], in which the patient has an increased respiratory drive.
* Mode of partial ventilatory support because there is no set rate
* Such hyperventilation and [[hypocapnia]] (decreased systemic carbon dioxide due to hyperventilation) usually occurs in patients with end-stage liver disease, hyperventilatory sepsis, and head trauma.  
* The clinician sets the FiO 2 and PEEP. The patient sets the respiratory rate and generates their desired flow rate. 
* [[Respiratory alkalosis]] will be evident from the initial [[arterial blood gas]] obtained, and the mode of ventilation can then be changed if so desired.
* After the optimal flow is achieved, the applied pressure can be turned off.
* Positive End Expiratory Pressure may or may not be employed to prevent [[atelectasis]].
* The volume given depends upon the patient's effort and lung/chest wall compliance
* High frequency oscillation is used most frequently in neonates, but is also used as an alternative mode in adults with severe ARDS.
* There is no minimal rate


==References==
==References==

Revision as of 18:24, 22 March 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Vishnu Vardhan Serla M.B.B.S. [2]

Choosing Amongst Ventilator Modes

Choice of ventilator mode depends upon the clinical condition of the patient. Choice of ventilator mode can be tailored to achieve specific goals of management and set to achieve spontaneous breathing, volume-targeted ventilation, pressure-targeted ventilation, or some combination. In some conditions, for example in case of spontaneously breathing patient, the patient set the respiratory rate and generates their desired flow rate.[1][2][3] The following are the various ventilator modes and their features:

Pressure support ventilation (PSV)

  • This mode supports patient initiated breaths with a set inspiratory pressure and positive end expiratory pressure (PEEP)
  • Mode of partial ventilatory support because there is no set rate
  • The clinician sets the FiO 2 and PEEP. The patient sets the respiratory rate and generates their desired flow rate. 
  • After the optimal flow is achieved, the applied pressure can be turned off.
  • The volume given depends upon the patient's effort and lung/chest wall compliance
  • There is no minimal rate

References

  1. ↑ "Treatment of severe cardiogenic pulmonary edema with continuous positive airway pressure delivered by face mask. - PubMed - NCBI".
  2. ↑ "How is mechanical ventilation employed in the intensive care unit? An international utilization review. - PubMed - NCBI".
  3. ↑ "Characteristics and outcomes in adult patients receiving mechanical ventilation: a 28-day international study. - PubMed - NCBI".

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