ASSISTED VENTILATION

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ASSISTED VENTILATION

• By
• Dr.Saif
• Assistant Professor Of Paediatrics
• Allied Hospital Faisalabad.

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Definition

• Movement of gas into and out of lungs by an
  external source connected to the patient

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History

• Hipocrates (400 B.C) work ignored for next 1000
  years.
• Paracealsus (1493-1541) Bellow and oral tube.

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• Vide Chaussier and his successors (1879).
  Aerophore pulmonare.

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• Fell-ODwyer apparatus (1887)

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• Alexander Graham Bells Negative Pressure
  Ventilator(1889)

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Five Ws of assisted ventilation

• WHO
• WHEN
• WHAT
• WHERE
• WHY

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Types of ventilators

• Negative pressure ventilators
• e.g, Airshield Isolette respirator
• Advantages
• Less oxygen toxicity
• Less pulmonary infection
• Less chances of atelectasis
• Less pulmonary air leaks
• Less airway trauma
•  

• Disadvantages
•  
• Patient inaccessible for routine investigations
• Hypothermia
• Neck abrasions
•  
• Not effect for V.L.B.W

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Negative Pressure Ventilator
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• Positive pressure ventilators
• Classification (by cycling mode)
• Time cycled
• Electrical e.g Sechrist, Bourns BP 200,
• Healthdyne 100,Bear Cub,
• Pneumatic e.g Baby bird
• Volume cycled
• e.g. Siemens,Bourns LS-104-150, Bonnett,Emerson
• Pressure cycled
• Flow cycled
• Mixed cycling

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Positive Pressure Ventilator
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• High Frequency Ventilators
• Delivers small gas volumes at high frequency.

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Classification of positern press ventilatoron (by
cyclic mod)

• Volume cycled
• Pressure cycled
• Time cycled
• Mined cycled

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Satisfactory ventilator

• All models of ventilation, should be
• Simple,
• Reliable,
• Small,
• Inexpensive,
• Wide range of respiratory rate upto 150,
• FiO2 21 to 100,
• Alarm system etc.

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• IT IS NOT THE GUN BUT MAN BEHIND THE GUN
•  
• 1965 Lancet editorial 
• The tedious argument about the virtues of
  respirators not invented over those readily
  available can be ended now that it is abundantly
  clear that the success of such apparatus depends
  on the skill with which it is used.

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Mode control mode

• Control mode
• Ventilator will take total control
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• Assist mode
• Ventilator initiate inspiration when pt
  generates sub base line pressure trigger level
•  
• Asst/cont. Mode
• Vent is set at certain level and its
  responds to all breathing efforts by the patient
  reaching trigger level. If patients rate falls
  below preset rate it will automatically enter
  control mode.
•  

• IMV
• Control mode unhandled spontaneous
  ventilation by the pt.
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• SIMV
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• CPAP
• Maintain increased transpulomanary
  pressure during expiratory phase of respiration.

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Ventilation settings

• Flow Rate
• 7L/min (4-10L/min)
• High flow rate when inspiratory time shortened
• A minimum flow of at least two times the infant
  calculated minute ventilation (tidal Volume RR)
• e.g. 10 Kg 70 50/3.50L/min
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• 1E Ration ? 11 to 12
• 2. Oxygen Con (FiO2 50-70
• 3. Peak Inspiratory pressure (PIP) 20-25cmH2O
  range (5 to 10 cm H2O)
• 4. Respi ratory rate frequency (f) varies
  2-150/min range
• 5. Positive end expiratory pressure (PEEP)
• 4-7 cm/H2O
• 6. Wave form range taper(sin) to square

• Mean air way pressure 5.0 to 80 cm H2O the mean
  of installations readings of press with in the
  air way
• Bar graph patient pressure display
• Breath status indicator
• D/C power indicator
• Battery power indicator
• Visual Alarm indicator
• Message display
• Alarm setting indicator
• Alarm Delay setting /display
• Means R/R

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