Transcription of BASIC MODES OF MECHANICAL VENTILATION
1 BASIC MODES OF MECHANICAL VENTILATION :Niall D. Ferguson, MD, FRCPC, MScHead of Critical Care Medicine University Health Network & Sinai Health SystemProfessor, Departments of Medicine & Physiology,Institute of Health Policy, Management and EvaluationInterdepartmental Division of Critical Care MedicineUniversity of TorontoOutlineHow ventilators workHow BASIC MODES workGeneral VENTILATION targetsHow to set PEEPV entilators blow gas to deliver volume and generate pressure3 Ventilators blow gas to deliver volume and generate pressure45 Ventilator MODES have 3 key elementsVentilator MODES have 3 key elements8 Ventilator MODES have 3 key elements9 Ventilator MODES have 3 key elements10 Ventilator MODES have 3 key elements11 Ventilator MODES have 3 key elementsVentilator MODES have 3 key elementsVentilator MODES have 3 key
2 Elements14 Which is better Volume or Pressure Control?Ventilator Targets16 Ventilator Targets17 Starting VENTILATION for Respiratory FailureOxygenation improvement with PEEPE verything we know about the ARDS clinical phenotype we learned in 1967 Set PEEP (cm of H2O) in ARDS Means & %ageSet StainSetting PEEPD efined range Low PEEP arm of ExPress(5-9 cm H2O)Plateau pressure limit High PEEP arm of ExPress(28-30 cm H2O)PEEP-FiO2 Table Higher vs. Lower ARMA, LOVS, ALVEOLIP ressure/Volume measurementsTranspulmonarypressure limitDecrementalPEEP titrationARDS NetworkHigh Stretch VT: PPLAT: 32-34 RR: 18 VMIN: 13 PEEP: 8 Mortality 40%Low Stretch VT: ml/kg PPLAT: 25 cm H2O RR: 29 VMIN: 13 L/min PEEP: 9 cm H2O Mortality 31%**p= Mortality: RR ( )HospMortality.
3 RR ( )Only PEEP by O2gavehigher PEEP with increasing severity & recruitabilityARMA & ALVEOLI TrialsLatent Class Modeling Summary Take Home Points Ventilators target either pressure or the other is then dependent on patient mechanics Remember volume-pressure relationship ( compliance ) Apply standard principles of lung-protection and target acceptable gas exchange Setting PEEP is as complicated as you want to make itUniversity of Toronto Critical Care Medicine International Fellowship @nialldfergusonOctober 4-7, 2020 Sheraton Centre Hotel, Toronto
