Introduction to Servo Systems

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Questions and Answers

What is the initial trigger timeout time calculated from?

The TCT multiplied by the patient's respiratory rate (correct)

The mean breathing rate of the patient

The standard time set regardless of patient breathing patterns

The maximum apnea time for the patient

What happens when the patient reaches the trigger timeout in CMV mode?

The system requires manual adjustment before resuming

The system automatically continues mandatory breaths indefinitely

It activates an alert system for the healthcare provider

The mode reverts back to assist mode (correct)

Which of the following types of mandatory breaths is NOT included?

VC-CMV

PC-CMV

PS-CMV (correct)

How many successive spontaneous breaths are needed to reach the set trigger timeout?

10 Signup and view all the answers

What does the Automatic Tube Compensation (ATC) do?

It adjusts for the size of the endotracheal tube and sets a percentage of compensation Signup and view all the answers

Which setting is described as a rise setting for mandatory breaths?

Percentage suppression setting Signup and view all the answers

Why is the VC-VS mode less preferred than PRVC-VS?

Due to its potential to cause higher levels of discomfort Signup and view all the answers

What does the type 'DC' stand for in mandatory breath types?

Demand Cycle Signup and view all the answers

Which component ensures the patient’s spontaneous effort can access flow between mandatory breaths?

Non synchronous IMV Signup and view all the answers

What is referred to as a sigh in ventilatory settings?

An additional setting used to increase PEEP intermittently Signup and view all the answers

What is a characteristic of the CMV mode?

It has a risk of hypocarbia if the patient triggers excessively. Signup and view all the answers

Which breathing mode has a trigger window?

IMV Signup and view all the answers

In the context of pressure cycling, what is its primary basis?

High pressure alarm for safety. Signup and view all the answers

What is a unique feature of the Servo U in terms of flow waveform?

It has a sliding scale between square and descending ramp patterns. Signup and view all the answers

What distinguishes VC-A/C from other modes?

It has set Vt, flow, and total Ti allows for calculated active Ti. Signup and view all the answers

For Servo I, what is the only option for the assisted mandatory trigger?

Square flow waveform. Signup and view all the answers

Which mode utilizes Vt and flow parameters while also calculating Ti?

VC A/C Signup and view all the answers

What limitation is set for Assisted Mandatory breathing?

TCT defines the mandatory trigger timing. Signup and view all the answers

What happens if there is no patient effort or trigger detected during the trigger window?

A mandatory breath is delivered at the start of the next trigger window Signup and view all the answers

What is the limit setting for airflow during mandatory breaths?

Pressure Signup and view all the answers

In PC-IMV settings, what is the role of the trigger window?

It allows the patient to initiate a spontaneous breath Signup and view all the answers

What happens during a spontaneous breath phase if there is patient effort?

The trigger window is shortened and extends spontaneous breathing Signup and view all the answers

In the PB980 settings, what determines the TCT for mandatory breathing?

It equals the set IMV TCT multiplied by 0.6 Signup and view all the answers

What respiratory rate setting applies to spontaneous settings across all mentioned ventilators?

PEEP Signup and view all the answers

What is a characteristic of the cycle setting in spontaneous breaths?

It follows a flow decay pattern Signup and view all the answers

How long is the trigger window set for adults in the PC-SIMV mode?

5 seconds Signup and view all the answers

Under what condition does a mandatory breath occur in SIMV settings?

If there is no patient effort for a specified time Signup and view all the answers

What is a key feature of the cycle off in flow decay settings?

It determines the end of inspiration Signup and view all the answers

What happens to the delivered tidal volume (Vt) when pressure increases due to higher PEEP?

Delivered Vt remains the same Signup and view all the answers

Which mode involves the first breath being a VC breath with a Pplat used as the PIP for the next breath?

DC-CMV Signup and view all the answers

What occurs when rise time is shorter?

Reaches peak flow quicker Signup and view all the answers

In pressure support ventilation, what determines the pressure limit during the first breath?

Upper limit pressure Signup and view all the answers

How does a higher rise time affect reaching peak flow?

Reaches peak flow slower Signup and view all the answers

What is the purpose of the Pplat during the first breath?

To establish the pressure limit for consecutive breaths Signup and view all the answers

Which parameter remains unchanged if PEEP is increased?

Peak inspiratory pressure (PIP) Signup and view all the answers

Which mode allows for a varying pressure limit based on the set tidal volume?

Pressure regulated volume control Signup and view all the answers

What does increasing the PEEP do to the delivered tidal volume (Vt)?

It has no effect on Vt Signup and view all the answers

In which scenario is a patient-triggered breath possible?

In pressure support ventilation Signup and view all the answers

What is the impact of a mandatory trigger on breathing patterns?

Reduces the work of breathing for the patient Signup and view all the answers

Which breath type involves flow-triggered ventilation?

Assisted Mandatory breath Signup and view all the answers

What is the effect of a flow control setting on the ventilator mode?

Improves flow consistency Signup and view all the answers

What happens during the first breath in the volume control mode?

It is a VC breath with a pause time Signup and view all the answers

What is the main purpose of the T insp.rise time in ventilator settings?

To manage the speed of pressure increase during inhalation Signup and view all the answers

In DC-IMV modes, what is the first mandatory breath initiated by the system?

Volume control (VC) breath with a pause time Signup and view all the answers

What triggers an assisted mandatory breath if the patient is unable to initiate a breath?

Flow or pressure detected by the system Signup and view all the answers

What role does the pressure limit play in mandatory breaths?

It ensures the pressure varies to maintain the set tidal volume Signup and view all the answers

In a PB980 ventilator, how is support provided during the first mandatory breath?

Through a variable pressure limit based on set tidal volume Signup and view all the answers

Which feature distinguishes the VC-SIMV with autoflow from other modes?

It guarantees volume delivery for every breath Signup and view all the answers

What does Pplat refer to in the context of mandatory breaths?

The plateau pressure measured during a breath hold Signup and view all the answers

In Servo U modes, what is the significance of the PS above PEEP setting?

It determines the pressure applied during spontaneous breaths Signup and view all the answers

What indicates a spontaneous breath in a ventilator setting?

The patient is breathing against a preset pressure Signup and view all the answers

Which parameter is crucial for determining the expiration phase in ventilator modes?

Flow decay Signup and view all the answers

What is the effect of a variable pressure limit during mandatory breaths?

It allows the ventilator to adjust pressure to reach the set tidal volume Signup and view all the answers

How does the pressure support affect spontaneous breathing in pressure-supported ventilation?

It enhances the patient's ability to breathe by reducing the work of breathing Signup and view all the answers

What is meant by 'cycle off' in ventilation settings?

End of inspiration signaled by a decrease in flow Signup and view all the answers

What does 'rise%' indicate in ventilator settings?

The rate of increase during inspiration Signup and view all the answers

Study Notes

General Info on Ventilator Modes

CMV (Controlled Mechanical Ventilation) has a risk of hypocarbia if patient triggers are excessive.
CSV (Continuous Spontaneous Ventilation) does not have a set respiratory rate (RR) but requires backup.
IMV (Intermittent Mandatory Ventilation) includes a trigger window for spontaneous breaths.
Pressure cycling is based on high pressure alarm, ensuring a safety mechanism.

VC-CMV (Volume Control - Continuous Mandatory Ventilation): Delivers set tidal volume (Vt) and inspiratory time (Ti).
Servo I and Servo U include calculated flow based on set parameters, while PB980 has maximum flow settings.
Evita provides options for Vt, flow, and total Ti to optimize ventilation.
For assisted breaths, Evita calculates active Ti by negating Tpause for Pplat time.

Breathing Trigger and Limit Mechanisms

Servo modes shift to CMV if there is no patient effort within trigger timeout durations.
Assisting mechanisms may include dynamic trigger timeout limits based on patient spontaneity.
Each ventilator unit has unique methodologies for pressure limit settings and inspiratory pressure (Pinsp).

Automatic Adjustment Features

Mode auto-adjustments (like DC-CMV) adapt pressure based on current tidal volume needs.
Sigh features can intermittently increase PEEP (Positive End-Expiratory Pressure) for patient benefit.
Automatic Tube Compensation (ATC) adjusts for endotracheal tube (ETT) size and setting requirements.

Rise Time and Cycle Mechanisms

Rise time adjustments impact how quickly peak flow is achieved for patient comfort.
Pressure limits are crucial in defining PIP which affects overall delivered tidal volumes.
The cycle of breaths is based largely on Ti parameters and responsive patient efforts.

Specific Characteristics of Ventilator Modes

Servo models allow for extensive customization with flow waveform setting percentages affecting breath delivery patterns.
PRVC employs variable pressure adjustments during both mandatory and spontaneous breathing phases.
PC-IMV (Pressure-Controlled Intermittent Mandatory Ventilation) includes flexible support and trigger functionality.

Mandatory vs. Spontaneous Breathing Analysis

Limits for mandatory breaths include specific metrics like RR and PEEP to maintain proper lung function through varying support levels.
Spontaneous settings can heavily influence total ventilation by allowing patient-triggered breaths to dictate pacing without mandatory overrides.
Each ventilator introduces unique parameters for triggering and mandatory breath delivery based on patient effort measurements.

Summary of the Ventilator Classification

Understanding features across Servo I, Servo U, PB980, and Evita helps in tailoring ventilation strategies to patient needs.
Key distinctions in volume vs. pressure control, rise time settings, and trigger parameters are vital for effective mechanical ventilation management.
Continuous assessment of patient responsiveness and adjusting ventilator settings improve overall care in critical care scenarios.### General Ventilation Modes
Focus on various ventilation support strategies including IMV (Intermittent Mandatory Ventilation) with pressure support.
Utilize SIMV (Synchronized Intermittent Mandatory Ventilation), specifically configurations such as PRVC (Pressure Regulated Volume Control) that tailor pressure support during mandatory breaths.

Cycle Off and Inspiration

Flow decay adjustments occur at the end of inspiration.
Parameters include cycle off, Esens%, and inspiratory termination.
Pressure Support (PS) settings are defined above PEEP (Positive End-Expiratory Pressure).

Pressure Support Levels

PS above PEEP includes variables like Psupp and ΔPsupp, influencing respiratory support during mandatory and spontaneous breaths.
Slope defines the rate of pressure change.

Rise Time and Other Settings

T insp. rise time is a crucial parameter affecting how quickly inspiratory pressure is applied.
Rise% describes the percentage of time the ventilator takes to reach the set inspiratory pressure.

DC-IMV Settings and Variants

Different ventilator brands (Servo I, Servo U, PB980, Evita) share similar settings under DC-IMV configurations.
Assistance is provided either through controlled (mandatory) or supported (assisted) breaths.

Triggering Mechanism

Mandatory breaths operate within established trigger windows, ensuring timely responses to patient demand.
1st mandatory breath is typically volume-controlled (VC) in different modes before switching to pressure control.

Breath Limits and Patterns

Initial breath responses involve pressure limits tailored to achieve target tidal volumes (Vt) without fixed settings.
Subsequent breaths operate under varying pressure limits based on desired Vt.

Breathing Cycles

Spontaneous breaths depend on pressure support set above PEEP, while mandatory breaths follow specific tidal volume and pressure parameters.
Cycle timing (Ti) greatly influences ventilation effectiveness and patient comfort.

Specific Ventilator Features

Specific settings like PC-SIMV with volume guarantee ensure mandatory breaths meet preset thresholds without exceeding pressure limits.
Volume control is maintained especially during the first mandatory breath, ensuring compliance with desired clinical outcomes.

Importance of Parameters

Understanding the interplay of different settings is essential in optimizing mechanical ventilation to accommodate individual patient needs.
Close monitoring of flow decay, rise time, and pressure support variations is fundamental for effective respiratory management.

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Description

This quiz covers foundational concepts related to servo systems, including components like Servo I, Servo U, and their applications. Additionally, it touches on DC mode layering and the risks associated with varying configurations. Test your knowledge of these critical areas in servomechanism technology.