Mechanical Ventilation Modes Quiz
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Questions and Answers

What type of breaths does PRVC deliver?

Pressure control breaths

What is the primary control of breaths in PRVC?

Pressure

What is the main goal of PRVC?

To target a set tidal volume

Which of these are settings for PRVC?

<p>Tidal volume (A), Respiratory rate (B), Inspiratory time (C), PEEP (D), FiO2 (E), All of the above (F)</p> Signup and view all the answers

Which of the following ventilators use the PRVC mode, but have different names for it?

<p>Hamilton (A), CareFusion (B), Drager (C), Servo (D), Medtronics (E), All of the above (F)</p> Signup and view all the answers

The high inspiratory alarm in PRVC is triggered by exceeding the set pressure limit.

<p>True (A)</p> Signup and view all the answers

What does the term 'adaptive' refer to in PRVC?

<p>The ventilator automatically adjusts the target tidal volume based on patient conditions.</p> Signup and view all the answers

What are the key characteristics of PRVC?

<p>Pressure controlled (A), Volume targeted (B), Patient or machine triggered (C), Time cycled (D), All of the above (E)</p> Signup and view all the answers

How does PRVC adjust the pressure delivered in subsequent breaths?

<p>Based on the volume of the previous breath.</p> Signup and view all the answers

What happens to the delivered volume if the pressure limit is reached before the target volume is reached?

<p>The ventilator will not deliver the full target volume. (C)</p> Signup and view all the answers

PRVC helps to protect the lungs from ______.

<p>barotrauma</p> Signup and view all the answers

VSV is a spontaneous mode of ventilation.

<p>True (A)</p> Signup and view all the answers

What type of support does VSV provide to the patient?

<p>Pressure support</p> Signup and view all the answers

What does the ventilator adjust in VSV to achieve the target tidal volume?

<p>Pressure</p> Signup and view all the answers

In VSV, the patient cannot breathe higher than the target Vt.

<p>False (B)</p> Signup and view all the answers

What is the term used to describe the patient's effort in VSV?

<p>Work of breathing (WOB)</p> Signup and view all the answers

How does APRV improve oxygenation?

<p>By increasing the mean airway pressure (C), By increasing the functional residual capacity (FRC) (D), All of the above (E)</p> Signup and view all the answers

What type of ventilation ratio does APRV utilize?

<p>Inverse ratio ventilation</p> Signup and view all the answers

APRV is a form of pressure support ventilation.

<p>True (A)</p> Signup and view all the answers

Which of these is NOT a characteristic of APRV?

<p>Volume controlled (C)</p> Signup and view all the answers

What are the two key pressure levels used in APRV?

<p>P-high and P-low</p> Signup and view all the answers

What is the typical range for T-high in APRV?

<p>3-5 seconds</p> Signup and view all the answers

The T-low in APRV should be long enough to ensure complete alveolar derecruitment.

<p>False (B)</p> Signup and view all the answers

What is the primary purpose of P-high in APRV?

<p>To promote gas exchange and alveolar recruitment</p> Signup and view all the answers

If P-high is set too high, what can occur?

<p>Increased work of breathing (B), Lung overdistension (C), All of the above (D)</p> Signup and view all the answers

What is the goal of P-low in APRV?

<p>To facilitate CO2 removal and maintain baseline pressure.</p> Signup and view all the answers

APRV is proven to be a highly effective rescue strategy for patients with acute respiratory distress syndrome (ARDS).

<p>False (B)</p> Signup and view all the answers

What are potential risks associated with APRV?

<p>High tidal volumes (A), Increased transpulmonary pressures (B), Increased risk of ventilator-induced lung injury (VILI) (C), All of the above (D)</p> Signup and view all the answers

What is the fundamental difference between APRV and BiPAP in terms of inspiratory time?

<p>APRV has a longer inspiratory time compared to BiPAP.</p> Signup and view all the answers

ASV is available on all types of ventilators.

<p>False (B)</p> Signup and view all the answers

What does ASV stand for?

<p>Adaptive Support Ventilation</p> Signup and view all the answers

What is the main principle behind ASV?

<p>ASV attempts to find the optimal breath pattern for the patient.</p> Signup and view all the answers

ASV uses a fixed breath pattern for all patients.

<p>False (B)</p> Signup and view all the answers

What is a Time Constant in ASV, and what does it represent?

<p>A Time Constant in ASV is a measure of how long it takes for a lung unit to fill or empty. It represents the time it takes for a change in pressure to reach 63% of its final value during inflation or deflation.</p> Signup and view all the answers

What is the main advantage of ASV?

<p>ASV provides individualized breath settings for each patient.</p> Signup and view all the answers

The C1V1 = C2V2 formula can still be used when adjusting ASV settings, but with a substitution for the RR variable.

<p>True (A)</p> Signup and view all the answers

ASV is considered a rescue strategy for critically ill patients.

<p>False (B)</p> Signup and view all the answers

Flashcards

Pressure-Regulated Volume Control (PRVC)

A type of mechanical ventilation that provides pressure-controlled breaths with a target tidal volume.

High Inspiratory Alarm in PRVC

The maximum pressure the ventilator will deliver, typically set 5 cmH2O below the PIP limit.

Adaptive PRVC

A type of PRVC where the ventilator automatically adjusts the target tidal volume and other parameters based on changing patient conditions.

PRVC Breath Delivery

The ventilator adjusts the flow rate on each breath to meet the target tidal volume set by the clinician.

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Indications for PRVC

PRVC is indicated for patients requiring the lowest possible pressure while ensuring a consistent tidal volume, especially in cases of ALI/ARDS.

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Advantages of PRVC

PRVC minimizes peak inspiratory pressure (PIP), guarantees consistent tidal volume and minute ventilation, and reduces patient work of breathing.

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Disadvantages of PRVC

PRVC can lead to varying mean airway pressure, potentially worsen auto-PEEP, and may be poorly tolerated by awake patients.

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PRVC Response to Decreasing Lung Compliance

The ventilator will increase pressure to maintain the target tidal volume if lung compliance decreases (worsens) during PRVC.

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PRVC Response to Improving Lung Compliance

The pressure required to reach the set tidal volume will decrease with improved lung compliance during PRVC.

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Volume Support Ventilation (VSV)

A mode of mechanical ventilation that provides patient-triggered pressure support with a volume target.

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Availability of VSV Across Ventilators

VSV is only available on certain ventilators, including Servo-I, PB 840, and Drager V500, each with a specific name for the mode.

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VSV Settings

VSV settings include a target tidal volume that serves as a minimum, allowing patients to exceed it, and a pressure limit to protect the lungs.

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VSV Pressure Adjustment

The ventilator automatically adjusts pressure over several breaths to achieve the target tidal volume in VSV.

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Airway Pressure Release Ventilation (APRV)

A ventilation mode that uses two CPAP pressures to recruit alveoli, prevent collapse, and improve ventilation-perfusion matching.

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Inverse Ratio Ventilation in APRV

APRV employs inverse ratio ventilation, meaning the inspiratory time is longer than the expiratory time.

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Benefits of APRV

APRV increases mean airway pressure, contributing to increased functional residual capacity (FRC), alveolar recruitment, and oxygenation.

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APRV Mode Characteristics

APRV combines features of pressure control and intermittent mandatory ventilation (IMV), allowing both patient-triggered and time-triggered breaths.

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Key APRV Parameters

APRV utilizes two set pressures (P-high and P-low) and two inspiratory times (T-high and T-low).

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T-high in APRV

T-high represents the time spent at the high inspiratory pressure during APRV, typically 3 to 5 seconds.

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T-low in APRV

T-low represents the time spent at the lower expiratory pressure during APRV, typically less than one second to prevent lung derecruitment.

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Importance of P-high Setting

Setting P-high too high can lead to overdistention and increased work of breathing, while setting it too low can cause alveolar derecruitment.

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P-low in APRV

P-low is the baseline expiratory pressure in APRV, typically set between 0 and 5 cmH2O and should be as low as possible to maximize ventilation.

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APRV Adjustments for Respiratory Acid-Base Imbalances

Adjusting APRV parameters can help correct respiratory acid-base imbalances. Increasing P-high and T-low can treat respiratory acidosis, while decreasing them can address respiratory alkalosis.

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Drop and Stretch Weaning Strategy for APRV

A weaning strategy for APRV that involves gradually decreasing P-high and increasing (stretching) T-high, slowly transitioning to CPAP.

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Adaptive Support Ventilation (ASV)

ASV is a ventilation mode that automatically adjusts respiratory rate, tidal volume, and inspiratory time based on patient lung mechanics and effort.

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ASV Settings

ASV settings include %MinVol (target minute ventilation), PEEP, FiO2, and limits for pressure, triggering sensitivity, ramp, and expiratory time.

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Time Constant in ASV

ASV utilizes time constants (compliance x resistance) to calculate the optimal breathing pattern for each breath.

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Gas Exchange Principles in ASV

When making changes in ASV, traditional principles of gas exchange (changing PEEP, FiO2, and minute ventilation) apply to adjust PaO2 and PaCO2.

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Calculating Minute Ventilation in ASV

The C1V1 = C2V2 formula can be used in ASV by substituting the %MinVol for either RR or Vt.

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Minute Ventilation Control in ASV

ASV automatically adjusts settings to achieve the targeted minute ventilation (%MinVol), while the ventilator adjusts the individual RR and Vt to achieve that goal.

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Study Notes

Mechanical Ventilation Modes

  • Pressure Regulated Volume Control (PRVC): A pressure-limited, time-cycled mode that targets a set tidal volume.
  • Different ventilator brands use various names for PRVC, such as APV/CMV (Hamilton), PRVC (CareFusion), Autoflow (Drager), PRVC (Servo), and VC+ (Medtronics).
  • PRVC settings include target tidal volume, respiratory rate, inspiratory time, PEEP, FiO2, and alarms (high inspiratory alarm equals pressure limit).
  • The pressure limit is not allowed to exceed 5 below the PIP limit.
  • PRVC taxonomy: pressure as control sequence, CMV or SIMV as breath sequence, adaptive targeting scheme. The ventilator adjusts the target(s) between breaths in response to varying patient conditions.
  • PRVC is pressure-controlled, calculated based off of previous breath, volume-targeted, and time-cycled.
  • The first breath is volume-controlled with a plateau pressure. Subsequent breaths use pressure control to achieve the targeted tidal volume.
  • This mode is used when aiming for a specific tidal volume.
  • The ventilator dynamically adjusts flow for each breath to get the target volume, while maintaining a maximum pressure.
  • If compliances are low, the pressure will increase to maintain the volume. The pressure is adjusted until the pressure limit is reached

Volume Support Ventilation (VSV)

  • Similar to PRVC and pressure support.
  • Spontaneous mode of ventilation with a volume target.
  • Patient-triggered and volume-targeted. Ventilator adjusts pressure and flow with time-based cycles.
  • VSV is only available on Servo-I, PB 840, Drager V500, and SPN-CPAP/VS ventilators.
  • VSV settings include target tidal volume, respiratory rate, inspiratory time, FiO2, PEEP, and sensitivity.
  • The ventilator adjusts pressure for every breath to achieve the target tidal volume as the patient's condition improves, the necessary pressure will decrease.
  • If the patient does more work of breathing (WOB) the pressure support (PS) will be lower. If the patient does less work, more pressure support is needed.
  • Breaths are spontaneous and the backup mode should be set appropriately.

Airway Pressure Release Ventilation (APRV)

  • Uses two CPAP pressures to recruit alveoli, prevent alveolar collapse, improve V/Q mismatch and improves oxygenation.

  • Form of PC-IMV (Pressure-Controlled Intermittent Mandatory Ventilation). Uses inverse ratio ventilation (I:E ratio where I > E).

  • Increases mean airway pressure (MAP), functional residual capacity (FRC), alveolar recruitment, and oxygenation.

  • Allows spontaneous breathing.

  • Mode characteristics include pressure controlled, pressure limited, volume variable, and triggering can be patient and/or time triggered. The patient is allowed to trigger between mandatory breaths.

  • Uses two set pressures (P-high on inspiration and P-low on expiration) and two set inspiratory times (T-high on inspiration and T-low on expiration).

  • Setting time parameters: T-high (inspiratory time) is usually 3-5 seconds and T-low (expiratory time) is usually less than one second to prevent derecruitment. The times should be long enough to achieve an appropriate tidal volume (4-6 ml/kg).

  • Setting P-high pressure: the inspiratory pressure is set approximately at the plateau pressure (usually mid-20s), or when diffusion happens if it is set too high, overdistention will occur and increase work of breathing (WOB), if it is set low, derecruitment occurs.

  • Setting P-low pressure: This is the baseline pressure, usually between 0-5 cm H2O. It gets the maximum ventilation in the short time frame. The pressure gradient between P-high and P-low creates expiratory tidal volume and where CO2 removal occurs.

  • The pressure, volume and flow to time waveforms are shown in a graph.

Adaptive Support Ventilation (ASV)

  • Available on Hamilton ventilators.
  • Determines respiratory rate (RR), tidal volume (Vt), and inspiratory time (Ti) based on lung compliance, resistance, and patient effort.
  • Breath-by-breath adjustments for time constants to measure time it takes for lung units to fill and empty.
  • Assuming optimal breathing pattern is identical to that of a spontaneous breathing patient (least work of breathing).

Changing Parameters

  • All rules for changing PaO2 and PaCO2 still apply when changing PEEP and FiO2.
  • Changing minute ventilation can alter PaCO2.
  • The C1V1 = C2V2 formula can be used in adjusting minute ventilation settings. Substitute respiratory rate (RR) or tidal volume (Vt) for the minute ventilation variable.

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Introduction to Mechanical Ventilation (IMV Lesson 9)

Description

Test your understanding of mechanical ventilation modes, specifically focusing on Pressure Regulated Volume Control (PRVC). This quiz will cover key settings, the taxonomy of PRVC, and how different ventilator brands implement this mode. Enhance your knowledge on adaptive targeting schemes and pressure control in ventilation.

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