Ventilator Types and Modes (1).pdf

General info Servo I Servo U PB980 Evita DC is...

General info Servo I Servo U PB980 Evita DC is mode layered CMV extension (from additional has risk of hypocarbia setting) takes a volume or if patient triggers too pressure mode and adds much autoflow or VG to make it the equivalent DC mode CSV No set RR but requires backup IMV Has trigger window Pressure cycling based on high pressure alarm - safety mechanism) Servo I Servo U PB980 Evita VC-CMV: Volume Control: Volume Control: VC A/C: VC-AC: Volume Control Volume Control 1)Assisted/Mandatory breath: -Vt and Ti (T insp time) are -Vt and Ti (T insp time) are -Vt and flow (V̇ MAX) are set (Ti is -Vt, flow, and total Ti are set Trigger: set (flow is calculated) set (flow is calculated) calculated) Set Vt and flow calculates Mandatory: TCT the active Ti Assisted mandatory: -Square flow waveform is -Flow pattern% setting: -Flow pattern: Tpause for Pplat time is Patient (via flow or only option Sliding scale between Discrete option of either total Ti subtracted by pressure) square (100%) and descending ramp or active Ti descending ramp square wave form Limit: Flow flow waveform. Descending ramp flow -additional autoflow setting would Decreasing flow waveform would have turn the mode into DC-CMV Cycle: pattern % would increased Ti if the Vt or Ti increase peak flow flow setting doesn’t Volume (rarely) needed to get the set changes  Vt within the set Ti -On-demand flow -Flow adaption pattern If pt has more flow setting demand, allows on-demand flow them to access more when flow pattern is flow by switching to 100% PS momentarily Other settings: Other settings: Other settings: Other settings -RR -RR -f (RR) -RR -PEEP -PEEP -PEEP -PEEP -T pause (Pplat) -T pause (Pplat) -Tpl (Pplat) -T insp. rise time -T insp. rise time Servo I Servo U PB980 Evita PC-CMV: Pressure Control: Pressure Control: PC A/C: PC-AC: Pressure Control Pressure Control 1)Assisted/Mandatory breath: -T insp. rise time: -T insp. rise time: -rise%: -Slope (rise time): Trigger: shorter rise time: shorter rise time: higher %: reaches peak shorter rise time: reaches Mandatory: TCT reaches peak flow reaches peak flow flow faster peak flow quicker Assisted mandatory: quicker quicker lower %: reaches peak Higher rise time: reaches Patient (via flow or Higher rise time: Higher rise time: flow slower peak slower pressure) reaches peak slower reaches peak slower Limit: Pressure -PC above PEEP -PC above PEEP -PI (inspiratory pressure) -Pinsp (inspiratory pressure) PIP = PC above PIP = PC above PC above PEEP value Is the PIP Cycle: PEEP+PEEP PEEP+PEEP PIP = PI+PEEP Increasing PEEP would Ti Increasing PEEP Increasing PEEP Increasing PEEP would not affect the PIP but the Volume (rarely) would increase PIP would increase PIP increase PIP but the delivered Vt decreases but the delivered Vt but the delivered Vt delivered Vt remains the (less pressure gradient; remains the same remains the same same Δ[PIP-PEEP] decreases)  -additional volume guarantee setting would turn the mode into DC-CMV Other settings: Other settings: Other settings: Other settings: -RR -RR -f (RR) -RR -PEEP -PEEP -PEEP -PEEP Servo I Servo U PB980 Evita: DC-CMV: PRVC PRVC VC+ A/C: VC-AC with autoflow: Pressure regulated Pressure regulated Volume Control+ VC-AC mode with 1)Assisted/Mandatory breath: volume control volume control autoflow on (flow setting now gets removed; flow Trigger: -1st breath is a VC breath -1st breath is a VC breath -1st breath is a VC breath with a automatically changes to Mandatory: TCT with a pause time of 10% to with a pause time of 10% to Pplat which is used as the PIP of get the the set Vt in the Assisted mandatory: get a Pplat which is used as get a Pplat which is used as the next breath set Ti) Patient (via flow or the PIP of the next breath the PIP of the next breath 1st breath is a VC breath pressure) with a Pplat which is used -Next sequential breath are -Next sequential breath are -Next sequential breath are PC as the PIP of the next Limit: PC with a varying pressure PC with a varying pressure with a varying pressure limit breath 1st breath: Flow (VC limit based on the set Vt limit based on the set Vt based on the set Vt Next sequential breath are breath with Pplat) Pressure must be ≤ Pressure must be ≤ Pressure must be ≤ upper PC with a varying following breaths: upper limit pressure upper limit pressure limit pressure -3cmH20 pressure limit based on Pressure (no set -5cmH20 -5cmH20 5 first breaths: each on breath can vary ±3cmH2O 1st breath is a PC breath regardless of PBW set at the Pinsp as the PIP  Next sequential breath are PC with a varying Other settings: Other settings: Other settings: pressure limit based on -RR -RR -f (RR) the set Vt -PEEP -PEEP -PEEP -Tidal volume -Tidal volume -Vt -T insp. rise time -T insp. rise time -rise% Servo I Servo U PB980 Evita PC-CSV: PS/CPAP: PS/CPAP: Spont PS: SPN-CPAP/PS: Pressure Support Pressure Support Pressure Support 1)Spontaneous breath: -Insp. cycle off -End Inspiration (cycle off) -Esens (cycle off) -Insp Term (cycle off) Trigger: -PS above PEEP -PS above PEEP -Psupp (PS above PEEP) -ΔPsupp (PS above PEEP) Patient (via flow or pressure) Backup settings: Backup settings: Backup settings: Backup settings: PC (PC-CMV) PC (PC-CMV) Apnea ventilation: able to Apnea ventilation Limit: pressure Can be turned off chose PC A/C (PC-CMV) or VC A/C (VC-CMV) Cycle: Flow decay -Backup Cycling: Ti cycled: based on IBW calculations Volume cycled: high Vt limit reached Other settings: Other settings: Other settings: Other settings: -PEEP -PEEP -PEEP -PEEP -T insp. rise time -T insp. rise time -rise% -slope Servo I Servo U PB980 Evita: DC-CSV: Volume Support (VS): Volume Support (VS): VS: SPN-CPAP/VS: Volume Support 1)Spontaneous breath: -1st breath is PC breath with -1st breath is same as 10 cmH2O above PEEP DC-CMV: a VC breath with a Trigger: Pplat which is used as the  Patient (via flow or PIP of the next breath -Backup Cycling: pressure) Ti cycled: based on IBW -Next sequential breath are -Next sequential breath are calculations Limit: Pressure (no set PC with a varying pressure PC with a varying pressure Volume cycled: high Vt pressure limit; pressure limit limit based on the set Vt limit based on the set Vt limit reached free to vary to reach set Vt) Cycle: Flow decay Basic Settings: Basic Settings: Basic settings: Basic settings: -Tidal Volume -Tidal Volume -Vt supp -Vt -PEEP -PEEP -PEEP -PEEP -Insp. cycle off (flow decay) -End inspiration (flow decay) -Esens% (flow decay) -insp term (flow decay) -T insp. rise time -T insp. rise time -rise% -slope Backup settings: Backup settings: Backup settings: Backup settings: Volume Control PRVC (DC-CMV) Apnea ventilation: able to Apnea ventilation (VC-CMV) Can be turned off chose PC A/C (PC-CMV) or VC A/C (VC-CMV) Servo I Servo U PB980 Evita: VC-IMV: SIMV (VC) + Pressure SIMV (VC) + Pressure SIMV VC: VC-SIMV: Support: Support: 1)Assisted/Mandatory breath: -Trigger window -Trigger window -Trigger window -Trigger window Trigger: If no pt effort/trigger If no pt effort/trigger Is (set IMV TCT)*(0.6) or 5 sec for adults Mandatory: TCT equal to 90% of the equal to 90% of the 10 sec whichever is less 1.5 sec for Assisted mandatory: trigger window, a trigger window, a If no pt effort/trigger pediatric/neonate Patient (via flow or mandatory breath is mandatory breath is detected during the trigger If no pt effort/trigger pressure) delivered delivered window, then a mandatory detected during the trigger breath would be delivered window, then a mandatory Limit: Flow at the start of the next breath would be delivered trigger window at the end of the trigger Cycle: Ti window Assisted (pt effort) 2) Spontaneous breath: mandatory breath would shorten the trigger window Trigger: and extend the Patient (via flow or spontaneous breathing pressure) phase Mandatory settings: Mandatory settings: Mandatory settings: Mandatory settings: Limit: Flow -Tidal Volume -Tidal Volume -Vt -Vt -SIMV rate (IMV RR) -SIMV rate (IMV RR) -f (IMV RR) -RR (IMV RR) Cycle: Flow decay -PEEP -PEEP -PEEP -PEEP -Ti -Ti -Ti -T pause (Pplat) -T pause (Pplat) -T pause (Pplat) -flow -flow -flow pattern% -flow pattern flow adaptation Spontaneous settings: Spontaneous settings: Spontaneous settings: Spontaneous settings: -Insp. cycle off (flow decay) -End inspiration (flow decay) -Esens% (flow decay) -Insp Term (cycle off) -PS above PEEP -PS above PEEP -Psupp (PS above PEEP) -ΔPsupp (PS above PEEP) -Slope Other/Both settings: Other/Both settings: Other/Both settings: Other/Both settings: -T insp. rise time -T insp. rise time -rise% (autoflow to turn into DC) PC-IMV: Servo I Servo U PB980 Evita: SIMV (PC) + Pressure SIMV (PC) + Pressure SIMV PC: PC-SIMV: 1)Assisted/Mandatory breath: Support: Support: Trigger: -Trigger window -Trigger window -Trigger window -Trigger window Mandatory: TCT If no pt effort/trigger If no pt effort/trigger Is (set IMV TCT)*(0.6) or 5 sec for adults Assisted mandatory: equal to 90% of the equal to 90% of the 10 sec whichever is less 1.5 sec for Patient (via flow or trigger window, a trigger window, a If no pt effort/trigger pediatric/neonate pressure) mandatory breath is mandatory breath is detected during the trigger If no pt effort/trigger delivered delivered window, then a mandatory detected during the trigger Limit: Pressure breath would be delivered window, then a mandatory at the start of the next breath would be delivered Cycle: Ti trigger window at the end of the trigger window 2) Spontaneous breath: Assisted (pt effort)  mandatory breath would Trigger: shorten the trigger window Patient (via flow or and extend the pressure) spontaneous breathing phase Limit: Pressure Mandatory settings: Mandatory settings: Mandatory settings: Mandatory settings: -SIMV rate (IMV RR) -SIMV rate (IMV RR) -f (IMV RR) -RR (IMV RR) Cycle: Flow decay -PEEP -PEEP -PEEP -PEEP -Ti -Ti -Ti -Ti -PC above PEEP -PC above PEEP -PC above PEEP -Pinsp (PIP) Spontaneous settings: Spontaneous settings: Spontaneous settings: Spontaneous settings: -Insp. cycle off (flow decay) -End inspiration (flow decay) -Esens% (flow decay) -Insp Term (cycle off) -PS above PEEP -PS above PEEP -Psupp (PS above PEEP) -ΔPsupp (PS above PEEP) -Slope Other/Both settings: Other/Both settings: Other/Both settings: Other/Both settings: -T insp. rise time -T insp. rise time -rise% (volume guaranteed to turn into DC) DC-IMV: Servo I Servo U PB980 Evita: SIMV (PRVC) + Pressure SIMV (PRVC) + Pressure SIMV DC: 1)Assisted/Mandatory breath: Support: Support: Trigger: -Trigger window -Trigger window -Trigger window -Trigger window Mandatory: TCT Same as previous Same as previous Same as previous PB980 Same as previous Evita Assisted mandatory: Servo I IMV modes Servo U IMV modes IMV modes IMV modes Patient (via flow or pressure) -1st mandatory breath is a -1st mandatory breath is a -1st mandatory breath is a VC VC breath with a pause time VC breath with a pause time breath with a Pplat which is used VC-SIMV with autoflow: Limit: of 10% to get a Pplat which of 10% to get a Pplat which is as the PIP of the next PC VC-SIMV with autoflow on 1st breath: Flow (VC is used as the PIP of the used as the PIP of the next mandatory breath with a varying (flow setting now gets breath with Pplat) next PC mandatory breath PC mandatory breath with a pressure limit based on the set Vt removed; flow following breaths: with a varying pressure limit varying pressure limit based automatically changes to Pressure (no set based on the set Vt on the set Vt get the the set Vt in the  pressure limit; pressure set Ti) limit free to vary to -Spontaneous breath based -Spontaneous breath based -Spontaneous breath based on 1st mandatory breath is a reach set Vt) on the PS above PEEP on the PS above PEEP the Psupp (PS above PEEP) VC breath with a Pplat which is used as the PIP Cycle: of the next PC mandatory Ti breath with a varying pressure limit based on 2) Spontaneous breath: the set Vt Spontaneous breath Trigger: based on the Psupp (PS Patient (via flow or above PEEP) pressure) Mandatory settings: Mandatory settings: Mandatory settings: PC-SIMV with VG: Limit: Pressure -Tidal Volume -Tidal Volume -Vt PC-SIMV with volume -SIMV rate (IMV RR) -SIMV rate (IMV RR) -f (IMV RR) guaranteed on Cycle: Flow decay -PEEP -PEEP -PEEP 1st mandatory breath is a -Ti -Ti -Ti PC breath set at the Pinsp as the PIP, and next Spontaneous settings: Spontaneous settings: Spontaneous settings: mandatory breath are PC -Insp. cycle off (flow decay) -End inspiration (flow decay) -Esens% (flow decay) with a varying pressure -PS above PEEP -PS above PEEP -Psupp (PS above PEEP) limit based on the set Vt Spontaneous breath Other/Both settings: Other/Both settings: Other/Both settings: based on the Psupp (PS -T insp. rise time -T insp. rise time -rise% above PEEP) Other info: Servo I/ Servo U PB980 Evita Automode: Tube Compensation (TC): CMV (for Evita): Initially starts in the CMV mode and switches to the Type of spontaneous Deliveries only mandatory, CSV mode when pt triggers. mode to reduce work of not assisted breaths No pt effort/trigger revert back to CMV mode if breathing for pt with Mandatory trigger only reaches trigger timeout time (Servo I: trigger timeout; artificial airway, to reduce (trigger is only TCT) Servo U: Max apnea time) its effect on resistance, Non synchronous IMV Dynamic trigger timeout limit triggering, and Vt Patient’s spontaneous ○ The trigger timeout time is initially the TCT Mode removes/integrates effort can’t trigger a breath (60/RR) and increases as the pt breaths %rise setting but are able to access the spontaneously to the set trigger timeout Additional settings: flow between the ○ Requires 10 successive spontaneous ○ % Supp mandatory breaths  breaths to reach the set ○ Tube I.D (internal Mandatory breaths types diameter) includes: Options: ○ Tube type ○ PC (“PC-CMV”) VC-VS (VC-CMV/ DC-CSV) (ETT/TT) ○ VC(“VC-CMV”) ○ DC PRVC-VS (DC-CMV/ DC-CSV): Uncomfortable for Set Vt is used as target for both mandatory and patients, only used when spontaneous modes high risk of autotrigger More preferred/comfortable to pt than VC-VS occurs Sigh: PC-PS (PC-CMV/ PC-CSV) Additional setting to PC uses: PC above PEEP increase PEEP PS uses: PS above PEEP intermittently ATC: Automatic tube compensation Compensates for ETT size and sets % of compensation