Limits...
Newer nonconventional modes of mechanical ventilation.

Singh PM, Borle A, Trikha A - J Emerg Trauma Shock (2014)

Bottom Line: Over the years, many small modifications in ventilators have been incorporated to improve patient outcome.Various intensive care units over the world have found these modes to improve patient ventilator synchrony, decrease ventilator days and improve patient safety.Their working principles with their advantages and clinical limitations are discussed in brief.

View Article: PubMed Central - PubMed

Affiliation: Department of Anaesthesia, All India Institute of Medical Sciences, Delhi, India.

ABSTRACT
The conventional modes of ventilation suffer many limitations. Although they are popularly used and are well-understood, often they fail to match the patient-based requirements. Over the years, many small modifications in ventilators have been incorporated to improve patient outcome. The ventilators of newer generation respond to patient's demands by additional feedback systems. In this review, we discuss the popular newer modes of ventilation that have been accepted in to clinical practice. Various intensive care units over the world have found these modes to improve patient ventilator synchrony, decrease ventilator days and improve patient safety. The various modes discusses in this review are: Dual control modes (volume assured pressure support, volume support), Adaptive support ventilation, proportional assist ventilation, mandatory minute ventilation, Bi-level airway pressure release ventilation, (BiPAP), neurally adjusted ventilatory assist and NeoGanesh. Their working principles with their advantages and clinical limitations are discussed in brief.

No MeSH data available.


Related in: MedlinePlus

Ventilatory graphics in VAPS (Volume assured pressure support mode) mode
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Figure 5: Ventilatory graphics in VAPS (Volume assured pressure support mode) mode

Mentions: Volume-assured pressure support (VAPS): This is a modification into pressure control mode. It makes the ventilator to switch from pressure control mode to volume control if a minimum set tidal volume is not achieved.[11] [Figure 5] The operator adjustable mechanical parameters are as in conventional pressure control mode-Pressure limit, peak flow rate, ventilator rate, and positive end-expiratory pressure (PEEP). Additionally, a minimum desired “Minimum tidal volume” is also defined. In patients where the lung compliance decreases this mode provides safety against increasing blood CO2 levels by maintaining minimal minute ventilation. It is tricky to understand the rationale behind the optimal setting in this mode. One must understand if the set pressure limit is too high it will not only cause unwanted barotrauma to lung but also would generate higher volume than minimal set tidal volume, thus negating the volume guarantee. Set flow rates must not be very low; in situations where minimal volume is not met it would cause a delayed switch from pressure control to volume control and would lead to unwanted prolongation of inspiratory time. Evidence in favor of this mode has shown that it leads to decreased work of breathing and lower intrinsic PEEP.[1213]


Newer nonconventional modes of mechanical ventilation.

Singh PM, Borle A, Trikha A - J Emerg Trauma Shock (2014)

Ventilatory graphics in VAPS (Volume assured pressure support mode) mode
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4126124&req=5

Figure 5: Ventilatory graphics in VAPS (Volume assured pressure support mode) mode
Mentions: Volume-assured pressure support (VAPS): This is a modification into pressure control mode. It makes the ventilator to switch from pressure control mode to volume control if a minimum set tidal volume is not achieved.[11] [Figure 5] The operator adjustable mechanical parameters are as in conventional pressure control mode-Pressure limit, peak flow rate, ventilator rate, and positive end-expiratory pressure (PEEP). Additionally, a minimum desired “Minimum tidal volume” is also defined. In patients where the lung compliance decreases this mode provides safety against increasing blood CO2 levels by maintaining minimal minute ventilation. It is tricky to understand the rationale behind the optimal setting in this mode. One must understand if the set pressure limit is too high it will not only cause unwanted barotrauma to lung but also would generate higher volume than minimal set tidal volume, thus negating the volume guarantee. Set flow rates must not be very low; in situations where minimal volume is not met it would cause a delayed switch from pressure control to volume control and would lead to unwanted prolongation of inspiratory time. Evidence in favor of this mode has shown that it leads to decreased work of breathing and lower intrinsic PEEP.[1213]

Bottom Line: Over the years, many small modifications in ventilators have been incorporated to improve patient outcome.Various intensive care units over the world have found these modes to improve patient ventilator synchrony, decrease ventilator days and improve patient safety.Their working principles with their advantages and clinical limitations are discussed in brief.

View Article: PubMed Central - PubMed

Affiliation: Department of Anaesthesia, All India Institute of Medical Sciences, Delhi, India.

ABSTRACT
The conventional modes of ventilation suffer many limitations. Although they are popularly used and are well-understood, often they fail to match the patient-based requirements. Over the years, many small modifications in ventilators have been incorporated to improve patient outcome. The ventilators of newer generation respond to patient's demands by additional feedback systems. In this review, we discuss the popular newer modes of ventilation that have been accepted in to clinical practice. Various intensive care units over the world have found these modes to improve patient ventilator synchrony, decrease ventilator days and improve patient safety. The various modes discusses in this review are: Dual control modes (volume assured pressure support, volume support), Adaptive support ventilation, proportional assist ventilation, mandatory minute ventilation, Bi-level airway pressure release ventilation, (BiPAP), neurally adjusted ventilatory assist and NeoGanesh. Their working principles with their advantages and clinical limitations are discussed in brief.

No MeSH data available.


Related in: MedlinePlus