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 volume support mode
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Figure 6: Ventilatory graphics in volume support mode

Mentions: Pressure limited flow cycled ventilation (aka volume support): It is a modification of pressure support mode where the support pressure is automatically adjusted by the ventilator to meet the minimal set tidal volume.[14] [Figure 6] The ventilator in initial breaths measures the delivered tidal volume and if the minimal volume set is higher than this, it automatically steps up the pressure support in the next breaths.[15] This mode achieves the advantages of pressure support assuring an adequate tidal volume despite changes in lung compliance. The respiratory therapist sets respiratory rate, minimal tidal volume and PEEP. Volume support is a useful mode for weaning as once the patient begins to achieve a desired tidal volume it automatically decreases the pressure support, thus gradually loading the respiratory muscles to take on work of breathing. Like the pressure support mode patient controls the I:E (Inspiratory time: Expiratory time) and the total inspiratory time, this improves the ventilator-patient synchrony. The basic caution prior to use of this mode is that patient must have spontaneous breathing activity else the ventilator will automatically shift to backup mode. Also if the set tidal volume is too large, the ventilator will raise the pressure support to achieve it and lead to problems like barotrauma, hemodynamic compromise, and intrinsic PEEP. If the set volume is too low, it may lead to inadequate pressure support and thus increased respiratory rate leading to increased work of breathing[16]


Newer nonconventional modes of mechanical ventilation.

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

Ventilatory graphics in volume support mode
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 6: Ventilatory graphics in volume support mode
Mentions: Pressure limited flow cycled ventilation (aka volume support): It is a modification of pressure support mode where the support pressure is automatically adjusted by the ventilator to meet the minimal set tidal volume.[14] [Figure 6] The ventilator in initial breaths measures the delivered tidal volume and if the minimal volume set is higher than this, it automatically steps up the pressure support in the next breaths.[15] This mode achieves the advantages of pressure support assuring an adequate tidal volume despite changes in lung compliance. The respiratory therapist sets respiratory rate, minimal tidal volume and PEEP. Volume support is a useful mode for weaning as once the patient begins to achieve a desired tidal volume it automatically decreases the pressure support, thus gradually loading the respiratory muscles to take on work of breathing. Like the pressure support mode patient controls the I:E (Inspiratory time: Expiratory time) and the total inspiratory time, this improves the ventilator-patient synchrony. The basic caution prior to use of this mode is that patient must have spontaneous breathing activity else the ventilator will automatically shift to backup mode. Also if the set tidal volume is too large, the ventilator will raise the pressure support to achieve it and lead to problems like barotrauma, hemodynamic compromise, and intrinsic PEEP. If the set volume is too low, it may lead to inadequate pressure support and thus increased respiratory rate leading to increased work of breathing[16]

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