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 airway pressure release ventilation
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Figure 7: Ventilatory graphics in airway pressure release ventilation

Mentions: APRV is a bi-level mode representing another open-lung ventilation strategy. It provides two levels of continuous positive airway pressure (CPAP) with an inverse I:E ratio of 2:1 or more. [Figure 7].[28] The rationale of using prolonged high-pressure phase is to prevent alveolar collapse and maintain recruitment. The release phase (expiratory phase) brings down mean airway pressure and plays significant role in maintaining normocarbia. The mode has dual functionality; in presence of spontaneous breathing the patient can breathe in any phase of respiratory cycle with supported breaths thus bringing down needs of sedation. In absence of spontaneous breathing activity, the bi-level pressure acts as time-cycled inverse ratio ventilation.[29] The tidal volume generated mainly depends upon respiratory compliance and difference between the two CPAP levels. The therapist sets Phigh,(high pressure in CPAP) Plow,(low pressure in CPAP) Thigh(time for Phigh)and Tlow (Time for Plow). Initial Phigh should be set to plateau pressure or the upper inflection point and Plow should be set at lower inflection point on volume-pressure curve. APRV should be used with caution in hypovolemic as increased intrathoracic pressure further lower venous return. APRV should be avoided in patients with obstructive lung diseases as it can cause air trapping or rupture of bullae in COPD. APRV has been shown to improve oxygenation in patients with ARDS simultaneously decreasing need of sedation or paralysis.[30]


Newer nonconventional modes of mechanical ventilation.

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

Ventilatory graphics in airway pressure release ventilation
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 7: Ventilatory graphics in airway pressure release ventilation
Mentions: APRV is a bi-level mode representing another open-lung ventilation strategy. It provides two levels of continuous positive airway pressure (CPAP) with an inverse I:E ratio of 2:1 or more. [Figure 7].[28] The rationale of using prolonged high-pressure phase is to prevent alveolar collapse and maintain recruitment. The release phase (expiratory phase) brings down mean airway pressure and plays significant role in maintaining normocarbia. The mode has dual functionality; in presence of spontaneous breathing the patient can breathe in any phase of respiratory cycle with supported breaths thus bringing down needs of sedation. In absence of spontaneous breathing activity, the bi-level pressure acts as time-cycled inverse ratio ventilation.[29] The tidal volume generated mainly depends upon respiratory compliance and difference between the two CPAP levels. The therapist sets Phigh,(high pressure in CPAP) Plow,(low pressure in CPAP) Thigh(time for Phigh)and Tlow (Time for Plow). Initial Phigh should be set to plateau pressure or the upper inflection point and Plow should be set at lower inflection point on volume-pressure curve. APRV should be used with caution in hypovolemic as increased intrathoracic pressure further lower venous return. APRV should be avoided in patients with obstructive lung diseases as it can cause air trapping or rupture of bullae in COPD. APRV has been shown to improve oxygenation in patients with ARDS simultaneously decreasing need of sedation or paralysis.[30]

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