Basic Vent Modes MADE EASY - Ventilator Settings Reviewed

Summary

In this ICU Advantage video, Eddie Watson explains the fundamental modes of mechanical ventilation: volume control and pressure control. He details settings like tidal volume, respiratory rate, and positive end expiratory pressure (PEEP). Eddie also covers modes from most to least supportive, including assist control (AC), synchronized intermittent mandatory ventilation (SIMV), and pressure support, emphasizing their impact on patients' work of breathing and the importance of monitoring parameters like minute ventilation and peak inspiratory pressure.

Takeaways

• 🌟 Eddie Watson introduces the lesson on basic ventilator modes, emphasizing their importance for understanding mechanical ventilation.
• 📚 The two main categories of ventilator modes are Volume Control and Pressure Control, each with different modes and settings.
• 🔍 Volume Control modes ensure a set volume of breath is delivered to patients, with pressure varying depending on patient needs.
• 🛠️ Pressure Control modes focus on maintaining a constant pressure, with the volume delivered changing based on patient factors.
• 🌡 Key settings in Volume Control include Tidal Volume (VT), Respiratory Rate (F or RR), Oxygen Concentration (FiO2), and Positive End Expiratory Pressure (PEEP).
• 🆘 Positive End Expiratory Pressure (PEEP) is crucial for maintaining open alveoli and improving oxygenation, with typical settings ranging from 5 to 20 cm H2O.
• 💪 Pressure Support (PS) acts like a 'spotter' in the gym, providing an extra push of air to assist patients during spontaneous breaths.
• 📊 Monitoring parameters include Minute Ventilation (VE), Peak Inspiratory Pressure (PIP), and Plateau Pressure (Pplat), indicating lung compliance.
• 🔄 Assist Control (AC) mode provides full control over ventilation, delivering a set volume and rate, but can lead to excessive ventilation.
• 🔄 Synchronized Intermittent Mandatory Ventilation (SIMV) allows for patient-initiated breaths between mandatory breaths, facilitating weaning from the ventilator.
• 🔄 Pressure Support mode is a form of spontaneous breathing with no mandatory breaths, relying on patient effort and PS settings.

Q & A

What are the two main categories of ventilator modes discussed in the video?

The two main categories of ventilator modes discussed are volume control and pressure control.

What is the fundamental difference between volume control and pressure control modes?

In volume control modes, the volume of air delivered is constant while the pressure changes. Conversely, in pressure control modes, the pressure is constant while the volume of air delivered changes.

What is the purpose of the tidal volume (VT) setting in volume control modes?

The tidal volume setting determines the volume of air that is delivered with each breath to the patient.

How is respiratory rate, or frequency (F or RR), calculated in terms of breaths per minute on a ventilator?

Respiratory rate is the number of breaths delivered per minute, calculated by dividing the set respiratory rate into 60 to determine the time interval between each breath.

What does FIO2 represent and how is it expressed?

FIO2 stands for fraction of inspired oxygen, and it represents the concentration of oxygen in the air mixture a patient receives. It is expressed as a fraction or a decimal.

What is the significance of Positive End Expiratory Pressure (PEEP) in a ventilator setting?

PEEP is a constant pressure applied throughout expiration to help keep alveoli open, improving oxygenation. It's similar to CPAP or BiPAP in non-invasive ventilation.

Why is Pressure Support (PS) used in volume control modes?

Pressure Support provides an extra push of air to assist patients during spontaneous breaths, similar to a gym spotter, helping them overcome the resistance of breathing through an ET tube.

What is minute ventilation (VE) and why is it important?

Minute ventilation is a measure of the amount of air delivered to a patient per minute, calculated by multiplying tidal volume by respiratory rate. It's crucial for understanding how much air is being delivered and for adjusting CO2 clearance.

What does Peak Inspiratory Pressure (PIP) indicate and what is the target range for it?

PIP indicates the maximum pressure reached during inspiration. The target is to keep it below 35 cm H2O to prevent lung injury.

Why is Plateau Pressure important in volume control modes?

Plateau Pressure is an indication of lung compliance. It is measured at the end of inspiration and should be under 30 cm H2O to prevent barotrauma.

How does Assist Control (AC or VC) mode differ from Synchronized Intermittent Mandatory Ventilation (SIMV) mode?

In AC mode, the ventilator delivers a full set tidal volume for both mandatory breaths and spontaneous breaths initiated by the patient. In SIMV mode, the ventilator delivers a set number of mandatory breaths, but spontaneous breaths can vary in volume and are assisted by pressure support.

What is the role of SIMV in the weaning process of a patient from a ventilator?

SIMV allows patients to gradually take over their work of breathing by reducing the number of mandatory breaths, increasing the patient's own respiratory effort, and facilitating the weaning process.

Why is Pressure Support often the last step before extubating a patient?

Pressure Support mode allows patients to breathe spontaneously with only the assistance of the set pressure support, making it a trial to assess their ability to breathe independently before extubation.