Maquet SERVO-i User manual

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THE ABCs OF VENTILATOR MODES
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VENTILATOR MONITOR DISPLAY

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VENTILATOR PARAMETERS
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VENTILATION PARAMETERS

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VENTILATOR PARAMETERS
!Number of breaths per minute ventilator delivers
!Ventilator can provide all patient’s ventilation, or patient
may be able to breath spontaneously between
ventilator breaths
!May titrate (adjust) rate to control carbon dioxide (CO2)
levels
Respiratory Rate (frequency):
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VENTILATOR PARAMETERS

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VENTILATOR PARAMETERS
!Tidal volume is the volume of gas the ventilator will deliver
to the patient with each breath
!Usual setting is 6 to 8 ml/kg (ideal body weight)
!Example: 100 kg patient = 600 ml tidal volume to 800 ml
tidal volume
Tidal Volume (TV):
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VENTILATOR PARAMETERS
!Devine:
!Men: 50 kg + 2.3 (height (in) – 60 )
!Women: 45.5 kg + 2.3 (height (in) – 60)
!Robinson:
!Men: 52 kg + 1.9 kg for each inch over 5 ft
!Women: 49 kg + 1.7 kg for each inch over 5 ft
!Miller:
!Men: 56.2 kg + 1.41 kg for each inch over 5 ft
!Women: 53.1 kg + 1.36 kg for each inch over 5 ft
!Hamwi:
!Men: 48 kg + 2.7 kg for each inch over 5 ft
!Women: 45.5 kg + 2.2 kg for each inch over 5 ft
Ideal body weight (kilograms):

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VENTILATOR PARAMETERS
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VENTILATOR PARAMETERS
!Volume of gas the ventilator will deliver to the patient
in one minute
!Minute volume = respiratory rate x tidal volume
!Example: RR 10 x 600 ml TV = 6 liter MV
Minute Volume (MV):

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VENTILATOR PARAMETERS
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VENTILATOR PARAMETERS
!Indicates amount of oxygen ventilator delivers
!Expressed as a percentage — room air is 21%
!FiO2varies widely depending on patient’s condition
!Arterial blood gases and pulse oximetry values will
help determine FiO2settings
!Titrate to keep oxygen saturation SpO2>96%
!FiO2range is 21% to 100%
FiO2(O2) Conc:

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VENTILATOR PARAMETERS
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VENTILATOR PARAMETERS
!PEEP maintains small end-expiratory pressure to help
prevent alveolar collapse and improve oxygenation
!Most patients are started on 5 cmH2O of PEEP
!Range on SERVO-i®(0 to 50 cmH2O)
PEEP (Positive End-Expiratory Pressure):

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VENTILATOR PARAMETERS
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VENTILATOR PARAMETERS
!Definition: Reflects airway resistance and lung
compliance (work required to move air through airways
and into alveoli)
!Elevated with either increased resistance or decreased
compliance
P-Peak (Peak Inspiratory Pressure )

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VENTILATOR PARAMETERS
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VENTILATOR PARAMETERS
!Method or way a breath is delivered
!Mode of ventilation should be tailored to needs of the
patient
!Controlled mode
!Supported (spontaneous) mode
!Combination mode
Ventilator mode:

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VENTILATOR PARAMETERS
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CATEGORIES OF VENTILATION MODES

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CATEGORIES OF VENTILATION MODES
!Controlled modes:
!Volume Control
!Pressure Control
!PRVC
!Supported (spontaneous) modes:
!Pressure support / CPAP
!Volume support
!NAVA®
!Combination modes:
!SIMV (VC) + PS
!SIMV (PC) + PS
!SIMV (PRVC) + PS
!Bi-vent
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CATEGORIES OF VENTILATION MODES
!Controlled modes:
!Every breath delivered to patient is a mechanical breath
(breath may be triggered by a timing mechanism or patient
effort)
!Supported (spontaneous) mode:
!Every breath is spontaneous (i.e., patient triggered and
patient cycled) but supported by ventilator
!Combination modes:
!Combination of both controlled and supported

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CONTROLLED MODES
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CONTROLLED MODES
!Every breath delivered to patient is
a mechanical breath (breath may be
triggered by a timing mechanism or
patient effort)

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CONTROLLED MODES
!A minute or tidal volume is preset
!Breaths are delivered at a preset
frequency/rate
!Pressure is variable throughout the
delivered breath
!Flow is constant throughout the breath
Volume Control:
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CONTROLLED MODES
1. Tidal Volume (ml)
2. Respiratory Rate (b/min)
3. PEEP (cmH2O)
4. Oxygen concentration (%)
5. I:E ratio / Insp. time
6. Pause time (s)
7. Inspiratory rise time (s)
8. Trigg. Flow / Trigg. Pressure
Volume Control — vent settings:
CONTROLLED MODES OF VENTILATION

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CONTROLLED MODES
!Part or portion of the ventilatory cycle necessary for inspiration
!Setting:
!0.1 to 5.00 sec
!Maintain an I:E of 1:2 or greater (1:3, 1:4, etc.)
Ti (Inspiratory Time):
CONTROLLED MODES OF VENTILATION

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CONTROLLED MODES
!Time for no flow or pressure delivery (%)
!Setting: 0.0 to 30%, or 0.00 to 1.50 sec
T pause:
CONTROLLED MODES OF VENTILATION

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CONTROLLED MODES
!Inspiratory Rise Time, or “T insp. Rise”, is the time taken to reach
the peak inspiratory flow or pressure at the start of each breath
!Inspiratory Rise Time (%) is applicable in Pressure Control, Volume
Control, PRVC, SIMV-Volume Control, SIMV-Pressure Control,
SIMV-PRVC. Setting can be in the range 0 to 20% of the respiratory
cycle time
!Inspiratory Rise Time, set in seconds, is applicable in Pressure
Support, Volume Support and Bi-Vent
!Setting: 0 to 0.40
!Adults range is 0 to 0.40 seconds
!Infants range is 0 to 0.20 seconds
T insp rise (Inspiratory Rise Time):
CONTROLLED MODES OF VENTILATION

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CONTROLLED MODES
!This determines the level of patient effort to trigger the ventilator to
initiate inspiration
!Trigger sensitivity can be set in flow triggering (Trigg. Flow) or
pressure triggering (Trigg. Pressure)
!Normally, flow triggering is typically preferable as this enables the
patient to breathe with less effort
!The higher the number (above 0) the more sensitive the ventilator is
to patient efforts
!The sensitivity is set as high as possible without self-triggering. This
ensures that triggering is patient-initiated and avoids auto-triggering
by the ventilator
!Setting: -20 to 0 (Pressure Trigger)
Above 0 (Flow Trigger)
Trigger:
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CONTROLLED MODES
!IPPV/CMV
!VCV-A/C
!Volume A/C
!VC-CMV
!VC-AC
Similar names for Volume Control:

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CONTROLLED MODES
!A pressure level is preset
!Breaths are delivered at a preset frequency
/ rate
!Pressure is constant throughout the
delivered breath
!Tidal and minute volume are variable
!Flow is variable throughout the breath
Pressure Control:
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CONTROLLED MODES
1. PC (Pressure Control level) above PEEP (cmH2O)
2. Respiratory Rate (b/min)
3. PEEP (cmH2O)
4. Oxygen concentration (%)
5. I:E ratio / Insp. time
6. Inspiratory rise time (s)
Pressure Control — vent settings: