...WISE men learn from others mistakes!
P.S. ...LIFE is too short to learn from own mistakes.
...the pic below is of an ICU ventilator!
...Insp Time 1.3 seconds is misunderstood as I:E ratio = 1:3!
...actually, with the setting of 1.3 seconds, the I:E ratio is 1:1.2, which is not as intended to be 1:3!
...I:E ratio is displayed on screen, when the Insp Time button is pressed! In the picture 1:E ratio is shown in the screen to be 1:1.2!
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...the bottom row of 5 buttons on the left of the big knob are - from left to right: IPPV, SIMV, CPAP and BiPAP, the fifth button is blank (for nothing).
...the column above the big knob has 3 buttons - from top to bottom are: Pinsp (mbar), delta P ASB above PEEP and PEEP (mbar).
...the column left to the above column - top to bottom are: VT (ml), T insp (sec), f (bpm - breaths per minute) and O2 (Vol %).
...presently, just need to concentrate on the bottom most row of buttons to choose the MODE of ventilation either IPPV - Intermittent Positive Pressure Ventilation, SIMV - Synchronised Intermittent Mandatory Ventilation, CPAP - Continuous Positive Airway Pressure and BiPAP - Bilevel Positive Airway Pressure.
...and to concentrate on the two columns: left column consisting of VT - Tidal Volume (volume of air or oxygen going in or out of the Lungs during each breath), Tinsp in seconds (time allowed for inspiration in seconds), f is the set Respiratory Rate - breaths per minute and O2 in volume %, which is the FiO2 - fraction or percentage of inspired oxygen.
...in the pic, the setting is for BiPAP ventilation (the light is glowing), which is Bilevel meaning two levels are set - the top of the right column (Pinsp 16 mbar/cmH2O) and bottom of the right column (PEEP 3 mbar/cmH2O). One bar is about 1000 mbar or millibar or cmH2O. Since, 1000 mbar = 1000 cm H2O = 760 mmHg = one atmospheric pressure, 1 mbar = 1 cmH2O!
...therefore for BiPAP ventilation bilevel settings are done: the inspiratory pressure 15 - 25 mbar, which is increased incrementally by 2 mbar at a time, say 15 to 17, then to 19 etc, as the need would be to drive in the oxygen to flush out the carbon dioxide in COPD patients - Chronic Obstructive Pulmonary Disease, which consists of two pathologies - Chronic Bronchitis and Emphysema - say, smokers for decades. The other setting is PEEP 3 mbar - positive end expiratory pressure, which keeps the alveoli open for greater surface area for exchange of gases - oxygen and carbon dioxide! Therefore, for BiPAP there are two - upper, inspiratory setting - to help inspiration and lower, expiratory setting - to ease expiration!
...delta P ASB above PEEP or pressure for Assisted Spontaneous Breath (ASB) is set, say at 9 mbar/cmH2O to help inspiration, to drive into the Lungs at a pressure of 9 mbar, when the Respiratory Rate increases above the set 21 breaths per minute. If a patient would be having the total Respiratory rate 30/min, then the set 21 breaths will be driven into Lungs at a pressure of 16 mbar; and the remaining 9 out of 30 breaths at a pressure of 9 mbar!
...tidal volume is not set for BiPAP. The patient generates his/her own tidal volume depending on the Pinsp setting. Therefore, VT button small screen is blank. Of course, upon relieving the bronchoconstriction with bronchodilators like Salbutamol nebulisation, the tidal volume would improve at the same settings!
...for COPD, the O2 % is kept towards lower side 28-35% unless required because upon supplying more oxygen, the patient will breath shallow and retain CO2!
...normal Respiratory rate is 12 -20/min. Herein, the setting is 21/min, which can be increased if needed!
...Facemask BiPAP is applied during acute exacerbation of COPD, ABG showing high PaCO2 like greater than 50 mmHg!
...IPPV mode is chosen for sedated and paralysed patients, say after a major abdominal operation, or for comatosed patient not having spontaneous respiratory effort. Tidal volume is also set, generally to begin with @ 7 ml/kg or adjusted according to chest condition and ABG.
...when spontaneous effort begins, the ventilatory mode is changed to SIMV - Synchronised Intermittent Mandatory Ventilation, which allows the patient to breathe on his own and the machine helps the spontaneous efforts generated by the patient. Lower Respiratory rate might be needed to be set to allow the patient to generate his own breaths!
...when the patient begins to generate good Respiratory effort and the chest condition and ABG improve, then the mode is switched to CPAP, which requires ASB, PEEP and O2 settings only, other settings go blank on the ventilator!
...thereafter, the patient can be weaned off the ventilator and connected to T-piece for further observation before extubation!
...please do not hesitate to ask curious questions!
Ventilation modes in intensive care:
https://www.draeger.com/Products/Content/nomenclature-bk-9066477-en.pdf
Mechanical Ventilation:
https://my.clevelandclinic.org/-/scassets/files/org/respiratory/fundamentals-of-mechanical-ventilation.ashx?la=en
Classification of Ventilator Modes: Update and Proposal for Implementation:
http://rc.rcjournal.com/content/respcare/52/3/301.full.pdf
Dräger Evita® Infinity® V500:
https://www.draeger.com/en-us_us/Hospital/Products/Ventilation-and-Respiratory-Monitoring/ICU-Ventilation-and-Respiratory-Monitoring/Evita-Infinity-V500-ventilator
P.S. ...LIFE is too short to learn from own mistakes.
...the pic below is of an ICU ventilator!
...Insp Time 1.3 seconds is misunderstood as I:E ratio = 1:3!
...actually, with the setting of 1.3 seconds, the I:E ratio is 1:1.2, which is not as intended to be 1:3!
...I:E ratio is displayed on screen, when the Insp Time button is pressed! In the picture 1:E ratio is shown in the screen to be 1:1.2!
@@@@@@@@@@@@@@@@@@@@@@@
...the bottom row of 5 buttons on the left of the big knob are - from left to right: IPPV, SIMV, CPAP and BiPAP, the fifth button is blank (for nothing).
...the column above the big knob has 3 buttons - from top to bottom are: Pinsp (mbar), delta P ASB above PEEP and PEEP (mbar).
...the column left to the above column - top to bottom are: VT (ml), T insp (sec), f (bpm - breaths per minute) and O2 (Vol %).
...presently, just need to concentrate on the bottom most row of buttons to choose the MODE of ventilation either IPPV - Intermittent Positive Pressure Ventilation, SIMV - Synchronised Intermittent Mandatory Ventilation, CPAP - Continuous Positive Airway Pressure and BiPAP - Bilevel Positive Airway Pressure.
...and to concentrate on the two columns: left column consisting of VT - Tidal Volume (volume of air or oxygen going in or out of the Lungs during each breath), Tinsp in seconds (time allowed for inspiration in seconds), f is the set Respiratory Rate - breaths per minute and O2 in volume %, which is the FiO2 - fraction or percentage of inspired oxygen.
...in the pic, the setting is for BiPAP ventilation (the light is glowing), which is Bilevel meaning two levels are set - the top of the right column (Pinsp 16 mbar/cmH2O) and bottom of the right column (PEEP 3 mbar/cmH2O). One bar is about 1000 mbar or millibar or cmH2O. Since, 1000 mbar = 1000 cm H2O = 760 mmHg = one atmospheric pressure, 1 mbar = 1 cmH2O!
...therefore for BiPAP ventilation bilevel settings are done: the inspiratory pressure 15 - 25 mbar, which is increased incrementally by 2 mbar at a time, say 15 to 17, then to 19 etc, as the need would be to drive in the oxygen to flush out the carbon dioxide in COPD patients - Chronic Obstructive Pulmonary Disease, which consists of two pathologies - Chronic Bronchitis and Emphysema - say, smokers for decades. The other setting is PEEP 3 mbar - positive end expiratory pressure, which keeps the alveoli open for greater surface area for exchange of gases - oxygen and carbon dioxide! Therefore, for BiPAP there are two - upper, inspiratory setting - to help inspiration and lower, expiratory setting - to ease expiration!
...delta P ASB above PEEP or pressure for Assisted Spontaneous Breath (ASB) is set, say at 9 mbar/cmH2O to help inspiration, to drive into the Lungs at a pressure of 9 mbar, when the Respiratory Rate increases above the set 21 breaths per minute. If a patient would be having the total Respiratory rate 30/min, then the set 21 breaths will be driven into Lungs at a pressure of 16 mbar; and the remaining 9 out of 30 breaths at a pressure of 9 mbar!
...tidal volume is not set for BiPAP. The patient generates his/her own tidal volume depending on the Pinsp setting. Therefore, VT button small screen is blank. Of course, upon relieving the bronchoconstriction with bronchodilators like Salbutamol nebulisation, the tidal volume would improve at the same settings!
...for COPD, the O2 % is kept towards lower side 28-35% unless required because upon supplying more oxygen, the patient will breath shallow and retain CO2!
...normal Respiratory rate is 12 -20/min. Herein, the setting is 21/min, which can be increased if needed!
...Facemask BiPAP is applied during acute exacerbation of COPD, ABG showing high PaCO2 like greater than 50 mmHg!
...IPPV mode is chosen for sedated and paralysed patients, say after a major abdominal operation, or for comatosed patient not having spontaneous respiratory effort. Tidal volume is also set, generally to begin with @ 7 ml/kg or adjusted according to chest condition and ABG.
...when spontaneous effort begins, the ventilatory mode is changed to SIMV - Synchronised Intermittent Mandatory Ventilation, which allows the patient to breathe on his own and the machine helps the spontaneous efforts generated by the patient. Lower Respiratory rate might be needed to be set to allow the patient to generate his own breaths!
...when the patient begins to generate good Respiratory effort and the chest condition and ABG improve, then the mode is switched to CPAP, which requires ASB, PEEP and O2 settings only, other settings go blank on the ventilator!
...thereafter, the patient can be weaned off the ventilator and connected to T-piece for further observation before extubation!
...please do not hesitate to ask curious questions!
Ventilation modes in intensive care:
https://www.draeger.com/Products/Content/nomenclature-bk-9066477-en.pdf
Mechanical Ventilation:
https://my.clevelandclinic.org/-/scassets/files/org/respiratory/fundamentals-of-mechanical-ventilation.ashx?la=en
Classification of Ventilator Modes: Update and Proposal for Implementation:
http://rc.rcjournal.com/content/respcare/52/3/301.full.pdf
Dräger Evita® Infinity® V500:
https://www.draeger.com/en-us_us/Hospital/Products/Ventilation-and-Respiratory-Monitoring/ICU-Ventilation-and-Respiratory-Monitoring/Evita-Infinity-V500-ventilator
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