The basics of: Invasive positive pressure ventilation (IPPV), Noninvasive positive pressure ventilation (NIPPV)

1. Share the knowledge! Spread the Health! Basics of Mechanical Ventilation Sarvodaya Manav Seva Charitable Trust YOUR NAME Institute PLEASE SEND US THE PRESENTATIONS (PPT), DOC FILES, PDF FILES, PHOTOGRAPHS, VIDEOS etc, WHICH ARE RELATED TO HEALTH & MEDICAL. WE WILL SHOW THEM AT www.YouNHealth.Com WITH YOUR NAME. Email: [email_address] ,

11. Intrinsic PEEP and Work of Breathing Volume V T V T FRC Pressure PEEPi Dynamic Hyperinflation PEEPi = intrinsic or auto PEEP; green triangle = tidal elastic work; red loop = flow resistive work; blue rectangle = work expended in offsetting intrinsic PEEP (an expiratory driver) during inflation When present, intrinsic PEEP contributes to the work of breathing and can be offset by applying external PEEP. Sarvodaya Manav Seva Charitable Trust

12. The Pressure and Work of Breathing can be Entirely Provided by the Ventilator (Passive Patient) Sarvodaya Manav Seva Charitable Trust + + + + Ventilator ₊ ₊

13. The Work of Breathing can be Shared Between the Ventilator and the Patient The ventilator generates positive pressure within the airway and the patient’s inspiratory muscles generate negative pressure in the pleural space. Paw = Airway pressure, Pes= esophageal pressure Sarvodaya Manav Seva Charitable Trust P AW P ES patient machine time AC mode

17. Pressure and Volume Targeted Ventilation Marini, Wheeler. Crit Care Med. The Essentials. 1997. VT Sarvodaya Manav Seva Charitable Trust

22. Auto-PEEP (Intrinsic PEEP, PEEPi) Marini, Wheeler. Crit Care Med. The Essentials. 1997. Note that AutoPEEP is not equivalent to air trapping. Active expiratory muscle contraction is an often under appreciated contributor (left panel) to positive pressure at the end of expiration Sarvodaya Manav Seva Charitable Trust

23. Suspecting and Measuring AutoPEEP Suspect AutoPEEP if flow at the end of expiration does not return to the zero baseline. AutoPEEP is commonly measured by performing a pause at the end of expiration. In a passive patient, flow interruption is associated with pressure equilibration through the entire system. In such conditions, proximal airway pressure tracks the mean alveolar pressure caused by dynamic hyperinflation. Sarvodaya Manav Seva Charitable Trust Time Pressure PEEPe PEEPi Total PEEP End expiratory pause

27. Approach to MV Sarvodaya Manav Seva Charitable Trust Is MV indicated ? Conservative treatment and periodic reassessment NO YES Contraindication to NIPPV ? NIPPV NO Success ? Invasive MV YES NO YES