Recording 1

Goals and Objectives (3)

1. Safety (gas exchange, lung protection)

2. comfort (synchrony, healthy ratio of vent support to own pt effort)

3. liberation (minimize vent time + adverse events)

Clinical indications

1. neurological issues (hypotonia, apnea, seizures (airway protection!), central hypoventilation, tumors, TBI, drug overdose)

   1. neuromuscular disorders (MG, GB, SCI, diaphragm paralysis)

2. Surgical (omphalocele/gastroschitis, neuro-tube defects, postops)

3. cardiovascular (sepsis (hypotension due to vasodilation), PPHN, cardiomyopathy, shock)

common situations for mech ventilation

1. restrictive (RDS, CDH, pneumonia, ARDS, scoliosis, CW, rib cage issues)

2. obstructive (MAS, BPD, choanal atresia, airway disorders, LTB, epiglottitis, tracheomalacia, asthma, CF, bronchiolitis)

3. pulmonary hypoplasia (CDH, oligohydarminos)

Conventional mechanical ventilation

Establish normal pattern of RR and VT for required Ve.

Changing RR = changes I:E and Ve.

CMV

All breaths MANDATORY, meaning every breath will breathe in the set VT, including VCCMV → VCAC and PCCMV → PCAC

IMV

MANDATORY and SPONTANEOUS breaths, mandatory are set while the spontaneous are not breathed at set rate. VC-IMV → VCSIMV and PC-IMV → PC-SIMV

CSV

all breaths are SPONTANEOUS, supported with a backup rate if apnea happens. PC-CSV → CPAP PSV

Drager VN500

PC-AC: every insp effort triggers a synchronized mandatory breath through setting Pinsp or variable P controls Vt

PC-SIMV: spont deaths supported w/ PS and are NOT volume guaranteed as Pt controls the Ti, volume and RR of spont breathing. Set RR does NOT set a back up rate.