Mechanical Ventilation Modes

control ventilation

• basic description

• all breaths are mandatory

• patient “locked out” of spontaneous breaths

control ventilation

• waveforms

control ventilation

• control

volume

control ventilation

• trigger

time

control ventilation

• limit

volume, flow, time

control ventilation

• cycling

volume

control ventilation

• indication

patients who can’t participate in WOB (i.e., transected C2 or C3 nerve)

volume control-assist control (VC-AC)

• basic description

• consistent volume; variable pressure

• spontaneous breaths are assisted

volume control-assist control (VC-AC)

• waveforms

volume control-assist control (VC-AC)

• control

volume

volume control-assist control (VC-AC)

• trigger

time, patient

volume control-assist control (VC-AC)

• limit

none

volume control-assist control (VC-AC)

• cycling

volume

volume control-assist control (VC-AC)

• indication

guaranteed V_T and V_E

volume control-intermittent mandatory ventilation (VC-IMV)

• basic description

• consistent volume

• spontaneous breaths not synched with ventilator

• causes “breath stacking”

volume control-intermittent mandatory ventilation (VC-IMV)

• waveforms

volume control-intermittent mandatory ventilation (VC-IMV)

• control

volume

volume control-intermittent mandatory ventilation (VC-IMV)

• trigger

time

volume control-intermittent mandatory ventilation (VC-IMV)

• limit

volume, flow, time

volume control-intermittent mandatory ventilation (VC-IMV)

• cycling

volume

volume control-intermittent mandatory ventilation (VC-IMV)

• spontaneous variables

none

volume control-intermittent mandatory ventilation (VC-IMV)

• indication

• guaranteed V_T and V_E

• patient can breathe between set breaths

volume control-synchronized intermittent mandatory ventilation (VC-SIMV)

• basic description

• consistent volume

• spontaneous breaths synched with ventilator

volume control-synchronized intermittent mandatory ventilation (VC-SIMV)

• waveforms

volume control-synchronized intermittent mandatory ventilation (VC-SIMV)

• control

volume

volume control-synchronized intermittent mandatory ventilation (VC-SIMV)

• trigger

time, patient

volume control-synchronized intermittent mandatory ventilation (VC-SIMV)

• limit

none

volume control-synchronized intermittent mandatory ventilation (VC-SIMV)

• cycling

volume

volume control-synchronized intermittent mandatory ventilation (VC-SIMV)

• spontaneous variables

none

volume control-synchronized intermittent mandatory ventilation (VC-SIMV)

• indication

• allows patient to breathe between set breaths

• weaning off ventilator

volume control-synchronized intermittent mandatory ventilation with pressure support (VC-SIMV w/ PS)

• basic description

• consistent volume

• spontaneous breaths synchronized with ventilator

• spontaneous breaths are pressure-supported

volume control-synchronized intermittent mandatory ventilation with pressure support (VC-SIMV w/ PS)

• waveforms

volume control-synchronized intermittent mandatory ventilation with pressure support (VC-SIMV w/ PS)

• control

volume; pressure (PS)

volume control-synchronized intermittent mandatory ventilation with pressure support (VC-SIMV w/ PS)

• trigger

time, patient

volume control-synchronized intermittent mandatory ventilation with pressure support (VC-SIMV w/ PS)

• limit

none; pressure (PS)

volume control-synchronized intermittent mandatory ventilation with pressure support (VC-SIMV w/ PS)

• cycling

volume; flow (PS)

volume control-synchronized intermittent mandatory ventilation with pressure support (VC-SIMV w/ PS)

• indication

• weaning from ventilator

• can postpone extubation if not used properly

volume control-inverse ratio ventilation (VC-IRV)

• basic description

• consistent volume

• inverse I:E ratio

volume control-inverse ratio ventilation (VC-IRV)

• waveforms

volume control-inverse ratio ventilation (VC-IRV)

• control

volume

volume control-inverse ratio ventilation (VC-IRV)

• trigger

time (patient?)

volume control-inverse ratio ventilation (VC-IRV)

• limit

none

volume control-inverse ratio ventilation (VC-IRV)

• cycling

volume

volume control-inverse ratio ventilation (VC-IRV)

• indication

• guaranteed V_T and V_E

• patients who are paralyzed and sedated

• oxygenation (maintain MAP)

continuous positive airway pressure (CPAP)

• basic description

patient breathes against constant positive pressure via mask

continuous positive airway pressure (CPAP)

• waveforms

continuous positive airway pressure (CPAP)

• indication

• OSA

• oxygenation for respiratory distress

continuous positive airway pressure with pressure support (CPAP w/ PS)

• basic description

• patient breathes against constant positive pressure via mask

• breaths are pressure-supported

continuous positive airway pressure with pressure support (CPAP w/ PS)

• waveforms

continuous positive airway pressure with pressure support (CPAP w/ PS)

• control

pressure

continuous positive airway pressure with pressure support (CPAP w/ PS)

• trigger

patient

continuous positive airway pressure with pressure support (CPAP w/ PS)

• limit

pressure

continuous positive airway pressure with pressure support (CPAP w/ PS)

• cycling

flow

continuous positive airway pressure with pressure support (CPAP w/ PS)

• indication

• OSA

• oxygenation for respiratory distress needing pressure support

pressure control-assist control (PC-AC)

• basic description

consistent pressure; variable volume

pressure control-assist control (PC-AC)

• waveforms

pressure control-assist control (PC-AC)

• control

pressure

pressure control-assist control (PC-AC)

• trigger

time, patient

pressure control-assist control (PC-AC)

• limit

pressure, time

pressure control-assist control (PC-AC)

• cycling

time

pressure control-assist control (PC-AC)

• indication

lung protection against barotrauma

pressure control-synchronized intermittent mandatory ventilation (PC-SIMV)

• basic description

• consistent pressure

• spontaneous breaths synchronized with ventilator

pressure control-synchronized intermittent mandatory ventilation (PC-SIMV)

• waveforms

pressure control-synchronized intermittent mandatory ventilation (PC-SIMV)

• control

pressure

pressure control-synchronized intermittent mandatory ventilation (PC-SIMV)

• trigger

time, patient

pressure control-synchronized intermittent mandatory ventilation (PC-SIMV)

• limit

pressure, time

pressure control-synchronized intermittent mandatory ventilation (PC-SIMV)

• cycling

time

pressure control-synchronized intermittent mandatory ventilation (PC-SIMV)

• spontaneous variables

none

pressure control-synchronized intermittent mandatory ventilation (PC-SIMV)

• indication

• lung protection against barotrauma

• allow spontaneous breaths

pressure control-inverse ratio ventilation (PC-IRV)

• basic description

• consistent pressure

• inverse I:E ratio

pressure control-inverse ratio ventilation (PC-IRV)

• waveforms

pressure control-inverse ratio ventilation (PC-IRV)

• control

pressure

pressure control-inverse ratio ventilation (PC-IRV)

• trigger

time (patient?)

pressure control-inverse ratio ventilation (PC-IRV)

• limit

pressure, time

pressure control-inverse ratio ventilation (PC-IRV)

• cycling

time

pressure control-inverse ratio ventilation (PC-IRV)

• indication

• lung protection against barotrauma

• oxygenation

bilevel positive airway pressure (BiPAP)

• non-invasive ventilation

• patient breathes against two pressures (IPAP and EPAP) to guarantee a V_T and to aid in ventilation

• used to treat CO₂ retention (i.e., COPD)

airway pressure release ventilation (APRV) / BiVent

• basic description

• set high/low pressures

• patient can breathe between set breaths

airway pressure release ventilation (APRV) / BiVent

• waveforms

airway pressure release ventilation (APRV) / BiVent

• control

pressure

airway pressure release ventilation (APRV) / BiVent

• trigger

time (high/low)

airway pressure release ventilation (APRV) / BiVent

• limit

time; pressure (PS)

airway pressure release ventilation (APRV) / BiVent

• cycling

time; flow (PS)

airway pressure release ventilation (APRV) / BiVent

• indication

• oxygenation

• patient comfort

(i.e., ARDS)

jet/oscillatory ventilation

• basic description

ventilation with set rates up to 60 b/min or higher

jet/oscillatory ventilation

• waveform

jet/oscillatory ventilation

• indication

• premature infants

• adults when conventional ventilation has failed

volume support (VS)

• basic description

• all breaths spontaneous

• pressure changes to maintain target volume

volume support (VS)

• waveforms

volume support (VS)

• control

pressure (target volume)

volume support (VS)

• trigger

patient

volume support (VS)

• limit

none

volume support (VS)

• cycling

flow

volume support (VS)

• indication

patients who can breathe on their own but need assistance with target V_T

pressure regulated volume control (PRVC)

• basic description

• pressure changes to maintain target volume

• patient can breathe between set breaths

pressure regulated volume control (PRVC)

• waveforms

pressure regulated volume control (PRVC)

• control

pressure (target volume)

pressure regulated volume control (PRVC)

• trigger

patient, time

pressure regulated volume control (PRVC)

• limit

time

pressure regulated volume control (PRVC)

• cycling

time