Respirators:

What is a ventilator?

 
Mechanical ventilators are electromechanical devices that support or ventilatory support for patients who can not breathe on their own or who need assisted ventilation to maintain adequate ventilation to allow them to maintain optimal bloodoxygenation. Invasive mechanical ventilation (IMV) of based on the supply of oxygen-enriched air to the lungs causing a positive pressure in the lungs, unlike thespontaneous breathing that makes a negative pressure to get air into the lungs.
 
Basic Dictionary:
 
The key concept is the respiratory cycle:
Shot or start of inspiration
Maintenance of inspiration
Cycling, changes in the inspiratory phase the expiratory
expiration

 

 

volume:
 
Tidal volume or tidal volume (VC): The amount of air that sends the patient breathingwith each breath.
Minute volume, is obtained by multiplying the respiratory rate per minute and tidal volume of each breath.
 
pressure:
 
VM pressure is the force per unit area required to move a tidal volume. It depends on two new concepts compliance and resistance of the system.
 
 
Peak pressure is the value in cm H2O obtained at the end of inspiration, related to the system resistance to airflow in the anatomical and artificial channels and the elasticity of the lung and rib cage.
Plateau pressure, plateau or static is the value at the end of inspiration by pausingand without inspiratory airflow. It relates to compliance toracopulmonar.
Mean alveolar pressure (Paw mean) is the average of all values ​​of pressure relax thelungs and chest during a respiratory cycle until there inspiratory and expiratoryresistance or. Can be related to the volume of the chest means.
Positive end-expiratory pressure (PEEP): The pressure at the end of expiration must be zero, but in a therapeutically or derived from the clinical situation can becomepositive, allowing the reopening of alveolar recruitment of collapsed areas
 
 
At the initiation of mechanical ventilation must be established the followingparameters:
Mode.
FiO2.
Respiratory rate (f).
Tidal volume (Vt) and minute (Vm).
PEEP.
Relationship inspiratory / expiratory (I: E).

 

 

Total ventilatory support techniques (SVT):
The ventilator does all the work to maintain effective alveolar ventilation.
 
Includes the following ways:
Controlled mechanical ventilation or IPPV.
Assist-control mechanical ventilation (AMV / c).
Mechanical ventilation with I: E ratio inverted (IRV).
Differential mechanical ventilation or pulmonary independent (SIL).
 
 
Partial ventilatory support techniques (SVP):
Both the patient and the ventilator work together to contribute to the effective alveolar ventilation.
 
Includes forms:
Pressure assisted or support ASB.
Synchronized intermittent mandatory ventilation or SIMV.
Ventilation with two levels of pressure, BIPAP.
Continuous pressure on the airway, CPAP.
Mandatory minute volume, MMV
 
ASB mode:
 
It assisted ventilation type that requires a patient's inspiratory effort, in which the ventilator cycles to detect such an inspiration inspiratory effort. Thus, the patient stillbreathing rate, and indirectly also the tidal volume. When the fan is detected (through the trigger or sensitivity) refers the patient inspiration flow of gases with a high initialpeak during inspiration to maintain a fixed pressure level which is usually between about 10 and 20 cmH2O. The patient should keep the stimuli of normal ventilation and should not be receiving sedatives or muscle relaxants.
This method reduces the fatigue caused by the work of breathing and improves the efficiency of the muscles of respiration. The fan takes in part the work of inspiration,although the patient remains in control of spontaneous breathing, so it has become abest mode for weaning from the ventilator.

 

 

SIMV mode:
 
The objective of this mode is to allow the patient undergoing mechanical ventilation make spontaneous breathing cycles interspersed fan. The patient makes spontaneous breathing on opening the inspiratory valve of the fan while it synchronizes the mandatory cycles with spontaneous or forced. The trigger must be set to low values ​​for the effort made by the patient to open the inspiratory valve is minimal.
Mandatory minute volume is fixed, fitted with a tidal volume and frequency. Among the mandatory ventilation strokes the patient can breathe spontaneously and contribute to the total minute volume. Spontaneous breathing can be assisted by ASB. This mode is useful for the withdrawal of mechanical ventilation in patients who have been exposed to weaning by a gradual reduction in the mandatory throughout the cardiac output and insufficient spontaneous breathing patients.
 
 
 
BIPAP mode:
 
For endotracheal tube and Mascara
 
It is a combined pressure-controlled ventilation with spontaneous breathing freely throughout the breathing cycle and pressure adjustable support at the level of CPAP.Can be used from patients without spontaneous breathing to spontaneously breathing patients before extubation. Weaning is accomplished by gradual reduction of the mandatory throughout the cardiac output and reduction of pressure support.
BIPAP ventilation mode is characterized by a pressure-controlled ventilation / time, allowing the patient to breathe spontaneously possible at all times.
 
 
 
 
 
 
 
CPAP Mode:
 
For endotracheal tube and mask.
 
It is a spontaneous breathing in achieving a level of continuous positive airway pressure throughout the respiratory cycle to increase the functional residual capacity, FRC. Spontaneous breathing can be assisted with support pressure ASB.
It is used in spontaneously breathing patients, and can be applied in patients without an endotracheal tube with expiratory valve which prevents the pressure falls below the set value.
 
 
 
MMV mode:
 
It is a form of pre-set minute volume ventilation, tidal volume adjusted and frequency.The patient can breathe spontaneously and contribute to the total minute volume. The difference between spontaneous breathing minute volume and minute volume set is offset by mandatory strokes.


Portable ventilator:

Portable ventilators:
 
They are designed to support through appropriate mechanical ventilation (MV) have tobe simple and manageable compact and lightweight to be handled by qualified personnel in a hospital (transfers) and outpatient (cardiopulmonary resuscitation).
 
Utility-hospital diagnostic testing (CT, MRI)
Utility Extraospitalaria: Transport Primary and secondary ground or air transportationmeans.
 
-Button: Off-On
-FiO2: Normally 50% 0 100%.
-Minute volume or tidal volume: 8-12ml/kg.
-Flow
-Respiratory rate: Between 10 and 20.
-Pressure alarms:
-Alarm Battery

Respirators noninvasive:

Noninvasive mechanical ventilation is a form of ventilatory support which can increasealveolar ventilation, keeping the airway intact, does not require endotracheal intubation or tracheostomy, thus avoiding the risk of pneumonia associated withmechanical ventilation, reducing the needs of sedation of the patient. Ventilation ismore physiological, less aggressive in some situations allowing oral feeding.
 
Respirators NIV:
 
     Respirators noninvasive ventilation (compensated leak, easy to use and program,transport, allowing home use, allow a few ways, not all have oxygen incorporatedsome allow only monitoring). Models are cycled pressure (BiPAP Respironics) and volume (Breas, O'nyx).
 
Programmable parameters:
 
 
IPAP. You can control the ventilation, the higher the IPAP, the higher tidal volume is generated during inspiration.
EPAP. Use this parameter to control the residual volume, controlling the functional capacity and oxygenation to maintain open airway and alveoli distended.
Ti: inspiratory time. To control the duration of the IPAP.
Ramp slope or inspiratory flow: This parameter can vary the speed and shape of the air entering the airways. The more slowly through the air in the airways, the longer the duration of ramp-time best the child will adapt to this mode of mechanical ventilation.The shorter, more abruptly enter the air and is easier for the patient try to fight thisfeeling so sudden and decoupling of the VM.
FiO2. Using this parameter can vary the percentage of O2 in the air.

Types of masks: