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Respiratory Failure & Mechanical Ventilation
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I completed Quiz: 2️⃣ Control Variables!
I completed 2️⃣ Control Variables!
I completed 1️⃣ Breath Phases!
Ventilator initiated breath with positive pressure of about 17-18 cm H2O (controlled breath but notice the flow #4 and the volume #6)
Pressure dropped from 18 cm H2O to -10 cm H2O as a result of patient's effort
Ventilator breath triggered by patient's efforts in #2 (assisted breath with slightly higher pressure than #1; pressure regulation)
Very minimal inspiratory flow associated with breath #1(positive pressure but no flow)
Very high flow (about 100 L/min) generated as the result of patient's effort in the second breath in association with the assisted breath.
Alexei Ortiz Milan
Oct 11
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Hello, just yesterday, I had a patient with very high PIP, which did not exceed 40 cmH2O because the maximum pressure (Pmax) was set at this level. The flow vs. time scalar displayed no inspiratory and expiratory flow, and the etCO2 was about 120 mmHg. We found copious fluid secretion in the ETT. After ETT suctioning, everything normalized (PIP, inspiratory and expiratory flow started displaying on the ventilator monitor, and etCO2 normalized). Unfortunately, I had to attend to the situation, and I did not take a screenshot of the ventilator.
VT 1200
Rate 40’s
Minute ventilation of 45 liters.
The highest I have ever seen!
Pressure control ventilation:
Same patient on APVcmv ( pressure regulation):
Mazen Kherallah
Sep 12
There is double triggered breaths in both P-CMV AND APVcmv (pressure regulation) modes. The first breath is machine triggered (time) and the second one is patient triggered but before full exhalation resulted in large tidal volume and autoPEEP.
Patient's expiratory effort during ventilator inspiratory phase
Patient's inspiratory effort during expiration
what is happening here?
Mazen Kherallah
Aug 17
@Everyone Notice no flow is associated with the second, third, and forth breath. These three breaths are delivered by the ventilator with positive pressure but no flow or volume. Patient obstructed the delivery of these breaths with assynchrony. The fifth breath is initiated by the patient with negative pressure and resulted into inspiratory flow and inspiratory volume of around 900 mL. Expiration was not long enough to exhale the whole volume and autoPEEP is generated. Patient was paralyzed after this.
Red arrow: expiratory effort during inspiration. Green arrow: inspiratory effort during inspiration in a PC mode of ventilation. @Ibrahim Ameen
Can it be considered as reverse triggering as the the previous 2 breaths was not triggered by the patients ??