medicare's definition of mechanical ventilation

Types of CPAP Masks and Bi PAP Masks Sleep apnea treatments are available in many different forms and one of these forms is sleep apnea machines. There are also many different sleep apnea machine type including CPAP machines, Bi PAP machines, Auto CPAP machines and more. Each of these sleep apnea machines needs a mask in order to provide the airway pressure from the machine into your nose and/or mouth. The CPAP masks and Bi PAP masks that will work for you may vary from what will work for someone else.

Types of CPAP/BiPAP Masks â Letâs find out!

Contents [ hide]1 Types of CPAP Masks and Bi PAP Masks2 Additional helpful articles3 What information do patients need to know about the CPAP full face masks?3.1 Overall Pros of the CPAP Full Face Masks3.2 Overall Cons of the CPAP Full Face Masks4 What information do patients need to know about the CPAP nasal masks?4.1 Overall Pros of the CPAP Nasal Masks4.2 Overall Cons of the CPAP Nasal Masks5 What information do patients need to know about the CPAP nasal pillows?5.1 Overall Pros of the CPAP Nasal Pillows5.2 Overall Cons of the CPAP Nasal Pillows6 Summary of the Types of CPAP Masks/Bi PAP Masks

However the CPAP masks include the CPAP full face masks, the CPAP nasal masks and the CPAP nasal pillows. If you are trying to find the types of masks that will work for you, read on for the pros and cons of these three types. Additional helpful articles Also some other articles that you might find helpful are my favorite CPAP masks, best masks for side sleepers, as well as the most comfortable masks on the market right now.

You should also be sure to check out these other helpful and informative articles all in one spot to help you find the right machine for your sleep apnea treatment so you can spend more time on the things that really matter to you: Best CPAP Machines Best Travel CPAPBest Bi PAP Machines What information do patients need to know about the CPAP full face masks? Sleep apnea patients already have the unfortunate experience of having the disorder and the lack of sleep due to the disorder and because of this their treatment should be as comfortable for them as possible.

One of the options for a comfortable mask for their treatment is a CPAP full face mask. Review the pros and cons of these masks below.

Overall Pros of the CPAP Full Face Masks Might Stay on Your Face Better Than Other Masks Will Cover Your Mouth and Nose, Allowing the Most Airflow Through Will Provide You With Efficient Pressure from the Mask Overall Cons of the CPAP Full Face Masks May Get in the Way of Your Eyes While Watching Television or Talking May Be Uncomfortable Might Press on Your Face in Too Many Spots The above pros and cons are the main ones that sleep apnea patients have mentioned over the years and these pros and cons may be able to help you choose the right types of CPAP masks/Bi PAP masks for you.

What information do patients need to know about the CPAP nasal masks? The treatments for sleep apnea patients often include sleep apnea machines.

These machines use a mask to deliver the airflow to the patient to allow them to breathe better during their sleep. Below are the pros and cons of the CPAP nasal masks that may be used. Overall Pros of the CPAP Nasal Masks Will Allow For Efficient Airflow Into The Nasal Passages Will Be More Comfortable Than a Full Face Mask Will Allow For More Visibility While Using the Mask Overall Cons of the CPAP Nasal Masks May Fall Off From the Face Easier Than Full Face Masks Won’t Provide the Airflow to The Mouth If You Need it To May Slip While You Are Sleeping These pros and cons of the CPAP nasal masks have been reported by some sleep apnea patients.

However, the cons were only reported by a minimal amount of patients. What information do patients need to know about the CPAP nasal pillows?

CPAP nasal pillows are just one of the mask types that are offered for sleep apnea treatments. Just as with all of the other masks available there are pros and cons with this mask type as well.

These pros and cons are listed just below. Overall Pros of the CPAP Nasal Pillows Allow For Great Pressure of Airflow Provides an Efficient Treatment for Sleep Apnea Works Great With Many CPAP Machines Overall Cons of the CPAP Nasal Pillows May Leave Some Marks on the Face During Use May Become Too Loose When You Move Might Move Around While You Are Sleeping These pros and cons are quite similar to those of the CPAP nasal masks however this type of mask is a bit different from the others.

These masks are often reported as the most comfortable. Summary of the Types of CPAP Masks/Bi PAP Masks There are different masks available for sleep apnea treatments. These mask for CPAP machines include the CPAP full face mask, the CPAP nasal mask and the CPAP nasal pillow.

Each of these three masks have their own pros and cons for sleep apnea patients. When you are choosing which mask may be right for you and your sleep apnea treatment, you should take into consideration what is most important for you.

These things could include what is comfortable, amount of airway pressure, will the mask stay still, will the mask provide for efficient and effective treatment and more.

The pros and cons listed above can help you to choose the right mask for you. Now that you understand the different types of CPAP masks, check out my review of the best CPAP masks for each mask type and what I have found to be the most comfortable CPAP masks on the market today.

Also make sure to pick up some additional tubing as well as tube cleaners with your mask. These things get pretty discussing as we all know. Some additional helpful articles for you might be: the best CPAP machines on the market today as well as my favorite Bi PAP machines. Also if you do not know the difference between the two, check out my article here. I hope this was helpful for you guys. Rest well!

Patients lung ventilators connect to the patients airway and are designed to replace or augment the patients ventilation automatically. They are used with a mask, endotracheal tube, (within the trachea) or tracheostomy tube (through an artificial opening in the trachea via the throat).

EBME & Clinical Engineering Articles

"EBME & Clinical Engineering Articles Fundamentals of Ventilation Details Category: Clinical Engineering The Lungs The lungs consist of two cone shaped spongy organs that contain alveoli and trap air for gas exchange. The lung is designed for gas exchange. Its prime function is to allow oxygen to move from the air into the venous blood and carbon dioxide to move out. Although the lung performs other functions, its primary responsibility is to exchange gas. Oxygen and carbon dioxide (CO2) move between air and blood by simple diffusion that is from an area of high to low partial pressure.

Ficks Law of diffusion states that the amount of gas that moves across a sheet of tissue is proportional to the area of the sheet but inversely proportional to its thickness.

The airways consist of a series of branching tubes which become narrower, shorter, and more numerous as they penetrate deeper into the lung. The trachea divides into right and left main bronchi, which in turn divide into lobar, then segmental bronchi.

The process continues down to the terminal bronchioles, which are the smallest airways outside the alveoli. All these bronchi make u p the conducting airways. Their function is to lead inspired a ir to the gas exchanging regions of the lungs.

Since conducting airways contain no alveoli, they do not participate in gas exchange. The terminal bronchioles divide into respiratory bronchioles, which have few alveoli. Finally, we come the alveolar ducts that are completely lined with alveoli. This alleviated area of the lung where gas exchange occurs is called the respiratory zone.

During inspiration, the volume of the thoracic cavity increases and air is drawn into the lung. The increase in volume is brought about partly by contraction of the diaphragm and partly by the actions of the intercostals muscles.

These muscular actions increase the size of the thoracic cavity and air flows in due to the reduced pressure inside the chest (inhalation; governed by Boyles law which states that the pressure of a gas is inversely proportional to its volume).

Inspired air flows down to the terminal bronchioles by bulk flow. Beyond that point, the combined cross-sectional area of the airways is so enormous because of the large number of branches, that the forward velocity of the gas becomes very small. Diffusion of gas within the airways then takes over as the dominant mechanism of ventilation in the respiratory zone. The rate of diffusion within the airways is so rapid, and the distances covered arson short, that differences in concentration within the alveoli are virtually abolished within a second.

An increase in thoracic volume results in a decrease in intrapulmonary pressure causing air to be pushed out of the lungs (exhalation).

The lung is elastic and returns passively to its pre-aspiratory volume during resting breathing. It is remarkably easy to distend. For example, a normal breath of about 500 ml requires distending pressure of 3 cm water. By contrast, a balloon may need a pressure of up to 30 cm water f or the same change in volume.

Blood in need of oxygenation enters both lungs via the pulmonary arteries (from the hearts right ventricle). Oxygenated blood leaves the lungs through the pulmonary veins to the hearts left atrium. Air inspired through the nose, is passed through the trachea and bronchea, eventually entering the terminal bronchioles which supply the alveoli or air sacs, each 0.2mm in diameter.

An estimated 300 million alveoli are contained in the lungs, generating up to 50 square metres of internal surface area at a lung volume of 3000ml.

(The area of an average tennis court). This gives rise to a total lung capacity of: 3.6 litres to 9.4 litres in an adult male. 2.5 litres to 6.9 litres in an adult female. Respiration Respiration is the interchange of gases between an organism and the medium in which it lives. Internal respiration is the exchange of gases between the blood stream and nearby cells. The mechanics of respiration Inspiration results from the contraction of the diaphragm and intercostal muscles.

The rib cage swings upwards and outwards. The enlarged cavity housing the lungs undergoes a pressure reduction (-3 mm Hg) with respect to the pressure existing outside the body.

Since the lungs are passive (no muscle tissue), they expand due to the positive external pressure.e.g. if the environmental pressure is 760 mm Hg, the lung pressure is 757 mm Hg upon inspiration. Expiration results from the relaxation of the diaphragm and intercostal muscles.

The rib cage moves inward and downwards. The elastic recoil of the lungs creates a higher than atmospheric intrapulmonic pressure (plus 3 mm Hg) that forces air out of the lungs. Parameters of respiration Tidal Volume The volume of gas inspired or expired during each respiratory cycle. Typically 500 ml. Inspiratory reserve volume The maximum amount of gas that can be inspired from the end-aspiratory position.

Expiratory reserve volume Amount of air that can be forced out of lungs after normal expiration Typically 1200 ml Residual volume The volume of gas remaining in the lungs at the end of a maximum expiration. Typically 1200 ml. Totaling capacity The amount of gas contained in the lung at the end of a maximum inspiration. Vital capacity The maximum volume of gas that can be expelled from the lungs following a maximum inspiration.

Tidal volume, plus insp.reserve volume, plus exp.eserve volume. Typically 4800 ml. Inspiratory capacity The maximum volume of gas that can be inspired from the resting expiratory position. Typ.3600 ml. Inspiritory reserve volume Additional volume that can be inspired after a normal inspiration.

Typically 3100 ml. Functional residual capacity The volume of gas remaining in the lungs at the resting end-expiratory position. Typically 2400 ml. Minute volume The total volume of air ventilated over a minute period. Should be qualified either inspiratory or expiratory.

Maximum voluntary ventilation The maximum volume of air that can be ventilated per minute (also referred to a Maximum Breathing Capacity). Total lung capacity Amount of gas contained in lungs at end of maximum inspiration Typically 6000 ml.

Lung compliance (The pulmonary volume change per unit pressure change). Essentially, lung compliance is the ability of the alveoli and lung tissue to expand on inspiration. In clinical terms it is defined as the volume increase in the lungs per unit increase in the lung pressure. While clearly not a complete description of the pressure-volume properties of the lung, it is nevertheless useful in practice as a measure of the comparative stiffness of the lung.

The stiffer the lung, the less the compliance. Compliance is reduced by diseases which cause an accumulation of fibrous tissue in the lung or by oedema in the alveolar spaces.

It is increased in pulmonary emphysema and also with age, probably because of alterations in the elastic tissue in both cases. There are two types of compliance, static and dynamic. The static compliance of the lung is the change in volume for a given change in transpulmonary pressure with zero gas flow.

Dynamic compliance measurements are made by monitoring the tidal volume used, while intra thoracic pressure measurements are taken during the instance of zero air flow that occur at the end inspiritory and expiratory levels with each breath. Lung compliance varies with the size of the lungs; a child has a smaller compliance than an adult does. Furthermore the volume-pressure curve is not linear, hence compliance does not remain constant. Fortunately, over the tidal volume range in which dynamic compliance measurements are usually performed, the relationship is approximately linear and a constant compliance is assumed.

Compliance values are given as litres per cm of water. Airway resistance Airway resistance relates to the ease with which air flows through tubular respiratory structures.

Higher resistance occurs in smaller tubes such as bronchioles and alveoli that have not emptied properly. It is a pneumatic analogy of hydraulic or electrical resistance (R=V/I) and, as such, is a ratio of pressure to flow. Thus for the determination of airway resistance, intra alveolar pressure and airflow measurements are required.

As was the case with compliance, airway resistance is not constant over the respiratory cycle. As pressure in the thoracic cavity becomes more negative, the airways are widened and the resistance is lowered. Conversely, during expiration, when the pressure in the thorax becomes positive, the airways are narrowed and resistance is increased. The intra alveolar pressure is given in cm water and the flow in litres per second; the airway resistance is expressed in cm water per litre per second.

Lung elasticity Lung elasticity is the ability of the lung elastic tissues to recoil during expiration. The lungs should return to rest state easily to ensure sufficient exhaust of gas. Intra-thoracic pressure is the positive and negative pressure occurring within the thoracic cavity.

These are critical to proper inspiration (negative internal pressure) and expiration (positive internal pressure). Intra alveolar pressure is of importance in maintaining proper respiration and gas exchange to and from the blood. Only a portion of the air entering the respiratory system actually reaches the alveoli. The volume of air that is not available for gas exchange with the blood resides in the conducting spaces, known as 'dead air' and fills dead spaces consisting of and 150 ml. Patient lung ventilators

Patients lung ventilators connect to the patients airway and are designed to replace or augment the patients ventilation automatically. They are used with a mask, endotracheal tube, (within the trachea) or tracheostomy tube (through an artificial opening in the trachea via the throat).

Most ventilators are positive pressure during inhalation to inflate the lungs with various gases or mixture of gases (air, oxygen, carbon dioxide, helium). Expiration is usually passive, although under certain conditions pressure may be applied during expiratory phase as well, in order to improve arterial oxygen tension.

Only in rare circumstances is negative airway pressure utilised during expiration. Most ventilators are operated in any of three modes Assistor mode. Controller mode. Assistor/controller mode. These three modes differ only in the method by which inspiration is initiated.

Assistor mode: Inspiration is triggered by the patient. A pressure sensor responds to the slight negative pressure that occurs each time a patient attempts to inhale and triggers are equipment to begin inflating the lungs. Thus, the ventilator helps the patient inspire when he wants to breathe. A sensitivity adjustment is provided to select the amount of patient effort required to trigger the ventilator.

The assistor mode is used for patients who are able to control the breathing but are unable to inhale a sufficient amount of air without assistance, or for whom the breathing requires too much effort (i.e.

asthmatics, pulmonary pneumonia, etc. )Controller mode: Breathing is controlled by a timer set to provide the desired respiration rate. Controlled ventilation is required for patients who are unable to breathe on their own. In this mode, the ventilator has complete control over the patients respiration and does not respond to any respiratory effort on the part of the patient. Assistor/controller mode: The ventilator is normally triggered when the patient attempts to breathe (as in the assistor mode).

However, if the patient fails to breathe within a pre-determined time, a timer automatically triggers the ventilator to inflate the lungs. Thus the patient controls his own breathing as long as he can, but if he should fail to do so, the equipment is able to take-over for him.

On the other hand, this mode can be used to wean the patient from the controlled ventilation. If the patient attempts to breathe during controlled ventilation, the equipment will sense the attempt and operate in the assist mode immediately, irrespective of which part of the control phase it had reached.

Ventilators in clinical use can be classified into two main groups: Pressure cycled Volume cycled. Pressure cycled, positive pressure, controller or assistor/controller type. This device is powered pneumatically from a source of gas and requires no electrical power.

The equipment in this category may contain an electrically powered compressor, or can be used with a separate compressor to commence ventilation with ambient air.

Timing for operation in the controller mode is accomplished by filling a chamber with a gas and letting it bleed off through an adjustable needle valve.

Pressure cycle ventilators can be quite small, but at the same time they can incorporate all the necessary equipment to control the flow of gas, mixed air and oxygen, sense the patients efforts to inspire, terminate inspiration when the desired pressure is reached, permit adjustment of the sensitivity of the triggering mechanism and the desired pressure level, and even generate negative pressure to assist expiration of some devices.

In the assistor/controller type, a special type of valve senses the small negative pressure created by patients attempts to breathe. Volume cycled ventilators use either a piston or bellows to dispense precisely controlled volume for each breath.

In the intensive care setting where patients have pulmonary abnormalities and require calculated volumes (derived from blood gas analysis) and concentrations of gas, this type of ventilator is preferred. It is much larger than the pneumatically operated ventilator and electrically operated to provide a much greater degree of control over the ventilation than the pressure cycle types.

Most volume-cycled equipments have adjustable pressure limits and alarms for safety. Also, their provision for adjusting pressure limits, and both inspiritory and expiratory times, can be used in conjunction with the volume setting to ensure therapeutic pulmonary function in the patient who needs it most. Volume cycle ventilators used in most intensive care units are always supplied with a spirometer to permit accurate monitoring of the patients ventilation.

Other available features may include a humidifier, and optional capabilities for negative pressure and positive end expiratory pressure (P. E. E. P.)Non- invasive ventilation (CPAP/Bi PAP)Use of CPAP and Bi PAP There is evidence that CPAP (Continuous Positive Airway Pressure) and Bi PAP (Bilevel Positive Airway Pressure) are effective in preventing need for intubation and also decreasing mortality in patients with Acute Respiratory Failure in properly selected patients.

Noninvasive treatment doesn't involve the use of surgery to provide breathing assistance; it relies on the use of masks and mouthpieces to deliver air.

Bi PAP differs from CPAP in that the pressure during expiration may be adjusted separately from the pressure delivered during inspiration. This ability to set independent pressures during inhalation and exhalation result in lower average airway pressures than those produced by nasal CPAP. Bi-PAP stands for Bilevel Positive Airway Pressure. The use of Bi-PAP machines is often called non-invasive face mask ventilation. This is because the trachea is not intubated so there is less trauma to the airway and more importantly there is a lower incidence of nosocomial infections.

CPAP delivers a continuous positive air pressure, most frequently at about 10 cm of water. This is delivered throughout the respiratory cycle and has been described as being similar to breathing with your head stuck out of a moving car.

Continuous means that the pressure delivered to the patient is the same for any given breath. C-PAP can actually increase the work of breathing and be lethal to some patients.

Bi PAP (Bilevel) means that the pressure varies during each breath cycle. When the user inhales, the pressure is similar to C-PAP. When they exhale, the pressure drops, making it much easier to breath. Inhale, pressure rises, exhale, pressure drops. Bi PAP delivers CPAP but also senses when an inspiratory effort is being made and delivers a higher pressure during inspiration. When flow stops, the pressure returns to the CPAP level. This positive pressure wave during inspirations unloads the diaphragm decreasing the work of breathing.

This form of ventilation has been used for years in patients with chronic respiratory failure due to neuromuscular problems or chest wall abnormalities. In patients with respiratory failure, a common technique is begin with the expiratory level at 5 and the inspiratory level at 15.

The levels are adjusted based on patient comfort tidal volume achieved and blood gases. As the use of Bi PAP machines has increased, their cost has gone down. There are also more types of masks available and this has has improved patient comfort and compliance.

The use of Bi PAP machines is often called non-invasive face mask ventilation. This is because the trachea is not intubated so there is less trauma to the airway and more importantly there is a lower incidence of nosocomial infections.

Bi-PAP is a registered trademark of Respironics, Inc. Other manufacturers make VPAP and Bilevel machines that provide this same basic feature. Sometimes you will see a ""ST"" behind Bi-PAP, VPAP, or Bilevel. The ST stands for Spontaneous Timed. This means that if the user does not breath on their own, the machine will initiate a breath for them.

This feature is very useful in treating central sleep apnea and a host of pulmonary disorders. For those patients who present to the emergency department with acute respiratory failure but with normal levels of consciousness, no major secretion problems and who are hemodynamically stable, a trial of Bi PAP or CPAP could be attempted prior to considering intubation and a mechanical ventilator.

John Sandham IEng MIIE MIHEEMArticle updated 28/2/05 Article updated 31/12/10References:depts.washington.edu/uwmedres/program/itc/ventilators.pdf - n.b. link reported dead as of 31 Dec 10www.corexcel.com/courses/body_vent5.htm - n.b. link reported dead as of 6 April 05http://www.books.md/L/dic/lungcompliance.phpwww.cyber-north.com/anatomy/respirat.htm - n.b. link reported dead as of 6 April 05http://www.inforesp.org/about%20ventilation.htmhttp://www.guideline.gov/summary/summary.aspx?view_id=1&doc_id=3753http://www.focusonals.com/cpap_and_a_bipap.htmhttp://www.theberries.ns.ca/Archives/CPAP.html "

CPAP stands for Continuous Positive Airway Pressure. CPAP therapy is the most commonly recommended, and the most effective, treatment for obstructive sleep apnea. A CPAP machine provides air at a constant prescribed pressure. The air is delivered to the person through a tube and a CPAP mask.

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"Search Frequently Asked Questions Search Or Ask a Question CPAP FAQs Sleep Apnea 101 Sleep Study New User Basics Side Effects Sleep Study Definitions Research Sleep Studies To prepare you for your sleep study, CPAP.com has created an Introduction to the Sleep Lab video.

To watch this video, click the ""Videos"" tab below. We recommend you view this video prior to your sleep lab visit. Your doctor referred you to a sleep lab to be able to diagnose and treat your sleep problems. A sleep lab looks like a normal bedroom, but it is equipped with instruments to measure your breathing and movements. During your sleep study, a sleep technician will gather necessary information from a separate room.

This is to provide you with comfort and privacy. While in the sleep study, monitors will be affixed to your face and your legs. The monitors are not uncomfortable and are essential to diagnose sleep apnea and other sleep related issues. The results of the test will make up your polysomnogram. Please Note: During the night, or in a separate study, your sleep tech will bring you a CPAP mask to help improve your sleep.

Pressure will be increased gradually as you need more air to open your passageway. FAQs Videos CPAP Users Say Did You Know Articles Sleep Study FAQs What is a Sleep Study (Polysomnography)? The Sleep Study (Polysomnography) is the gold standard for the diagnosis of several sleep disorders including, sleep apnea, restless leg syndrome, and narcolepsy.

The results of the test are referenced as a polysomnogram which is frequently abbreviates as PSG. Polysomnography is conducted in a sleep center, hospital or in a person's home. The test is usually performed at night to record the person's normal sleep pattern. Electrodes are placed on the scalp, the outer edge of the eyelids, and to the skin on the chin in preparation for the test.

Characteristic patterns from the electrodes are recorded during three stages: while you are awake, while your eyes are closed, and while you are asleep. Also, a computer is used to record the time it takes to fall asleep, the time it takes to enter the REM cycle, the body movement, the breathing patterns, and the sleep architecture.

The person gathering and scoring the data is called a Polysomnographic Technician. What should I expect during my Sleep Study? CPAPtalk.com has created an ""Introduction To The Sleep Lab"" video that explains the process of verifying, diagnosing and treating Sleep Apnea.

If you are curious about the process or would like to know what to expect during your sleep study you can view the video in the Videos Tab of this page.

What is titration, as it relates to sleep studies? If a sleep study determines you have obstructive sleep apnea (OSA), you will need a ""titration study"" to determine the pressure level required to maintain your airway during sleep. A titration study may take place during the same night as your diagnosing sleep study or it may be scheduled for a later date.

Titration is a scientific lab term, meaning to slowly add a little bit more of something until you reach a desired effect. During your titration study, a skilled technician will monitor your sleep and slowly increase the air pressure on a CPAP machine until you are able to sleep without or with few sleep events (apneas and hypopneas). Your pressure needs vary throughout the night, so an overnight sleep study is required to prescribe you the correct pressure. Your prescribed CPAP single pressure setting will be set to the highest level you needed during the night. By prescribing the highest pressure, your doctor hopes to prevent as many sleep events as possible.

The downside of this approach is that you will have the highest pressure at all times even when it's only necessary for part of the night. APAPs offer technologies which allow the pressure to be adjusted on a breath by breath basis, which you may find helps your therapy.

Do sleep tests require prescriptions? Yes. Both CPAP.com and Traditional Sleep Labs work closely with doctors to make the transition of paperwork seamless for the patient.

Where can I get a sleep study close to where I live? We provide a CPAPtalk.com tool to help you find sleep labs in your area. Simply click the link and enter your address or zipcode to find one near you. Locate Sleep Apnea Services How is Sleep Apnea diagnosed? An overnight sleep study is usually suggested when a diagnosis of obstructive sleep apnea is suspected. The sleep test is typically conducted in a specialized sleep lab by a sleep doctor and a respiratory therapist.

The test is called a Polysomnogram (PSG) or Polysomnography test. The following paragraph describes common signs and symptoms of sleep apnea.

Please Note: It is common that people are unaware of their sleep apnea. In many cases, they do not realize they have difficulty breathing in their sleep. The obstructed breath while sleeping is usually discovered by someone else. Grasping for air or suddenly losing your breath while sleeping, may be an indicator of sleep apnea.

Also, snoring can be a significant sign that you are struggling with sleep apnea. However, many conditions can lead to snoring, so it is not an absolute symptom of sleep apnea.

Other signs and symptoms include: daytime exhaustion, drowsiness, lack of concentration, headaches, impotence or decreased sex drive, moodiness, lack of energy, acid reflux (gastro-esophageal reflux), restless sleep, night sweats, memory problems, nighttime choking, chest pain, swelling of the legs in the obese, grogginess upon waking, anxiety, depression, and increased urination at night. Some people first learn of their sleep apnea when they fall asleep at the wheel of a car, or are involved in a car wreck caused by the side effects of having untreated sleep apnea. What is CPAP therapy?

CPAP stands for Continuous Positive Airway Pressure. CPAP therapy is the most commonly recommended, and the most effective, treatment for obstructive sleep apnea. A CPAP machine provides air at a constant prescribed pressure. The air is delivered to the person through a tube and a CPAP mask.

CPAP therapy provides a constant airflow which keeps the airway open so uninterrupted breathing is maintained during sleep. The air stream eliminates Sleep Apnea events and allows the person to get a restful sleep. The level of air pressure required to maintain your airway is determined during your sleep study.

Your doctor will write a prescription for a CPAP machine set at that pressure. CPAP therapy is delivered through a nasal mask that seals around the nose, nasal pillows which seal at the nasal opening, or nasal prong masks that seal inside the nares. Full face masks are available for a person who breathes through both the nose and mouth. Many innovative and comfortable options are available and advances in the delivery of CPAP therapy are continually occurring.

For instance: Some machines offer a comfort feature such as FLEX or EPR technology. It provides exhalation relief, a slight drop in pressure at the time of exhalation to help make therapy more natural.

APAP, Bi PAP and Bi Level machines offer various levels of pressure throughout the night. What questions should I ask at my sleep study? Did I have any central apneas? How many? Were there any comorbidities? What were they? Did I breathe or leak through my mouth?

How often? What do you recommend to prevent it? Did I exhibit positional sleep apnea (PSA)? Was my apnea more severe in one sleeping position as compared to others? Is my pressure requirement higher in one position as compared to others? (Often sleep apnea is more severe when sleeping on the back.

)Is there anything else unusual about the results? How will I know my therapy is preventing apneas? I would like to own a data-capable machine and software to monitor apneas, hypopneas and mask leak.

Will you help me with the appropriate prescription? In addition to the questions: Get a copy of your PSG. It is your legal right to have one. Get a copy of your CPAP prescription. It is your legal right to have one.

Make sure the prescription calls for a humidifier with the machine. What terms should I be familiar with before my Sleep Study? You can check out our Learning Center Definitions Page to become familiar with some common sleep apnea terms.

Stages of Sleep Stage 1: The lightest stage of sleep. Transitional stage from wake. Stage 1 shifts: The number of times the sleep stage changed to stage 1. Stage 2: The first true stage of sleep. Stages 3-4: The deepest, most restorative sleep. Stage REM: The dreaming stage; Normally occurs every 60-90 minutes.

What are the symptoms of Sleep Apnea? The following symptoms go hand and hand with Sleep Apnea: Loud and frequent snoring Periods of not breathing during sleep Snorting, gasping or choking during sleep Need to urinate during the night High blood pressure Morning headaches Awakening tired in the morning Daytime or evening lethargy GERD (Gastroesophageal reflux disease)Drowsy driving, limited attention, memory loss and poor judgment Personality changes Weight gain, severe leg swelling, body mass index of 25 or more Hyperactive behavior, especially in children Decreased size of airways and large neck What are the benefits of using CPAP therapy?

Successful CPAP users report improvements in: Quality of Sleep Quality of Life Energy and Motivation Mood & Disposition Job Performance Sexual Drive and Performance Alertness While Driving A failure to use CPAP therapy to treat Sleep Apnea may increase your risk for conditions linked to untreated OSA: Hypertension (OSA increases your risk of hypertension by up to five times)Stroke Congestive Heart Failure (CHF)What are the health risks of untreated Sleep Apnea?

Untreated Sleep Apnea can lead to: High Blood Pressure Stroke Heart Attack Congestive Heart Failure Cardiac Arrhythmia Depression Glaucoma Obesity Diabetes Chronic Fatigue Morning Headache I suspect I have sleep apnea, what should I do?

Sleep apnea is a serious and potentially fatal medical condition. If you or a loved one suspect you have it, you should be tested as soon as possible. Sleep Questionnaire. This is a simple test you can fill out and take with you to your physician visit.

It evaluates you for the most common symptoms of sleep apnea. Sleep Apnea Screening Questionnaire Sleep Study. A polysomnogram, or sleep study, measures many key metrics while you sleep. These metrics are used to determine if you have sleep apnea or a number of other sleep related conditions such as central sleep apnea or restless leg syndrome.

CPAPtalk.com has created an ""Introduction To The Sleep Lab"" video that explains the process of verifying, diagnosing and treating sleep apnea.

If you are curious about the process or would like to know what to expect during your sleep study you can view the video in the Videos Tab of this page. If you have tested positive for sleep apnea, it should be treated. CPAP is the most popular and proven way to treat sleep apnea.

Here is our advice on navigating the tricky process of getting effective equipment: Get The Best Equipment. Watch Out! There is a significant difference between basic and high end CPAP equipment. High end equipment is generally smaller, lighter, quieter, less prone to leaks, easier to breathe against, better humidified and easier to travel with than basic CPAP Equipment. The key to CPAP treatment is comfort, choose wisely! Many traditional, brick and mortar CPAP providers will set you up on a CPAP and bill your insurance company.

If this approach to getting your equipment is used, you will most likely be given basic equipment. This is because there is only one billing code for all CPAP Machines and very few unique codes for CPAP Masks. Due to this, the insurance company will pay your CPAP Provider the same amount if you get a high end or basic machine. Usually, the amount paid to traditional CPAP providers by insurance companies is not enough to cover the cost of high end CPAP equipment and the patient is left to make do with basic equipment.

If you would like high end equipment, there are a variety of ways to obtain it online for equal or lesser cost than dealing with traditional CPAP dealers. CPAP.com (CPAP Retailer). CPAP.com sells high end CPAP supplies and equipment direct to consumers. Many times buying with cash is less expensive than the copay and deductible charged through insurance. If you want a way around the hassle and low end equipment provided by insurance companies and local providers, this is a good choice. "

rs. Once you know what to do, you can sleep well with a CPAP machine. Get to Know Your Gear When you have sleep apnea, you can stop breathing, briefly, up to 30 times or more an hour when your airways close or get blocked. CPAP, short for continuous positive airway pressure, pushes air into them to keep them open. The machine has a pump that controls the airflow, a tube that carries the air from the machine to you, and a mask that goes over your mouth, nose, or both.

How to Sleep Easier With Your CPAP Machine

"How to Sleep Easier With Your CPAP Machine By John Donovan Your doctor wants you on a CPAP machine to help your sleep apnea. You might worry you’ll be tied to a noisy gadget all night with tubes there, a mask here, and straps going every which way.

It can seem overwhelming, says David Rapoport, MD, the director of research at the NYU Sleep Disorders Center.“We work very hard to try to get people to be more open to the idea,” he says. “What’s remarkable is, when they try it, they often say, ‘That’s not so bad.’”There may be some hurdles at first, but they don’t have to be deal-breake

Continue Reading Belowyou might like Some things about it may take some getting used to: Masks and straps: If you’ve never slept with something on your face, it’ll probably take some time for you to wear the CPAP mask without thinking about it.

Most modern ones fall in one of three groups: A nasal mask that goes over your nose A ""nasal pillow mask"" that fits under your nose A full mask, which covers your mouth and nose Among those three main types, there are kinds including: Full-face masks that go over your eyes as well Nose masks with prongs that go into your nose As long as the mask is sealed enough so that the air pressure from the tube stays constant, the CPAP will do its job.

It’s up to you to find out which type is most comfortable on your face, and which straps are best to hold it in place. You may have to try a few different types before you find one you like.1 2 3 View All "

A metal or plastic tube, called a tracheotomy tube, is inserted through the opening. This tube acts like a windpipe and allows the person to breathe. Oxygen or a mechanical ventilator may be hooked up to the tube to bring oxygen to the lungs. A dressing is placed around the opening.

Tracheotomy

"Surgery St-Wr Tracheotomy Tracheotomy Follow City-Data.com founder on our Forum or @Lech Mazur Definition A tracheotomy is a surgical procedure that opens up the windpipe (trachea).

It is performed in emergency situations, in the operating room , or at bedside of critically ill patients. The term tracheostomy is sometimes used interchangeably with tracheotomy. Strictly speaking, however, tracheostomy usually refers to the opening itself while a tracheotomy is the actual operation.

Purpose

A tracheotomy is performed if enough air is not getting to the lungs, if the person cannot breathe without help, or is having problems with mucus and other secretions getting into the windpipe because of difficulty swallowing. There are many reasons why air cannot get to the lungs.

The windpipe may be blocked by a swelling; by a severe injury to the neck, nose, or mouth; by a large foreign object; by paralysis of the throat muscles; or by a tumor.

The patient may be in a coma, or need a ventilator to pump air into the lungs for a long period of time. Demographics Emergency tracheotomies are performed as needed in any person requiring one. Descript

ion Emergency tracheotomy There are two different procedures that are called tracheotomies. The first is done only in emergency situations and can be performed quite rapidly. The emergency room physician or surgeon makes a cut in a thin part of the voice box (larynx) called the cricothyroid membrane.

A tube is inserted and connected to an oxygen bag. This emergency procedure is sometimes called a cricothyroidotomy .

Surgical tracheotomy The second type of tracheotomy takes more time and is usually done in an operating room. The surgeon first makes a cut (incision) in the skin of the neck that lies over the trachea. This incision is in the lower part of the neck between the Adam's apple and top of the breastbone.

The neck muscles are separated and the thyroid gland, which overlies the trachea, is usually cut down the middle. The surgeon identifies the rings of cartilage that make up the trachea and cuts into the tough walls.

your ventilations (breaths are delivered through a valve in the mask so that you do not have direct contact with the patient's mouth. most pocket masks have one-way valves that allow your ventilations to enter but prevent the patient's exhaled air from coming back through the valve and in contact with you.

Chapter 7 Respiratory System

"215 terms JLewis122171Chapter 7 Respiratory System EMT-Basic Learn Flashcards Write Spell Test Match Gravity Like this study set?

Create a free account to save it. Create a free account Maybe later Sortwhat do the cells of the human body need to survive oxygen What are the ABCs airway, breathing, and circulationwhy are the ABCs so important they are the means by which oxygen is brought into the body and carried to the cellswhen can air not get into the body if the airway (the passage that leads from the mouth to the lungs) is not openwhat is an airway the passage that leads from the mouth to the lungswhen does the air not get into the body even if the airway is open if the person is unable to breathewhen is an open airway and the ability to breath of no use if the heart is not pumping blood through the lungs to pick up oxygen and circulate it to the cells of the bodywhat is another way of breathing respirationwhat are the parts of the respiratory system nose, mouth, pharynx, oropharynx, nasopharynx, uvula, epiglottis, larynx (voice box), cricoid cartilage, trachea, carina, bronchi (right and left mainstem bronchus), bronchioles, lungs, alveoli (alveolar sacs), diaphragmwhat is respiratory distress increased work of breathing; a sensation of shortness of breathwhat is respiratory failure the reduction of breathing to the point where oxygen intake is not sufficient to support lifewhat does it mean to inhale breathe in oxygenwhat does it mean to exhale breathe out carbon dioxidewhat muscles are involved in respiratory distress accessory muscleswhat is minute volume the amount of air breathed in during each respiration multiplied by the number of breaths per minutewhat is respiratory arrest when breathing completely stopsdefine adequate breathing patient is breathing adequately but needs supplemental oxygen due to a medical or traumatic conditionwhat are the signs of adequate breathing?

rate and depth of breathing are adequate, no abnormal breath sounds, air moves freely in and out of the chest; skin color normalwhat intervention is proper for adequate breathing use oxygen by nonbreather mask or nasal cannulawhat is inadequate breathing the patient is moving some air in and out but it is slow or shallow an not enough to livewhat are the signs of inadequate breathing patient has some breathing but not enough to live; rate or depth outside of normal limits; shallow ventilations; diminished or absent breath sounds; noises such as crowing, stridor, snoring, gurgling or gasping; blue (cyanosis) or gray skin color; and decreased minute volumehow should an emt treat inadequate breathing assisted ventilations (air forced into the lungs under pressure) with a pocket face mask, bag-valve mask or FROPVD.what are the signs that a patient is not breathing at all no chest rise, no evidence of air being moved from the mouth; no breath soundshow do you treat a patient who is not breathing at all provide artificial ventilations with a pocket face mask, bag valve mask, FROPVD or ATV at 10-12 per minutes for an adult and 20 per minute for an infant or childdescribe the process of oxygen getting into the blood air enters the lungs through the trachea and moves through the bronchi (and then the bronchioles, the smaller branches from the bronchi) ending up in the small air sacs called alveolican you use an oxygen powered ventiliation on infants or children do not use oxygen-powered ventilation devices on infants or childrenwhat does a nonrebreather mask require a nonrebreather mask requires adequate breathing to pull oxygen into the lungsdoes a nonrebreather mask provide ventilation to a patient who is not breathing or is not breathing inadequately a nonrebreather mask does not provide ventilation to a patient who is not breathing or who is breathing inadequatelywhere are oxygen and carbon dioxide exchanged in the alveoliwhen does air not get to the body cells all oxygen that is inhaled rests in the trachea, the bronchi, and the bronchioles the air that does not reach the alveoli and does not get transferred into the bloodwhat is anatomical dead space areas of the lungs outside the alveoliwhat percentage of inhaled air rests in the dead space?

about 30 percent of all inhaled airif you have 150 ml of dead space per breath, how much of 500 m L would be taken in during each breath?

350 (500m L minus 150m L) gets to the alveoli to exchange oxygen and carbon dioxidewhat is the patient's condition when they have adequate breathing patient speaks full sentences and is alert and calmwhat type of mask do you use to ventillate an adequately breathing patient nonrebreather mask or nasal cannulahow does the patient appear when they are experiencing increased respiratory distress visibly short of breath speaking 3 to 4 word sentences increasing anxietywhat type of mask do you use to ventilate a patient with increasing respiratory distress nonrebreather maskhow does the patient appear when they are in severe respiratory distress speaking only 1 to 2 word sentences very diaphoretic sweaty severe anxietyhow do you treat a patient who is in severe respiratory distress using assisted ventillations from any of the following: pocket face mask (PFM), bag-valve mask (BVM) or flow-restricted, oxygen powered ventilation device (FROPVD) to assist the patient's own ventilations adjusting the rate or rapid or slow breathinghow do you know when a patient in severe respiratory distress continues to deteriorate sleepy with head bobbing; becomes unarousablehow can you identify if the patient is in respiratory distress no breathinghow do you treat a patient in respiratory distress provide artificial ventilations using pocket face mask (PFM), bag-valve mask (BVM) or flow restricted oxygen powered ventillation device (FROPV)at what rate do you provide assisted ventilations 12 per minute for an adult and 20 per minute for a childwhat are the effects of minute volume and dead space on respiration even though the respiratory rate increases ventilations are often inadequate due to shallow depth of breathing and dramatic effect of dead space on lungswhat are the signs of adequate breathing?

adequate and equal expansion of both sides of the chest when the patient inhales; listen for air entering and leaving the nose, mouth, and chest. the breath sounds when ausculated or listened to with a stethoscope should be present and equal on both sides of the chest.

sound sounds from the mouth and nose should be typically free of gurgling, gasping, crowing, wheezing and stridor (harsh high pitched sound during inhalation), feel for air moving out of the nose or mouth; check for typical coloration (no bue or gray color); and note rate, rhythm, quality and depth of breathing typical for person at restwhat are the signs of inadequate breathing chest movements are absent, minimal or uneven; movement associated with breathing is limited to the abdomen (abdominal breathing); no air can be felt or heard at the nose or mouth, or the amount of air exchanged is below normal; breath sounds are diminished or absent; noises such as wheezing, crowing, stridor, snoring, gurgling or gasping are heard during breathing; rate of breathing is too rapid or too slow; breathing is very shallow, very deep or appears labored; patient's skin, lips, tongue, ear lobes or nail beds are blue (cyanosis) inspirations prolonged indicating possible upper airway obstruction); expirations prolonged indicating a possible lower airway obstruction; patient unable to speak, or patient cannot speak full sentences because of shortness of breath; in children there nay be retractions (pulling in muscle about clavicles and between and below ribs; nasal flaring (widening of nostrils of nose with respirations) may be present especially in infants and childrenwhat are the normal rates of breathing for adequate breathing adults 12 to 20 per minute child 15 to 30 per minute infant 25 to 50 per minutewhat type of rhythm is exhibited in adequate breathing regularwhat are the quality of breaths in adequate breathing breath sounds are present and equal with chest expansions adequate an equal and with minimum effortwhat is the depth of breathing in adequate breathing adequatehow do you treat life-threatning respiratory problems related to inadequate breathing opening and maintaining the airway; providing artificial ventillation to the nonbreathing patient and the patient with inadequate breathing; provide supplemental oxygen to the breathing patient; suctioning as needed.what is the airway the passageway by which air enters or leaves the body.what are the structures of the airway nose, mouth, pharynx, larynx, trachea, bronchi and lungswhat position should the patient be in for procedures of airway evaluation, opening the airway and artificial ventilation supine (lying flat on back)what do you do if you suspect an injury protect the head and neck as you position the patientwhat has priority airway and breathing or spine protection airway and breathing have priority over protection of the spine and must be ensured as soon as quickly as possiblewhat are the indications that head, neck, or spinal injury may have occurred especially when the patient is unconscious and cannot tell you what happened mechanism of injury is one that can cause head, neck or spine injury.

(for ex. pt who is found on ground near ladder or stairs may have such injury. motor vehicle collisons are another common cause of head, neck and spine injuries.

Any injury at or above the level of the shoulders indicate that head, neck or spine injuries may also be present; family or bystanders may tell you that an injury to the head, neck or spine has occurred or they may give you information that leads you to suspect it.what is maintaining a patient airway an airway (passage from nose or mouth to lungs) that is open and clear and will remain open and clear without interference to the passage of air into and out of the bodywhat are most airway problems caused by most airway problems are caused by the tongue as the head flexes forward the tongue may slide into the airway causing an obstructionwhy does the tongue cause problems the tongue loses muscle tone and musles of the lower jaw relaxwhy is the risk of tongue obstruction even greater during unconsciousness the tongue loses muscle tone and muscles of the lower jaw relax because the tongue is attached to the lower jawwhat are the two positions recommended for opening the airway head-chin lift maneuver and the jaw-thrust maneuverdefine head-tilt, chin-lift maneuver a means of correcting blockage of the airway by the tongue by tilting the head back and lifting the chin.

used when no trauma or injury is suspecteddefine jaw-thrust manuever a means of correcting blockage of the airway by moving the jaw forward without tilting the head or neck.

used when trauma or injury is suspected to open the airway without causing further injury to the spinal cord in the neckwhat are the steps for the head-chin lift manuever once the patient is supine, place one hand on the forehead and place the fingertips of the other hand under the bony area at the center of the patient's lower jaw; tilt the head by applying gentle pressure to the patient's forehead; use your fingertips to lift the chin and to support the lower jaw.

move the jaw forward to a point where the lower teeth are almost touching the upper teeth; do not compress the soft tissues under the lower jaw, which can obstruct the airway; do not allow the patient's mouth to be closed; to provide an adequate opening at the mouth, you may need to use the thumb of the hand supporting the chin to pull back the patient's lower lip.

Do not insert your thumb into the patient's mouth (to avoid being bitten)when is the jaw-thrust maneuver most commonly used to open the airway of an unconscious patient with suspected head, neck or spine injury or unknown mechanism of injurywhat are the steps in the jaw-thrust manuever carefully keep the patient's head, neck or spine aligned, moving him as a unit as you place him in the supine position; kneel at the top of the patient's head.

for long-term comfort it may be helpful to rest your elbows on the same surface as the patient's head; carefully reach forward and gently palce one hand on each side of the patient's lower jaw at the angles of the jaw below the ears; stabilize the patient's head with your forearms; using your index fingers, push the angles of the patient's lower jaw forward; you may need to retract the patient's lower lip with your thumb to keep the mouth open; do not tilt or rotate the patient's headwhat is the most effective way to clear the patient's airway with a rigid-tip Yankauer suction deviceventilation the breathing in of air or oxygen or providing breaths artificiallyartificial ventilation forcing air or oxygen into the lungs when a patient has stopped breathing or has inadequate breathing.

also called positive pressure ventilationwhat are the 4 methods of ventilation in order of preference mouth to mask (preferably with high concentration supplemental oxygen at 15 liters per minute), two rescuer bag valve mask (BVM) preferably with high concentration supplemental oxygen at 15 liters per minute; flow-restricted, oxygen powered ventilation device; one rescuer bag-valve mask (preferably with high concentration oxygen at 15 liters per minute)how do you determine the signs of adequate artificial ventilation (to ensure that the patient is being ventilated adequately) watch the chest rise and fall with each ventilation; see the patient's heart rate return to normal with artificial ventilation; ensure that the rate of ventilation is sufficient- approximately 10 to 12 per minute in adults; 20 per minute in children and a minimum of 20 per minute in infants When does inadequate artificial ventillation occur the chest does not rise and fall with ventilation, the patient's heart rate does not return to normal with artificial ventilation; the rate of ventilation is too fast or too slowfor what reason is mouth to mouth ventilation not recommended unless there is no alternative method for artificial respiration available techniques for artificial ventilation should also ensure adequate isolation of the rescuer from the patient's body fluids including saliva, blood and vomithow do you ventilate a patient with rapid ventilations carefully assess the adequacy of respirations; explain the procedure to the patient; calm reassurance and a simple explanation such as ""Im going to help you breathe"" are essential in the awake patient; place the mask (pocket face mask or BVM) over the patient's mouth and nose; after sealing the mask on the patient's face, squeeze the bag with the patient's inhalation.

watch as the patient's chest begins to rise and deliver the ventilation with the start of the patient's own inhalation.

the goal will be to increase the volume of each breath. over the next several breaths, adjust the rate so you are ventilating fewer times per minute but with greater volume per breath (increasing the minute volume)how to ventilate a patient with slow ventilations carefully assess the adequacy of respirations; explain the procedure to the patient; calm assurance and a simple explanation such as ""I'm going to help you breathe"" are essential in the awake patient.

place the mask (pocket face mask or BVM) over the patient's mouth and nose. after sealing the mask on the patient's face, squeeze the bag every time the patient begins to inhale.

if the rate is very slow, add ventilations in between the patient's own to obtain a rate of approximately 12 per minute with adequate minute volumeshould you ventilate a patient who is vomiting or has vomitus in his airway do not ventilate a patient who is vomiting or who has vomitus in his airway. positive pressure ventilation will force the vomitus into the patient's lungs. Make sure the patient is not actively vomiting and suction any vomitus from the airway before ventilatingwhat is a pocket face mask a device, usually with a one-way valve, to aid in artificial ventilation.

a rescuer breathes through the valve when the mask is placed over the patient's face. . it also acts as a barrier to prevnet contact with a patient's breath or body fluids. it can be used with supplemental oxygen when itted with an oxygen inlethow is mouth to mask ventilation performed using a pocket face maskwhat are the infection control features of a face mask

your ventilations (breaths are delivered through a valve in the mask so that you do not have direct contact with the patient's mouth. most pocket masks have one-way valves that allow your ventilations to enter but prevent the patient's exhaled air from coming back through the valve and in contact with you.

what is the concentration of oxygen when high concentration oxygen is attached to an inlet an oxygen concentration of approximately 50 percent is delivered.what is the oxygen concentration delivered by mouth to mask ventilations without supplemental oxygen 16 percent oxygen concentrationwhat is it important to use clear plastic in pocket face masks you must be able to observe the patient's mouth and nose for vomiting or secretions that need to be suctioned and for you to observe the color of lips, and indication of the patient's respiratory status.why would it be important to have a pocket mask with a face strap to put over the patient's head it will be helpful during one-rescuer CPR since it will hold the mask on the patient's face while you were performing chest compression but it does not replace the need for proper hand placement on the maskwhat are the steps for providing mouth to mouth ventilation position yourself at the patient's head and open the airway.

it may be necessary to clear the airway of obstructions. if necessary, insert an oropharyngeal airway to keep the patient's airway open.

connect oxygen to the inlet on the mask and run at 15 liters per minute. if oxygen is not immediately available, do not delay mouth to mask ventilationshow do you use a pocket face mask with a patient without suspected spine injury -EMT at top of patient's head position yourself directly above (at the top of) the patient's head; apply the mask to the patienthow do you use a pocket face mask on a patient without suspected spine injury-alternative EMT beside patient's head position yourself beside the patient's head; apply the mask to the patient; use the bridge of the nose as a guide for correct position; seal the mask by placing your index finger and thumb of the hand closer to the top of the patient's head along the top border of the mask; place the thumb of the hand closer to the patient's feet on the lower margin of the mask; place the remaining fingers of the hand along the bony margin of the jaw; lift the jaw while performing a head-lift, chin-tilt manuever; compress the outer margins of the mask against the face to obtain a seal; give breaths into the one-way valve on the mask.

watch for the chest to risehow do you use a pocket face mask on a patient with suspected spine injury- EMT at top of patient's head position yourself directly above (at the top of) the patient's head; apply the mask to the patient; use the bridge of the nose as a guide for correct position; place the thumb sides of your hands along the mask to hold it firmly on the face; use your remaining fingers to lift the angle of the jaw (Do not tilt the head backward); when lifting the jaw, squeeze the mask with your thumbs and fingers to achieve a seal.

Give breaths into the one-way valve on the mask. watch the chest to rise. position the mask on the patient's face so that the apex (top of the triangle) is over the bridge of the nose and the base is between the lower lip and prominence of the chin (center the ventilation port over the patient's mouth).

hold the mask firmly in place while maintaining head tilt. use one of these positions or some variation-with the aim of achieving a tight seal: a) thumbs over the top of the mask, index fingers over the bottom of the mask and remaining fingers under the patient's jaw; b) thumbs along the side of the mask and remaining fingers under the patient's jaw.

Take a breath and exhale into the mask port or one-way valve at top of the mask port. Each ventilation should be delivered over 1 second in adults, infants and children.

watch for visible chest rise. Remove your mouth from the port and allow for passive exhalation. Continue mouth to mouth ventilations or CPRwhat is a bag-valve mask a handheld device with a face mask and self-refilling bag that can be squeeze to provide artificial ventilations to a patient. it can deliver air from the atmosphere or oxygen from a supplemental oxygen supply systemwhen can a bag-mask valve be used on a patient who is not breathing and to assist ventilations in the patient whose own respiratory attempts are not enough to support life such as a patient in respiratory failure or drug overdosewhat type of barrier does the bag-mask valve provide an infection control barrierwhat is use of bag-valve mask in the field often referred to baggingwhat are the parts of a bag mask valve self-refilling shell that is easily cleaned and sterilized.

(some bag-mask valve units are designed for single use and are then disposed of. the system must have a non-jam valve that allows an oxygen inlet flow of 15 liters per minute. the valve should be nonrebreathing (preventing the patient from rebreathing his own exhalations) and not subject to freezing in cold temperatures.

most systems have a standard 15/22 respiratory fitting to ensure a proper fit with other equipment, face masks and endotracheal tubes.how does the bag valve mask work oxygen flowing at 15 liters per minute is attached to the BVM and enters the reservoir to be delivered to the patient the next time the bag is squeezed.how much oxygen do BVM (bag mask valve) units without a reservoir provide 50 percent oxygenwhat happens when the bvm bag is released a passive expiration by the patient occurshow much of air does the bvm hold 1,000 to 1,600 millilitershow many rescuers does the American Heart Association recommend use a BVM to perform artificial ventilation two rescuerswhat is the most difficult part of delivered BVM artificial ventilations obtaining an adequate mask seal so that air does not leak in or out around the edges of the mask seal so that air does not leak in or out around the edges of the maskhow can the two rescuer technique be modified it can be modified so that the jaw thrust manuever can be used during BVM ventilationswhat are pop-off valves in older bag, these are valves designed to open after certain pressures are obtained.

studies have shown that pop-off valves may prevent adequate ventilations.when do you use a jaw thrust manuever when performing BVM bag mask valve when performing BVM ventilation on a patient with a suspected head, neck or spine injury.how do you use a bag mask valve on a patient without suspected spine injury open the airway and insert appropriately size oral or nasal airway (if no gag reflex); position your thumbs over the top of the mask, index fingers over the bottom of the mask;place the mask over the patient's face.

position the mask over the patient's nose and lower to the chin (large, round-style masks are centered first on the mouth); use your middle, ring and little fingers to bring the jaw up to the mask; connect the bag to the mask and have assistant squeeze the bag until the chest rises; if the chest does not rise and fall, reevaluate head position and mask seal.

if unable to ventilate, use another device (e.g. pocket face mask or FPOPVD)how do you use the bag mask valve with a patient with suspected spine injury open the airway with a jaw thrust and insert an appropriate size airway if no gag reflex; have an assistant manualy immobilize the head and neck; immobilization of the head between your knees may be acceptable if no assistance is available; place the thumb sides of your hands along the mask to hold it firmly on the face.

place the mask on the patient's face as previously described. use your little and ring fingers to bring the jaw up to the mask without tilting the head or neck. have assistant squeeze the bag with two hands until the chest rises. continually evaluate ventilationshow do you perform two-rescuer BVM ventilations when no trauma is suspected open the patient's airway using the head-tilt, chin-lift maneuver, suction and insert an airway adjunct as necessary.

select the correct bag-valve mask size (adult, child or infant). kneel at the patient's head, position thumbs over the top half of the mask index fingers over the bottom half.

place the apex or top of the triangular mask over the bridge of the patient's nose. then lower the mask over the mouth and upper chin. if the mask has a large round cuff surrounding a ventilation port, center the port over the patient's mouth. user middle, ring and little fingers to bring the patient's jaw up to the mask. maintain the head-tilt, chin lift maneuver.

the second rescuer should connect bag to mask, if not already done. while you maintain the mask seal, the second rescuer should squeeze the bag with two hans until the patient's chest rises. the second rescuer should squeeze the bag about 5 seconds for an adult, once every 3 second for a child or infant. the second rescuer should release pressure on the bag and let the patient exhale passively. while this occurs the bag is refilling from the oxygen source.how to perform two-rescuer BVM ventilation when trauma is suspected open the patient's airway using the jaw-thrust manuever.

suction and insert an airway adjunct. select the correct bag-valve mask size (adult, child or infant). kneel at the patient's head. place thumb sides of your hands along the mask to hold it firmly on the face.

use your remaining fingers to bring the jaw upward, toward the mask, without tilting the head or neck. the second rescuer should squeeze the bag to ventilate the patient as previously described for the nontrauma patient.how to perform one-rescuer BVM ventilation position yourself at the patient's head and establish an open airway.

suction and insert an airway adjunct as necessary. select the correct size mask for the patient. position the mask on the patient's face as described during two-rescuer BVM technique. form a C around the ventilation port with thumb and index finger. use middle, ring and little fingers under the patient's jaw to hold the jaw to the mask. with your other hand, squeeze the bag once every 5 seconds. for infants and children, squeeze the bag once ever 3 seconds.

the squeeze should be a full one, causing the patient's chest to rise. release pressure on the bag and let the patient exhale passively. while this occurs the bag is refilling from the oxygen source.when should you provide ventilations with a one-rescuer bag-valve mask only when no other option is available because use of a bag-valve mask by a single rescuer is the last choice of artificial ventilation procedure.how should you apply one rescuer bvm ventilation position yourself at the patient's head and establish an open airway.

suction and insert an airway adjunct as necessary. select the correct size mask for the patient. position the mask on the patient's face.

form a c around the ventilation port with thumb and index finger. use middle, ring and little fingers under the patient's jaw to hold the jaw to the mask. with your other hand, squeeze the bag once every 5 seconds. for infants and children, squeeze the bag once every 3 seconds. the squeeze should be a full one, causing the patient's chest to rise. release pressure on the bag and let the patient exhale passively.

while this occurs, the bag is refilling from the oxygen sourcewhat should you do if the chest does not rise and fall during BVM ventilation reposition the head, check for the escape of air around the mask and reposition fingers and mask; check for airway obstruction or obstruction in the BVM system.

resuction the patient if necessary. consider insertion of an airway adjunct if not already done. if none of these methods work, use an alternative method of artificial ventilation such as pocket mask or flow-restricted, oxygen powered ventilation device.when can the BVM also be used during CPRhow is the BVM used during CPR squeezing the bag once each time a ventilation is deliveredwhat are the reasons for not using a BVM during one rescuer CPR a single rescuer would take too much time picking up the BVM and obtaining a face seal each time a ventilation is deliveredhow do you provide artificial ventilation to a stoma breather clear any mucus plugs or secretions from the stoma; leave the head and neck in a neutral position, as it is unnecessary to position the airway prior to ventilations in a stoma breather; use a pediatric-sized mask to establish a seal around the stoma; ventilate at the appropriate rate for the patient's age; if unable to artificially ventilate through the stoma, consider sealing the stoma and attempting artificial ventilation through teh mouth and nose.what is a stoma a permanent surgical opening in the neck through which the patient breatheswhat is flow restricted oxygen powered ventilation device a device that uses oxygen under pressure to deliver artificial ventilations.

its trigger is placed so that the rescuer can operate it while still using both hands to maintain a seal on the face mask.

it has automatic flow restriction to prevent overdelivery of oxygen to the patientwhat are the recommended features of FROPVD (flow restricted oxygen powered ventilation device) a peak flow rate of 100 percent oxygen at up to 40 liters per minute; an inspiratory pressure relief valve that opens at approximately 60 cm of water pressure; an audible alarm when the relief valve is activated; a rugged design and construction; a trigger that enables teh rescuer to use both hands to maintain a mask seal while triggering the device; satisfactory operation in both ordinary and extreme environmental conditionshow do you use FROPVD follow same procedures for mask seal as recommended for BVM.

trigger the device until the hest rises and repeats every 5 seconds. if the chest does not rise, reposition the head, check the mask seal, check for obstructions and consider the use of an alternative artificial ventilation procedure.what should you be careful of when using a FROPVD if the patient has a chest trauma be especially careful not to over-inflate as you can make the injury worstwhen should you consider using an alternative artificial ventilation procedure after using FROPVD if the chest does not rise, reposition the head, check the mask seal, check for obstructionswhat would happen if too much air entered the stomach instead of the lungs when using a FROPVD if too much air entered the stomach gastric distention would result which could cause the patient to regurgitate and possibly compromise the airway with stomach contentswhat should you do if neck injury is suspected when using a FROPVD have an assistant hold the patient's head manually or put a rigid collar or head blocks on the patient to prevent movement.what type of FROPVD can you use on a child a child unit on which you have been given special training in its use by Medical Directorwhat is an automatic transport ventilator a device that provides positive pressure ventilations.

it includes settings designed to adjust ventilation rate and volume, is portable and is easily carried on an ambulancewhen should you use an ATV when prolonged ventilation is necessary and when only one rescuer is available to ventilate the patient.how should the FROPVD be used on a patient without suspected spine injury open the airway and insert an appropriately sized oral or nasal airway position thumbs over the top of mask, index fingers over the bottom half; place mask over the face and use the middle, ring or little fingers to bring the patient's jaw up to the mask; trigger the ventilation device until the chest rises.

do not overinflate. reevaluate ventilations frequentlyhow should the FROPVD be used on a patient with suspected spine injury open the airway with a jaw thrust and insert appropriate size airway if no gag reflexes.

have an assistant manually immobilize the head and neck. immobilization of the head between our knees may be acceptable if no assistance is available; place the thumb side of your hands along the mask to hold it firmly on the face; place the mark on the patient's face as previously described; use your remaining fingers to bring the jaw up to the mask without tilting the head or neck.

trigger the ventilation device until the chest rises. do not over-inflate. monitor ventilationswhat is the most common impediment to an open airway tonguewhy is the tongue the most common impediment to an open airway when a patient is unconscious the muscles relax.

the tongue will slide back into the pharynx and obstruct the airway. even though a head-tilt, chin lift or jaw-thrust manuever will help open a patient's airway, the tongue may return to its obstructive position once the maneuver is released.what is an adjunct airway devices that aid in maintaining an open airway which may be used early in patient's care of an unresponsive patient and continue throughout the carewhat are the two most common adjunct airways oropharyngeal airway (oral airway) and the nasopharyngeal airway (nasal airway)oropharyngeal airway a curved device inserted through the patient's mouth into the pharynx to help maintain an open airway.

they are inserted into the mouth and help keep the tongue from falling back into the pharynx.what is a nasopharyngeal airway nasal airway is inserted through the nose and rests in the pharynx. a flexible breathing tube inserted through the patient's nose into the pharynx to help maintain an open airwaywhat are the rules for using airway adjuncts use an airway on all unconscious patient who do not exhibit a gag reflex.

the gag reflex causes vomiting or retching when something is placed in the pharynx. when a patient is deeply unconscious, the gage reflex usually disappears but may reappear as the patient begins to regain consciousness.

a patient with a gag reflex who cannot tolerate an oropharyngeal airway may be able to tolerate a nasopharyngeal airway. open the patient's airway manually before using an adjunct device. when inserting the airway, take care not to push the patient's tongue into the pharynx. do not continue inserting the airway if the patient begins to gag. continue to maintain the airway manually and do not use an adjunct device.

if the patient remains unconscious for a prolonged time, you may later attempt to insert an airway to determine if the gag reflex is still present. when an airway adjunct is in place, you must maintain the had-tilt, chin lift or jaw thrust manuever and monitor the airway. when an airway adjunct is in place, remain ready to suction the airway to clear secretions as needed.

if the patient regain consciousness or develops a gag reflex, remote the airway immediately. be prepared to suction the patient again. use infection control practices while maintaining the airway. wear disposable gloves. in airway maintenance, there is a chance of patient's body fluids coming in contact with your face and eyes.

wear mask or googles or other protective eyewear to prevent this contactwhat is the gag reflex vomiting or retching that results when something is placed in back of the pharynx.

this is tied to the swallow reflexeswhat is an oropharyngeal airway is a curved device usually made of plastic that is inserted into the patient's mouth.what part of the oropharyngeal airway rests against the patient's lips flangehow do you know when an oropharyngeal airway is applied correctly an airway of proper size will extend from the corner of the patient's mouth to the tip of the earlobe on the same side of the patient's face.

or measure from the center of the patient's mouth to the angle of the lower jaw bone.what must you do first before using an oropharyngeal airway measure it against the patient and verify it as being the right size.

if the airway is not the correct size, do not use it on the patientdescribe the steps to insert the oropharyngeal airway place the patient on his back.

when caring for the patient with no indications of spinal injury, the neck may be hyperextended. if there are possible spinal injuries, use the jaw-thrust maneuver, moving the patient no more than necessary to ensure an open airway (the airway takes priority over the spine). extreme care must be taken. perform a crossed-finger technique. that is, cross the thumb and forefinger of one hand and place them on the upper and lower teeth at the corner of the patient's mouth. spread your fingers apart to open the patient's jaws. position the airway so that its tip is pointing toward the roof of the patient's mouth.

insert the airway and slide it along the roof of the patient's mouth, past the soft tissue hanging down from the back (the uvula) or until you meet resistance against the soft palate.

do not push the patient's tongue back into the pharynx. any airway insertion is made easier by using a tongue blade (tongue depressor), this procedure should not be performed by feel only.

gently rotate the airway 180 degrees so that the tip is pointing down into the patient's pharynx which prevent pushing the tongue back or insert the airway with the tip already pointing down toward the patient's pharynx, using a tongue depressor to press the tongue down and forward to avoid obstructing the airway.

this is the preferred method for airway insertion in an infant or child,. position the patient. place the nontrauma patient in a maximum head-tilt position. if there are possible spine injuries, maintain cervical stabilization at all times during airway management. check to see that the flange of the airway is against the patient's lips. if the airway is too long or too short, remove the airway and replace it with the correct size.

place the mask you will use for ventilation over the in-place airway adjunct. if no barrier device is available, provide direct mouth to adjunct ventilation just as you would provide mouth to mouth ventilation,. monitor the patient closely. if there is a gag reflex, remove the airway adjunct at once by following the anatomical curvature.

you do not need to rotate the device when removing ti.why is the nasopharyngeal airway popular because the nasopharnygeal airway does not stimulate the gag reflex it can be used on patient who have a reduced level of responsiveness but still have an intact gag reflexwhat other benefits are there to using a nasopharyngeal airway can be used when the teeth are clenched and when there are oral injurieswhat are the steps to insert a nasopharyngeal airway measure the nasopharyngeal airway from the patient's nostril to the earlobe or to the angle of the jaw.

choosing the correct length will ensure an appropriate diameter. lubricate the outside of the tube with a water based lubricant before insertion. do not use a petroleum jelly or any other type of non-water based lubricant. such substances can damage the tissue lining of the nasal cavity and the pharynx and increase the risk of infection. gently push the tip of the nose upward. keep the patient's head in a neutral position. most nasorphyngeal airways are designed to be placed in the right nostril.

the bevel should point toward the base of the nostril toward the septum (the wall that separates the nostrils). insert the airway into the nostril. advance the airway until the flange rests firmly against the patient's nostril. never force a nasopharyngeal airway. if you experience difficulty advancing the airway, pull the tube out and try other nostrilwhat is it sometimes necessary to do to ensure an open airway to the level of the lungs to insert an endotracheal (through the trachea) tube.

this is an advanced life support procedures that in some jurisdictions may be performed by EMTSwhat is sunctioning use of vaccum device to remove blood, vomitus, and other secretions or foreign materials from the airwaywhen does suctioning need to be done immediately whenever a gurgling sound is heard, whether before during or after ventilationwhat is the risk of blood, vomitus and secretions being stuck in the throat materials that are allowed to remain in the airway may be forced into the trachea and eventually into the lungswhat type of suctioning devices are there> mounted suction systems, portable suction units, tubing, tips and catheterswhat are mounted suction systems many ambulances have a suction unit mounted in the patient compartment: usually installed near the head of the stretcher so they are easily used.

these mounted systems often called on-board units create a suctioning vaccum produced by the engine's manifold or an electrical power source.what must be true for mounted suction systems to be effective suction devices must furnish an air intake of at least 30 liters per minute at the open end of a collection tube.

this will occur is the system can generate a vaccum of no less than 300mmhg (milimeters of mercury) when collecting tube is clamped See more "

A ventilator is a machine that helps a patient to breathe. Patients are usually placed on a ventilator because of a medical problem that makes it hard for them to breathe well on their own. While on the ventilator, the body is able to rest so that it can heal. The ventilator can help with breathing or totally breathe for the patient.

When Someone You Love is on a Ventilator

When Someone You Love is on a Ventilator This information was designed to help you understand what a ventilator is and how it helps your loved one. If you have any questions, please be sure to ask your doctor, nurse, or respiratory therapist. What is a ventilator?

What to Expect Your loved one may feel frustrated or anxious because he or she can’t talk while on the ventilator.

There are several ways to help promote communication. You can speak with the nurses about what might work best for your loved one. Often patients on a ventilator are given medicine that puts them in a coma-like condition so that the ventilator does all the work of breathing. Eating and Activity Your loved one will be fed through an IV (intravenous) or feeding tube while on the ventilator.

However, some patients without tracheostomy tubes are able to eat by mouth. If your loved one is strong enough, he or she may sit up in a chair while on the ventilator. How You Can Help There are many things you can do to comfort your loved one. Try talking to him or her as you normally would or let your loved one know you’re near by touching or holding his or her hand.

You may be able to bring items from home, like a pillow or robe. Please check with the nurse first. Some patients need special instructions for their visitors, such as special visiting times or a time limit to the visit.

Please follow these instructions. They are in place to allow the patient care team to give your loved one the care he or she needs. Alarms, Alerts, and Warnings Even though there may not be a care team member at the patient’s bedside, there are a number of devices that will alert the staff of any problems or changes.

The monitor is a small screen above the patient’s bed. It helps keep track of things like the patient’s heart rhythm and blood pressure. Both the monitor and the ventilator are equipped with alarms. Each of the alarms will alert a staff member if a change has taken place in the patient’s condition.

Each sound refers to a different condition. Often when an alarm sounds, there is no great cause for concern. The problem may correct itself, and this will be monitored from the nurses’ station. Other times, a care team member may come to check the alarm. Our staff of highly trained professionals is capable of handling all alarms.

Coming Off the Ventilator The ventilator brings oxygen into the lungs and helps get rid of carbon dioxide from the patient’s body. Sometimes a patient may become dependent on a ventilator because of his or her medical problems. This may make it difficult to get the patient off the ventilator.

Pressure support is a spontaneous mode of ventilation also named Pressure Support Ventilation (PSV). The patient initiates every breath and the ventilator delivers support with the preset pressure value. With support from the ventilator, the patient also regulates their own respiratory rate and their tidal volume.

Modes of mechanical ventilation

"From Wikipedia, the free encyclopedianavigation search Modes of mechanical ventilation are one of the most important aspects of the usage of mechanical ventilation. The mode refers to the method of inspiratory support. In general, mode selection is based on clinician familiarity and institutional preferences, since there is a paucity of evidence indicating that the mode affects clinical outcome.

The most frequently used forms of volume-limited mechanical ventilation are intermittent mandatory ventilation (IMV) and continuous mandatory ventilation (CMV). [1] There have been substantial changes in the nomenclature of mechanical ventilation over the years, but more recently it has become standardized by many respirology and pulmonology groups.

[2] [3] Writing a mode is most proper in all capital letters with a dash between the cycle and the strategy (i.e.

PC-IMV, or VC-MMV etc. )Contents [ hide ]1 Taxonomy for mechanical ventilation1.1 10 maxims1.2 How modes are classified1.3 Example mode classification is given below2 Descriptions of common modes2.1 Assist mode, control mode, and assist-control mode2.2 Airway pressure release ventilation2.3 Mandatory minute ventilation2.4 Pressure-regulated volume control2.5 Continuous positive airway pressure2.5.1 Automatic positive airway pressure2.6 Bilevel positive airway pressure2.7 High-frequency ventilation (Active)2.8 High-frequency ventilation (Passive)2.9 Volume guarantee3 Spontaneous breathing and support settings3.1 Positive end-expiratory pressure3.2 Pressure support4 Other ventilation modes and strategies4.1 Closed loop systems4.1.1 Adaptive Support Ventilation4.1.2 Automatic Tube Compensation4.1.3 Neurally Adjusted Ventilatory Assist4.1.4 Proportional Assist Ventilation4.2 Liquid ventilation4.2.1 Total liquid ventilation4.2.2 Partial liquid ventilation5 See also6 References Taxonomy for mechanical ventilation [ edit]The taxonomy is a logical classification system based on 10 maxims of ventilator design [4]10 maxims [ edit]A breath is one cycle of positive flow (inspiration) and negative flow (expiration) defined in terms of the flow-time curve.

Inspiratory time is defined as the period from the start of positive flow to the start of negative flow. Expiratory time is defined as the period from the start of expiratory flow to the start of inspiratory flow.

The flow-time curve is the basis for many variables related to ventilator settings. A breath is assisted if the ventilator does work on the patient.

An assisted breath is one for which the ventilator does some portion of the work of breathing. For constant flow inflation, work is defined as inspiratory pressure multiplied by tidal volume. Therefore, an assisted breath is identified as a breath for which airway pressure (displayed on the ventilator) rises above baseline during inspiration. An unassisted breath is one for which the ventilator simply provides the inspiratory flow demanded by the patient and pressure stays constant throughout the breath.

A ventilator assists breathing using either pressure control or volume control based on the equation of motion for the respiratory system. Providing assistance means doing work on the patient, which is accomplished by controlling either pressure or volume.

A simple mathematical model describing this fact is known as the equation of motion for the passive respiratory system: Pressure = (Elastance × Volume) + (Resistance × Flow)In this equation, pressure, volume, and flow are all continuous functions of time.

Pressure is actually a pressure difference across the system (e.g., transrespiratory pressure defined as pressure at the airway opening minus pressure on the body surface). Elastance (defined as the change in pressure divided by the associated change in volume; the reciprocal of compliance) and resistance (defined as a change in pressure divided by the associated change in flow) are parameters assumed to remain constant during a breath.

Volume control (VC) means that both volume and flow are preset prior to inspiration. In other words, the right hand side of the equation of motion remains constant while pressure changes with changes in elastance and resistance. Pressure control (PC) means that inspiratory pressure is preset as either a constant value or it is proportional to the patient’s inspiratory effort.

In other words, the left-hand side of the equation of motion remains constant while volume and flow change with changes in elastance and resistance. Time control (TC) means that, in some rare situations, none of the main variables (pressure, volume, or flow) are preset.

In this case only the inspiratory and expiratory times are preset. Breaths are classified by the criteria that trigger (start) and cycle (stop) inspiration. The start of inspiration is called the trigger event. The end of inspiration is called the cycle event.

Trigger and cycle events can be initiated by the patient or the machine. Inspiration can be patient triggered or patient cycled by a signal representing inspiratory effort. Inspiration may also be machine triggered or machine cycled by preset ventilator thresholds. Patient triggering means starting inspiration based on a patient signal independent of a machine trigger signal. Machine triggering means starting inspiratory flow based on a signal from the ventilator, independent of a patient trigger signal.

Patient cycling means ending inspiratory time based on signals representing the patient determined components of the equation of motion, (ie, elastance or resistance and including effects due to inspiratory effort). Flow cycling is a form of patient cycling because the rate of flow decay to the cycle threshold is determined by patient mechanics.

Machine cycling means ending inspiratory time independent of signals representing the patient determined components of the equation of motion. Breaths are classified as spontaneous or mandatory based on both the trigger and cycle events. A spontaneous breath is a breath for which the patient both triggers and cycles the breath. A spontaneous breath may occur during a mandatory breath (e.g. Airway Pressure Release Ventilation). A spontaneous breath may be assisted or unassisted. A mandatory breath is a breath for which the machine triggers and/or cycles the breath.

A mandatory breath can occur during a spontaneous breath (e.g., High Frequency Jet Ventilation). A mandatory breath is, by definition, assisted. There are 3 breath sequences: Continuous mandatory ventilation (CMV), Intermittent Mandatory Ventilation (IMV), and Continuous Spontaneous Ventilation (CSV). A breath sequence is a particular pattern of spontaneous and/or mandatory breaths. The 3 possible breath sequences are: continuous mandatory ventilation, (CMV, spontaneous breaths are not allowed between mandatory breaths), intermittent mandatory ventilation (IMV, spontaneous breaths may occur between mandatory breaths), and continuous spontaneous ventilation (CSV, all breaths are spontaneous).

There are 5 basic ventilatory patterns: VC-CMV, VC-IMV, PC-CMV, PC-IMV, and PC-CSV. The combination VC-CSV is not possible because volume control implies machine cycling and machine cycling makes every breath mandatory, not spontaneous.

A sixth pattern, TC-IMV is possible but rare. Within each ventilatory pattern there are several variations that can be distinguished by their targeting scheme (s).

A targeting scheme is a description of how the ventilator achieves preset targets. A target is a predetermined goal of ventilator output. Examples of within-breath targets include inspiratory flow or pressure and rise time (set-point targeting), tidal volume (dual targeting) and constant of proportionality between inspiratory pressure and patient effort (servo targeting). Examples of between-breath targets and targeting schemes include average tidal volume (for adaptive targeting), percent minute ventilation (for optimal targeting) and combined PCO2, volume, and frequency values describing a “zone of comfort” (for intelligent targeting, e.g., Smart Care PS or Intelli Vent-ASV).

The targeting scheme (or combination of targeting schemes) is what distinguishes one ventilatory pattern from another.

There are 7 basic targeting schemes that comprise the wide variety seen in different modes of ventilation: Set-point: A targeting scheme for which the operator sets all the parameters of the pressure waveform (pressure control modes) or volume and flow waveforms (volume control modes). Dual: A targeting scheme that allows the ventilator to switch between volume control and pressure control during a single inspiration. Bio-variable: A targeting scheme that allows the ventilator to automatically set the inspiratory pressure or tidal volume randomly to mimic the variability observed during normal breathing.

Servo: A targeting scheme for which inspiratory pressure is proportional to inspiratory effort. Adaptive: A targeting scheme that allows the ventilator to automatically set one target (eg, pressure within a breath) to achieve another target (eg, average tidal volume over several breaths).

Optimal: A targeting scheme that automatically adjusts the targets of the ventilatory pattern to either minimize or maximize some overall performance characteristic (eg, minimize the work rate done by the ventilatory pattern). Intelligent: A targeting scheme that uses artificial intelligence programs such as fuzzy logic, rule based expert systems, and artificial neural networks.

A mode of ventilation is classified according to its control variable, breath sequence, and targeting scheme (s).

The preceding 9 maxims create a theoretical foundation for a taxonomy of mechanical ventilation. The taxonomy is based on these theoretical constructs and has 4 hierarchical levels: Control Variable (Pressure or Volume, for the primary breath)Breath Sequence (CMV, IMV, or CSV)Primary Breath Targeting Scheme (for CMV or CSV)Secondary Breath Targeting Scheme (for IMV)The “primary breath” is either the only breath there is (mandatory for CMV and spontaneous for CSV) or it is the mandatory breath in IMV.

The targeting schemes can be represented by single, lower case letters: set-point = s, dual = d, servo = r, bio-variable = b, adaptive = a, optimal = o, intelligent = i.

A tag is an abbreviation for a mode classification, such as PC-IMVs,s. Compound tags are possible, eg, PC-IMVoi,oi. How modes are classified [ edit]Step 1: Identify the primary breath control variable. If inspiration starts with a preset inspiratory pressure, or if pressure is proportional to inspiratory effort, then the control variable is pressure.

If inspiration starts with a preset tidal volume and inspiratory flow, then the control variable is volume. If neither is true, the control variable is time. Step 2: Identify the breath sequence. Determine whether trigger and cycle events are patient or machine determined. Then, use this information to determine the breath sequence. Step 3: Identify the targeting schemes for the primary breaths and (if applicable) secondary breaths.

Example mode classification is given below [ edit]Mode Name: A/C Volume Control (Covidien PB 840)Inspiratory volume and flow are preset, so the control variable is volume. Every breath is volume cycled, which is a form of machine cycling. Any breath for which inspiration is machine cycled is classified as a mandatory breath.

Hence, the breath sequence is continuous mandatory ventilation. The operator sets all the parameters of the volume and flow waveforms so the targeting scheme is set-point. Thus, the mode is classified as volume control continuous mandatory ventilation with set-point targeting (VC-CMVs). Mode Name: SIMV Volume Control Plus (Covidien PB 840)The operator sets the tidal volume but not the inspiratory flow.

Because setting volume alone (like setting flow alone) is a necessary but not sufficient criterion for volume control, the control variable is pressure. Spontaneous breaths are allowed between mandatory breaths so the breath sequence is IMV. The ventilator adjusts inspiratory pressure between breaths to achieve an average preset tidal volume, so the targeting scheme is adaptive. The mode tag is PC-IMVa,s. Descriptions of common modes [ edit]Assist mode, control mode, and assist-control mode [ edit]

A basic distinction in mechanical ventilation is whether each breath is initiated by the patient (assist mode) or by the machine (control mode). Dynamic hybrids of the two (assist-control modes) are also possible, and control mode without assist is now mostly obsolete.

Airway pressure release ventilation [ edit]Airway pressure release ventilation graph Airway pressure release ventilation is a time-cycled alternant between two levels of positive airway pressure, with the main time on the high level and a brief expiratory release to facilitate ventilation. [5]Airway pressure release ventilation is usually utilized as a type of inverse ratio ventilation.

The exhalation time (T low) is shortened to usually less than one second to maintain alveoli inflation. In the basic sense, this is a continuous pressure with a brief release. APRV currently the most efficient conventional mode for lung protective ventilation. [6]Different perceptions of this mode may exist around the globe. While 'APRV' is common to users in North America, a very similar mode, biphasic positive airway pressure (BIPAP), was introduced in Europe.

[7] The term APRV has also been used in American journals where, from the ventilation characteristics, BIPAP would have been perfectly good terminology. [8] But Bi PAP (tm) is a trademark for a noninvasive ventilation mode in a specific ventilator (Respironics Inc.).

Other manufacturers have followed with their own brand names (BILEVEL, DUOPAP, BIVENT). Although similar in modality, these terms describe how a mode is intended to inflate the lung, rather than defining the characteristics of synchronization or the way spontaneous breathing efforts are supported. Intermittent mandatory ventilation has not always had the synchronized feature, so the division of modes were understood to be SIMV (synchronized) vs IMV (not-synchronized). Since the American Association for Respiratory Care established a nomenclature of mechanical ventilation the ""synchronized"" part of the title has been dropped and now there is only IMV.

Mandatory minute ventilation [ edit]Mandatory minute ventilation (MMV) allows spontaneous breathing with automatic adjustments of mandatory ventilation to the meet the patient’s preset minimum minute volume requirement. If the patient maintains the minute volume settings for V T x f, no mandatory breaths are delivered. If the patient's minute volume is insufficient, mandatory delivery of the preset tidal volume will occur until the minute volume is achieved.

The method for monitoring whether or not the patient is meeting the required minute ventilation (V E) differs by ventilator brand and model, but, in general, there is a window of monitored time, and a smaller window checked against the larger window (i.e., in the Dräger Evita® line of mechanical ventilators there is a moving 20-second window, and every 7 seconds the current tidal volume and rate are measured) to decide whether a mechanical breath is needed to maintain the minute ventilation.

MMV is an optimal mode for weaning in neonatal and pediatric populations and has been shown to reduce long-term complications related to mechanical ventilation. [9]Pressure-regulated volume control [ edit]Pressure-regulated volume control is an IMV based mode. Pressure-regulated volume control utilizes pressure-limited, volume-targeted, time-cycled breaths that can be either ventilator- or patient-initiated.

The peak inspiratory pressure delivered by the ventilator is varied on a breath-to-breath basis to achieve a target tidal volume that is set by the clinician.

For example, if a target tidal volume of 500 m L is set but the ventilator delivers 600 m L, the next breath will be delivered with a lower inspiratory pressure to achieve a lower tidal volume. Though PRVC is regarded as a hybrid mode because of its tidal-volume (VC) settings and pressure-limiting (PC) settings fundamentally PRVC is a pressure-control mode with adaptive targeting. Continuous positive airway pressure [ edit]Continuous positive airway pressure (CPAP) is a non-invasive positive pressure mode of respiratory support.

CPAP is a pressure applied at the end of exhalation to keep the alveoli open and not fully deflate. This mechanism for maintaining inflated alveoli helps increase partial pressure of oxygen in arterial blood, an appropriate increase in CPAP increases the Pa O 2.

CPAP is not technically a mode of ""ventilation"" as it does not directly affect the minute volume.

Automatic positive airway pressure [ edit]Automatic positive airway pressure (APAP) is a form of CPAP that automatically tunes the amount of pressure delivered to the patient to the minimum required to maintain an unobstructed airway on a breath-by-breath basis by measuring the resistance in the patient's breathing. Bilevel positive airway pressure [ edit]Bilevel positive airway pressure (BPAP) is a mode used during non-invasive ventilation (NIV).

First used in 1988 by Professor Benzer in Austria, [10] it delivers a preset inspiratory positive airway pressure (IPAP) and expiratory positive airway pressure (EPAP). BPAP can be described as a Continuous Positive Airway Pressure system with a time-cycled change of the applied CPAP level.

[11] CPAP, BPAP and other non-invasive ventilation modes have been shown to be effective management tools for chronic obstructive pulmonary disease and acute respiratory failure.

[12]Often BPAP is incorrectly referred to as ""Bi PAP"". Bi PAP® is the name of a portable ventilator manufactured by Respironics Corporation; it is just one of many ventilators that can deliver BPAP. High-frequency ventilation (Active) [ edit]The term active refers to the ventilator's forced expiratory system.

In a HFV-A scenario, the ventilator uses pressure to apply an inspiratory breath and then applies an opposite pressure to force an expiratory breath. In high-frequency oscillatory ventilation (sometimes abbreviated HFOV) the oscillation bellows and piston force positive pressure in and apply negative pressure to force an expiration. [13]High-frequency ventilation (Passive) [ edit]The term passive refers to the ventilator's non-forced expiratory system.

In a HFV-P scenario, the ventilator uses pressure to apply an inspiratory breath and then returns to atmospheric pressure to allow for a passive expiration. This is seen in High-Frequency Jet Ventilation, sometimes abbreviated HFJV. Also categorized under High Frequency Ventilation is High Frequency Percussive Ventilation, sometimes abbreviated HFPV. With HFPV it utilizes an open circuit to deliver its subtidal volumes by way of the patient interface known as the Phasitron.

Volume guarantee [ edit]Volume guarantee an additional parameter available in many types of ventilators that allows the ventilator to change its inspiratory pressure setting to achieve a minimum tidal volume. This is utilized most often in neonatal patients who need a pressure controlled mode with a consideration for volume control to minimize volutrauma. Spontaneous breathing and support settings [ edit]Positive end-expiratory pressure [ edit]Positive end expiratory pressure (PEEP) is pressure applied upon expiration.

PEEP is applied using either a valve that is connected to the expiratory port and set manually or a valve managed internally by a mechanical ventilator. PEEP is a pressure that an exhalation has to bypass, in effect causing alveoli to remain open and not fully deflate. This mechanism for maintaining inflated alveoli helps increase partial pressure of oxygen in arterial blood, and an increase in PEEP increases the Pa O 2. [14]Pressure support [ edit]

Pressure support is a spontaneous mode of ventilation also named Pressure Support Ventilation (PSV). The patient initiates every breath and the ventilator delivers support with the preset pressure value. With support from the ventilator, the patient also regulates their own respiratory rate and their tidal volume.

For longer term settings a tracheostomy tube is used instead. In the chronic (long term) setting, indications for tracheotomy include the need for long-term mechanical ventilation and tracheal toilet (e.g. comatose patients, or extensive surgery involving the head and neck).

Tracheotomy

"From Wikipedia, the free encyclopedianavigation search This article is about the surgical procedure called a tracheotomy.

For a similar procedure, see Cricothyrotomy. Tracheotomy Completed tracheotomy:1 – Vocal folds 2 – Thyroid cartilage 3 – Cricoid cartilage 4 – Tracheal rings5 – Balloon cuff ICD-10-PCS 0B110F4ICD-9-CM 31.1Me SH D014140Medline Plus 002955 [ edit on Wikidata]Tracheotomy ( US: / ˌ t r eɪ k i ˈ ɒ t əm i / tray-kee- AW -tə-mee ), or tracheostomy, is a surgical procedure which consists of making an incision on the anterior aspect of the neck and opening a direct airway through an incision in the trachea (windpipe). The resulting stoma (hole) can serve independently as an airway or as a site for a tracheal tube or tracheostomy tube [1] to be inserted; this tube allows a person to breathe without the use of the nose or mouth.

Contents [ hide ]1 Etymology and terminology2 Indications2.1 Long term ventilation2.2 Bypassing upper airway blockages3 Parts4 Surgical procedure4.1 Instruments4.2 Percutaneous tracheotomy4.3 The translaryngeal tracheostomy TLT Fantoni method5 Complications6 Alternatives7 Routine care7.1 Suctioning8 History8.1 Prior to 16th century8.2 16th–18th centuries8.3 19th century8.4 20th century9 See also10 References11 External links Etymology and terminology [ edit]The etymology of the word tracheotomy comes from two Greek words: the root tom- (from Greek τομή tomḗ) meaning ""to cut"", and the word trachea (from Greek τραχεία tracheía ).

[2] The word tracheostomy, including the root stom- (from Greek στόμα stóma) meaning ""mouth,"" refers to the making of a semi-permanent or permanent opening, and to the opening itself.

Some sources offer different definitions of the above terms. Part of the ambiguity is due to the uncertainty of the intended permanence of the stoma at the time it is created. [3]Indications [ edit]Long term ventilation [ edit]Main article: Mechanical ventilation Tracheotomy tubes and endotracheal tubes are often attached to ventilators to assist in breathing. An endotracheal tube (above) used in acute settings requires sedation.

Tracheotomy may result in a significant reduction in the administration of sedatives and vasopressors, as well as the duration of stay in the intensive care unit. [4] In extreme cases, the procedure may be indicated as a treatment for severe obstructive sleep apnea (OSA) seen in patients intolerant of continuous positive airway pressure (CPAP) therapy.

The reason tracheostomy works well for OSA is because it is the only surgical procedure that completely bypasses the upper airway. This procedure was commonly performed for obstructive sleep apnea until the 1980s, when other procedures such as the uvulopalatopharyngoplasty, genioglossus advancement, and maxillomandibular advancement surgeries were described as alternative surgical modalities for OSA.

Bypassing upper airway blockages [ edit]In the acute (short term) setting, indications for tracheotomy include such conditions as severe facial trauma, tumors of the head and neck (e.g., cancers, branchial cleft cysts ), and acute angioedema and inflammation of the head and neck.

In the context of failed orotracheal or nasotracheal intubation, either tracheotomy or cricothyrotomy may be performed. Parts [ edit]An outer cannula (top item) with inflatable cuff (top right), an inner cannula (center item) and an obturator (bottom item)A tracheostomy tube consists of an outer cannula or main shaft, an inner cannula, and an obturator.

The obturator is used when inserting the tracheostomy tube to guide the placement of the outer cannula and is removed once the outer cannula is in place.

The outer cannula remains in place but, because of the buildup of secretions, there is an inner cannula that may be removed for cleaning or replaced. Tracheostomy tubes may have cuffs, inflatable balloons at the end of the tube to secure it in place.

A tracheostomy tube may be fenestrated with one or several holes to let air through the larynx, allowing speech. [5]Surgical procedure [ edit]Instruments [ edit]As with most other surgical procedures, some cases are more difficult than others. Surgery on children is more difficult because of their smaller size. Difficulties such as a short neck and bigger thyroid glands make the trachea hard to open.

[6] There are other difficulties with patients with irregular necks, the obese, and those with a large goitre.

The many possible complications include hemorrhage, loss of airway, subcutaneous emphysema, wound infections, stomal cellulites, fracture of tracheal rings, poor placement of the tracheostomy tube, and bronchospasm"". [7]By the late 19th century, some surgeons had become proficient in performing the tracheotomy procedure.

The main instruments used were:“Two small scalpels, one short grooved director, a tenaculum, two aneurysm needles which may be used as retractors, one pair of artery forceps, haemostatic forceps, two pairs of dissecting forceps, a pair of scissors, a sharp-pointed tenotome, a pair of tracheal forceps, a tracheal dilator, tracheotomy tubes, ligatures, sponges, a flexible catheter, and feathers”.

[6]Haemostatic forceps were used to control bleeding from separated vessels that were not ligatured because of the urgency of the operation. Generally, they were used to expose the trachea by clamping the isthmus thyroid gland on both sides. To open the trachea physically, a sharp-pointed tentome allowed the surgeon easily to place the ends into the opening of the trachea. The thin points permitted the doctor a better view of his incision. Tracheal dilators, such as the “Golding Bird”, were placed through the opening and then expanded by “turning the screw to which they are attached.” Tracheal forceps, as displayed on the right, were commonly used to extract foreign bodies from the larynx.

The optimum tracheal tube at the time caused very little damage to the trachea and “mucus membrane”. [6]The best position for a tracheotomy was and still is one that forces the neck into the biggest prominence.

Usually, the patient was laid on his back on a table with a cushion placed under his shoulders to prop him up. The arms were restrained to ensure they would not get in the way later. [6] The tools and techniques used today in tracheotomies have come a long way. The tracheotomy tube placed into the incision through the windpipe comes in various sizes, thus allowing a more comfortable fit and the ability to remove the tube in and out of the throat without disrupting support from a breathing machine.

In today’s world general anesthesia is used when performing these surgeries, which makes it much more tolerable for the patient. Special tracheostomy tube valves (such as the Passy-Muir valve [8]) have been created to assist people in their speech.

The patient can inhale through the unidirectional tube. Upon expiration, pressure causes the valve to close, redirecting air around the tube, past the vocal folds, producing sound. [9]Significant improvements to surgical instruments for tracheotomy include the direct suction tracheotomy tube invented by Josephine G. Fountain (RN); she was awarded patent no.

3039469 in 1962 for the direct suction tracheotomy tube, which improved the ways mucus could be cleared from the trachea and increased patient breathing and comfort.

[10]Percutaneous tracheotomy [ edit]While there were some earlier false starts, the first widely accepted percutaneous tracheotomy technique was described by Pat Ciaglia, a New York surgeon, in 1985. This technique involves a series of sequential dilatations using a set of seven dilators of progressively larger size. [11] The next widely used technique was developed in 1989 by Bill Griggs, an Australian intensive care specialist.

This technique involves the use of a specially modified pair of forceps with a central hole enabling them to pass over a guidewire enabling the performance of the main dilation in a single step. [12] Since then a number of other techniques have been described. In 1995, Fantoni developed a translaryngeal approach of percutaneous tracheostomy which involves passing a guidewire through the larynx and over it railroading a tracheostomy tube with a cone shaped structure.

It is also known as the In-and-out procedure. A variant of the original Ciaglia technique, using a single tapered dilator known as a ""blue rhino"", is the most commonly used of these newer techniques and has largely taken over from the early multiple dilator technique. Ambesh SP (2005) introduced a T-Trach kit (T-Dagger) which contains a T-shaped dilator with an elliptical shaft. The shaft of the dilator is marked in its length according to the sizes of tracheostomy tube to be introduced and has a number of holes.

This T-shaped dilator provides better grip during its introduction and its elliptical shaft forms a calibrated tracheal stoma between two tracheal rings and minimizes tracheal ring fracture. [13] The Griggs and Ciaglia Blue Rhino techniques are the two main techniques in current use. A number of comparison studies have been undertaken between these two techniques with no clear differences emerging [14]The translaryngeal tracheostomy TLT Fantoni method [ edit]The translaryngeal tracheostomy is a percutaneous technique characterized by the exclusive procedure to carry out the stoma.

A cone of soft plastic material, welded to a flexible cannula, is passed into trachea through the glottis, and then extracted outside of the neck through the pretracheal layers.

The direction of this dilational manoeuvre is from the inside of the tracheal lumen to the outside of the neck (In/Out) and therefore completely opposite to the Out/In of other traditional percutaneous tracheostomies.

The cone is then separated from the cannula, which results in it being positioned in the trachea. This method ensures considerable advantages, two of which are of particular importance: the abolition of the risk of perforation of the posterior wall and the reduction of local trauma to a level that is unlikely to be further lowered.

The use of a ventilation catheter during the time of the procedure allows full control of the airway and to extend the indications of the technique to patients with severe respiratory failure.

Complications [ edit]A 2000 Spanish study of bedside percutaneous tracheostomy reported overall complication rates of 10–15% and a procedural mortality of 0%, [15] which is comparable to those of other series reported in the literature from the Netherlands [16] [17] and the United States. [18] [19]A 2003 American cadaveric study identified multiple tracheal ring fractures with the Ciaglia Blue Rhino technique as a complication occurring in 100% of their small series of cases.

[20] The comparative study above also identified ring fractures in 9 of 30 live patients [14] while another small series identified ring fractures in 5 of their 20 patients.

[21] The long term significance of tracheal ring fractures is unknown. [ citation needed]But the main complication of this procedure is obstruction of the hole due to accumulation of mucus produced by respiratory normal flora, which in turn will lead to hypoxia and further complications due to reduced level of oxygen received by lungs. [22]Alternatives [ edit]Biphasic cuirass ventilation is a form of non-invasive mechanical ventilation that can in many cases allow patients an alternative mode of respiratory support, allowing patients to avoid an invasive tracheostomy and its many complications.

While this method has not been proven to help in every case, it has been shown to be an effective alternative for many. [ citation needed]Routine care [ edit]Suctioning [ edit]Caring for a tracheotomy mostly includes suctioning to prevent occlusions and replacing supplies.

Because of the lack of filtering and humidifying by the nose and the ineffective cough mechanism, there is a buildup of secretions. Suctioning is only performed when clinically necessary because there are many potential risks. Risks include hypoxia and so suctioning is limited to 10 to 20 seconds at a time and the patient is hyperoxygenated just before and after suctioning.

Risks also include atelectasis, or collapsing lung tissue from high suction pressure, and so pressure is limited to 80–120 mm Hg. Risks also include tissue damage. The suction catheter is inserted no more than 1 cm past the length of the tube to avoid contact with trachea tissue.

Suctioning is only done during withdrawing the catheter at least 1/2 inch. Risks also include infection. [5]History [ edit]A tracheostomy from prior to the 20th century Prior to 16th century [ edit]Tracheotomy was first depicted on Egyptian artifacts in 3600 BC.

[23] Hippocrates condemned the practice of tracheotomy as incurring an unacceptable risk of damage to the carotid artery. Warning against the possibility of death from inadvertent laceration of the carotid artery during tracheotomy, he instead advocated the practice of tracheal intubation.

[7]Despite the concerns of Hippocrates, it is believed that an early tracheotomy was performed by Asclepiades of Bithynia, who lived in Rome around 100 BC.

Galen and Aretaeus, both of whom lived in Rome in the 2nd century AD, credit Asclepiades as being the first physician to perform a non-emergency tracheotomy. Antyllus, another Roman physician of the 2nd century AD, supported tracheotomy when treating oral diseases.

He refined the technique to be more similar to that used in modern times, recommending that a transverse incision be made between the third and fourth tracheal rings for the treatment of life-threatening airway obstruction. [7]In 1000, Abu al-Qasim al-Zahrawi (936–1013), an Arab who lived in Arabic Spain, published the 30-volume Kitab al-Tasrif, the first illustrated work on surgery.

He never performed a tracheotomy, but he did treat a slave girl who had cut her own throat in a suicide attempt. Al-Zahrawi (known to Europeans as Albucasis) sewed up the wound and the girl recovered, thereby proving that an incision in the larynx could heal. Circa AD 1020, Avicenna (980–1037) described tracheal intubation in The Canon of Medicine in order to facilitate breathing.

[24] The first correct description of the tracheotomy operation for treatment of asphyxiation was described by Ibn Zuhr (1091–1161) in the 12th century. According to Mostafa Shehata, Ibn Zuhr (also known as Avenzoar) successfully practiced the tracheotomy procedure on a goat, justifying Galen's approval of the operation.

[25]16th–18th centuries [ edit]The European Renaissance brought with it significant advances in all scientific fields, particularly surgery. Increased knowledge of anatomy was a major factor in these developments. Surgeons became increasingly open to experimental surgery on the trachea. During this period, many surgeons attempted to perform tracheotomies, for various reasons and with various methods. Many suggestions were put forward, but little actual progress was made toward making the procedure more successful.

The tracheotomy remained a dangerous operation with a very low success rate, [ quantify] and many surgeons still considered the tracheotomy to be a useless and dangerous procedure. The high mortality rate [ quantify] for this operation, which had not improved, supported their position.

From the period 1500 to 1832 there are only 28 known reports of tracheotomy. [26] In 1543, Andreas Vesalius (1514–1564) wrote that tracheal intubation and subsequent artificial respiration could be life-saving. Antonio Musa Brassavola (1490–1554) of Ferrara treated a patient suffering from peritonsillar abscess by tracheotomy after the patient had been refused by barber surgeons.

The patient apparently made a complete recovery, and Brassavola published his account in 1546. This operation has been identified as the first recorded successful tracheostomy, despite many ancient references to the trachea and possibly to its opening.

[26] Ambroise Paré (1510–1590) described suture of tracheal lacerations in the mid-16th century. One patient survived despite a concomitant injury to the internal jugular vein.

Another sustained wounds to the trachea and esophagus and died. Hieronymus Fabricius Towards the end of the 16th century, anatomist and surgeon Hieronymus Fabricius (1533–1619) described a useful technique for tracheotomy in his writings, although he had never actually performed the operation himself. He advised using a vertical incision and was the first to introduce the idea of a tracheostomy tube. This was a straight, short cannula that incorporated wings to prevent the tube from advancing too far into the trachea.

He recommended the operation only as a last resort, to be used in cases of airway obstruction by foreign bodies or secretions. Fabricius' description of the tracheotomy procedure is similar to that used today. Julius Casserius (1561–1616) succeeded Fabricius as professor of anatomy at the University of Padua and published his own writings regarding technique and equipment for tracheotomy.

Casserius recommended using a curved silver tube with several holes in it. Marco Aurelio Severino (1580–1656), a skillful surgeon and anatomist, performed multiple successful tracheotomies during a diphtheria epidemic in Naples in 1610, using the vertical incision technique recommended by Fabricius. He also developed his own version of a trocar. [27]In 1620 the French surgeon Nicholas Habicot (1550–1624), surgeon of the Duke of Nemours and anatomist, published a report of four successful ""bronchotomies"" which he had performed.

[28] One of these is the first recorded case of a tracheotomy for the removal of a foreign body, in this instance a blood clot in the larynx of a stabbing victim.

He also described the first tracheotomy to be performed on a pediatric patient. A 14-year-old boy swallowed a bag containing 9 gold coins in an attempt to prevent its theft by a highwayman. The object became lodged in his esophagus, obstructing his trachea. Habicot suggested that the operation might also be effective for patients suffering from inflammation of the larynx.

He developed equipment for this surgical procedure which displayed similarities to modern designs (except for his use of a single-tube cannula). Sanctorius (1561–1636) is believed to be the first to use a trocar in the operation, and he recommended leaving the cannula in place for a few days following the operation. [29] Early tracheostomy devices are illustrated in Habicot’s Question Chirurgicale [28] and Julius Casserius' posthumous Tabulae anatomicae in 1627.

[30] Thomas Fienus (1567–1631), Professor of Medicine at the University of Louvain, was the first to use the word ""tracheotomy"" in 1649, but this term was not commonly used until a century later.

[31] Georg Detharding (1671–1747), professor of anatomy at the University of Rostock, treated a drowning victim with tracheostomy in 1714. [32] [33] [34]19th century [ edit]In the 1820s, the tracheotomy began to be recognized as a legitimate means of treating severe airway obstruction. In 1832, French physician Pierre Bretonneau employed it as a last resort to treat a case of diphtheria. [35] In 1852, Bretonneau's student Armand Trousseau reported a series of 169 tracheotomies (158 of which were for croup, and 11 for ""chronic maladies of the larynx"") [36] In 1858, John Snow was the first to report tracheotomy and cannulation of the trachea for the administration of chloroform anesthesia in an animal model.

[37] In 1871, the German surgeon Friedrich Trendelenburg (1844–1924) published a paper describing the first successful elective human tracheotomy to be performed for the purpose of administration of general anesthesia. [38] In 1880, the Scottish surgeon William Macewen (1848–1924) reported on his use of orotracheal intubation as an alternative to tracheotomy to allow a patient with glottic edema to breathe, as well as in the setting of general anesthesia with chloroform.

[39] [40] At last, in 1880 Morrell Mackenzie's book discussed the symptoms indicating a tracheotomy and when the operation is absolutely necessary. [7]20th century [ edit]In the early 20th century, physicians began to use the tracheotomy in the treatment of patients afflicted with paralytic poliomyelitis who required mechanical ventilation. However, surgeons continued to debate various aspects of the tracheotomy well into the 20th century.

Many techniques were described and employed, along with many different surgical instruments and tracheal tubes. Surgeons could not seem to reach a consensus on where or how the tracheal incision should be made, arguing whether the ""high tracheotomy"" or the ""low tracheotomy"" was more beneficial. The currently used surgical tracheotomy technique was described in 1909 by Chevalier Jackson of Pittsburgh, Pennsylvania.

Jackson emphasised the importance of postoperative care, which dramatically reduced the death rate. By 1965, the surgical anatomy was thoroughly and widely understood, antibiotics were widely available and useful for treating postoperative infections, and other major complications had also become more manageable. See also [ edit]Cricothyrotomy Laryngotomy List of surgeries by type References [ edit]^ Molnar, Heather.

""Types of Tracheostomy Tubes"".^ Romaine F. Johnson (6 March 2003). ""Adult Tracheostomy"". Houston, Texas: Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine.

Archived from the original on 17 May 2008.^ Jonathan P Lindman; Charles E Morgan (7 June 2010). ""Tracheostomy"". emedicine from Web MD. External link in |publisher= ( help)^ Eberhardt, Lars Karl (2008). ""Dilatational Tracheostomy on an Intensive Care Unit"".^ a b Taylor, C. R., Lillis, C., Le Mone, P., Lynn, P. (2011) Fundamentals of nursing: The art and science of nursing care. Philadelphia: Lippincott Williams & Wilkins, page 1382-1383, 1404.^ a b c d Wharton, Henry R. (January 1897).

""Minor Surgery and Bandaging"". American Journal of the Medical Sciences. 113 (1): 104–106. doi: 10.1097/00000441-189701000-00008.^ a b c d Alfio Ferlito; Alessandra Rinaldo; Ashok R. Shaha; Patrick J. Bradley (December 2003). ""Percutaneous Tracheotomy"". Acta Otolaryngologica. 123 (9): 1008–1012. doi: 10.1080/00016480310000485.

PMID 14710900.^ Passy, Victor; Baydur, A.; Prentice, W.; Darnell-Neal, R. (June 1993). ""Passy-muir® tracheostomy speaking valve on ventilator-dependent patients"". Laryngoscope. 103 (6): 653–658. doi: 10.1288/00005537-199306000-00013. PMID 8502098.^ James H. Cullen (1 June 1963). ""An Evaluation of Tracheostomy in Pulmonary Emphysema"". Annals of Internal Medicine. 58 (6): 953–960. doi: 10.7326/0003-4819-58-6-953. PMID 14024192.^ US patent 3039469^ Ciaglia P, Firsching R, Syniec C (June 1985). ""Elective percutaneous dilatational tracheostomy. A new simple bedside procedure; preliminary report"". Chest. 87 (6): 715–9. doi: 10.1378/chest.87.6.715. PMID 3996056.^ Griggs WM, Worthley LI, Gilligan JE, Thomas PD, Myburg JA (June 1990). ""A simple percutaneous tracheostomy technique"". Surgery, Gynecology & Obstetrics. 170 (6): 543–5.

PMID 2343371.^ Ambesh SP, Tripathi M, Pandey CK, Pant KC, Singh PK (July 2005). ""Clinical evaluation of the 'T-Dagger': a new bedside percutaneous dilational tracheostomy device"". Anaesthesia. 60 (7): 708–11. doi: 10.1111/j.1365-2044.2005.04236.x. PMID 15960723.^ a b Ambesh SP, Pandey CK, Srivastava S, Agarwal A, Singh DK (December 2002). ""Percutaneous tracheostomy with single dilatation technique: a prospective, randomized comparison of Ciaglia blue rhino versus Griggs' guidewire dilating forceps"". Anesthesia and Analgesia. 95 (6): 1739–45, table of contents. doi: 10.1097/00000539-200212000-00050.

PMID 12456450.^ Añón JM, Gómez V, Escuela MP, et al. (2000). ""Percutaneous tracheostomy: comparison of Ciaglia and Griggs techniques"". Critical Care. 4 (2): 124–8. doi: 10.1186/cc667. PMC 29040. PMID 11056749.^ van Heurn LW, van Geffen GJ, Brink PR (July 1996). ""Clinical experience with percutaneous dilatational tracheostomy: report of 150 cases"". The European Journal of Surgery.

162 (7): 531–5. PMID 8874159.^ Polderman KH, Spijkstra JJ, de Bree R, et al. (May 2003). ""Percutaneous dilatational tracheostomy in the ICU: optimal organization, low complication rates, and description of a new complication"".

Chest. 123 (5): 1595–602. doi: 10.1378/chest.123.5.1595. PMID 12740279.^ Hill BB, Zweng TN, Maley RH, Charash WE, Toursarkissian B, Kearney PA (August 1996). ""Percutaneous dilational tracheostomy: report of 356 cases"". The Journal of Trauma. 41 (2): 238–43; discussion 243–4. doi: 10.1097/00005373-199608000-00007. PMID 8760530.^ Powell DM, Price PD, Forrest LA (February 1998).

""Review of percutaneous tracheostomy"". The Laryngoscope. 108 (2): 170–7. doi: 10.1097/00005537-199802000-00004. PMID 9473064.^ Hotchkiss KS, Mc Caffrey JC (January 2003). ""Laryngotracheal injury after percutaneous dilational tracheostomy in cadaver specimens"". The Laryngoscope. 113 (1): 16–20. doi: 10.1097/00005537-200301000-00003. PMID 12514375.^ Byhahn C, Lischke V, Halbig S, Scheifler G, Westphal K (March 2000).

""Ciaglia Blue Rhino: Ein weiterentwickeltes Verfahren der perkutanen Dilatationstracheotomie"" [Ciaglia blue rhino: a modified technique for percutaneous dilatation tracheostomy. Technique and early clinical results]. Der Anaesthesist (in German). 49 (3): 202–6. doi: 10.1007/s001010050815.

PMID 10788989.^ university of Jordan. Faculty of medicine, department of anesthesia.^ Steven E. Sittig; James E. Pringnitz (February 2001). ""Tracheostomy: evolution of an airway"" (PDF). AARC Times: 48–51.^ Patricia Skinner (2008). ""Unani-tibbi"".

In Laurie J. Fundukian. The Gale Encyclopedia of Alternative Medicine (3rd ed.). Farmington Hills, Michigan: Gale Cengage. ISBN 978-1-4144-4872-5. External link in |publisher= ( help)^ Mostafa Shehata (April 2003). ""The Ear, Nose and Throat in Islamic Medicine"" (PDF). Journal of the International Society for the History of Islamic Medicine. 2 (3): 2–5. ISSN 1303-667X.^ a b Goodall, E. W. (1934).

""The story of tracheostomy"". British Journal of Children's Diseases. 31: 167–76, 253–72.^ Armytage WHG (1960). ""Nova et Vetera"". British Medical Journal. 1 (5179): 1129–1130. doi: 10.1136/bmj.1.5179.1129. PMC 1966956.^ a b Nicholas Habicot (1620). Question chirurgicale par laquelle il est démonstré que le Chirurgien doit assurément practiquer l'operation de la Bronchotomie, vulgairement dicte Laryngotomie, ou perforation de la fluste ou du polmon (in French).

Paris: Corrozet. p. 108.^ Sanctorii Sanctorii (1646). Sanctorii Sanctorii Commentaria in primum fen, primi libri canonis Avicennæ (in Latin). Venetiis: Apud Marcum Antonium Brogiollum. p. 1120. OL 15197097M.^ Julius Casserius (Giulio Casserio) and Daniel Bucretius (1632).

Tabulae anatomicae LXXIIX ... Daniel Bucretius ... XX. que deerant supplevit & omnium explicationes addidit (in Latin). Francofurti: Impensis & coelo Matthaei Meriani.^ Cawthorne T, Hewlett AB, Ranger D (1959). ""Discussion: Tracheostomy To-Day"". Proceedings of the Royal Society of Medicine. 52 (6): 403–405. PMC 1871130. PMID 13667911.^ Georges Detharding (1745). ""De methodo subveniendi submersis per laryngotomiam (1714)"". In Von Ernst Ludwig Rathlef; Gabriel Wilhelm Goetten; Johann Christoph Strodtmann. Geschichte jetzlebender Gelehrten, als eine Fortsetzung des Jetzlebenden. Zelle: Berlegts Joachim Undreas Deek.

p. 20.^ Price JL (1962). ""THE EVOLUTION OF BREATHING MACHINES"". Medical History. 6 (1): 67–72. doi: 10.1017/s0025727300026867. PMC 1034674. PMID 14488739.^ Wischhusen HG, Schumacher GH (1977).

""Curriculum vitae des Rostocker Professors für Anatomie, Botanik und der höheren Mathematik"" [Curriculum vitae of the professor of anatomy, botany and higher mathematics Georg Detharding (1671–1747) at the University of Rostock]. Anatomischer Anzeiger (in German). 142 (1–2): 133–40. PMID 339777.^ Armand Trousseau (1833). ""Mémoire sur un cas de tracheotomie pratiquée dans la période extrème de croup"". Journal des connaissances médico-chirurgicales. 1 (5): 41.^ Armand Trousseau (1852). ""Nouvelles recherches sur la trachéotomie pratiquée dans la période extrême du croup"".

In Jean Lequime and J. de Biefve. Annales de médecine belge et étrangère. Brussels: Imprimerie et Librairie Société Encyclographiques des Sciences Médicales. pp. 279–288.^ Snow, J (1858). ""Fatal cases of inhalation of chloroform, Treatment of suspended animation from chloroform"". In Richardson, BW. On chloroform and other anaesthetics: their action and administration. London: John Churchill. pp. 120–200, 251–62.^ Trendelenburg, F (1871). ""Beiträge zu den Operationen an den Luftwegen"" [Contributions to airways surgery].

Archiv für Klinische Chirurgie (in German). 12: 112–33.^ Macewen, W (1880). ""General Observations on the Introduction of Tracheal Tubes by the Mouth, Instead of Performing Tracheotomy or Laryngotomy"". British Medical Journal. 2 (1021): 122–4. doi: 10.1136/bmj.2.1021.122. PMC 2241154. PMID 20749630.^ Macewen, W (1880). ""Clinical Observations on the Introduction of Tracheal Tubes by the Mouth, Instead of Performing Tracheotomy or Laryngotomy"".

British Medical Journal. 2 (1022): 163–5. doi: 10.1136/bmj.2.1022.163. PMC 2241109. PMID 20749636. External links [ edit]Wikimedia Commons has media related to Tracheotomy. Look up tracheotomy, pharyngotomy, laryngotomy, or tracheostomy in Wiktionary, the free dictionary. Plotnikow GA, Roux N, Feld V, et al. (October 2013). ""Evaluation of tracheal cuff pressure variation in spontaneously breathing patients"". International Journal of Critical Illness and Injury Science. 3 (4): 262–8. doi: 10.4103/2229-5151.124148. PMC 3891193. PMID 24459624. Tracheotomy Info (A Community For Tracheotomy-wearers and the people who love them) at tracheotomy.info Tracheostomy Products and Support (Online resource for tracheostomy products, supplies and support) at trachs.com Aaron's tracheostomy page (Caring for a tracheostomy) at tracheostomy.com (Pictures with video clipping) at drtbalu.com [1] [2]"" Tracheotomy "" at Dorland's Medical Dictionary Smiths Medical Tracheostomy Training Videos A Video of Rescue Breathing for Laryngectomees and Neck Breathers""Book of Simplification Concerning Therapeutics and Diet"", is a manuscript from 1497 that discusses tracheotomies Site and blog with information about tracheostomies Global Tracheostomy Collaborative. International collaborative with resources for hospitals, caregivers, and patients about tracheostomies, including international research [3]Dilatational Tracheostomy On An Intensive Care Unit [ hide]v t e Tests, surgery and other procedures involving the respiratory system ( ICD-9-CM V3 21–22, 30–34, ICD-10-PCS 0B)Upper RTnose Rhinoplasty Septoplasty Alarplasty Rhinectomy Rhinomanometry Acoustic rhinometrysinus Sinusotomylarynx Laryngoscopy Laryngectomy Laryngotomy Thyrotomy Laryngotracheal reconstruction Lower RTtrachea Cricothyrotomy Tracheoesophageal puncture Tracheotomybronchus Bronchoscopylung Pneumonectomy Lobectomy Wedge resection Lung transplantation Decortication of lung Heart–lung transplant Chest wall, pleura, mediastinum, and diaphragmpleura / pleural cavity Thoracentesis Pleurodesis Thoracoscopy Thoracotomy Chest tubemediastinum Mediastinoscopy Nuss procedure Medical imaging Bronchography CT pulmonary angiogram High-resolution computed tomography Spiral CTVentilation/perfusion scan CPRs Pneumonia severity index CURB-65Lung function test Body plethysmography Spirometry Bronchial challenge test Capnography Diffusion capacity Cytology Sputum culture Bronchoalveolar lavage Respiratory therapy / intubation Artificial respiration CPR Hyperbaric medicine Decompression chamber Heliox Mechanical ventilation Nebulizer Negative pressure ventilator Oxygen therapy Positive pressure ventilation Postural drainage Surgical airway management Categories: Emergency medical procedures Otorhinolaryngology Trachea surgery Sleep surgery "

A tracheostomy (tray-kee-OS-tuh-me) is an opening cut into the windpipe, or trachea. It is used as an airway for breathing. After the opening is made, a small tube is inserted to let air in, and to attach a breathing machine (mechanical ventilator) if needed. Mucus can more easily be coughed up and out or removed with a suction catheter.

Tracheostomy â What Does It Mean?

Tracheostomy — What Does It Mean? What is a tracheostomy?

Why would someone need a tracheostomy? Some reasons a person may need a tracheostomy include: Having a breathing tube (endotracheal [end-o-TRAK-eall] tube) for one to two weeks and on a machine that helps a patient to breathe (a ventilator)Having mucus in the lungs and not being able to cough strongly enough to remove it An allergic reaction that has made the airway swell and possibly close Surgery of the head or neck How is a tracheostomy better than an endotracheal tube?

Advantages of the tracheostomy include: More comfort Easier cleaning of the mouth and face May allow swallowing and the ability to eat and drink May allow speech with the help of a speaking device May help weaning from the ventilator May reduce swelling in the airway and mouth caused by having an endo-tracheal tube in place for a long time Who will perform the tracheostomy?

A doctor will perform this surgery in the operating room or at the bedside in the intensive care unit. What happens when the patient doesn’t need the ventilator to breathe anymore? When someone is “weaned” (able to breathe without the help of a ventilator), the tracheostomy may still be needed for some time to help the patient breathe more easily and cough out mucus.

The patient must be able to cough and breathe deeply before the tracheostomy tube is taken out. Can a person speak with a tracheostomy? There are devices that can help some patients speak. The device can be put over the end of the tracheostomy tube.

When the patient takes a breath, the valve opens to let air into the lungs. When the patient breathes out, the valve closes. Then all the air passes through the vocal cords and out of the mouth or nose. The movement of air through the vocal cords lets the patient speak as long as he or she can take a deep enough breath to push air through the windpipe.

Not all patients who have a tracheostomy tube can use a speaking device. The patient can be evaluated by the health care team to decide if this is possible. Specific instructions will be given if the patient is able to use a speaking device. How is the tracheostomy tube removed? When the patient no longer needs the tracheostomy tube, the doctor may cover the opening with a plug to test the patient’s breathing for a period of time.

Once the tube is removed, the hole in the skin will be covered with sterile gauze. The wall of the windpipe and the hole in the skin may close in time. Occasionally, depending on why the tracheostomy was performed, the hole is permanently left open. This hole is called a stoma. Reviewed 2011

Once the tube is in, it is secured, and it can be attached to a mechanical ventilator, anesthesia machine, or bag valve mask, also known as an ambu bag. An ambu bag can be manually manipulated to help the patient breathe. When a tube is threaded through the nose into the airway, it is called nasotracheal intubation. In both cases, a doctor carefully listens to the patient's breath sounds to ensure that the tube is in the trachea, and to make sure that air is being supplied to both lungs.

What is Intubation?

Intubation refers generally to inserting a flexible tube anywhere in the human body, but most people use it specifically to refer to tracheal intubation, which involves putting a down into someone's trachea to secure his or her airway.

The procedure is often used in emergency medicine when a patient is having difficulty breathing, and it is also used during surgery to keep the airway open for the delivery of anesthetic drugs and oxygen. In addition, patients on mechanical ventilators will be intubated so that the ventilator can breathe for them.

This can be a dangerous procedure when it is not performed properly, and training in intubation is usually quite extensive. To perform a tracheal intubation, a doctor or emergency medical technician ideally uses a laryngoscope, a medical device which is inserted into the mouth to open the jaw.

The laryngoscope also lets the doctor clearly see the patient's throat, ensuring that the tube is placed in the correct passage; if the procedure is performed improperly and the tube ends up in the esophagus, the results for the patient can be quite unpleasant and even deadly if not caught in time. An intubation tube is slowly threaded into the throat, with a doctor requesting a smaller or larger size if needed.

If the patient is at all conscious, he or she may fight the process, since it feels extremely unpleasant.

When the tube is removed, the procedure is known as extubation. Patients are extubated when they are feeling better, or when a surgery is over and the patient is ready to breathe on his or her own.

Intubation is also used for endoscopic procedures, procedures in which doctors look into the body with tools like cameras or medical devices which make visibility easier, like laryngoscopes. Endoscopy is used to diagnose various conditions all over the body, from the respiratory and gastrointestinal tracts to various organs in the abdomen. In order to perform endoscopy, a tube is inserted into the area of interest so that tools can be fed through it.

Ad You might also Like Recommended Related wise GEEK Articles What Is Intubation Sedation? What Is the Difference between a Tracheostomy and Intubation? What Is an Intubation Injury? What Is Asthma Intubation? What Is Neonatal Intubation? What Are Common Post-Intubation Complications?

What Is an Awake Intubation? Ad Discuss this Articleanon316363Post 3@kelly d: What probably occurred is that when using a laryngoscope to view the inside of your throat, it hit your teeth. We read about it and are told to avoid putting pressure on the teeth with the scope when trying to view the tracheal opening.anon92895Post 2@kellyd: Talk to your doctor or hospital.

Demand answers!kellyd Post 1I just went through a double mastectomy. When I woke up two of my teeth were broken and a large piece of skin is missing leaving exposed bone in my mouth which has not heeled in two months.

I am trying to figure out what machine could have done this to me during surgery. I can't find anything here that explains. How this could have happened? Could someone elaborate for me? Kelly Post your comments Post Anonymously Loginusernamepasswordforgot password? Registerusernamepasswordconfirmemail

.pressure trigger a trigger for initiating assisted ventilation, consisting of a mechanism formeasuring pressure and starting assisted ventilation when pressure reaches a given level.time trigger a trigger for initiating assisted ventilation, consisting of a mechanism thatmeasures frequency of respirations and starts assisted ventilation when the respiratoryfrequency is at a given point.

trigger

trigger Also found in: Dictionary, Thesaurus, Legal, Financial, Acronyms, Idioms, Encyclopedia, Wikipedia. Related to trigger: Trigger fingertrigger [ trig´er] an event that stimulates initiation of a subsequent event or process.flow trigger a trigger for initiating assisted ventilation, consisting of a mechanism for measuringthe patient's inspiratory effort and starting of assisted ventilation when flow reaches a givenlevel

Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health, Seventh Edition. © 2003 by Saunders, an imprint of Elsevier, Inc. All rights reserved.trig·ger ( trig'ĕr ), Term describing a system in which a relatively small input turns on a relatively large output,the magnitude of which is unrelated to the magnitude of the input. Farlex Partner Medical Dictionary © Farlex 2012trigger Etymology: D, trekker, that which pullsa substance, object, or agent that initiates or stimulates an action. Mosby's Medical Dictionary, 9th edition. © 2009, Elsevier.trigger Cell biology An event resulting in a cascade of intracellular activities.

Forensics The decision part of a firearm, the pulling of which, even if the gun being held is not loaded, is a critical element in a crime and a virtually indisputable sign of culpability. Health legislation An “if-then” clause placed in legislation, such that if certain actions do not occur by a predetermineddate, then a specific action is taken.

Triggers can be “hard” or “soft”, depending on the severity of the needed corrective measures. Managed care Any event (s) that causes a contingency plan to be implemented—e.g., a critical supplier does notdeliver a product in an appropriate timeframe. Psychiatry A factor that initiates and aggravates a behaviour or response. Pulmonary medicine A factor that may exacerbate asthma; a stimulus which causes an increase in asthma symptomsand/or airflow limitation.

Vox populi Any device or situation in which a minimal effort has a disproportionately great consequence. Segen's Medical Dictionary. © 2012 Farlex, Inc. All rights reserved.trigger Pulmonology A factor that may exacerbate asthma; a stimulus that causes an ↑ inasthma Sx and/or airflow limitation Mc Graw-Hill Concise Dictionary of Modern Medicine.

© 2002 by The Mc Graw-Hill Companies, Inc.trig·ger ( trig'ĕr) A substance, insect, object, or agent that initiates or stimulates an action. Medical Dictionary for the Health Professions and Nursing © Farlex 2012Patient discussion about trigger Q. What is the ingredient in perfume or Cologne that will trigger an asthma attack? There is something in cologne/perfume that's not in body spray that triggers my asthma.

I went out with a friend and he had on cologne and my asthma starting bothering me. Before going out my asthmahadn't bothered me in months because I stay away from things that may trigger an attack. Thisoften happens with other things like bleach, ajax or any bad odor A. Anything that irritates the nose and bronchi can cause an attack. No one really knowswhy...but it does. Cigarettes and pollution are common cause also. Q. how can these trigger his episodes and what exactly has happened to him?

My son is a bipolar patient. We took him to the doctor as his manic episode has started again. This episodewas a high one as compared to his previous episodes. Previous episodes used to get triggered due to his work related stress. He keeps himself in routine which makes his life comfortable.

Recently he went on a vacation with his colleagues. Once he was back I found his condition was worse andsoon his episodes started again. His regular medicines were not of any help. So I took him to thedoctor. His medicines were not changed except a new one was added. Doctor had told to reduce on any stress as much as possible. Strictly he has been told to reduce on anything which triggersstress like coffee, tea, high sugar intake, on cigarettes as well.

How can these trigger his episodesand what exactly has happened to him? A. Depending on the type of vacation he took it is possible that he drank a lot of alcohol whichinterfears with the effectivness of his medications.

It is also probable that he did not keep theroutine that he is on while on his vacation. If it was a tropical vacationhe could have spentmornings drinking coffee waking up from late nights.

There are so many possibilities. Now that he is home he can begin his routine again, take his medications as perscribed and you will seethat the episode passes.

I hope that for you and your son the episode passes quickly andwithout too much damage. Q. what is the difference between tender points and trigger points. I read somewhere in thenet that there are two points called tender and trigger points which are one of the symptoms of fibromyalgia.

Is that true? If so what is the difference between tender points and trigger points? A. What you have read about tender and trigger points are true. A tender point hurts to the touchand causes some degree of pain in that area, while a trigger point may not necessarily be painful to the touch but causes a degree of pain to be felt in another area.

Fibromyalgia patientstypically have a number of tender points and, according to the American College of Rheumatology, the diagnostic criteria for fibromyalgia stipulates that an FMS sufferer shouldhave pain upon palpation (i.e.

touch) in eleven of the generally accepted eighteen tender points. A tender point is verified in a physical examination in which approximately nine pounds of pressure are applied by touch and the patient acknowledges that pain is felt.

More discussions about trigger This content is provided by i Medix and is subject to i Medix Terms. The Questions and Answers are not endorsed or recommended and are made available by patients, not doctors. Want to thank TFD for its existence? Tell a friend about us, add a link to this page, or visit the webmaster's page for free fun content . Link to this page: Facebook Twitter

Continuous positive airway pressure (CPAP) machines are used to maintain an open airway in patients diagnosed with obstructive sleep apnea. The machine functions by blowing pressurized air into the airway via mask at a setting determined by sleep study and prescribed by a physician.

What is a CPAP Humidifier?

This pressurized air can cause patients to suffer from dry and irritated noses, dry mouths, and sore throats. A CPAP humidifier can add moisture to the air introduced with the CPAP and may help decrease discomfort. The continuous flow of air from a CPAP machine can be irritating to the tissues of the nose, mouth, and throat.

This irritation may result in nosebleeds, increased mucous, congestion, and coughing or sneezing. The main reason for the irritation is the drying effect of the pressurized air. Adding a CPAP humidifier to the device increases the moisture of the air delivered through the mask. In many machines, a passive humidifier attaches to the CPAP. The pressurized air is run through the cold water before progressing through a short hose to the CPAP and then through a hose to the mask, taking water molecules with it.

This type of humidifier is minimally effective for devices with higher pressures. In cooler environments, the moist air may feel uncomfortably cold as it passes through the mask.

Ad Some humidifiers utilize heat to create moisture. A heated water container is connected in the same way as the passive humidifier. The heat allows the air to hold more moisture and thus carries more effectively humidified air to the patient.

A heated CPAP humidifier is usually adjustable so that the patient can fine-tune the humidity to his or her individual comfort level. Either type of humidifier may be available as an integrated unit. An integrated humidifier is offered as a component part attached directly to the CPAP machine.

This type of humidifier is smaller and eliminates the need for additional hoses and power cords. Integrated units are generally specific to and compatible with only one CPAP machine. In other words, if a new machine is purchased, an older humidifier may not work with it. A stand-alone humidifier is a universal module and can be connected by a short hose to most CPAP machines.

The water chamber is often larger than in other units. This is both an advantage, in terms of improved humidity, and a disadvantage, as the equipment is often larger and bulkier.

Some humidifiers are built right into the CPAP. Other than the water tank that is removable for filling and cleaning, the humidifier and CPAP are a single unit and cannot be separated. This eliminates the need for extra hoses and power cords, and often is a much smaller piece of equipment. A CPAP humidifier can make the machine more comfortable for a sleep apnea patient. Moister air keeps mucous membranes hydrated. This reduces irritation and often improves the overall CPAP experience for patients. Ad

Propofol is used to help you relax before and during general anesthesia for surgery or other medical procedure. Propofol is also used in critically ill patients who require a breathing tube connected to a ventilator (a machine that moves air in and out of the lungs when a person cannot breathe on their own).

propofol (Diprivan)

Brand Names: Diprivan Generic Name: propofol (Pronunciation: PROE poe fol)What is propofol (Diprivan)? What are the possible side effects of propofol (Diprivan)? What is the most important information I should know about propofol (Diprivan)? What should I discuss with my health care provider before I receive propofol (Diprivan)? How is propofol given (Diprivan)?

What happens if I miss a dose (Diprivan)? What happens if I overdose (Diprivan)? What should I avoid after receiving propofol (Diprivan)? What other drugs will affect propofol (Diprivan)? Where can I get more information? What is propofol (Diprivan)? Propofol slows the activity of your brain and nervous system.

Propofol may be used for other purposes not listed in this medication guide. What are the possible side effects of propofol (Diprivan)? Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Call your doctor at once if you have a serious side effect such as:pain, swelling, blisters, or skin changes where the medicine was injected;seizure (convulsions);weak or shallow breathing; orfast or slow heart rate.

Less serious side effects may include:nausea;cough;slight burning or stinging around the IV needle;mild itching or skin rash;numbness or tingly feeling;confusion, agitation, anxiety;muscle pain; ordiscolored urine. This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect.

You may report side effects to FDA at 1-800-FDA-1088. What is the most important information I should know about propofol (Diprivan)? You should not receive this medication if you are allergic to propofol or to eggs, soy products, or soybeans.

Before you receive propofol, tell your doctor if you have epilepsy or other seizure disorder, high triglycerides (fats in the blood), liver disease, or kidney disease. Your caregivers will monitor your heart function, blood pressure, and breathing while you are under the effects of propofol. Tell your caregivers at once if you have a serious side effect such as seizure, weak or shallow breathing, fast or slow heart rate, or pain, swelling, blisters, or skin changes where the medicine was injected.

Before you receive propofol, tell your doctor about all other medications you use, especially chloral hydrate (Somnote), droperidol (Inapsine), a sedative, or a narcotic pain medication such as fentanyl (Actiq, Duragesic). Propofol can cause severe drowsiness or dizziness, which may last for several hours. You will need someone to drive you home after your surgery or procedure.

Do not drive yourself or do anything that requires you to be awake and alert for at least 24 hours after you have been treated with propofol. What should I discuss with my health care provider before I receive propofol (Diprivan)? You should not receive this medication if you are allergic to propofol or to eggs, soy products, or soybeans. If you have certain conditions, you may need a dose adjustment or special tests to safely receive this medication.

Before you receive propofol, tell your doctor if you have:epilepsy or other seizure disorder;high triglycerides (fats in the blood);liver disease; orkidney disease.

FDA pregnancy category B. Propofol is not expected to be harmful to an unborn baby. However, tell your doctor if you are pregnant before you are treated with propofol. Propofol can pass into breast milk and may harm a nursing baby. Before you receive this medication, tell your doctor if you are breast-feeding a baby. How is propofol given (Diprivan)? Propofol is given as an injection through a needle placed into a vein.

You will receive this injection in a hospital or surgical setting. You will relax and fall asleep very quickly after propofol is injected. Your caregivers will monitor your heart function, blood pressure, and breathing while you are under the effects of propofol.

What happens if I miss a dose (Diprivan)? Since propofol is given by a healthcare professional in a controlled setting, you are not likely to miss a dose.

What happens if I overdose (Diprivan)? An overdose of propofol is unlikely to occur since the medication is given by a healthcare professional. Your vital signs will be closely watched while you are under anesthesia to make sure the medication is not causing any harmful effects.

What should I avoid after receiving propofol (Diprivan)? Propofol can cause severe drowsiness or dizziness, which may last for several hours. You will need someone to drive you home after your surgery or procedure. Do not drive yourself or do anything that requires you to be awake and alert for at least 24 hours after you have been treated with propofol.

What other drugs will affect propofol (Diprivan)? Tell your doctor about all other medications you use, especially:chloral hydrate (Somnote);droperidol (Inapsine);a barbiturate such as amobarbital (Amytal), butabarbital (Butisol), mephobarbital (Mebaral), secobarbital (Seconal), or phenobarbital (Solfoton);diazepam (Valium) or similar medicines such as alprazolam (Xanax), chlordiazepoxide (Librium), clorazepate (Tranxene), estazolam (Pro Som), flurazepam (Dalmane), lorazepam (Ativan), midazolam (Versed), temazepam (Restoril), triazolam (Halcion), and others; ora narcotic medication such as fentanyl (Actiq, Duragesic), hydrocodone (Lortab, Vicodin), hydromorphone (Dilaudid, Palladone), morphine (Kadian, MS Contin, Oramorph, and others), oxycodone (Oxy Contin), oxymorphone (Numorphan, Opana), and others.

This list is not complete and there may be other drugs that can interact with propofol. Tell your doctor about all your prescription and over-the-counter medications, vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start a new medication without telling your doctor. Where can I get more information? Your doctor or pharmacist can provide more information about propofol.

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed. Dementia Pictures Slideshow Alzheimer's Disease Slideshow Pictures Brain Foods Slideshow Pictures Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect.

Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise.

Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners.

The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient.

Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects.

If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist. Copyright 1996-2013 Cerner Multum, Inc. Version: 1.03. Revision date: 12/15/2010. Your use of the content provided in this service indicates that you have read,understood and agree to the End-User License Agreement,which can be accessed by clicking on this link.

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Mechanical ventilation If chronic respiratory failure doesn’t improve with other treatments, your doctor may put you on a ventilator, or breathing machine. This machine pumps oxygen through a tube that is placed into your mouth or nose and down into your windpipe.

Chronic Respiratory Failure

Chronic Respiratory Failure Symptoms Causes Diagnosis Treatment Complications What is chronic respiratory failure? Respiratory failure can happen when your respiratory system is unable to remove enough carbon dioxide from the blood, causing it to build up in your body. The condition can also develop when your respiratory system can’t take in enough oxygen, leading to dangerously low levels of oxygen in your blood.

Respiratory failure may be acute or chronic. Acute respiratory failure is a short-term condition. It occurs suddenly and is typically treated as a medical emergency. Chronic respiratory failure, however, is an ongoing condition. It gradually develops over time and requires long-term treatment. Chronic respiratory failure usually happens when the airways that carry air to your lungs become narrow and damaged.

This limits air movement through the body, which means that less oxygen gets in and less carbon dioxide gets out. Chronic respiratory failure can also be classified as hypoxemic or hypercapnic respiratory failure. Low blood oxygen levels cause hypoxemic respiratory failure. High carbon dioxide levels cause hypercapnic respiratory failure.

Symptoms What are the symptoms of chronic respiratory failure? Symptoms of chronic respiratory failure may not be noticeable at first. They usually occur slowly over an extended period of time. When symptoms do develop, they may include:difficulty breathing or shortness of breath, especially when activecoughing up mucouswheezingbluish tint to the skin, lips, or fingernailsrapid breathingfatigueanxietyconfusiondaily headache Chronic respiratory failure is a serious illness that gets worse over time.

As the condition increases in severity, people may develop an abnormal heart rhythm, stop breathing, or slip into a coma.

Causes What causes chronic respiratory failure? Certain lung diseases can cause chronic respiratory failure. Conditions that affect the way in which the brain, muscles, bones, or surrounding tissues support breathing can also cause chronic respiratory failure.

Diseases and conditions that commonly lead to chronic respiratory failure include:chronic obstructive pulmonary disease (COPD)complicated pneumoniacystic fibrosisspinal cord injuriesstrokemuscular dystrophy ALS (Lou Gehrig’s disease)injury to the chestdrug or alcohol misusesmoking Diagnosis How is chronic respiratory failure diagnosed? Your doctor will be able to diagnose chronic respiratory failure by performing a physical exam and by asking you about your symptoms and medical history.

They may also run certain tests to confirm the diagnosis. Often an ongoing illness or significant injury has occurred prior to its development. Medical history Your doctor will ask you about lung diseases or conditions you currently have or have had in the past to learn more about your medical history.

Physical examination During a physical exam, your doctor will use a medical device called a stethoscope to listen for abnormal sounds in your lungs and heart. Pulse oximetry test Pulse oximetry is a simple and painless test that evaluates how well oxygen is being sent to various parts of the body.

Your doctor will place a small sensor on the tip of your finger or ear lobe to determine whether you are getting enough oxygen. In healthy people, normal oxygen saturation range will be between 96 to 100 percent. Any percentage under 90 indicates an abnormally low oxygen level.

Arterial blood gas test An arterial blood gas test is a safe, easy procedure that measures the amount of oxygen and carbon dioxide in the blood. It also measures the p H, or acid content, of your blood. Your doctor will take blood from an artery at your wrist. They will then send the blood to a lab for analysis. The results of this test indicate oxygen and carbon dioxide levels in your blood, as well as the overall chemistry of your blood.

Imaging tests Your doctor can use a chest X-ray or CT scan to obtain a better view of your lungs. These tests may reveal possible causes of chronic respiratory failure. Bronchoscopy A bronchoscope is a thin, flexible lighted instrument that can be inserted into your airway and lungs.

Doctors can use this test to get a closer look at the lung passages, as well as take samples of airway and lung tissue. Treatment How is chronic respiratory failure treated? Although acute respiratory failure is a medical emergency that must be treated in a hospital, chronic respiratory failure may be managed at home, depending on its cause. In severe cases, medical professionals can help you manage the condition in a long-term healthcare center.

Treatment options typically include:treating the underlying cause of respiratory failureremoving excess carbon dioxide from the bloodincreasing oxygen levels in the blood Oxygen therapy You may receive oxygen therapy if you don’t have enough oxygen in your blood. Oxygen therapy raises oxygen levels by increasing the amount of oxygen you inhale. Oxygen is distributed from a tank through a tube.

The gas enters the lungs through a facemask, nasal tubes, or one larger tube directly inserted into the windpipe.

There are small, portable oxygen machines available that can be carried in a shoulder bag. Tracheostomy In severe cases of chronic respiratory failure, a tracheostomy may be needed. During this procedure, your doctor places a tube in your windpipe so that you can breathe more easily. The tube is inserted through a cut in the front of your neck where your windpipe is located. This tube may be temporary or permanent.

Mechanical ventilation If chronic respiratory failure doesn’t improve with other treatments, your doctor may put you on a ventilator, or breathing machine. This machine pumps oxygen through a tube that is placed into your mouth or nose and down into your windpipe.

Since the ventilator blows air directly into your lungs, you don’t have to work as hard to breathe oxygen in on your own.

Depending on the severity of your condition, the ventilator may just need to help you with breathing, or it may need to do all of the breathing for you. Other forms of breathing assistance, known as noninvasive ventilation (NIV) include Bi PAP and CPAP.

These may be appropriate long-term options for certain conditions. Complications What are the potential complications of chronic respiratory failure? There often isn’t any cure for chronic respiratory failure, but symptoms can be managed with treatment.

If you have a long-term lung disease, such as COPD or emphysema, you may need continuous help with your breathing. Your specific outlook depends on the exact cause of your respiratory failure, your overall health, and how quickly you receive treatment. Speak with your doctor to learn more about the outlook for your particular case.

ly. The breathing tube is a common name for the ETT Tube which you put down a patients trachea and into the lungs this helps us have direct access to the lungs. The respirator (ventilator, life support) is the machine that puts oxygen into the lungs at a set volume and rate.

Whats the difference between a breathing tube and a ventilator?

Health Diseases & Conditions Respiratory Diseases Whats the difference between a breathing tube and a ventilator?1 following 3 answers Answers Relevance Rating Newest Oldest Best Answer: A breathing tube may be either an endotracheal tube (goes thru the mouth and into the windpipe) or a tracheal tube ( goes thru a surgical hole into the windpipe).

They offer a clear, guaranteed airway. The ventilator is what actually moves the air in and out. A person may only need a breathing tube, and be able to breathe on their own - lungs and diaphram muscles are working.

Or they may need both a breathing tube and a ventilator. Darwinall · 9 years ago3 0 Comment Asker's rating Ventilator Breathing Tube Source (s):https://shrinks.im/ba XFUcheng · 1 year ago0 0 Comment Ventilator Tube Source (s):https://shrinke.im/a9VHObrott · 1 year ago0 0 Comment This Site Might Help You.

RE: Whats the difference between a breathing tube and a ventilator? Source (s):whats difference breathing tube ventilator: https://shortly.im/dcr VKBreena · 3 years ago0 0 Comment I am a Respiratory Therapist and I work with these instruments dai

This machine can actually keep some one alive if they are not able to breath on their own. Deloris · 2 years ago0 0 Comment A breathing tube is an articial breather, it's a tube thats put down your throat, to the lungs where gas exchange occurs the other end is hooked up to a machine called a mechanical ventilator which does the action of breathing the breathing tube is the choice of transportation that the ventilator chooses to use to carry the oxygen from the machine to the person :)Source (s):http://www.icu-usa.com/tour/equipment/ETT.htm The Rock Star Mike · 9 years ago0 1 Comment Maybe you would like to learn more about one of these?

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Most often, doctors use drug-induced comas for patients on ventilators -- machines that take over the work of breathing. A tube is placed from the patient's mouth into the airway (a procedure called intubation).

What Is a Drug-Induced Coma?

What Is a Drug-Induced Coma? By DR. MARK WERNICKJan. 9, 2006Email In recent days, two people in the news -- Israeli Prime Minister Ariel Sharon and West Virginia coal miner Randal Mc Cloy Jr. -- underwent medically induced comas to help them recover from serious life-threatening conditions.

A drug-induced coma, better known as sedation in the medical field, is commonly used in medical, surgical and neurological intensive care units. It is also used when patients undergo major operations. The types of drugs that are used to produce such effects include anesthetics, benzodiazepines (which are often given to outpatients for anxiety) and opioids (pain medications).

The dosages of these medications can be adjusted quickly to produce the desired level of consciousness in an individual patient.

Intubation can be quite irritating and uncomfortable for patients, and therefore sedation is used to make the breathing tube more pleasant. In a medical intensive care unit, the most frequent respiratory problems that lead to intubation include emphysema, heart failure and pneumonia.

Other patients who receive sedation in the intensive care unit include those who have suffered strokes (they sometimes lose the ability to breathe on their own); patients withdrawing from alcohol who become combative; patients who have ingested toxins (they can't protect their airways); and patients with severe, life-threatening infections. The length of time patients may require sedation varies, and it depends upon the underlying condition that led to the placing of the breathing tube.

For example, an otherwise healthy patient who is intubated for pneumonia may need only sedation and ventilatory support for a few days. But patients with severe underlying lung disease (such as emphysema) often require sedation and ventilatory support for weeks, and sometimes although rarely, months.

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Mechanics of Ventilation Ventilation, or breathing, is the movement of air through the conducting passages between the atmosphere and the lungs. The air moves through the passages because of pressure gradients that are produced by contraction of the diaphragm and thoracic muscles.

Mechanics of Ventilation

Pulmonary ventilation Pulmonary ventilation is commonly referred to as breathing. It is the process of air flowing into the lungs during inspiration (inhalation) and out of the lungs during expiration (exhalation). Air flows because of pressure differences between the atmosphere and the gases inside the lungs. Air, like other gases, flows from a region with higher pressure to a region with lower pressure.

Muscular breathing movements and recoil of elastic tissues create the changes in pressure that result in ventilation. Pulmonary ventilation involves three different pressures: Atmospheric pressure Intraalveolar (intrapulmonary) pressure Intrapleural pressure Atmospheric pressure is the pressure of the air outside the body. Intraalveolar pressure is the pressure inside the alveoli of the lungs. Intrapleural pressure is the pressure within the pleural cavity.

These three pressures are responsible for pulmonary ventilation. Inspiration Inspiration (inhalation) is the process of taking air into the lungs. It is the active phase of ventilation because it is the result of muscle contraction. During inspiration, the diaphragm contracts and the thoracic cavity increases in volume.

This decreases the intraalveolar pressure so that air flows into the lungs. Inspiration draws air into the lungs. Expiration Expiration (exhalation) is the process of letting air out of the lungs during the breathing cycle.

During expiration, the relaxation of the diaphragm and elastic recoil of tissue decreases the thoracic volume and increases the intraalveolar pressure. Expiration pushes air out of the lungs.« Previous (Respiratory System) Next (Respiratory Volumes and Capacities) »

one Situations that may call for a tracheostomy include: Medical conditions that require the use of a breathing machine (ventilator) for an extended period, usually more than one or two weeks

Overview

Overview Tracheostomy Tracheostomy (tray-key-OS-tuh-me) is a surgically created hole through the front of your neck and into your windpipe (trachea).

The term for the surgical procedure to create this opening is tracheotomy. A tracheostomy provides an air passage to help you breathe when the usual route for breathing is somehow obstructed or impaired. A tracheostomy is often needed when health problems require long-term use of a machine (ventilator) to help you breathe.

In rare cases, an emergency tracheotomy is performed when your airway is suddenly blocked, such as after a traumatic injury to your face or neck. When a tracheostomy is no longer needed, it's allowed to heal shut or is surgically closed. For some people, a tracheostomy is permanent. Mayo Clinic's approach Why it's d

Medical conditions that block or narrow your airway, such as vocal cord paralysis or throat cancer Paralysis, neurological problems or other conditions that make it difficult to cough up secretions from your throat and require direct suctioning of the windpipe (trachea) to clear your airway Preparation for major head or neck surgery to assist breathing during recovery Severe trauma to the head or neck that obstructs breathing Other emergency situations when breathing is obstructed and emergency personnel can't put a breathing tube through your mouth and into your trachea Emergency care Most tracheotomies are performed in a hospital setting.

However, in the case of an emergency, it may be necessary to create a hole in a person's throat when outside of a hospital, such as at the scene of an accident.

Emergency tracheotomies are difficult to perform and have an increased risk of complications. A related and somewhat less risky procedure used in emergency care is a cricothyrotomy. This procedure creates a hole directly into the voice box (larynx) at a site immediately below the Adam's apple (thyroid cartilage).

Once a person is transferred to a hospital and stabilized, a cricothyrotomy is replaced by a tracheostomy if there's a need for long-term breathing assistance. Request an Appointment at Mayo Clinic Risks Tracheostomies are generally safe, but they do have risks.

Some complications are particularly likely during or shortly after surgery. The risk of such problems greatly increases when the tracheotomy is performed as an emergency procedure. Immediate complications include: Bleeding Damage to the trachea Air trapped in tissue under the skin of the neck (subcutaneous emphysema), which can cause breathing problems and damage to the trachea or food pipe (esophagus)Buildup of air between the chest wall and lungs (pneumothorax), which causes pain, breathing problems or lung collapse A collection of blood (hematoma) may form in the neck and compress the trachea, which causes breathing problems Misplacement or displacement of the tracheostomy tube Long-term complications are more likely the longer a tracheostomy is in place.

These problems include: Displacement of the tracheostomy tube from the trachea Narrowing of the trachea Abnormal tissue formation in the trachea Obstruction of the tracheostomy tube Development of an abnormal passage between the trachea and esophagus (fistula), which can increase the risk of fluids or food entering the lungs Development of a passage between the trachea and the innominate artery (tracheoinnominate fistula), which can generate life-threatening bleeding Infection Bacterial colonization, which may cause illness, such as pneumonia If you still need a tracheostomy after you've left the hospital, you'll need to keep regularly scheduled appointments for monitoring possible complications.

You'll also receive instructions about when you should call your doctor about problems, such as: Bleeding at the tracheostomy site or from the trachea Difficulty breathing through the tube Pain or a change in comfort level Redness Swelling A change in the position of your tracheostomy tube How you prepare How you prepare for a tracheostomy depends on the type of procedure you'll undergo.

If you'll be receiving general anesthesia, your doctor may ask that you avoid eating and drinking for several hours before your procedure.

You may also be asked to stop certain medications. Plan for your hospital stay After the tracheostomy procedure, you'll likely stay in the hospital for several days as your body heals.

If possible, plan ahead for your hospital stay by bringing: Comfortable clothing, such as pajamas, a robe and slippers Personal care items, such as your toothbrush and shaving supplies Entertainment to help you pass the time, such as books, magazines or games Writing supplies, such as a pencil and a pad of paper to help you communicate since you'll be unable to talk at first What you can expect During the procedure A tracheotomy is most commonly performed in an operating room with general anesthesia, which makes you unaware of the surgical procedure.

A local anesthetic to numb the neck and throat is used if the surgeon is worried about the airway being compromised from general anesthesia or if the procedure is being done in a hospital room rather than an operating room. The type of procedure you undergo depends on why you need a tracheostomy and whether the procedure was planned. There are essentially two options: Surgical tracheotomy can be performed in an operating room or in a hospital room.

During a surgical tracheotomy, the surgeon usually makes a horizontal incision through the skin at the lower part of the front of your neck. The surgeon carefully pulls back the surrounding muscles and cuts through a small portion of the thyroid gland, exposing the windpipe (trachea).

At a specific spot on your windpipe near the base of your neck, the surgeon creates a hole and inserts a tracheostomy tube into the hole. A neck strap attached to the face plate of the tube keeps it from slipping out of the hole, and temporary sutures also can be used to secure the faceplate to the skin of your neck.

Minimally invasive tracheotomy is typically performed in a hospital room. The doctor makes a small incision near the base of the front of the neck. A special lens is fed through the mouth so that the surgeon can view the inside of the throat. Using this view of the throat, the surgeon guides a needle into the windpipe to create the tracheostomy hole. The hole is then expanded to accommodate the tracheostomy tube. A neck strap attached to the faceplate of the tube keeps it from falling out of the windpipe. After the procedure You'll likely spend several days in the hospital as your body heals. During that time, you'll learn skills necessary for maintaining and coping with your tracheostomy: Caring for your tracheostomy tube.

A nurse will teach you how to clean and change your tracheostomy tube to help prevent infection. You'll continue to do this as long as you have a tracheostomy. Speaking. In general, a tracheostomy prevents you from speaking because exhaled air goes out the tracheostomy opening rather than up through your voice box.

However, there are devices and techniques for redirecting airflow enough to produce speech. Depending on the tube size and design, the diameter of your trachea, and the condition of your voice box, you may be able to use your voice with the tube in place.

If necessary, you'll meet with a speech therapist or a nurse trained in tracheostomy care, who can suggest options for communicating and help you learn to use your voice again.

Eating. While you're healing, you'll receive nutrients through an intravenous (IV) line inserted into a vein in your body, a feeding tube that passes through your mouth or nose, or a tube inserted directly into your stomach. When you're ready to eat again, you may need to work with a speech therapist, who can help you regain the muscle strength and coordination needed for swallowing.

Coping with dry air. The air you breathe will be much drier since it no longer passes through your moist nose and throat before reaching your lungs.

This can cause irritation, coughing and excess mucus coming out of the tracheostomy. Directly instilling small amounts of saline into the tracheostomy tube may help loosen secretions and add moisture. A saline nebulizer treatment can be delivered to a mist collar via a tube attached to a nebulizer machine. You may use a device called a heat and moisture exchanger, which captures moisture from the air you exhale and humidifies the air you inhale.

Coping with other effects. Your health care team will show you ways to cope with the other common effects of the tracheostomy. For instance, you may also learn to use a suction machine to help you clear secretions from your throat or airway. Results In most cases, a tracheostomy is temporary, providing an alternative breathing route until other medical issues are resolved. If a person needs to remain connected to a ventilator indefinitely, the tracheostomy is often the best permanent solution.

Your health care team will help you determine when it's appropriate to remove the tracheostomy tube.

The hole may heal shut on its own, or it can be closed surgically. Clinical trials Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this disease. By Mayo Clinic Staff Tracheostomy care at Mayo Clinic Request an Appointment at Mayo Clinic Doctors & Departments Jan. 03, 2018Share on: Facebook Twitter References Mayo Clinic in Minnesota is has been recognized as one of the top hospitals in Ear, Nose & Throat in the nation for 2017-2018 by U. S. News & World Report.

Learn more about this top honor Tracheostomy About Doctors & Departments Care at Mayo Clinic Advertisement Mayo Clinic does not endorse companies or products. Advertising revenue supports our not-for-profit mission. Advertising & Sponsorship Policy Opportunities Ad Choices Mayo Clinic Marketplace Check out these best-sellers and special offers on books and newsletters from Mayo Clinic.

FREE TRIAL – Mayo Clinic Health Letter Best Treatment Strategies for Arthritis Mayo Clinic on Digestive Health Effective Home Remedies from Mayo Clinic The Mayo Clinic Diet Online PRC-20164061Patient Care & Health Information Tests & Procedures Tracheostomy

12assist-control ventilation A type of mechanical ventilation with a minimum frequency of respirations determined by ventilatorsettings. It also permits the patient to initiate ventilation at the same tidal volume or pressure as set on the ventilator. See also: ventilation

assist-control ventilation

"Correct all you're your grammar errors instantly. Try it now.assist-control ventilation Also found in: Dictionary, Thesaurus, Legal, Encyclopedia. Related to assist-control ventilation: Positive pressure ventilationas·sist-con·trol ven·ti·la·tionartificial positive-pressure ventilation by machine in which a full breath is producedautomatically, following a patient's natural inspiratory effort.

In the event that the patient doesnot initiate such an effort, the machine will provide a baseline, or ""backup"" respiratory rate. Farlex Partner Medical Dictionary © Farlex 2012as·sist-con·trol ven·ti·la·tion ( ă-sist' kŏn-trōl' ven'ti-lā'shŭ

n) 1. Continuous mandatory ventilation.2. A mode of mechanical respiration in which all breaths are mandatory and are either patient or machine triggered, and machine cycled; a minimum breathing rate is set but the patientcan trigger breaths at a faster pace.

Medical Dictionary for the Health Professions and Nursing © Farlex 20

ort Mechanical ventilation Assisted ventilation could be defined as the movement of gas into and out of lungs by an external source connected directly to the patient. The external source could be the resuscitation bag, continuous distending pressure device or a mechanical ventilator.

Symposium: neonatologyOverview of assisted ventilation in the newborn

Paediatrics and Child Health Volume 24, Issue 1, January 2014, Pages 1-6Symposium: neonatology Overview of assisted ventilation in the newborn Prashant Mallya Samir Gupta Show morehttps://doi.org/10.1016/j.paed.2013.06.008 Get rights and content Abstract Respiratory support of the newborn is an integral part of newborn care. This can be provided non-invasively using a nasal interface, or invasively through an endotracheal tube.

The choice of support depends upon the infant's respiratory drive, severity of lung disease and airway patency. Current practice of mechanical ventilation to assist spontaneous breathing in newborn has improved over the years. The utilization of microprocessor technology in newborn ventilation has allowed delivering small tidal volumes and utilising newer modes of ventilation that have a potential to limit ventilation induced lung injury (VILI).

However, optimizing respiratory support to match the needs of the babies still remains a challenge and newer modes of ventilation need to be assessed in babies through well-designed trials.

Previous article Next article Keywords CPAP oxygen preterm respiratory support ventilationventilation induced lung injury Introduction During spontaneous breathing rib cage expands and diaphragm contracts. This results in expansion of the lung, drop in intra-thoracic pressure and flow of air from the atmosphere into the lungs. This cycle reverses during expiration when diaphragm relaxes, chest recoils and positive intra-thoracic pressure forces air to flow out of the lungs to the atmosphere.

The first ventilator developed during the polio epidemics in the early 1900s, the ‘Iron Lung’, was a negative pressure ventilator and widely used with good result. However due to the bulky apparatus and patient confinement, ‘Iron Lung’ lost its popularity. Compactness, portability and ease of use led to widespread use of modern ventilator systems since 1950s.

A major development in neonatal ventilation occurred with the introduction of Continuous Positive Airway Pressure (CPAP) by Gregory that supported spontaneously breathing infants using Bubble CPAP. However, infants needing invasive respiratory support through endotracheal tube received it through modification of adult ventilators. These were continuous flow, time cycled, and pressure limited devices. The combination of intermittent positive pressure breath with spontaneous breaths, while utilising continuous gas flow was called Intermittent Mandatory Ventilation (IMV).

A significant problem with this mode was ‘fighting the ventilator’ and need for paralysis due to patient ventilator asynchrony. One of the complications of ventilation in newborn first described by Northway et al in 1968 was called bronchopulmonary dysplasia.

It was attributed to positive pressure ventilation although initially thought to be due to oxygen toxicity. Innovation in microprocessor technology in the 1990s led to emergence of various patient triggered ventilation modes with a potential for better patient ventilator synchrony and patient comfort. Physiology of ventilation Understanding the key concepts of mechanics of breathing is important for setting the ventilator and matching the needs of the patient and disease patho-physiology.

These are: •Resistance and compliance of the breathing apparatus•Time constant. Resistance is expressed in terms of a change in pressure divided by flow. The standard units of resistance are cm H 2 0/L/second. An example of increased airway resistance is bronchopulmonary dysplasia.

Compliance is expressed as a change in volume divided by a change in pressure. An example of low compliance is surfactant deficiency in preterm infants. Time constant determines the time necessary for alveolar pressure to reach 63% of a change in airway pressure.

Mathematically, the time constant is defined as compliance times the airway resistance. This is expressed in units of seconds of time. Thus, poorly compliant lung have short time constant and accordingly will need short inspiratory time, and conditions with increased airway resistance have longer time constants and thus benefit from longer inspiratory times.

The interplay of these factors is expressed in a mathematical model commonly referred to as equation of motion. When applied in assisted ventilation, we can infer: •When ventilator pressure is zero this is normal unassisted breathing•If the ventilator provides more flow than is demanded then airway pressure will rise above baseline and the breath is ‘assisted’.•If both respiratory muscles and the ventilator pressure are not zero then this is called partial ventilatory support•If the muscle pressure is zero then the ventilator provides all the work of breathing and this is total ventilatory supp

A mechanical ventilator has four parts. A pressurized source of either air or oxygen that acts as a driving force, a blending chamber that receives this mixture, a flow control that regulates how much is delivered to the patient and an exhalation valve. Between the air/oxygen source and the exhalation valve there is a continuous flow available to help the infant breathe spontaneously which is also called as “bias flow”.

The aim of mechanical ventilation would be to replicate normal physiologic process of delivering a tidal volume breath. Generally 4–8 ml/kg is the starting point. This is further titrated depending upon the disease pathology and gestation with older infants needing more than 6 ml/kg. Mechanical ventilation could be patient triggered or controlled by the device. In the UK, most neonatal units prefer patient triggered modes.

Patient triggering can be achieved through many interfaces, but use of hot wire anemometer or variable orifice differential pressure transducer (pneumotachograph) is the most sensitive method with a typical response time of 5–25 milliseconds.

The aim is to achieve synchrony and deliver the tidal volume in the early part of inspiration. Trigger mechanism could be change in pressure or change in the flow sensed by the ventilator. The trigger threshold in flow trigger method is usually set at 0.2–0.5 L/min. This means, for every 0.2 L air or oxygen displacement detected in the bias flow the ventilator would offer the preset ventilatory support.

Trigger threshold to identify expiration (usually a set percentage of the peak flow) can also be included to help synchronize spontaneous breathing at expiration. The advantage is patient comfort and patient regulation of its spontaneous breathing. This concept of synchrony during expiration is called flow cycling.

An exciting development in patient triggered mode is synchronizing with neural impulses to identify diaphragm contraction to gain assisted breath. This will be discussed later in the article. Methods of providing mechanical respiratory support include Mechanical ventilation strategies to provide assisted support could be divided into •Tidal ventilation (conventional)•Non tidal ventilation e.g.

high frequency oscillation where respiratory support strategy utilizes sub physiological tidal volumes with extremely high rate. The mechanical ventilators are broadly classified into volume or pressure modalities. In volume controlled ventilation, the volume delivery is consistent but the pressures vary to deliver the desired tidal volume.

The flow to achieve this tidal volume is constant and has non decelerating square waveform. In a pressure controlled ventilation, preset pressures are consistently achieved with variable volume delivery depending upon the compliance of the lungs and the flow pattern is crescendo–decrescendo type.

Each modality of ventilation have their advantages and disadvantages. Regardless of the chosen modality it is important to remember that inadvertent injury to lungs due to assisted ventilation should be limited ( Figure 1 ). Download high-res image (157KB) Download full-size image Figure 1. Ventilation target variables. In pressure limited ventilation as compliance improves, the delivered tidal volume increases at same pressures. In contrast, with volume control ventilation as compliance improves, the tidal volume remains the same but the pressures wean automatically.

Patient triggered modes include•Assist control ventilation•Synchronized intermittent mandatory ventilation•Pressure support ventilation•Proportional assist ventilation•Neurally adjusted ventilator assist In Patient triggered mode (Synchronized ventilation) the assisted breath can be controlled for three variables ( Figure 2 ): •Identification of a trigger (spontaneous breath) usually change in flow or pressure•Control/delivery of the breath using either pressure or volume limit as determined by the clinician•Termination of the breath (cycling mechanism)- usually determined by a set time or percentage of peak flow.

Download high-res image (169KB) Download full-size image Figure 2. Phase variables. There are subtle differences between various patient triggered modes. The following section describes salient features of individual modes. •Assist control ventilation (A/C mode): there are two components of A/C mode that supports its use in preterm infant during the acute phase of illness.

The first component is assisting all spontaneous breaths and the second a safety of having a back up rate.

The infant gets full support utilising pressure or volume controlled ventilation modality as set by the clinician. If the infant has inherent respiratory drive then every breath would receive support at the set pressure/volume settings. This also means that reducing back up rate for weaning will not be effective. If the infant fails to trigger a spontaneous breath then the back up rate would deliver the mandatory breath at the set respiratory rate.

For example if the ventilator back up rate is 40 then the infant has up to 1.5 seconds to trigger a spontaneous breath to receive an assistance ‘award’. In the event the infant does not trigger a spontaneous breath then the ventilator delivers the controlled breath.

In the acute phase of illness, infants get maximum support and reduce patient effort with least work of breathing.•Synchronized intermittent mandatory ventilation (SIMV)SIMV supports fixed number of breaths as determined by the clinician. Based on the set back up rate if the infant triggers a breath in 1st half of the cycle, then ventilator would deliver a synchronized breath.

For example if the ventilator set rate is 40 breaths/min and the infants' spontaneous drive is 60 breaths/min then the ventilator would try to synchronize its breath delivery if the spontaneous breath falls within 1.5 seconds window. Spontaneous breaths over the ventilator set rate are unsupported or ‘unrewarded’. As this mode relies on patient effort, we could also call this as one of the partial support mode.

Weaning on ventilator is gradually reducing the back up rate. Previously, this approach was thought to help with respiratory muscle conditioning and endurance building.

Current practice does not encourage use of very low ventilator rate (less than 20) whilst weaning on this mode due to fatigue and increased risk of failure upon extubation. Hence, SIMV is often coupled with another form of partial support called as pressure support ventilation to support the spontaneous breaths through endotracheal tube as the infant takes over its own work of breathing.

•Pressure support ventilation (PSV)PSV is another form of respiratory support because it relies on the patient effort to trigger a breath. PSV is patient triggered, pressure limited and flow cycled mode of ventilation. In theory this mimics a spontaneous breathing effort with full control to the infant to determine the pace of breathing (respiratory rate) and length of breathing (inspiratory time).

This is achieved by flow cycling. ( Figure 3 ). The clinician only controls the pressure limit to determine the tidal volume. It is called PS max when pressure support offers the neonate a full tidal volume breath and it is called PS min when pressure support is just enough to overcome the tube resistance and prevent fatigue.

Ideal level of pressure support for weaning preterm infants is still unknown. In adult population, PSV is a very popular due to patient comfort However due to concerns of apnoea of prematurity, PSV is currently not used as a primary mode and often coupled with SIMV to guarantee at least fixed number of breaths to maintain gas exchange.

When used with SIMV this mode has shown to decrease the time to weaning on mechanical ventilation as compared to SIMV alone. •Proportional Assist Ventilation (PAV)Download high-res image (716KB) Download full-size image Figure 3.

Schematic diagram showing difference between synchronized Intermittent mandatory ventilation SIMV (left hand panel) supporting only fixed number of breaths and assist control ventilation (A/C) (right hand panel) supporting every spontaneous effort above the trigger threshold. A/C mode shown in this example is flow cycled and therefore achieving complete synchrony at both inspiration and expiration. Despite bias flow and ‘on demand’ flow features on modern ventilators, it is sometimes not possible to match the patient demand.

For e.g. in infants with bronchopulmonary dysplasia with variable flow demand, PAV could offer the advantage of meeting that demand. PAV, as the name suggests, offers respiratory support in proportion to the infant's demand. Higher the inspiratory flow generated by the baby, greater the pressure assist, volume assist and flow assist provided by the ventilator to meet that demand via servo control throughout the respiratory cycle.

Correct application and benefits of this mode depends on the clinicians understanding of the resistive and elastic demands that vary between patient and disease pathology. The advantage of using PAV is lower mean airway pressure compared to conventional patient triggered ventilation.

The disadvantage however is failure or inadequacy with PAV with longer episodes of desaturation and higher than usual tidal volume delivery. •Neurally adjusted Ventilatory assist (NAVA)As the name suggests, NAVA uses neural impulses from the electromyographic activity of the diaphragm through a special nasogastric tube which could also be used for feeding.

Hence this is also a synchronized or patient triggered mode of ventilation. The tube has electrodes that identify impulses from the diaphragm and oesophagus and correct position can be identified from the neural waveforms. Currently, only available on Servo-I ventilator marketed by Maquet®, Sweden, NAVA uses the electrical activity to synchronize the mechanical breath and taper the inspiratory pressure in proportion to the patient effort.

Thus, the infant is in control of determining the respiratory rate, peak inspiratory pressure, tidal volume, inspiratory and expiratory times. Until recently, apnoea of prematurity was a concern leading to hypoventilation states and lack of algorithm to flip to conventional mechanical ventilation.

But this issue has now been resolved with improved patient ventilator interaction. Hybrid modes There is growing evidence that minimizing ‘volutrauma’ limits development of BPD by limiting over distension of the alveoli rather than barotrauma due to excess pressure. Newer ventilators have incorporated algorithms targeting volumes using traditional time cycled pressure limited ventilation.

This has led to the development of hybrid modes. Until recently, mechanical ventilators were programmed to control either Pressure or Volume modality to deliver desired tidal volume. However, with advancement in microprocessor technology it is possible to use dual control and use features from ‘best of both the worlds’.

The aim is to deliver a consistent tidal volume and prevent any additional barotrauma or volutrauma. The newer hybrid techniques include •Volume guarantee (VG)•Pressure regulated volume control (PRVC)•Volume assured pressure support (VAPS)Some of the popular volume targeting hybrid modes are discussed here: •Volume limit/Guarantee ventilation (VG).

Volume guarantee is an additional function with pressure limit ( P max) in time cycled pressure limited ventilation. The clinician sets the tidal volume delivery and the ventilator tries to maintain consistent tidal volume delivery based on the previous breath (usually 8–10 breaths in Babylog 8000 plus Drager®) Based on whether the desired tidal volume is reached, the ventilator chooses how much pressure is needed for the next breath.

Thus even though this is not true volume targeted ventilation, the patient receives the benefit of near consistent tidal volume delivery.

The benefit of this particular mode is ‘auto weaning’ of the peak pressures necessary to achieve the desired tidal volume after surfactant administration in surfactant deficient lung disease and preventing air leak. Presence of large leak in the circuit would be unsuitable for this mode to function adequately as the feedback depends on the expiratory tidal volume from the previous breath.

As tidal volume range varies from 4 to 8 ml/kg, it is not clear whether targeting at upper or lower end of this range has any benefit in limiting lung injury and improving outcomes.

•Pressure regulated volume control ventilation (PRVC)This is a hybrid mode and allows the benefit of using flow cycling utilising variable flow characteristics of pressure controlled ventilation along with the advantage of targeting tidal volume.

The ventilator constantly acquires information on the lung compliance and the resistance on each breath and changes the pressure settings as needed to achieve the set tidal volume for the subsequent breaths (adjusted on previous 4 breaths in Siemens Servo 300A, Servo-i).

The particular mode of ventilation could be useful in conditions such as chronic lung disease. Both of the above two mentioned modes use information from previous breaths to change the flow and volume characteristics for subsequent breaths.

•Volume Assured Pressure Support (VAPS)This particular mode is unique in its breath delivery. Complex set of algorithms monitor the breath delivery by monitoring the flow and converts an otherwise variable flow pressure controlled breath to a constant flow volume controlled breath, if the desired tidal volume delivery is not possible in that breath.

The machine calculates delivered tidal volume until the decelerating flow reaches the set transition point before converting the breath type to a constant flow to achieve the desired tidal volume. Thus, unlike the previous two modes breath delivery is regulated in the same breath. Non tidal assisted ventilation High frequency ventilators deliver non tidal ventilation at supra-physiologic rates.

The three available types are •High frequency oscillatory ventilation (HFOV)•High frequency jet ventilation•High frequency flow interrupter In the UK HFOV is the preferred method. HFOV maintains a constant distending pressure (MAP) with an aim to recruit all parts of the lungs adequately (open lung concept). This results in recruiting the atelectatic portions of the lungs and reducing the ventilation perfusion mismatch.

The movement of the column of air is done by ‘wobble’ and small tidal volumes equivalent to or less than the dead space along with high rate generally 500–900 cycles (8–15 Hz) per minute is introduced.

The idea is at frequencies close to the resonance frequency of the intubated respiratory system one can achieve higher alveolar pressures with better gas exchange.

Current evidence Invasive versus non invasive respiratory support Although, CPAP is perceived as ‘gentle’, mode of respiratory support, three large randomized controlled trials CPAP or Intubation and Ventilation trial (COIN), Surfactant Positive Pressure and Pulse Oximetry Randomised Trial (SUPPORT) and Vermont Oxford Network trial (VON) compared CPAP to standard conventional mechanical ventilation.

All three trials have failed to show any decrease in short term clinical outcomes such as bronchopulmonary dysplasia or death. However, these studies have confirmed the safety and practicability of using it in select group of preterm infants who are breathing spontaneously at birth and require less than 40% oxygen. Volume or pressure modality? Current evidence suggests volume targeted ventilation has advantage over pressure controlled ventilation.

It is reported to reduce bronchopulmonary dysplasia, severe intraventricular haemorrhage and pneumothorax when compared with pressure controlled ventilation. Therefore, irrespective of the chosen modality: pressure or volume, a clinician caring for the preterm infant should aim to the tidal volume delivery in normal range.

This review however included trials on volume guarantee as well as volume controlled modes of ventilation. Tidal versus non tidal ventilation approach Although theoretically non shearing forces and ‘open lung’ concept seem advantageous, Cochrane review does not support this the superiority of non tidal ventilation over tidal ventilation.

With the use of non tidal ventilation, there could be some advantage in preventing BPD and death but there are concerns regarding increased incidence of intracranial bleeds and periventricular leukomalacia. Perhaps this uncertainty has dictated many clinicians to choose this as a rescue mode rather than early elective method.

Of the studies included in the Cochrane review three large studies (Hi Fi) study ( N = 673) included infants who did not receive any antenatal steroids hence applying results in current practice is limited. UKOS study ( N = 797) used low volume strategy using mean airway pressure of 6–8 cm H 2 O as distending pressure.

Using low mean airway pressure could have been the confounding factor to identify the benefits. Routinely, the starting pressure is 2 cm over the conventional mechanical ventilator set MAP which is higher than 6 cm H 2 O.

The study also allowed crossover to conventional methods determined by trial exit criteria. Only study supported decreased incidence of chronic lung disease and reduced duration of ventilation in 500 patients. This study did not report any significant difference in the adverse neurological outcomes between the two groups. Synchronized versus non synchronized intermittent mandatory ventilation The current evidence on synchronized ventilation modes is limited due to the advances in technology and reports no benefit of synchronized modes in terms of BPD outcome over non synchronized method of mechanical ventilation.

Previously reported issues such as delay in triggering, inability to maintain consistent tidal volume delivery have been largely overcome.

However, it does encourage its use due to decreased incidence of air leaks and shorter duration of ventilatory support. Weaning on mechanical ventilation Early weaning on mechanical ventilation is important to reduce the adverse outcomes of prolonged ventilation. However, there are no predictable indices but rather arbitrary time points and the clinicians” hunch” that dictates this process.

Current evidence suggests weaning on patient triggered mode is faster than IMV and Assist Control mode reduces duration of ventilation than SIMV. PSV seems to be an attractive mode to facilitate this process of transferring the work of breathing from the ventilator to the infant.

In an RCT, addition of pressure support ventilation to SIMV has shown reduced duration of weaning compared to SIMV alone.

These studies however have only investigated fixed levels of PSV. Variable levels of pressure support have been compared in a crossover trial and suggest better figures for rapid shallow breathing index (RSBI) in favour of full pressure support reflecting better comfort of breathing on full pressure support.

There is on going randomized trial (POST trial) comparing pressure support and SIMV for weaning preterm infants on mechanical ventilation. Best tidal volume? There is as yet inadequate evidence on the optimum tidal volume necessary to prevent VILI and maintain adequate gas exchange. In an RCT in preterm infants (25–32 weeks), 5mls/kg volume guarantee seems favourable with lower inflammatory markers in tracheal aspirates than low tidal volume (4 ml/kg or less) strategy in the acute phase of the illness.

We also know tidal volume requirement increases with increasing postnatal age despite permissive hypercapnia. Whether strategies with high or low tidal volume delivery prevent incidence of BPD is yet unknown.

Newer and hybrid modes of ventilation Recent studies have shown practicability and benefits of lower distending pressure and improved response time with hybrid modes. The newer hybrid modes of ventilation offer presumed advantages in terms of small physiologic changes over conventional methods of triggered ventilation.

However, long-term patient outcome has never been tested in a randomized controlled trial. Way forward Closed loop Oxygen control: in a multicentre crossover trial comparing automated closed loop oxygen saturation targeting to manual targeting showed improved oxygen saturation in the desired range with fewer adjustments and reduced work load on nurses.

Monitoring minute ventilation and end tidal CO 2In infants <2500 g, needing mechanical ventilation for RDS, Pa CO 2 values closely correlated to the minute ventilation. In addition monitoring end tidal CO 2 values could be performed via capnography via endotracheal tube.

Conclusions In extreme preterm babies invasive mechanical ventilation still remains standard of care. Babies supported non-invasively should be closely monitored with guidance on when to interfere without causing undue delay in escalating respiratory support based on clinical and objective parameters such as mean airway pressure and fractional concentration of inspired oxygen. In babies chronically ventilated with fluctuating oxygen requirements, closed loop Fi O2 seems to be promising but the safety and efficacy of this novel technique should be assessed in well-designed clinical trials.

Haemodynamic assessment of sick babies is equally important and respiratory support techniques should be utilized based on the underlying problem while limiting iatrogenic lung injury. Practice points•Understanding disease pathology and applying concepts of time constant would help in providing optimum ventilatory support.•There is growing evidence that targeting tidal volume regardless of the ventilation modality could minimize short term adverse neonatal outcomes.•There is consensus when to commence mechanical ventilation but there is limited data on optimum tidal volume and best weaning methods.•Despite newer modes of ventilation are increasingly available for infant use, clinicians must use them with caution until long-term outcomes are available through well-designed randomized controlled trial.

Further reading1 S. E. Courtney, D. J. Durand, J. M. Asselin, M. L. Hudak, J. L. Aschner, C. T. Shoemaker High-frequency oscillatory ventilation versus conventional mechanical ventilation for very-low-birth-weight infants N Engl J Med, 347 ( 2002), pp. 643 - 6522 G. Dimitriou, A. Greenough, F. Griffin, V. Chan Synchronous intermittent mandatory ventilation modes compared with patient triggered ventilation during weaning Arch Dis Child Fetal Neonatal Ed, 72 ( 1995), pp. F188 - F1903 A. Greenough Update on patient-triggered ventilation Clin Perinatol, 28 ( 2001), pp. 533 - 5464 S. Gupta, S. K. Sinha Surfactant, mechanical ventilation or CPAP for respiratory management of preterm infants?

Infant, 6 ( 2010), pp. 191 - 1945 S. Gupta, S. K. Sinha Newer modalities of mechanical ventilation in extremely premature infant Paediatr Child Health, 17 ( 2007), pp. 37 - 426 S. Gupta, S. K. Sinha Care of the ventilated infant Paediatr Child Health, 19 ( 2009), pp. 544 - 5507 M. Keszler, S. Nassabeh-Montazami, K. Abubakar Evolution of tidal volume requirement during the first 3 weeks of life in infants <800 g ventilated with volume guarantee Arch Dis Child Fetal Neonatal Ed, 94 ( 2009), pp.

F279 - F2828 J. Lee, H.-S. Kim, J. A. Sohn, et al. Randomized crossover study of neurally adjusted ventilatory assist in preterm infants J Pediatr, 161 ( 2012), pp.

808 - 813e29 C. J. Morley, P. G. Davis, L. W. Doyle, L. P. Brion, J.-M. Hascoet, J. B. Carlin Nasal CPAP or intubation at birth for very preterm infants N Engl J Med, 358 ( 2008), pp. 700 - 70810 William H. Northway, R. C. Rosan Radiographic features of pulmonary oxygen toxicity in the newborn: bronchopulmonary dysplasia Radiology, 91 ( 1968), pp. 49 - 5811 Z. C. Reyes, N. Claure, M. K. Tauscher, C. D’Ugard, S. Vanbuskirk, E. Bancalari Randomized, controlled trial comparing synchronized intermittent mandatory ventilation and synchronized intermittent mandatory ventilation plus pressure support in preterm infants Pediatrics, 118 ( 2006), pp. 1409 - 141712 A. Schulze, E. Rieger-Fackeldey, T. Gerhardt, N. Claure, R. Everett, E. Bancalari Randomized crossover comparison of proportional assist ventilation and patient-triggered ventilation in extremely low birth weight infants with evolving chronic lung disease Neonatology, 92 ( 2007), pp. 1 - 713 S. K. Sinha, S. M. Donn Weaning from assisted ventilation: art or science? Arch Dis Child Fetal Neonatal Ed, 83 ( 2000), pp. F64 - F70Copyright © 2013 Elsevier Ltd. All rights reserved.

n) 1. Continuous mandatory ventilation.2. A mode of mechanical respiration in which all breaths are mandatory and are either patient or machine triggered, and machine cycled; a minimum breathing rate is set but the patientcan trigger breaths at a faster pace.

assist-control ventilation

"Correct all you're your grammar errors instantly. Try it now.assist-control ventilation Also found in: Dictionary, Thesaurus, Legal, Encyclopedia. Related to assist-control ventilation: Positive pressure ventilationas·sist-con·trol ven·ti·la·tionartificial positive-pressure ventilation by machine in which a full breath is producedautomatically, following a patient's natural inspiratory effort.

In the event that the patient doesnot initiate such an effort, the machine will provide a baseline, or ""backup"" respiratory rate. Farlex Partner Medical Dictionary © Farlex 2012as·sist-con·trol ven·ti·la·tion ( ă-sist' kŏn-trōl' ven'ti-lā'shŭ

Medical Dictionary for the Health Professions and Nursing © Farlex 20

12assist-control ventilation A type of mechanical ventilation with a minimum frequency of respirations determined by ventilatorsettings. It also permits the patient to initiate ventilation at the same tidal volume or pressure as set on the ventilator. See also: ventilation

t. R11.0, T46.2x5A, I48.91The patient arrived to the hospital in acute respiratory failure and hypoxia. The patient was intubated, and the physician documents that the patient is being admitted to the hospital for treatment of the acute respiratory failure with hypoxia. The patient also has congestive heart failure. Mechanical ventilation was provided for 48 consecutive hours. Code the procedure for the mechanical ventilation.

ICD-10 Coding Final Review

"75 terms mina_jordan ICD-10 Coding Final Review Learn Flashcards Write Spell Test Match Gravity Advertisement Upgrade to remove ads Like this study set? Create a free account to save it. Create a free account Maybe later Sort The correct sequencing of early onset Alzheimer's disease with dementia is G30.0 followed by F02.80 TCode Q03.9 and Code G91.9 can be used together if both are present.

FThe coding of late effects (or sequela) always requires two codes. FCode category Z85 is used only when a primary neoplasm has been excised or eradicated and is no longer under treatment with no existing evidence of the existing primary malignancy.

TAftercare Z codes (Z42-Z51) are used to show that continued care is provided for injuries. FThe correct sequencing for severe sepsis with MRSA and acute respiratory failure is: R65.20 + J96.00 + A41.02. FWhen a patient with AIDS is admitted for treatment, code B20 is always listed as the principal diagnosis.

FCode Z79.4 should be assigned to code E10.22 when the patient has been put on long-term insulin. TThere are a minimum of three codes reported for an underdose of insulin due to insulin pump failure. FSelection of ""in remission"" for categories F10-F19 requires the provider's clinical judgement. TOnly one code is reported for anemia of chronic disease.

FCode G81.91 is assigned with code I66.9 for cerebral thrombosis with transient right hemiplegia that has cleared by the time the patient is discharged. TWhen a patient is admitted with respiratory failure and another acute condition (such as AMI or CVA) the principal diagnosis is always respiratory failure.

FCodes from category J09 should only be assigned for confirmed cases. TAcute pulmonary edema is included in codes I50.- and no additional code is assigned. TWhen mechanical ventilation is used during a surgical procedure, it is normally coded as a procedure. FThe codes for hypertension with chronic kidney disease stage 4 are I10, N18.4. FWhen a cystoscopy is performed to visualize the bladder and no other procedure is performed, code 0TJB8ZZ is assigned. TOnly code N40.1 is assigned for enlarged prostate with nocturia. FThe stage of a pressure ulcer may be assigned based on nursing documentation.

TIf laterality is not identified in the medical record, assign the code for the unspecified side. TCode Z33.2 is assigned for elective termination of pregnancy without complication. TA patient is admitted to the hospital because he suffers a subsequent AMI after discharge for care of an initial AMI (two weeks prior).

A code from category I21 is sequenced as the principal diagnosis FHypertensive heart disease with congestive heart failure is coded I11.0 + I50.9. TWhen coding a neoplasm, the first step is to go to the Neoplasm Table. FCode C50.811 is assigned for one carcinoma of the breast located at the spot where the right upper and lower quadrants join/overlap.

TC78.7 + C18.7 is correct sequencing for the diagnoses in the following case: Carcinoma of sigmoid colon with small metastatic nodules on the liver; sigmoid resection of the colon carried out.

FWhen coding fractures, if documentation is not present, nondisplaced and closed are considered the default classifications. FBurns of the same site are coded to the highest degree only. TBurns due to a chemical such as lye is coded to corrosion. TWhen no intent for a poisoning is provided, the code for undetermined poisoning should be assigned.

FAll conditions that occur postoperatively are classified as complications. FAll intraoperative and postprocedural complications are classified to categories T80-T88. FThe presence of CKD in a patient that has had a kidney transplant indicates that there is the complication of rejection.

FWhat does the dash (-) mean in ICD-10-CM? Additional characters are needed. A patient was admitted to the hospital because of unstable angina, and a percutaneous transluminal angioplasty was carried out quickly to abort an impending myocardial infarction. The results of the angioplasty showed arteriosclerotic blockage of the native coronary artery. What is the principal diagnosis?

I25.110A patient is admitted with severe abdominal pain, nausea and vomiting due to acute pyelonephritis and diverticulitis. Both underlying conditions are treated, and the physician believes both equally meet the criteria for principal diagnosis. How is this coded? either pyelonephritis or diverticulitis listed first Which approach in ICD-10-PCS is defined as ""entry, by puncture or minor incision, of instrumentation through the skin or mucous membrane and/or any other body layers necessary to reach and visualize the site of the procedure?""

percutaneous endoscopic A breast lumpectomy is an example of which root operation in ICD-10-PCS? excision What seventh character is assigned to code S82.62x for a patient who broke his left lateral malleolus two weeks ago?

He was initially seen in the emergency room, and is now coming to the hospital to have an ORIF done for his displaced fracture.

AHow is coma due to poisoning by heroin, initial encounter coded? T40.1x1A, R40.20If drug or alcohol use, abuse and dependence are all documented, assign the code for _____.

dependence If the affected side is documented, but not specified as dominant or non-dominant, ambidextrous patients would have which coded as the default in category G81? dominant A patient accidently picked up her husband's medication and mistook it for her hypertension medication. She had a reaction and was taken to the ER. This is coded as _____. poisoning A term pregnancy, liveborn was delivered; breech presentation; 38 weeks gestation; delivery by partial breech vacuum extraction.

O32.1xx0, Z37.0, Z3A.38, 10D07Z6What code is assigned for acute gastritis without bleeding? K29.00A patient was prescribed Amiodarone to control his atrial fibrillation. The patient quit taking his prescribed medication on his own one week ago, because he said the medication made him nauseous. He is now admitted for control of atrial fibrillation and medication adjustmen

t. R11.0, T46.2x5A, I48.91The patient arrived to the hospital in acute respiratory failure and hypoxia. The patient was intubated, and the physician documents that the patient is being admitted to the hospital for treatment of the acute respiratory failure with hypoxia. The patient also has congestive heart failure. Mechanical ventilation was provided for 48 consecutive hours. Code the procedure for the mechanical ventilation.

5A1945ZA patient had a CABG performed using harvested saphenous vein to bypass four blockages in the coronary arteries. In addition to the excision code for the saphenous vein harvesting, how many bypass codes are assigned? 1Assign the codes to this case. The patient has carcinoma of the ascending colon with prior resection and was admitted for his first chemotherapy treatment. Code the principal (first-listed) diagnosis. Z51.11This patient had an acute cerebral infarction with left-sided hemiparesis. She was transferred to the LTC facility with a diagnosis of acute CVA. What code is assigned in the long term care facility?

I69.354This 58-year-old male patient has carcinoma of the left lower lung lobe. A thoracoscopic ablation of the left lower lung lobe was performed. Code the principal (first-listed) diagnosis. C34.32This 58-year-old male patient has carcinoma of the left lower lung lobe.

A thoracoscopic ablation of the left lower lung lobe was performed. Code the procedure. 0B5J4ZZThe patient has acute and chronic cholecystitis and underwent a laparoscopic total cholecystectomy. Code the principal (first-listed) diagnosis. K81.2The patient has acute and chronic cholecystitis and underwent a laparoscopic total cholecystectomy. Code the procedure. 0FT44ZZAssign the code for a patient being seen in the emergency room for a compression fracture due to senile osteoporosis (initial encounter).

M80.08x AA pregnant patient at 20 weeks gestation has a chronic cystitis and has recurrent bouts of acute cystitis during her pregnancy, with an acute episode at time of admission. Code the principal (first-listed) diagnosis. O23.12A pregnant patient at 20 weeks gestation has a chronic cystitis and has recurrent bouts of acute cystitis during her pregnancy, with an acute episode at time of admission.

Code the secondary diagnosis. Z3A.20Assign the code for a newborn, delivered vaginally (born in the hospital) with tetralogy of Fallot.

Code the principal (first-listed) diagnosis. Z38.00Assign the code for a newborn, delivered vaginally (born in the hospital) with tetralogy of Fallot. Code the secondary diagnosis. Q21.3Assign the code for infection due to gastric band procedure. K95.01A 26-year-old female is admitted with bleeding and a threatened abortion.

She is at 18 weeks. Drugs were given and the abortion is averted. What is the principal diagnosis? O20.0A patient with acute alcohol intoxication, abuse, and dependence was admitted for treatment and underwent alcohol abuse detoxification. Code the procedure HZ2ZZZZAssign the codes to this case. The patient has carcinoma of the ascending colon with prior resection and was admitted for his first chemotherapy treatment. Code the secondary diagnosis C18.2Assign the procedure code for a hysteroscopy with an intraluminal lithotripsy of the right fallopian tube calcification.

0UF58ZZThe patient is treated for an intracapsular fracture of the neck of the left femur (initial treatment). An open reduction with insertion of nail was done. Code the principal (first-listed) diagnosis. S72.012AThe patient is treated for an intracapsular fracture of the neck of the left femur (initial treatment).

An open reduction with insertion of nail was done. Code the procedure. 0QS704ZWhat is the correct code for an initial encounter for a foreign body in the left ear?

T16.2XXAThe patient was diagnosed with carcinoma of the left lobe of the thyroid gland and underwent an open total thyroidectomy. Code the principal (first-listed) diagnosis. C73The patient was diagnosed with carcinoma of the left lobe of the thyroid gland and underwent an open total thyroidectomy. Code the procedure. 0GTK0ZZA patient with acute alcohol intoxication, abuse, and dependence was admitted for treatment and underwent alcohol abuse detoxification.

Code the principal (first-listed) diagnosis. F10.229The patient arrived to the hospital in acute respiratory failure and hypoxia. The patient was intubated, and the physician documents that the patient is being admitted to the hospital for treatment of the acute respiratory failure with hypoxia. The patient also has congestive heart failure. Mechanical ventilation was provided for 48 consecutive hours. Code the principal (first-listed) diagnosis. J96.01Assign the code for anemia due to antineoplastic chemotherapy.

D64.81Assign the code for bilateral open-angle glaucoma, mild stage. H40.10X1The patient arrived to the hospital in acute respiratory failure and hypoxia. The patient was intubated, and the physician documents that the patient is being admitted to the hospital for treatment of the acute respiratory failure with hypoxia. The patient also has congestive heart failure. Mechanical ventilation was provided for 48 consecutive hours. Code the secondary diagnosis. I50.9 "

Ventilators are typically used by ALS patients having difficulty breathing. There are several kinds of non-invasive ventilators, such as small devices that fit over the nose and mouth. Patients may also opt for a tracheostomy, a surgical procedure in which a tube is placed into the throat.

What is ALS and how does it affect the body?

"What is ALS and how does it affect the body? A motor neuron at a magnification of 250x (© Visuals Unlimited/Corbis)ALS -- amyotrophic lateral sclerosis -- is a progressive disease that primarily affects motor neurons, the nerve cells that connect the brain to muscles throughout the body. For reasons that remain unknown, the motor neurons of people with ALS degenerate and eventually die, causing the individual to lose the ability to control voluntary muscles.

With some, the condition first weakens and disables muscles in the arms or legs; with others, symptoms first appear in the throat area. In most cases, ALS develops into complete paralysis, including the loss of speech. Because ALS primarily affects motor neurons, most of the body's involuntary functions, such as the heart, the digestive system and the senses, are generally unaffected.

The brain's function also remains largely unchanged, though patients may experience mild behavioral effects, such as changes in their reasoning and social interaction skills.

ALS ultimately affects an individual's ability to breathe and swallow. ALS typically develops in individuals aged 40 to 70, but it can affect individuals in their 20s or 30s. About 5 to 10 percent of cases, known as familial ALS (FALS), are the result of an inherited genetic defect.

But in more than 90 percent of ALS patients -- including Stephen Heywood, profiled in the film So Much So Fast -- the disease develops seemingly at random, with no apparent risk factors.

This form is known as sporadic ALS (SALS). In North America, ALS is commonly referred to as Lou Gehrig's Disease, after the famous New York Yankees baseball player who left the team after being diagnosed with ALS in 1939. He succumbed two years later. Watch a short video from Project ALS illustrating how ALS affects the body. The ALS Association (ALSA) has a good Q&A about familial ALS. How many people have ALS? It is estimated that 30,000 people in the U. S. have ALS at any given time, with approximately 5,600 new cases diagnosed annually.

More than 5,000 people die from the disease each year. How is ALS diagnosed? What are the early symptoms?

There is no specific test or procedure to diagnose ALS. Rather, doctors generally reach a diagnosis by using a battery of tests to eliminate other possibilities. These tests include: blood and urine sampling; spinal taps; neurological examinations; muscle and/or nerve biopsies; imaging technologies, including MRIs, x-rays and myelograms (an x-ray examination of the spine); and electrodiagnostic tests that measure muscles' and nerves' response to electrical currents.

Doctors will also take a family history in order to help determine if an individual has familial ALS. There is a genetic test to look for the gene mutation linked to FALS; however, only 20 percent of individuals with FALS actually display the mutation, so the genetic test is not in itself conclusive.

The most common early symptom of ALS is muscle weakness in the arms, legs, or throat muscles. Individuals may experience difficulty speaking clearly or swallowing. They may be unable to complete tasks that require fine motor skills or may find themselves tripping or abnormally clumsy. Some individuals also experience muscle fatigue, cramps or twitching. Among older ALS patients, the first signs of the disease are often mistaken for the common effects of aging. What is the average life expectancy?

ALS is a fatal disease: Most ALS patients die within two to five years of diagnosis. Common causes of death are respiratory failure and/or cardiac problems related to insufficient oxygen. Patients may also suffer respiratory infections, such as pneumonia.

Up to 10 percent of ALS patients live for 10 years or more after diagnosis. Some of these are patients who have opted to use a ventilator to assist breathing. Physicist Stephen Hawking has lived more than 40 years with the disease, though he does not use a respirator.

Read more of Hawking's story. Is there a cure? What are the existing treatments? There is currently no cure for ALS and only one FDA-approved drug treatment.

The approved drug -- riluzole, approved in 1995 and sold under the brand name Rilutek -- is a twice-a-day pill that targets glutamate, an amino acid made in each cell in the body that carries signals along motor neurons. Though the exact cause of ALS is still unknown, some scientists theorize that people who develop ALS produce an overabundance of glutamate that proves toxic to the motor neurons. Researchers believe that Rilutek may help protect neurons from glutamate, but the drug's exact effects are not fully understood.

In the first year of clinical trials, Rilutek appeared to impede the disease's progress and prolong life by an average of three months. However, by the end of the trial's five-year run, there was no significant difference in life extension between patients who received Rilutek and those who received a placebo.

Drug development and clinical trials seeking more and better treatments for ALS are ongoing. Organizations like the ALS Therapy Development Institute, featured in So Much So Fast, are applying new models to the process of drug development in the hopes of speeding up research that could lead to identifying new treatment options for ALS.

What devices and technologies are available to help people with ALS? In the beginning stages of ALS, patients may use walkers or canes before progressing to a wheelchair.

There are power wheelchairs available that can be controlled by the head or chin or by a ""sip-and-puff"" mouth device. Transfer boards and patient lifts are also available to help maneuver the patient's body. And there are a multitude of devices -- from elastic shoelaces to silverware aids -- available to help with daily tasks.

When swallowing becomes too difficult, patients may opt to have a feeding tube placed directly into the stomach. Through the tube, they are given water and special liquid supplement formulas designed to meet all nutritional needs. After the feeding tube is inserted, patients can still eat orally, so long as they can safely chew and swallow. Some individuals, including Stephen Heywood, make this decision proactively, as weight loss can exacerbate other effects of the disease.

Ventilators are typically used by ALS patients having difficulty breathing. There are several kinds of non-invasive ventilators, such as small devices that fit over the nose and mouth. Patients may also opt for a tracheostomy, a surgical procedure in which a tube is placed into the throat.

CPAP is the abbreviation for continuous positive airway pressure. This is a treatment for people who suffer from obstructive sleep apnea. With CPAP, a face mask is worn at night. The mask is attached to a machine that sends pressurized air into your airway, keeping it open while you sleep. This can help to eliminate snoring and other sleep apnea symptoms.

What does CPAP mean?

Honor Society of Nursing (STTI)Administration

Continue Learning about Sleep Apnea Treatment Related to Sleep Apnea Treatment Sleep Apnea Causes Mixed Sleep Apnea Complex Sleep Apnea Living With Sleep Apnea Central Sleep Apnea Sleep Apnea Complications Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view.

It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.

Mechanical ventilation can decrease the patient’s work of breathing by unloading respiratory muscles in a synchronous manner. 1 Mechanical ventilation can also maintain long-term respiratory support of patients with chronic ventilatory problems.

Overview of Mechanical Ventilatory Support and Management of Patient- and Ventilator-Related Responses

Skip to main page content HOME CURRENT ISSUE ARCHIVE FEEDBACK SUBSCRIBE ALERTS HELPSearch GOAdvanced »User Name Password Sign In Overview of Mechanical Ventilatory Support and Management of Patient- and Ventilator-Related Responses Irene Grossbach, RN, MSN ⇓, Linda Chlan, RN, Ph D and Mary Fran Tracy, RN, Ph D, CCNS+ Author Affiliations Irene Grossbach has practiced as a pulmonary clinical nurse specialist for 28 years and is an adjunct assistant professor in the school of nursing at the University of Minnesota in Minneapolis.

Linda Chlan is an associate professor in the school of nursing at the University of Minnesota in Minneapolis. Mary Fran Tracy is a critical care clinical nurse specialist at the University of Minnesota Medical Center, Fairview in Minneapolis.

Corresponding author: Irene Grossbach, rn, msn, 3043 East Calhoun Parkway, Minneapolis, MN 55408 (e-mail: igrossbach@netscape.net ). Next Section Abstract Nurses must be knowledgeable about the function and limitations of ventilator modes, causes of respiratory distress and dyssynchrony with the ventilator, and appropriate management in order to provide high-quality patient-centered care.

Prompt recognition of problems and action by the nurse may resolve acute respiratory distress, dyspnea, and increased work of breathing and prevent adverse events. This article presents an overview of mechanical ventilation modes and the assessment and management of dyspnea and patient-ventilator dyssynchrony.

Strategies to manage patients’ responses to mechanical ventilatory support and recommendations for staff education also are presented.

This article has been designated for CE credit. A closed-book, multiple-choice examination follows this article, which tests your knowledge of the following objectives: Differentiate various (common) modes of mechanical ventilation Identify management strategies for patient responses to mechanical ventilatory support Discuss assessments and causes of patient-ventilator dyssynchrony Mechanical ventilatory support is routinely needed for critically ill adults in intensive care units and is also a common therapy in subacute and long-term care settings.

The primary goals of mechanical ventilatory support are to normalize arterial blood gas levels and acid-base imbalance by providing adequate ventilation and oxygenation.

Critical care nurses encounter numerous issues related to ventilator support, including physiological conditions that impede optimal ventilator function, dyspnea, and patient-ventilator dyssynchrony.

IMV Synchronized Intermittent Mandatory Ventilation A preset rate and tidal volume are set, but the machine allows the patient to initiate AND perform their own breaths as well. Positive pressure is applied to ASSIST with the breath, but it is the patient doing the WOB. The ventilator synchronizes the automated breaths with the patient's own breaths.

Critical Care Nursing - Mechanical Ventilation

"29 terms eun2007Critical Care Nursing - Mechanical Ventilation The basics of settings and modes of mechanical ventilation set-up that involve nurses.

PEEP, Vt, SIMV, AC, CMV, etc... Created by UTA AP BSN nursing student JBLearn Flashcards Write Spell Test Match Gravity Advertisement Upgrade to remove ads Sort Common means of sedation for patient receiving mechanical ventilation Morphine Ativan propofol (""milk of amnesia"")Primary nursing concerns for patient with ET tube Unplanned (inadvertent) extubation Aspiration Once inserted, what is important for the initial nurse to establish concerning the ET tube?

Measurement of the tube (on the tube itself) at a specific point on the patient. Ex: 22 cm at the patient's lip.

If this changes, we know the tube has moved. Unless medically contraindicated, how should a mechanically ventilated patient be positioned? Supine, HOB at 30 - 45 degrees (to prevent aspiration)What other intervention is almost always administered with mechanical ventilation?

OG or NG tube to intermittent suction Vt Tidal Volume. Usually 6 - 10 m L/kg (ideal body weight)Fi O2 Fraction of inspired oxygen delivered to the patient. May be between 21% (normal room air) and 100%. PEEP Positive End-Expiratory Pressure. The amount of residual pressure in the lungs at the end of expiration that keeps alveoli partially inflated so they are more easily inflated and perfused with the next breath.

~ 5 cm H2Of Rate # of breaths administered / minute 8 - 12 bpm Sensitivity The degree of negative pressure created by the patient's attempt to breathe that will stimulate the ventilator to either administer a full breath, or assist the patient with positive air pressure.

2 L/min CMV Controlled Mandatory Ventilation Ventilator does all the work. Set rate and tidal volume that is delivered with each breath.

No accommodation for patient-initiated breaths. Administered to patient who are paralyzed or heavily sedated. ACV Assist-Control Ventilation There is a set rate and tidal volume. BUT, the patient is able to initiate an extra breath. The ""extra breath"" is delivered by the machine, NOT performed by the patient. The delivered breath is a full-tidal volume breath (may be more than the patient needed). S

PSV Pressure Support Ventilation Positive pressure that is applied to the airway ONLY DURING INSPIRATION. The patient initiates and performs that actual breaths, but the machine makes them easier with positive pressure. Think of really smart CPAP. Decreases the work of breathing. Patient has to have their own stable respiratory drive.

Primary nursing concerns with Vents Regularly auscultate breath sounds and monitor RR for irregularities. Maintain appropriate tube placement and cuff inflation. Prevent skin breakdown. Develop plan for communication (before insertion if possible). Administer sedatives, analgesics, and/or paralytics prn to maintain comfort and promote cooperation with vent.

ET tube suctioning. Monitor ABGs. ECMO Extracorporeal Membrane Oxygenation. Modification of cardiac bypass. Large-bore catheters are inserted, blood is removed, oxygenated, CO2 is removed, and then returned to body. Complications with positive pressure ventilation Increased intra-thoracic pressure can cause compression of thoracic vessels. Decreased CVP Decreased CO Hypotension (We need to compensate to avoid shock)Barotrauma The PRESSURE of the air can cause damage to lungs / alveoli. Patients with decreased pulmonary accommodation (emphysema) are at increased risk. Can lead to pneumothorax.

Volutrauma The VOLUME of the air is more than the lungs can handle and physical damage to the lungs occurs. Hypo- and Hyperventilation of alveoli Can lead to abnormal Pa O2 and Pa CO2 levels --> p H alterations --> acidosis / alkalosis --> etc.

What is the main thing we want to avoid with mechanical ventilation?? Ventilator Associated Pneumonia (VAP). 9 - 27% of all intubated patients. Signs of VAP Elevated temp and WBCs. Purulent sputum. Odorous sputum.

Crackles or rhonchi on auscultation. Pulmonary infiltrates on X-ray. Nursing interventions to prevent VAP HOB elevated to 30 - 45 degrees. Use of an ET-tube with a suction port above the cuff. Proper and regular oral care. Oral suctioning prn.

HAND WASHING and proper aseptic/clean technique as indicated. What medications can be expected to help prevent aspiration? H2 receptor blockers (Zantac) and proton pump inhibitors (Nexium, Protonix). Decrease gastric acid secretions. Problems caused by increased thoracic pressure Decreased BP --> decreased tissue perfusion. Decreased blood flow back to heart --> INCREASED ICP, decreased myocardial and pulmonary perfusion.

Proper oral care of a ventilated patient Brush their teeth 2x / day. Apply moisturizing agent to lips q4h. Adverse effects of propofol Hypotension Bradycardia Elevated triglyceride levels What test is performed before paralyzing a patient for Ventilation therapy?

Train-of-Four (TOF) of the ulnar nerve What should be on hand during an extubation procedure? Intubation Kit. In-case the patient doesn't tolerate the procedure well, we need to be ready to put another tube back down. Advertisement Upgrade to remove ads Features Quizlet Live Quizlet Learn Diagrams Flashcards Mobile Help Sign up Help Center Honor Code Community Guidelines Students Teachers About Company Press Jobs Privacy Terms Follow us Language© 2018 Quizlet Inc. "

Coming Off the Ventilator The ventilator brings oxygen into the lungs and helps get rid of carbon dioxide from the patient’s body. Sometimes a patient may become dependent on a ventilator because of his or her medical problems. This may make it difficult to get the patient off the ventilator.

When Someone You Love is on a Ventilator This information was designed to help you understand what a ventilator is and how it helps your loved one. If you have any questions, please be sure to ask your doctor, nurse, or respiratory therapist. What is a ventilator?

A ventilator is a machine that helps a patient to breathe. Patients are usually placed on a ventilator because of a medical problem that makes it hard for them to breathe well on their own. While on the ventilator, the body is able to rest so that it can heal. The ventilator can help with breathing or totally breathe for the patient.

What to Expect Your loved one may feel frustrated or anxious because he or she can’t talk while on the ventilator.

There are several ways to help promote communication. You can speak with the nurses about what might work best for your loved one. Often patients on a ventilator are given medicine that puts them in a coma-like condition so that the ventilator does all the work of breathing. Eating and Activity Your loved one will be fed through an IV (intravenous) or feeding tube while on the ventilator.

However, some patients without tracheostomy tubes are able to eat by mouth. If your loved one is strong enough, he or she may sit up in a chair while on the ventilator. How You Can Help There are many things you can do to comfort your loved one. Try talking to him or her as you normally would or let your loved one know you’re near by touching or holding his or her hand.

You may be able to bring items from home, like a pillow or robe. Please check with the nurse first. Some patients need special instructions for their visitors, such as special visiting times or a time limit to the visit.

Please follow these instructions. They are in place to allow the patient care team to give your loved one the care he or she needs. Alarms, Alerts, and Warnings Even though there may not be a care team member at the patient’s bedside, there are a number of devices that will alert the staff of any problems or changes.

The monitor is a small screen above the patient’s bed. It helps keep track of things like the patient’s heart rhythm and blood pressure. Both the monitor and the ventilator are equipped with alarms. Each of the alarms will alert a staff member if a change has taken place in the patient’s condition.

Each sound refers to a different condition. Often when an alarm sounds, there is no great cause for concern. The problem may correct itself, and this will be monitored from the nurses’ station. Other times, a care team member may come to check the alarm. Our staff of highly trained professionals is capable of handling all alarms.

CPAP stands for continuous positive airway pressure. It is the most popular treatment for obstructive sleep apnea (OSA). It uses air pressure generated by a machine, delivered through a tube into a mask that fits over the nose or mouth.

CPAP vs BiPAP

CPAP vs Bi PAPCPAP vs BIPAP – Research & Treatments What is the difference between CPAP and BIPAPBoth CPAP and Bi PAP are treatments for sleep apnea that use airway pressure to treat pauses in breathing during sleep.

Each technology has unique benefits that is used to treat sleep disordered breathing problems. While there are differences between the two, there are also many similarities. Read on to discover CPAP vs BIPAP information that may assist you in finding the best solution. What is CPAP?

What is Bi PAP? Bi PAP refers to Bilevel or two-level positive airway pressure. Like CPAP, air is sent through a tube into a mask that fits over the nose. While CPAP generally delivers a single pressure, Bi PAP delivers an inhale pressure and an exhale pressure. Bi PAP is a trademark of Respironics. Which is better, CPAP or Bi PAP? Each is used for a special purpose. Historically, Bi PAP was more expensive than CPAP. Bi PAP is often used when CPAP is not tolerated by the user.

There are new technologies that increase comfort with CPAP. CPAPBi PAP is sometimes used in patients who have pulmonary (lung) issues, like COPD. The difference in pressures helps to eliminate extra CO2 carbon dioxide gas from the body. CPAP and Bi PAP machines look similar.

The attachments are the same. There are other type of ventilatory support devices, including Adaptive Servo Ventilation (ASV). ASA sponsor CPAP Masks Old content – To be modified or deleted: The CPAP machine is designed to deliver air pressure through the nostrils into the back of the throat in order to keep the airway open.

The pressure is adjustable. There are several potential modifications to the way the air can be delivered in order to keep the airway open during sleep.

The Bi PAP or bilevel machine is very similar to the C-PAP machine. Utilizing the identical setup as a CPAP with tubing and masks, the Bi PAP uses a different pressure setting. While CPAP delivers one pressure, Bi PAP delivers two pressures. These two pressures are known as inhalation positive airway pressure (IPAP) and exhalation positive airway pressure (EPAP).cpap vs bipap Bi PAP is often used with individuals who need extra respiratory support.

It is often prescribed for patients with congestive heart failure/coronary artery disease and pulmonary or neurologic medical disorders. Patients with neuromuscular disorders may also benefit from the pressure differential of a bilevel positive airway pressure device. The Bi PAP is usually preset with two settings. The effort when inhaling and exhaling is monitored. When the person sleeping doesn’t breathe for a programmed period of time, the Bi PAP may be set to deliver a breath.

This is usually set as a minimum breath or ‘back-up rate’ that sets a minimum breaths per minute (BPM). This setting is designed so that the patient breathes a set frequency of breaths per minute. One of the many advantages of the Bi PAP machine is that the strain is decreased during expiration.

This limits the amount of energy expended during exhalation. In other words, it is easier to breathe out with Bi PAP than with CPAP.

New Bi PAP machines are similar in size to CPAP devices. They are about the size of a lunchbox. Many are very quiet. They’re designed to be silent so as not to interrupt the sleeper. Most Bi PAP units offer a humidifier option to prevent the drying of the mucosal membranes. CPAP, Bi PAP machine In summary, the primary difference between CPAP and Bi PAP, or bilevel, machines is the pressure differential.

While CPAP has one pressure. Bi PAP has two pressures. The ordering sleep physician usually decides what type of breathing treatment should be used. A sleep study often aids in the decision making of this process. Disclosure: Some compensated affiliate links on this website.

We receive compensation in the form of commissions or other payment from some of the companies whose products we list. Bi PAP is a trademark of Respironics and is a promotional partner of ASA. What are the similarities between CPAP vs Bi PAP?

CPAP and Bilevel PAP both use air pressure for the treatment of sleep disordered breathing. Both use the exact same attachments. This includes the cpap mask, hose, filter, humidifier. Both sleep breathing machines now come in portable versions which can be transported very easily. Both can be used for treating obstructive sleep apnea. (Visited 14,218 times, 66 visits today)Share This: Related posts: Travel Portable CPAP Top CPAP Machines and CPAP Masks Reviews

. BIPAP is either used with a specific BIPAP machine or it can be applied using a mechanical ventilator ( Ventilators (Breathing Machines). A BIPAP mask is fitted on to your loved ones face and attached to the ventilator with flexible circuits (tubing).

BIPAP

"BIPAPWhat is Bi PAP ventilation? Bilevel positive airway pressure ( BIPAP) is a continuous positive airway pressure (CPAP) mode used during Non- Invasive Ventilation (NIV) (positive pressure ventilation). It delivers a preset inspiratory (breathing in) positive airway pressure (IPAP) and expiratory (breathing out) positive airway pressure (EPAP). BIPAP can be described as a continuous positive airway pressure system with a time-cycled or flow-cycled change of the applied CPAP level.

CPAP, BIPAP and other non-invasive ventilation modes have been shown to be effective management tools for chronic obstructive pulmonary disease ( COPD) and acute respiratory failure.

The main purpose of BIPAP ventilation is to push air and oxygen into the lungs, whilst also keeping the lungs and the alveoli inflated, allowing more oxygen to enter the lungs. The main reason for using BIPAP is if your loved one is unable to breathe effectively and therefore is unable to inhale sufficient oxygen into the lungs.

BIPAP is an alternative therapy to Intubation and mechanical ventilation. During BIPAP your loved one would get a few breaks to be put back on an oxygen mask, as BIPAP on the one hand can be extremely effective improving oxygenation, but on the other hand can be very tiring

The main use of BIPAP is in Patients with Pneumonia COPDAcute Severe Asthma Cardiac failureafter Extubation Example of a full face mask Example of a BIPAP Machine These images sourced through Google using ‘bipap’ as keyword How Long is Bi PAP therapy being Used? BIPAP is often used before Intubation or after Extubation. In both cases, this can range from several hours to several days and sometimes several weeks.

If your loved one is requiring ongoing BIPAP or Non-invasive mask ventilation and wants to leave Intensive Care and/or Hospital, check out www.intensivecareathome.com for more information Also, have a look here for home BIPAP/CPAP services Quality of life nursing services for Adults& Children requiring Non-Invasive mask ventilation such as CPAP or BIPAP and/or High-flow Oxygen therapy Quality of life nursing services for Adults& Children requiring Non-Invasive mask ventilation such as CPAP or BIPAP and/or High-flow Oxygen therapy Depending on your individual needs we optimise your Quality of Life needs if you are dependent on Non-Invasive mask Ventilation … Continue reading Intensive Care At Home 0Word Press Embed HTML Embed Copy and paste this URL into your Word Press site to embed Are There Any Complications?

All Intensive Care interventions and procedures carry a degree of potential risk even when performed by skilled and experienced staff. Please discuss these issues with the medical and nursing staff who are caring for your loved one. Any Questions? Of course, if you have any questions or concerns, please discuss them with the ICU nurses and doctors. The information contained on this page is general in nature and therefore cannot reflect individual Patient variation.

It is meant as a back up to specific information which will be discussed with you by the Doctors and Nurses caring for your loved one. INTENSIVE ARE HOTLINE attests to the accuracy of the information contained here BUT takes no responsibility for how it may apply to an individual Patient.

Please refer to the full disclaimer. Related articles: How long is a Patient kept on a BIPAP machine in Intensive Care?

How long can a breathing tube or an endotracheal tube can stay in? How long should a Patient be on a ventilator before having a Tracheostomy?

What is an induced coma and why is my critically ill loved one in an induced coma? The 3 most dangerous mistakes that you are making but you are unaware of, if your loved one is a critically ill Patient in Intensive Care How to always achieve your goals whilst your loved one is critically ill in Intensive Care Why you must make up your own mind about your critically ill loved one’s situation in Intensive Care even if you’re not a doctor or a nurse!Follow this proven 5 step process on how to be in control and influential if your loved one is a long-term Patient in Intensive Care How to quickly take control and have real power and influence if your loved one is critically ill in Intensive Care Why does my loved one need a Tracheostomy in Intensive Care?

Tracheostomy and weaning off the ventilator in Intensive Care, how long can it take? Be more selfish if your loved one is critically ill in Intensive Care How to stay positive if your loved one is critically ill in Intensive Care4 ways on how to be more persuasive if your loved one is critically ill in Intensive Care My sister has been in ICU for 21 weeks with Tracheostomy and still ventilated.

What do we need to do? Severe lung failure and my aunty is not expected to survive…3 quick steps on how to position and prepare yourself well mentally, whilst your loved one is critically ill in Intensive Care How to get what you want whilst your loved one is critically ill in Intensive Care5 steps to become a better negotiator if your loved one is critically ill in Intensive Care How to make sure that your values and beliefs are known whilst your loved one is critically ill in Intensive Care How to make sure that “what you see is always what you get” whilst your loved one is critically ill in Intensive Care What the doctors and the nurses behaviour in Intensive Care is telling you about the culture in a unit How long does it take to wake up from a Traumatic brain injury or severe head injury How to take control if your loved one has a severe brain injury and is critically ill in Intensive Care Family Meetings in Intensive Care or the Elephant in the Room What you need to do if your loved one is dying in Intensive Care (part one)What you need to do if your loved one is dying in Intensive Care (part two)Intensive Care at its best?

How INTENSIVECAREHOTLINE. COM Can Help You What you and your Family need to do if your critically ill loved one is very sick in Intensive Care and faces an uncertain future How long can somebody stay in Intensive Care?

My Family can’t agree on what’s best for my sister in Intensive Care…Help!My husband is dying in Intensive Care, but we need more time…My mother sustained serious brain damage after a stroke and she now is in multi- organ failure Download YOUR FREE ""INSTANT IMPACT"" Report NOW and discover how you will have PEACE OF MIND , CONTROL, POWER& INFLUENCE whilst your loved one is critically ill in INTENSIVE CAREEmail: What is your biggest frustration right now: We respect your email privacy Email Marketing by AWeber SHARE THIS PAGE: "

Adaptive Support Ventilation ® (ASV ®)Intelligent ventilation mode for passive and spontaneously breathing adult and pediatric patients Automatically adjusts ventilation to lung mechanics and applies lung-protective strategies

Adaptive Support Ventilation Â®  (ASV Â®)

Shortens ventilation time Play video Adaptive Support Ventilation (ASV): What do clinicians think? Your browser does not currently recognize any of the video formats available. Click here to visit our frequently asked questions about HTML5 video.0:00 / 2:09Ventilation adapted to the patient All Hamilton Medical ventilators feature the intelligent ventilation mode Adaptive Support Ventilation (ASV). ASV adjusts respiratory rate, tidal volume, and inspiratory time continuously depending on the patient’s lung mechanics and effort.

ASV adapts ventilation breath-by-breath, 24 hours a day, and from intubation to extubation. ASV automatically employs lung-protective strategies to minimize complications from Auto PEEP and volutrauma/barotrauma.

It also prevents apnea, tachypnea, dead space ventilation, and excessively large breaths. Within the rules of this lung-protective strategy, ASV encourages the patient to breathe spontaneously. ASV is a well established mode in critical care since 1998 and has become a standard mode in many units around the world. ASV has been successfully used in a variety of patient groups — including post-operative, COPD, and ARDS partients (Celli 2014, Agarwal 2013, Kirakli 2011, Gruber 2008, Sulzer 2001).

What customers say about ASVHAMILTON-T1: Transport Ventilation at Swiss Air-Ambulance Rega Your browser does not currently recognize any of the video formats available. Click here to visit our frequently asked questions about HTML5 video.0:00 / 2:57Dr. Olivier Seiler Deputy Medical Director (till 2014)Rega Air Ambulance, Zurich, Switzerland ASV in particular has proven its worth in everyday use.

Our crews are highly enthusiastic about it. They say that they don’t have to worry about the ventilation and can focus on setting the patient up. HAMILTON-G5: Adaptive Support Ventilation at the Methodist Hospital in Houston, TXYour browser does not currently recognize any of the video formats available.

Click here to visit our frequently asked questions about HTML5 video.0:00 / 2:16Ken Hargett Director Respiratory Care The Methodist Hospital, Houston (TX), USAASV adapts to the patient's needs by continuously adjusting the pressure needed while maintaining a safe ventilation range. It provides all levels of ventilation regardless what the patient’s needs are. Craig Jolly Adult Clinical Education Coordinator University Medical Center, Lubbock (TX), USAWhat ASV does for us as therapists is it allows us to make sure that we are crafting the breath in the absolutely best possible way for that patient at that time.

Scientific evidence on ASVSince its introduction in 1998, ASV has received a lot of interest from the scientific community and has been the topic of well over 30 studies.

Studies show that: In passive patients, ASV selects different tidal volume / respiratory rate combinations for normal lung, COPD, and ARDS patients (Arnal 2008). In active patients, ASV decreases work of breathing and improves patient-ventilator synchrony (Wu 2010, Tassaux 2010). In the ICU, ASV decreases the weaning duration in medical patients (Chen 2011) and COPD patients (Kirakli 2011).

In post-cardiac surgery, ASV allows earlier extubation than conventional modes (Gruber 2008, Sulzer 2001) with fewer manual adjustments (Petter 2003) and fewer ABG analyses performed (Sulzer 2001). The bibliography gives an overview of the results of the studies on ASV and of some of the underlying principles.

Adaptive Support Ventilation (ASV) bibliography ASV benefits Improved patient safety and comfort Ease of use Increased efficiency How ASV works Adaptive Support Ventilation (ASV) - How does it work?

Your browser does not currently recognize any of the video formats available. Click here to visit our frequently asked questions about HTML5 video.0:00 / 6:22ASV maintains an operator set minute volume and automatically determines an optimal tidal volume / respiratory rate combination based on the minimal work of breathing principle described by Otis (Otis 1954). ASV takes into account the patient’s respiratory mechanics, which are measured breath-by-breath by the proximal flow sensor.

ASV ensures optimal ventilation for each patient during passive ventilation, spontaneous breathing, and weaning. ASV in passive patients In passive patients, ASV is a volume-targeted pressure controlled mode with automatic adjustment of inspiratory pressure, respiratory rate, and inspiratory/expiratory time ratio.

Maximum tidal volume is controlled by setting a maximum inspiratory pressure. Expiratory time is determined according to the expiratory time constant in order to prevent dynamic hyperinflation. ASV in active patients In spontaneously breathing patients, ASV is a volume-targeted pressure support mode with automatic adjustment of pressure support according to the spontaneous respiratory rate.

The automatic decrease of pressure support when the patient recovers their inspiratory strength is very useful for weaning. ASV can also be used to perform a weaning trial before extubation. Availability of ASVASV is available on all current Hamilton Medical mechanical ventilators.

See ventilator overview Downloads Brochures ASV brochure PDF / 2.5 MB689132.04ENBibliographies ASV bibliography PDF / 797.3 KBELO20151136S.03ENMore downloads References Arnal J-M, Wysocki M, Nafati C, Donati S, Granier I, Corno G, et al. Automatic selection of breathing pattern using adaptive support ventilation. Intensive Care Med. 2008 Jan;34 (1):75‑81.

Celli P, Privato E, Ianni S, Babetto C, D'Arena C, Guglielmo N, Maldarelli F, Paglialunga G, Rossi M, Berloco PB, Ruberto F, Pugliese F. Adaptive support ventilation versus synchronized intermittent mandatory ventilation with pressure support in weaning patients after orthotopic liver transplantation. Transplant Proc. 2014 Sep;46 (7):2272-8. Chen C-W, Wu C-P, Dai Y-L, Perng W-C, Chian C-F, Su W-L, et al.

Effects of implementing adaptive support ventilation in a medical intensive care unit. Respir Care.

2011 Jul;56 (7):976‑983. Gruber PC, Gomersall CD, Leung P, Joynt GM, Ng SK, Ho K-M, et al. Randomized controlled trial comparing adaptive-support ventilation with pressure-regulated volume-controlled ventilation with automode in weaning patients after cardiac surgery. Anesthesiology. 2008 Jul;109 (1):81‑87. Iotti GA, Polito A, Belliato M, Pasero D, Beduneau G, Wysocki M, et al. Adaptive support ventilation versus conventional ventilation for total ventilatory support in acute respiratory failure. Intensive Care Med. 2010 Aug;36 (8):1371‑1379. Kirakli C, Ozdemir I, Ucar ZZ, Cimen P, Kepil S, Ozkan SA.

Adaptive support ventilation for faster weaning in COPD: a randomised controlled trial. Eur Respir J. 2011 Oct;38 (4):774‑780. Otis AB. The work of breathing. Physiol Rev. 1954 Jul;34 (3):449-58Petter AH, Chioléro RL, Cassina T, Chassot P-G, Müller XM, Revelly J-P. Automatic « respirator/weaning » with adaptive support ventilation: the effect on duration of endotracheal intubation and patient management.

Anesth Analg. 2003 Dec;97 (6):1743‑1750. Sulzer CF, Chioléro R, Chassot PG, Mueller XM, Revelly JP. Adaptive support ventilation for fast tracheal extubation after cardiac surgery: a randomized controlled study.

Anesthesiology. 2001 Dec;95 (6):1339‑1345. Tassaux D, Dalmas E, Gratadour P, Jolliet P. Patient-ventilator interactions during partial ventilatory support: a preliminary study comparing the effects of adaptive support ventilation with synchronized intermittent mandatory ventilation plus inspiratory pressure support. Crit Care Med. 2002 Apr;30 (4):801‑807. Wu C-P, Lin H-I, Perng W-C, Yang S-H, Chen C-W, Huang Y-CT, et al. Correlation between the %Min Vol setting and work of breathing during adaptive support ventilation in patients with respiratory failure. Respir Care. 2010 Mar;55 (3):334‑341.

Adaptive Support Ventilation ® (ASV ®)Intelligent ventilation mode for passive and spontaneously breathing adult and pediatric patients Automatically adjusts ventilation to lung mechanics and applies lung-protective strategies

Shortens ventilation time Play video Adaptive Support Ventilation (ASV): What do clinicians think? Your browser does not currently recognize any of the video formats available. Click here to visit our frequently asked questions about HTML5 video.0:00 / 2:09Ventilation adapted to the patient All Hamilton Medical ventilators feature the intelligent ventilation mode Adaptive Support Ventilation (ASV). ASV adjusts respiratory rate, tidal volume, and inspiratory time continuously depending on the patient’s lung mechanics and effort.

ASV adapts ventilation breath-by-breath, 24 hours a day, and from intubation to extubation. ASV automatically employs lung-protective strategies to minimize complications from Auto PEEP and volutrauma/barotrauma.

It also prevents apnea, tachypnea, dead space ventilation, and excessively large breaths. Within the rules of this lung-protective strategy, ASV encourages the patient to breathe spontaneously. ASV is a well established mode in critical care since 1998 and has become a standard mode in many units around the world. ASV has been successfully used in a variety of patient groups — including post-operative, COPD, and ARDS partients (Celli 2014, Agarwal 2013, Kirakli 2011, Gruber 2008, Sulzer 2001).

What customers say about ASVHAMILTON-T1: Transport Ventilation at Swiss Air-Ambulance Rega Your browser does not currently recognize any of the video formats available. Click here to visit our frequently asked questions about HTML5 video.0:00 / 2:57HAMILTON-G5: Adaptive Support Ventilation at the Methodist Hospital in Houston, TXYour browser does not currently recognize any of the video formats available.

Click here to visit our frequently asked questions about HTML5 video.0:00 / 2:16Craig Jolly Adult Clinical Education Coordinator University Medical Center, Lubbock (TX), USAWhat ASV does for us as therapists is it allows us to make sure that we are crafting the breath in the absolutely best possible way for that patient at that time.

Previous Next1 2 3Scientific evidence on ASVSince its introduction in 1998, ASV has received a lot of interest from the scientific community and has been the topic of well over 30 studies. Studies show that: In passive patients, ASV selects different tidal volume / respiratory rate combinations for normal lung, COPD, and ARDS patients (Arnal 2008). In active patients, ASV decreases work of breathing and improves patient-ventilator synchrony (Wu 2010, Tassaux 2010).

In the ICU, ASV decreases the weaning duration in medical patients (Chen 2011) and COPD patients (Kirakli 2011). In post-cardiac surgery, ASV allows earlier extubation than conventional modes (Gruber 2008, Sulzer 2001) with fewer manual adjustments (Petter 2003) and fewer ABG analyses performed (Sulzer 2001).

The bibliography gives an overview of the results of the studies on ASV and of some of the underlying principles. Adaptive Support Ventilation (ASV) bibliography ASV benefits Improved patient safety and comfort Ease of use Increased efficiency How ASV works Adaptive Support Ventilation (ASV) - How does it work?

Your browser does not currently recognize any of the video formats available. Click here to visit our frequently asked questions about HTML5 video.0:00 / 6:22ASV maintains an operator set minute volume and automatically determines an optimal tidal volume / respiratory rate combination based on the minimal work of breathing principle described by Otis (Otis 1954). ASV takes into account the patient’s respiratory mechanics, which are measured breath-by-breath by the proximal flow sensor.

ASV ensures optimal ventilation for each patient during passive ventilation, spontaneous breathing, and weaning. ASV in passive patients In passive patients, ASV is a volume-targeted pressure controlled mode with automatic adjustment of inspiratory pressure, respiratory rate, and inspiratory/expiratory time ratio.

Maximum tidal volume is controlled by setting a maximum inspiratory pressure. Expiratory time is determined according to the expiratory time constant in order to prevent dynamic hyperinflation. ASV in active patients In spontaneously breathing patients, ASV is a volume-targeted pressure support mode with automatic adjustment of pressure support according to the spontaneous respiratory rate.

The automatic decrease of pressure support when the patient recovers their inspiratory strength is very useful for weaning. ASV can also be used to perform a weaning trial before extubation. Availability of ASVASV is available on all current Hamilton Medical mechanical ventilators.

See ventilator overview Downloads Brochures ASV brochure PDF / 2.5 MB689132.04ENBibliographies ASV bibliography PDF / 797.3 KBELO20151136S.03ENMore downloads References Arnal J-M, Wysocki M, Nafati C, Donati S, Granier I, Corno G, et al. Automatic selection of breathing pattern using adaptive support ventilation. Intensive Care Med. 2008 Jan;34 (1):75‑81.

Celli P, Privato E, Ianni S, Babetto C, D'Arena C, Guglielmo N, Maldarelli F, Paglialunga G, Rossi M, Berloco PB, Ruberto F, Pugliese F. Adaptive support ventilation versus synchronized intermittent mandatory ventilation with pressure support in weaning patients after orthotopic liver transplantation. Transplant Proc. 2014 Sep;46 (7):2272-8. Chen C-W, Wu C-P, Dai Y-L, Perng W-C, Chian C-F, Su W-L, et al. Effects of implementing adaptive support ventilation in a medical intensive care unit. Respir Care.

2011 Jul;56 (7):976‑983. Gruber PC, Gomersall CD, Leung P, Joynt GM, Ng SK, Ho K-M, et al. Randomized controlled trial comparing adaptive-support ventilation with pressure-regulated volume-controlled ventilation with automode in weaning patients after cardiac surgery.

Anesthesiology. 2008 Jul;109 (1):81‑87. Iotti GA, Polito A, Belliato M, Pasero D, Beduneau G, Wysocki M, et al. Adaptive support ventilation versus conventional ventilation for total ventilatory support in acute respiratory failure. Intensive Care Med. 2010 Aug;36 (8):1371‑1379. Kirakli C, Ozdemir I, Ucar ZZ, Cimen P, Kepil S, Ozkan SA.

Adaptive support ventilation for faster weaning in COPD: a randomised controlled trial. Eur Respir J. 2011 Oct;38 (4):774‑780. Otis AB. The work of breathing. Physiol Rev. 1954 Jul;34 (3):449-58Petter AH, Chioléro RL, Cassina T, Chassot P-G, Müller XM, Revelly J-P. Automatic « respirator/weaning » with adaptive support ventilation: the effect on duration of endotracheal intubation and patient management.

Anesth Analg. 2003 Dec;97 (6):1743‑1750. Sulzer CF, Chioléro R, Chassot PG, Mueller XM, Revelly JP. Adaptive support ventilation for fast tracheal extubation after cardiac surgery: a randomized controlled study. Anesthesiology. 2001 Dec;95 (6):1339‑1345. Tassaux D, Dalmas E, Gratadour P, Jolliet P. Patient-ventilator interactions during partial ventilatory support: a preliminary study comparing the effects of adaptive support ventilation with synchronized intermittent mandatory ventilation plus inspiratory pressure support. Crit Care Med. 2002 Apr;30 (4):801‑807. Wu C-P, Lin H-I, Perng W-C, Yang S-H, Chen C-W, Huang Y-CT, et al. Correlation between the %Min Vol setting and work of breathing during adaptive support ventilation in patients with respiratory failure. Respir Care. 2010 Mar;55 (3):334‑341.

Nasotracheal intubation In medicine, mechanical ventilation is a method to mechanically assist or replace spontaneous breathing. Mechanical ventilation is typically used after an invasive intubation, a procedure wherein an endotracheal or tracheostomy tube is inserted into the airway.

Mechanical ventilation

"Mechanical ventilation From Wikipedia, the free encyclopedia Jump to: navigation, search In architecture and climate control, mechanical or forced ventilation is the use of powered equipment, e.g. fans and blowers, to move air — see ventilation (architecture).

It is used in acute settings such as in the ICU for a short period of time during a serious illness. It may be used at home or in a nursing or rehabilitation institution if patients have chronic illnesses that require long-term ventilation assistance.

The main form of mechanical ventilation is positive pressure ventilation, which works by increasing the pressure in the patient's airway and thus forcing air into the lungs. Less common today are negative pressure ventilators (for example, the ""iron lung"") that create a negative pressure environment around the patient's chest, thus sucking air into the lungs.

Mechanical ventilation is often a life-saving intervention, but carries many potential complications including pneumothorax, airway injury, alveolar damage, and ventilatorassociated pneumonia. [citation needed] For this reason the pressure and volume of gas used is strictly controlled, and reduced as soon as possible.

[citation needed]Contents [hide] •• • •• •• • • •1 History o 1.1 Negative pressure machines o 1.2 Positive pressure machines 2 Indications for use 3 Types of ventilators 4 Modes of ventilation o 4.1 Conventional ventilation 4.1.1 Breath termination 4.1.2 Breath initiation o 4.2 High Frequency Ventilation (HFV) o 4.3 Non-invasive ventilation (Non-invasive Positive Pressure Ventilation or NIPPV) o 4.4 Proportional Assist Ventilation (PAV) o 4.5 Adaptive Support Ventilation (ASV) o 4.6 Neurally Adjusted Ventilatory Assist (NAVA) 5 Choosing amongst ventilator modes 6 Initial ventilator settings o 6.1 Tidal volume, rate, and pressures o 6.2 Sighs o 6.3 Initial Fi O2 o 6.4 Positive end-expiratory pressure (PEEP) o 6.5 Positioning o 6.6 Sedation o 6.7 Prophylaxis 7 Modification of settings o 7.1 When to withdraw mechanical ventilation 8 Connection to ventilators 9 Terminology 10 References • •11 Further reading 12 External links History The roman physician Galen may have been the first to describe mechanical ventilation: ""If you take a dead animal and blow air through its larynx [through a reed], you will fill its bronchi and watch its lungs attain the greatest distention.""

[1] Vesalius too describes ventilation by inserting a reed or cane into the trachea of animals [2]. In 1908 George Poe demonstrated his mechanical respirator by asphyxiating dogs and seemingly bringing them back to life.

[3] Negative pressure machines An Iron Lung The iron lung, also known as the Drinker and Shaw tank, was developed in 1929 and was one of the first negative-pressure machines used for long-term ventilation. It was refined and used in the 20th century largely as a result of the polio epidemic that struck the world in the 1940s. The machine is effectively a large elongated tank, which encases the patient up to the neck. The neck is sealed with a rubber gasket so that the patient's face (and airway) are exposed to the room air.

While the exchange of oxygen and carbon dioxide between the bloodstream and the pulmonary airspace works by diffusion and requires no external work, air must be moved into and out of the lungs to make it available to the gas exchange process. In spontaneous breathing, a negative pressure is created in the pleural cavity by the muscles of respiration, and the resulting gradient between the atmospheric pressure and the pressure inside the thorax generates a flow of air.

In the iron lung by means of a pump, the air is withdrawn mechanically to produce a vacuum inside the tank, thus creating negative pressure. This negative pressure leads to expansion of the chest, which causes a decrease in intrapulmonary pressure, and increases flow of ambient air into the lungs.

As the vacuum is released, the pressure inside the tank equalizes to that of the ambient pressure, and the elastic coil of the chest and lungs leads to passive exhalation. However, when the vacuum is created, the abdomen also expands along with the lung, cutting off venous flow back to the heart, leading to pooling of venous blood in the lower extremities.

There are large portholes for nurse or home assistant access. The patients can talk and eat normally, and can see the world through a well-placed series of mirrors.

Some could remain in these iron lungs for years at a time quite successfully. Today, negative pressure mechanical ventilators are still in use, notably with the Polio Wing Hospitals in England such as St. Thomas' (by Westminster in London) and the John Radcliffe in Oxford.

The prominent device used is a smaller device known as the cuirass. The cuirass is a shell-like unit, creating negative pressure only to the chest using a combination of a fitting shell and a soft bladder.

Its main use is in patients with neuromuscular disorders who have some residual muscular function. However, it was prone to falling off and caused severe chafing and skin damage and was not used as a long term device. In recent years this device has re-surfaced as a modern polycarbonate shell with multiple seals and a high pressure oscillation pump in order to carry out biphasic cuirass ventilation.

Positive pressure machines Mechanical ventilator The design of the modern positive-pressure ventilators were mainly based on technical developments by the military during World War II to supply oxygen to fighter pilots in high altitude. Such ventilators replaced the iron lungs as safe endotracheal tubes with high volume/low pressure cuffs were developed. The popularity of positive-pressure ventilators rose during the polio epidemic in the 1950s in Scandinavia and the United States.

Positive pressure through manual supply of 50% oxygen through a tracheostomy tube led to a reduced mortality rate among patients with polio and respiratory paralysis. However, because of the sheer amount of man-power required for such manual intervention, mechanical positive-pressure ventilators became increasingly popular. Positive-pressure ventilators work by increasing the patient's airway pressure through an endotracheal or tracheostomy tube. The positive pressure allows air to flow into the airway until the ventilator breath is terminated.

Subsequently, the airway pressure drops to zero, and the elastic recoil of the chest wall and lungs push the tidal volume -- the breath -- out through passive exhalation. This is an example of a neonatal (infant) ventilator. Indications for use Mechanical ventilation is indicated when the patient's spontaneous ventilation is inadequate to maintain life.

It is also indicated as prophylaxis for imminent collapse of other physiologic functions, or ineffective gas exchange in the lungs.

Because mechanical ventilation only serves to provide assistance for breathing and does not cure a disease, the patient's underlying condition should be correctable and should resolve over time.

In addition, other factors must be taken into consideration because mechanical ventilation is not without its complications (see below) Common medical indications for use include: • • • •• • • •Acute lung injury (including ARDS, trauma) Apnea with respiratory arrest, including cases from intoxication Chronic obstructive pulmonary disease (COPD) Acute respiratory acidosis with partial pressure of carbon dioxide (p CO2) > 50 mm Hg and p H < 7.25, which may be due to paralysis of the diaphragm due to Guillain-Barré syndrome, Myasthenia Gravis, spinal cord injury, or the effect of anaesthetic and muscle relaxant drugs Increased work of breathing as evidenced by significant tachypnea, retractions, and other physical signs of respiratory distress Hypoxemia with arterial partial pressure of oxygen (Pa O2) with supplemental fraction of inspired oxygen (Fi O2) < 55 mm Hg Hypotension including sepsis, shock, congestive heart failure Neurological diseases such as Muscular Dystrophy Amyotrophic Lateral Sclerosis Types of ventilators Ventilation can be delivered via: •Hand-controlled ventilation such as: Bag valve mask •Bag valve mask Continuous-flow or Anaesthesia (or T-piece) bag A mechanical ventilator.

Types of mechanical ventilators include: o Transport ventilators. These ventilators are small, more rugged, and can be powered pneumatically or via AC or DC power sources.

o ICU ventilators. These ventilators are larger and usually run on AC power (though virtually all contain a battery to facilitate intra-facility transport and as a back-up in the event of a power failure). This style of ventilator often provides greater control of a wide variety of ventilation parameters (such as inspiratory rise time). Many ICU ventilators also incorporate graphics to provide visual feedback of each breath. NICU ventilators.

Designed with the preterm neonate in mind, these are a specialized subset of ICU ventilators which are designed to deliver the smaller, more precise volumes and pressures required to ventilate these patients.

o PAP ventilators. these ventilators are specifically designed for noninvasive ventilation. this includes ventilators for use at home, in order to treat sleep apnea. o o Modes of ventilation Conventional ventilation The modes of ventilation can be thought of as classifications based on how to control the ventilator breath. Traditionally ventilators were classified based on how they determined when to stop giving a breath.

The three traditional categories of ventilators are listed below. As microprocessor technology is incorporated into ventilator design, the distinction among these types has become less clear as ventilators may use combinations of all of these modes as well as flow-sensing, which controls the ventilator breath based on the flow-rate of gas versus a specific volume, pressure, or time.

Breath termination •In a volume-cycled ventilator the ventilator delivers a pre-set volume of gas with each breath. Once the specified volume of breath is delivered, the positive pressure is terminated after a certain specified time period. Both pressure and volume modes of ventilation have their respective limitations. Many manufacturers provide a mode or modes that utilize some functions of each.

These modes are flow-variable, volume-targeted, pressure-regulated, time-limited modes (for example, pressure-regulated volume control — PRVC). This means that instead of providing an exact tidal volume each breath, a target volume is set and the ventilator will vary the inspiratory flow at each breath to achieve the target volume at the lowest possible peak pressure.

The inspiratory time limits the length of the inspiratory cycle and therefore the I: E ratio. Pressure regulated modes such as PRVC or Auto-flow (Draeger) can most easily be thought of as turning a volume mode into a pressure mode with the added benefit of maintaining more control over tidal volume than with strictly pressure-control.

Breath initiation The other method of classifying mechanical ventilation is based on how to determine when to start giving a breath. Similar to the termination classification noted above, microprocessor control has resulted in a myriad of hybrid modes that combine features of the traditional classifications.

Note that most of the timing initiation classifications below can be combined with any of the termination classifications listed above. ••••Assist Control (AC). In this mode the ventilator provides a mechanical breath with either a pre-set tidal volume or peak pressure every time the patient initiates a breath.

Traditional assist-control used only a pre-set tidal volume--when a preset peak pressure is used this is also sometimes termed Intermittent Positive Pressure Ventilation or IPPV. However, the initiation timing is the same--both provide a ventilator breath with every patient effort. In most ventilators a back-up minimum breath rate can be set in the event that the patient becomes apnoeic. Although a maximum rate is not usually set, an alarm can be set if the ventilator cycles too frequently.

This can alert that the patient is tachypneic or that the ventilator may be auto-cycling (a problem that results when the ventilator interprets fluctuations in the circuit due to the last breath termination as a new breath initiation attempt).

Synchronized Intermittent Mandatory Ventilation (SIMV). In this mode the ventilator provides a pre-set mechanical breath (pressure or volume limited) every specified number of seconds (determined by dividing the respiratory rate into 60 thus a respiratory rate of 12 results in a 5 second cycle time). Within that cycle time the ventilator waits for the patient to initiate a breath using either a pressure or flow sensor. When the ventilator senses the first patient breathing attempt within the cycle, it delivers the preset ventilator breath.

If the patient fails to initiate a breath, the ventilator delivers a mechanical breath at the end of the breath cycle. Additional spontaneous breaths after the first one within the breath cycle do not trigger another SIMV breath.

However, SIMV may be combined with pressure support (see below). SIMV is frequently employed as a method of decreasing ventilatory support (weaning) by turning down the rate, which requires the patient to take additional breaths beyond the SIMV triggered breath.

Controlled Mechanical Ventilation (CMV). In this mode the ventilator provides a mechanical breath on a preset timing. Patient respiratory efforts are ignored. This is generally uncomfortable for children and adults who are conscious and is usually only used in an unconscious patient.

It may also be used in infants who often quickly adapt their breathing pattern to the ventilator timing. Pressure Support Ventilation (PSV). When a patient attempts to breath spontaneously through an endotracheal tube, the narrowed diameter of the airway results in higher resistance to airflow, and thus a higher work of breathing.

PSV was developed as a method to decrease the work of breathing in-between ventilator mandated breaths by providing an elevated pressure triggered by spontaneous breathing that ""supports"" ventilation during inspiration. Thus, for ••example, SIMV might be combined with PSV so that additional breaths beyond the SIMV programmed breaths are supported. However, while the SIMV mandated breaths have a preset volume or peak pressure, the PSV breaths are designed to cut short when the inspiratory flow reaches a percentage of the peak inspiratory flow (e.g. 10-25%). Also, the peak pressure set for the PSV breaths is usually a lower pressure than that set for the full ventilator mandated breath.

PSV can be also be used as an independent mode. However, since there is generally no back-up rate in PSV, appropriate apnoea alarms must be set on the ventilator. Continuous Positive Airway Pressure (CPAP). A continuous level of elevated pressure is provided through the patient circuit to maintain adequate oxygenation, decrease the work of breathing, and decrease the work of the heart (such as in leftsided heart failure — CHF).

Note that no cycling of ventilator pressures occurs and the patient must initiate all breaths. In addition, no additional pressure above the CPAP pressure is provided during those breaths. CPAP may be used invasively through an endotracheal tube or tracheostomy or non-invasively with a face mask or nasal prongs.

Positive end-expiratory pressure (PEEP) is functionally the same as CPAP, but refers to the use of an elevated pressure during the expiratory phase of the ventilatory cycle. After delivery of the set amount of breath by the ventilator, the patient then exhales passively. The volume of gas remaining in the lung after a normal expiration is termed the functional residual capacity (FRC). The FRC is primarily determined by the elastic qualities of the lung and the chest wall. In many lung diseases, the FRC is reduced due to collapse of the unstable alveoli, leading to a decreased surface area for gas exchange and intrapulmonary shunting (see above), with wasted oxygen inspired.

Adding PEEP can reduce the work of breathing (at low levels) and help preserve FRC. High Frequency Ventilation (HFV)Sensormedics 3100 High Frequency ventilator Main article: High frequency ventilation High-Frequency Ventilation refers to ventilation that occurs at rates significantly above that found in natural breathing (as high as 300-900 ""breaths"" per minute). Within the category of high-frequency ventilation, the two principal types are flow interruption and high-frequency oscillatory ventilation (HFOV).

The former operates similarly to a conventional ventilator, providing increased circuit pressure during the inspiratory phase and dropping back to PEEP during the expiratory phase. In HFOV the pressure wave is driven by an electromagnetically controlled diaphragm similar to a loudspeaker. Because this can rapidly change the volume in the circuit, HFOV can produce a pressure that is lower than ambient pressure during the expiratory phase.

This is sometimes called ""active"" expiration. In both types of high-frequency ventilation the pressure wave that is generated at the ventilator is markedly attenuated by passage down the endotracheal tube and the major conducting airways. This helps protect the alveoli from volutrauma that occurs with traditional positive pressure ventilation. Although the alveoli are kept at a relatively constant volume, similar to CPAP, other mechanisms of gas exchange allow ventilation (the removal of CO2) to occur without tidal volume exchange.

Ventilation in HFV is a function of frequency, amplitude, and I: E ratio and is best described graphically as the area under the curve of an oscillatory cycle. Amplitude is analogous to tidal volume in conventional ventilation; larger amplitudes remove more CO2.

Seemingly paradoxical, lower frequencies remove more CO2 in HFOV whereas in conventional ventilation the opposite is true. As frequency decreases, there is less attenuation of the pressure wave transmitted to the alveoli. This results in increased mixing of gas and thus ventilation. I-time is set as a percentage of total time (usually 33%). Amplitude is a function of power and is subject to variability due to changes in compliance or resistance. Therefore, power requirements may vary significantly during treatment and from patient to patient.

Patient characteristics and ventilator settings determine whether Pa CO2 changes may be more sensitive to amplitude or frequency manipulation. In HFOV, mean airway pressure (MAP) is delivered via a continuous flow through the patient circuit which passes through a variable restriction valve (mushroom valve) on the expiratory limb.

Increasing the flow through the circuit and/or increasing the pressure in the mushroom valve increases MAP. The MAP in HFOV functions similarly to PEEP in conventional ventilation in that it provides the pressure for alveolar recruitment. Non-invasive ventilation (Non-invasive Positive Pressure Ventilation or NIPPV) This refers to all modalities that assist ventilation without the use of an endotracheal tube. Non-invasive ventilation is primarily aimed at minimizing patient discomfort and the complications associated with invasive ventilation.

It is often used in cardiac disease, exacerbations of chronic pulmonary disease, sleep apnea, and neuromuscular diseases. Non-invasive ventilation refers only to the patient interface and not the mode of ventilation used; modes may include spontaneous or control modes and may be either pressure or volume modes. Some commonly used modes of NIPPV include: •Continuous positive airway pressure (CPAP). ••Bi-level Positive Airway Pressure (BIPAP). Pressures alternate between Inspiratory Positive Airway Pressure (IPAP) and a lower Expiratory Positive Airway Pressure (EPAP), triggered by patient effort.

On many such devices, backup rates may be set, which deliver IPAP pressures even if patients fail to initiate a breath. (Wheatley 2000 et all) Intermittent positive pressure ventilation (IPPV) via mouthpiece or mask Proportional Assist Ventilation (PAV) Proportional Assist Ventilation (PAV) is a form of synchronised ventilator support based upon the Equation of Motion in which the ventilator generates pressure in proportion to the instantaneous patient effort.

Unlike other modes of partial support, there is no target flow, tidal volume or pressure. PAV’s objective is to allow the patient to attain ventilation and breathing pattern his ventilatory control system desires. The main operational advantages of PAV are automatic synchrony with inspiratory efforts, exhalation and adaptability to change in ventilatory demand.

Proportional Assist Ventilation Plus — PAV+ (Puritan Bennett – 840 ventilator range) and Proportional Pressure Support — PPS (Drager Evita series), are commercially available implementations of PAV which automatically amplify the patient's own spontaneous effort to breathe by increasing airway pressure during inspiration proportionally to a set amplification factor.

In PAV+, the level of amplification, thus the level of work of breathing, is set through a single setting (%support) and the pressure applied is continuously and automatically adjusted based on measures (including automatic assessment of Elastance and Resistance) taken throughout the inspiratory cycle to maintain an appropriate level of support. Adaptive Support Ventilation (ASV) ASV is a positive pressure mode of mechanical ventilation that is closed-loop controlled. In this mode, the frequency and tidal volume of breaths of a patient on the ventilator are automatically adjusted based on the patient’s requirements.

The lung mechanics data are used to adjust the depth and rate of breaths to minimize the work rate of breathing. In the ASV mode, every breath is synchronized with patient effort if such an effort exists, and otherwise, full mechanical ventilation is provided to the patient.

This technique was originally described as one of the embodiments of US Patent No. 4986268. [4] In this invention, a modified version of an equation derived in physiology in 1950 [5] to minimize the work rate of breathing in man, was used for the first time to find the optimum frequency of mechanical ventilation. The rationale was to make the patient's breathing pattern comfortable and natural within safe limits, and thereby stimulate spontaneous breathing and reduce the weaning time.

A prototype of the system was built by the inventor in late 1980s. The inventor is Dr. Fleur T. Tehrani who is a professor of electrical engineering at California State University, Fullerton, in USA. Shortly after the Patent was issued in 1991, Hamilton Medical, a ventilator manufacturing company, contacted the inventor and discussed marketing the technology with her.

Some years later, Hamilton Medical marketed this closed-loop technique under license of this Patent as ASV. Since the issuance of the Patent in 1991, a number of articles have been published by the inventor and her colleagues that are related to the invention, and some of them describe further advancements of the closed-loop techniques presented in the Patent.

[6] Neurally Adjusted Ventilatory Assist (NAVA) NAVA is a new positive pressure mode of mechanical ventilation, where the ventilator is controlled directly by the patient's own neural control of breathing.

The neural control signal of respiration originates in the respiratory center, and are transmitted through the phrenic nerve to excite the diaphragm. These signals are monitored by means of electrodes mounted on a nasogastric feeding tube and positioned in the esophagus at the level of the diaphragm. As respiration increases and the respiratory center requires the diaphragm for more effort, the degree of ventilatory support needed is immediately provided.

This means that the patient's respiratory center is in direct control of the mechanical support required on a breath-by-breath basis, and any variation in the neural respiratory demand is responded to by the appropriate corresponding change in ventilatory assistance.

Reference: New method permits neural control of mechanical ventilation Choosing amongst ventilator modes Assist-control mode minimizes patient effort by providing full mechanical support with every breath. This is often the initial mode chosen for adults because it provides the greatest degree of support.

In patients with less severe respiratory failure, other modes such as SIMV may be appropriate. Assist-control mode should not be used in those patients with a potential for respiratory alkalosis, in which the patient has an increased respiratory drive. Such hyperventilation and hypocapnia (decreased systemic carbon dioxide due to hyperventilation) usually occurs in patients with end-stage liver disease, hyperventilatory sepsis, and head trauma.

Respiratory alkalosis will be evident from the initial arterial blood gas obtained, and the mode of ventilation can then be changed if so desired. Positive End Expiratory Pressure may or may not be employed to prevent atelectasis in adult patients. It is almost always used for pediatric and neonatal patients due to their increased tendency for atelectasis.

High frequency oscillation is used most frequently in neonates, but is also used as an always alternative mode in adults with severe ARDS. Pressure Regulated Volume Control is another option. Initial ventilator settings The following are general guidelines that may need to be modified for the individual patient. Tidal volume, rate, and pressures ••For adult patients and older children o tidal volume is calculated in milliliters per kilogram. Traditionally 10 ml/kg was used but has been shown to cause barotrauma, or injury to the lung by overextension, so 6 to 8 ml/kg is now common practice in ICU.

Hence a patient weighing 70 kg would get a TV of 420–480 ml. In adults a rate of 12 strokes per minute is generally used. o with acute respiratory distress syndrome (ARDS) a tidal volume of 6–8 ml/kg is used with a rate of 10–12 per minute.

This reduced tidal volume allows for minimal volutrauma but may result in an elevated p CO2 (due to the relative decreased oxygen delivered) but this elevation does not need to be corrected (termed permissive hypercapnia) For infants and younger children o without existing lung disease—a tidal volume of 4–8 ml/kg to be delivered at a rate of 30–35 breaths per minute o with RDS—decrease tidal volume and increase respiratory rate sufficient to maintain p CO2 between 45 and 55 [vague].

Allowing higher p CO2 (sometimes called permissive hypercapnia) may help prevent ventilator induced lung injury As the amount of tidal volume increases, the pressure required to administer that volume is increased.

This pressure is known as the peak airway pressure. If the peak airway pressure is persistently above 45 cm H2O (4.4 k Pa) for adults, the risk of barotrauma is increased (see below) and efforts should be made to try to reduce the peak airway pressure.

In infants and children it is unclear what level of peak pressure may cause damage. In general, keeping peak pressures below 30 cm H2O (2.9 k Pa) is desirable. Monitoring for barotrauma can also involve measuring the plateau pressure, which is the pressure after the delivery of the tidal volume but before the patient is allowed to exhale.

Normal breathing pattern involves inspiration, then expiration. The ventilator is programmed so that after delivery of the tidal volume (inspiration), the patient is not allowed to exhale for a half a second.

Therefore, pressure must be maintained in order to prevent exhalation, and this pressure is the plateau pressure. Barotrauma is minimized when the plateau pressure is maintained < 30–35 cm H2O. Sighs An adult patient breathing spontaneously will usually sigh about 6–8 times per hour to prevent microatelectasis, and this has led some to propose that ventilators should deliver 1½–2 times the amount of the preset tidal volume 6–8 times per hour to account for the sighs.

However, such high quantity of volume delivery requires very high peak pressure that predisposes to barotrauma. Currently, accounting for sighs is not recommended if the patient is receiving 10-12 m L/kg or is on PEEP. If the tidal volume used is lower, the sigh adjustment can be used, as long as the peak and plateau pressures are acceptable.

Sighs are not generally used with ventilation of infants and young children. Initial Fi O2 Because the mechanical ventilator is responsible for assisting in a patient's breathing, it must then also be able to deliver an adequate amount of oxygen in each breath.

The Fi O2 stands for fraction of inspired oxygen, which means the percent of oxygen in each breath that is inspired. (Note that normal room air has ~21% oxygen content). In adult patients who can tolerate higher levels of oxygen for a period of time, the initial Fi O2 may be set at 100% until arterial blood gases can document adequate oxygenation.

An Fi O2 of 100% for an extended period of time can be dangerous, but it can protect against hypoxemia from unexpected intubation problems. For infants, and especially in premature infants, avoiding high levels of Fi O2 (>60%) is important. Positive end-expiratory pressure (PEEP) Main article: Positive end-expiratory pressure PEEP is an adjuvant to the mode of ventilation used to help maintain functional residual capacity (FRC).

At the end of expiration, the PEEP exerts pressure to oppose passive emptying of the lung and to keep the airway pressure above the atmospheric pressure. The presence of PEEP opens up collapsed or unstable alveoli and increases the FRC and surface area for gas exchange, thus reducing the size of the shunt.

For example, if a large shunt is found to exist based on the estimation from 100% Fi O2 (see above), then PEEP can be considered and the Fi O2 can be lowered (< 60%) in order to maintain an adequate Pa O2, thus reducing the risk of oxygen toxicity. In addition to treating a shunt, PEEP may also be useful to decrease the work of breathing. In pulmonary physiology, compliance is a measure of the ""stiffness"" of the lung and chest wall. The mathematical formula for compliance (C) equals change in volume divided by change in pressure.

The higher the compliance, the more easily the lungs will inflate in response to positive pressure. An underinflated lung will have low compliance and PEEP will improve this initially by increasing the FRC, since the partially inflated lung takes less energy to inflate further. Excessive PEEP can however produce overinflation, which will again decrease compliance. Therefore it is important to maintain an adequate, but not excessive FRC.

Indications. PEEP can cause significant haemodynamic consequences through decreasing venous return to the right heart and decreasing right ventricular function. As such, it should be judiciously used and is indicated for adults in two circumstances. • •If a Pa O2 of 60 mm Hg cannot be achieved with a Fi O2 of 60% If the initial shunt estimation is greater than 25%If used, PEEP is usually set with the minimal positive pressure to maintain an adequate Pa O2 with a safe Fi O2.

As PEEP increases intrathoracic pressure, there can be a resulting decrease in venous return and decrease in cardiac output. A PEEP of less than 10 cm H2O (1 k Pa) is usually safe in adults if intravascular volume depletion is absent. Lower levels are used for pediatric patients. Older literature recommended routine placement of a Swan-Ganz catheter if the amount of PEEP used is greater than 10 cm H2 for hemodynamic monitoring.

More recent literature has failed to find outcome benefits with routine PA catheterisation when compared to simple central venous pressure monitoring. [7] If cardiac output measurement is required, minimally invasive techniques, such as oesophageal doppler monitoring or arterial waveform contour monitoring may be sufficient alternatives. [8] [9] PEEP should be withdrawn from a patient until adequate Pa O2 can be maintained with a Fi O2 < 40%.

When withdrawing, it is decreased through 1–2 cm H2O decrements while monitoring haemoglobin-oxygen saturations. Any unacceptable haemoglobin-oxygen saturation should prompt reinstitution of the last PEEP level that maintained good saturation. Positioning Prone (face down) positioning has been used in patients with ARDS and severe hypoxemia. It improves FRC, drainage of secretions, and ventilation-perfusion matching (efficiency of gas exchange). It may improve oxygenation in > 50% of patients, but no survival benefit has been documented. Sedation Most intubated patients receive sedation through a continuous infusion or scheduled dosing to help with anxiety or psychological stress.

Daily interruption of sedation is commonly helpful to the patient for reorientation and appropriate weaning. Prophylaxis • • •To protect against ventilator-associated pneumonia, patients' beds are often elevated to about 30°. Deep vein thrombosis prophylaxis with heparin or sequential compression device is important in older children and adults.

A histamine receptor (H2) blocker or proton-pump inhibitor may be used to prevent gastrointestinal bleeding, which has been associated with mechanical ventilation Modification of settings In adults when 100% Fi O2 is used initially, it is easy to calculate the next Fi O2 to be used and easy to estimate the shunt fraction.

The estimated shunt fraction refers to the amount of oxygen not being absorbed into the circulation. In normal physiology, gas exchange (oxygen/carbon dioxide) occurs at the level of the alveoli in the lungs. The existence of a shunt refers to any process that hinders this gas exchange, leading to wasted oxygen inspired and the flow of un-oxygenated blood back to the left heart (which ultimately supplies the rest of the body with unoxygenated blood).

When using 100% Fi O2, the degree of shunting is estimated by subtracting the measured Pa O2 (from an arterial blood gas) from 700 mm Hg. For each difference of 100 mm Hg, the shunt is 5%. A shunt of more than 25% should prompt a search for the cause of this hypoxemia, such as mainstem intubation or pneumothorax, and should be treated accordingly.

If such complications are not present, other causes must be sought after, and PEEP should be used to treat this intrapulmonary shunt. Other such causes of a shunt include: • •Alveolar collapse from major atelectasis Alveolar collection of material other than gas, such as pus from pneumonia, water and protein from acute respiratory distress syndrome, water from congestive heart failure, or blood from haemorrhage When to withdraw mechanical ventilation Withdrawal from mechanical ventilation—also known as weaning—should not be delayed unnecessarily, nor should it be done prematurely.

Patients should have their ventilation considered for withdrawal if they are able to support their own ventilation and oxygenation, and this should be assessed continuously. There are several objective parameters to look for when considering withdrawal, but there is no specific criteria that generalizes to all patients.

The best measure of when a patient may be extubated is the Rapid Shallow Breathing Index (Tobin Index). This is calculated by dividing the respiratory rate by the tidal volume in liters (RR/TV). A rapid shallow breathing index of less than 100 is considered ideal for extubation. Certainly, other measures such as patient's mental status such be considered. Connection to ventilators There are various procedures and mechanical devices that provide protection against airway collapse, air leakage, and aspiration: •Face mask - In resuscitation and for minor procedures under anaesthesia, a face mask is often sufficient to achieve a seal against air leakage.

Airway patency of the unconscious patient is maintained either by manipulation of the jaw or by the use of nasopharyngeal or oropharyngeal airway. These are designed to provide a passage of air to the pharynx through the nose or mouth, respectively. Poorly fitted masks often cause nasal bridge ulcers, a problem for some patients. Face ••••••masks are also used for non-invasive ventilation in conscious patients.

A full face mask does not, however, provide protection against aspiration. Laryngeal mask airway - The laryngeal mask airway (LMA) causes less pain and coughing than a tracheal tube. However, unlike tracheal tubes it does not seal against aspiration, making careful individualised evaluation and patient selection mandatory.

Tracheal intubation is often performed for mechanical ventilation of hours to weeks duration. A tube is inserted through the nose (nasotracheal intubation) or mouth (orotracheal intubation) and advanced into the trachea. In most cases tubes with inflatable cuffs are used for protection against leakage and aspiration. Intubation with a cuffed tube is thought to provide the best protection against aspiration.

Tracheal tubes inevitably cause pain and coughing. Therefore, unless a patient is unconscious or anaesthetized for other reasons, sedative drugs are usually given to provide tolerance of the tube. Other disadvantages of tracheal intubation include damage to the mucosal lining of the nasopharynx or oropharynx and subglottic stenosis.

Oesophageal obturator airway - commonly used by emergency medical technicians, if they are not authorized to intubate.

It is a tube which is inserted into the oesophagus, past the epiglottis. Once it is inserted, a bladder at the tip of the airway is inflated, to block (""obturate"") the oesophagus, and air or oxygen is delivered through a series of holes in the side of the tube. Cricothyrotomy - Patients who require emergency airway management, in whom tracheal intubation has been unsuccessful, may require an airway inserted through a surgical opening in the cricothyroid membrane.

This is similar to a tracheostomy but a cricothyrotomy is reserved for emergency access. [1] Tracheostomy - When patients require mechanical ventilation for several weeks, a tracheostomy may provide the most suitable access to the trachea. A tracheostomy is a surgically created passage into the trachea. Tracheostomy tubes are well tolerated and often do not necessitate any use of sedative drugs.

Tracheostomy tubes may be inserted early during treatment in patients with pre-existing severe respiratory disease, or in any patient who is expected to be difficult to wean from mechanical ventilation, i.e., patients who have little muscular reserve.

Mouthpiece - Less common interface, does not provide protection against aspiration. There are lipseal mouthpieces with flanges to help hold them in place if patient is unable. Terminology Terminology used in the field of mechanical ventilation and respiratory support: • • •APRV Airway pressure release ventilation ASB Assisted spontaneous breathing—also ASV = assisted spontaneous ventilation ASV Adaptive support ventilation—a patented technology—closed-loop mechanical respiration, a further development of MMV.

Can also stand for assisted spontaneous ventilation. • • • • • • •• • • • • • • • • • • • • • • • • • • •• • • • •ATC Automatic tube compensation BIPAP Biphasic positive airway pressure CMV Continuous mandatory ventilation CPAP Continuous positive airway pressure CPPV Continuous positive pressure ventilation EPAP Expiratory positive airway pressure HFV High frequency ventilation o HFFI High frequency flow interruption o HFJV High frequency jet ventilation o HFOV High frequency oscillatory ventilation o HFPPV High frequency positive pressure ventilation ILV Independent lung ventilation—separate sides positive pressure ventilation.

IPAP Inspiratory positive airway pressure IPPV Intermittent positive pressure ventilation IRV Inversed ratio ventilation— mechanical ventilation with switched respiration phases/time rate. LFPPV Low frequency positive pressure ventilation MMV Mandatory minute volume NAVA Neurally adjusted ventilatory assist NIF Negative inspiratory force—amount of force generated by a patient against a closed valve; greater than 20 cm H2O indicates an adequately strong diaphragm.

PAP Positive airway pressure PAV and PAV+ Proportional assist ventilation and proportional assist ventilation plus P/F ratio Ratio of Pa O2 off an ABG and Fi O2 off the ventilator. P/F < 200 indicates ARDS, P/F < 300 indicates ALI PC Pressure conrol—pressure-controlled, fully mechanical ventilation. PCMV (P-CMV) Pressure controlled mandatory ventilation PCV Pressure controlled ventilation—pressure-controlled, fully mechanical ventilation. PEEP Positive end-expiratory pressure PNPV Positive negative pressure ventilation—switching pressure mechanical ventilation PPS Proportional pressure support PRVC Pressure regulated volume controlled ventilation PSV Pressure support ventilation—supported spontaneous respiration, see also ASB. RSBI Rapid shallow breathing index—ratio of breath rate divided by the tidal volume. RSBI<105 declares a patient can be extubated and maintain themselves. Also indicates patient has a good chance of staying extubated. [10] (S) IMV (Synchronized) intermittent mandatory ventilation S-CPPV Synchronized continuous positive pressure ventilation S-IPPV Synchronized intermittent positive pressure ventilation TNI Therapy with nasal insufflation—nasal high-flow mechanical ventilation for respiration support. VCMV (V-CMV) Volume controlled mandatory ventilation • •VCV Volume controlled ventilation—volume-controlled, fully mechanical ventilation. ZAP Zero airway pressure—spontaneous respiration under atmospheric pressure. "

The ventilator delivers preset breaths in coordination with the respiratory effort of the patient. With each inspiratory effort, the ventilator delivers a full assisted tidal volume. Spontaneous breathing independent of the ventilator between A/C breaths is not allowed.

Ventilator Management

"Drugs & Diseases > Clinical Procedures Ventilator Management Updated: Oct 17, 2017Author: Allon Amitai, MD; Chief Editor: Zab Mosenifar, MD, FACP, FCCP more... Print Introduction to Ventilator Management Intubation, with subsequent mechanical ventilation, is a common life-saving intervention in the emergency department (ED). Given the increasing length of stay of ventilated patients in EDs, it is necessary for emergency practitioners to have a good understanding of techniques to optimize mechanical ventilation and minimize complications. Many different strategies of positive-pressure ventilation are available; these are based on various permutations of triggered volume-cycled and pressure-cycled ventilations and are delivered at a range of rates, volumes, and pressures.

Poor ventilatory management can inflict serious pulmonary and extrapulmonary damage that may not be immediately apparent. Because many of the effects of ventilator-induced lung injury are delayed and not seen while patients are in the ED, much of our understanding of the adverse consequences of volutrauma, air-trapping, barotrauma, and oxygen toxicity has come from the critical care literature.

While the fundamental principles underlying mechanical ventilatory support have changed little over the decades, much progress has been made in our understanding of the secondary pathophysiologic changes associated with positive-pressure ventilation. Ventilatory strategies have been devised for different disease processes to protect pulmonary parenchyma while maintaining adequate gas exchange, and they may be responsible for the increased rates of survival for pathologies such as acute respiratory distress syndrome (ARDS).

Several recent clinical trials have demonstrated that optimizing ventilatory parameters reduces overall duration of mechanical ventilation and organ failure. Additionally, an upsurge in utilization of noninvasive ventilation has permitted many patients to avoid the risks and complications of tracheal intubation. [ 1, 2]Modes of Mechanical Ventilation Volume-cycled mode Inhalation proceeds until a set tidal volume (TV) is delivered and is followed by passive exhalation.

A feature of this mode is that gas is delivered with a constant inspiratory flow pattern, resulting in peak pressures applied to the airways higher than that required for lung distension (plateau pressure). Since the volume delivered is constant, applied airway pressures vary with changing pulmonary compliance (plateau pressure) and airway resistance (peak pressure). Because the volume-cycled mode ensures a constant minute ventilation despite potentially abnormal lung compliance, it is a common choice as an initial ventilatory mode in the ED.

A major disadvantage is that high airway pressures may be generated, potentially resulting in barotrauma.

Close monitoring and use of pressure limits are helpful in avoiding this problem. Note that ventilators set to volume-cycled mode function well as monitors of patients' pulmonary compliance, which will be decreased in physiological states such as worsening ARDS, pneumothorax, right mainstem intubation, chest-wall rigidity, increased intra-abdominal pressure, and psychomotor agitation (""fighting the vent""). These pathophysiological states increase peak pressure and should be considered whenever pressure alarms are sounded. In pressure-cycled settings, by contrast, such states result only in reduced delivered volumes and may not trigger alarms. Given that the airway resistance and pulmonary compliance of the critical ED patient is unknown, the authors recommend the volume-cycled mode for initial ventilation of most patients. Pressure-cycled mode

A set peak inspiratory pressure (PIP) is applied, and the pressure difference between the ventilator and the lungs results in inflation until the peak pressure is attained and passive exhalation follows. The delivered volume with each respiration is dependent on the pulmonary and thoracic compliance.

A theoretical advantage of pressure-cycled modes is a decelerating inspiratory flow pattern, in which inspiratory flow tapers off as the lung inflates. This usually results in a more homogeneous gas distribution throughout the lungs. However, no definite evidence exists that this results in a reduction of the rate of ventilator-induced lung injury or overall mortality.

Nevertheless, pressure-cycled ventilation has achieved considerable popularity in the intensive care setting for management of patients with ARDS, whose lungs are most likely to be characterized by a broad range of alveolar dysfunction and are also most vulnerable to the effects of barotrauma and volutrauma.

A major disadvantage is that dynamic changes in pulmonary mechanics may result in varying tidal volumes. This necessitates close monitoring of minute ventilation and limits the usefulness of this mode in many emergency department patients.

However, newer ventilators can provide volume-assured pressure-cycled ventilation, which increase peak pressures as needed to deliver a preset minimum tidal volume. High-frequency oscillatory support In this ventilatory strategy, ultra-high respiratory rates (180-900 breaths per minute) are coupled with tiny tidal volumes (1-4 m L/kg) and high airway pressures (25-30 mm water).

[ 3] This is a commonly accepted ventilatory setting for premature infants and has now also been used in small critical care unit studies on patients with ARDS, with reports of improving oxygenation and lung recruitment. [ 4, 5]While this setting cannot currently be recommended for routine ED use, it may in the future be found appropriate for the management of patients with ARDS.

Types of support Most ventilators can be set to apply the delivered tidal volume in a control mode or a support mode. Control mode In control mode, the ventilator delivers the preset tidal volume once it is triggered regardless of patient effort.

If the patient is apneic or possesses limited respiratory drive, control mode can ensure delivery of appropriate minute ventilation. Support mode In support mode, the ventilator provides inspiratory assistance through the use of an assist pressure. The ventilator detects inspiration by the patient and supplies an assist pressure during inspiration. It terminates the assist pressure upon detecting onset of the expiratory phase. Support mode requires an adequate respiratory drive. The amount of assist pressure can be dialed in. Methods of Ventilatory Support Continuous mandatory ventilation Breaths are delivered at preset intervals, regardless of patient effort.

This mode is used most often in the paralyzed or apneic patient because it can increase the work of breathing if respiratory effort is present. Continuous mandatory ventilation (CMV) has given way to assist-control (A/C) mode because A/C with the apneic patient is tantamount to CMV. Many ventilators do not have a true CMV mode and offer A/C instead. Assist-control ventilation

The ventilator delivers preset breaths in coordination with the respiratory effort of the patient. With each inspiratory effort, the ventilator delivers a full assisted tidal volume. Spontaneous breathing independent of the ventilator between A/C breaths is not allowed.

Mechanical ventilation systems come in a variety of forms. Almost all systems use a machine called a ventilator that pushes air through a tube for delivery to the patient's airways. The air may be delivered through a nasal or face mask, or through an opening in the trachea (windpipe), called a tracheostomy.

Mechanical ventilation

"Surgery La-Pa Mechanical Ventilation Mechanical ventilation Follow City-Data.com founder on our Forum or @Lech Mazur Definition Mechanical ventilation is the use of a mechanical device (machine) to inflate and deflate the lungs.

Purpose Mechanical ventilation provides the force needed to deliver air to the lungs in a patient whose own ventilatory abilities are diminished or lost. Description Breathing requires the movement of air into and out of the lungs. This is normally accomplished by the diaphragm and chest muscles.

A variety of medical conditions can impair the ability of these muscles to accomplish this task, including:muscular dystrophiesmotor neuron disease, including ALSdamage to the brain's respiratory centerspoliomyasthenia gravismyopathies affecting the respiratory musclesscoliosis Mechanical ventilation may also be used when the airway is obstructed, especially at night in sleep apnea. Mechanical ventilation may be required only at night, during limited daytime hours, or around the clock, depending on the patient's condition.

Some patients require mechanical ventilation only for a short period, during recovery from traumatic nerve injury, for instance. Others require it chronically, and may increase the number of hours required over time as their disease progresses.

Mechanical ventilation is not synonymous with the use of an oxygen tank. Supplemental oxygen is used in patients whose gas exchange capacity has diminished, either through lung damage or obstruction of a major airway. For these patients, the muscles that deliver air work well, but too little oxygen can be exchanged in the remaining lung, and so a higher concentration is supplied with each breath.

By the same token, many patients who require mechanical ventilation do not need supplemental oxygen. Their gas exchange capacity is normal, but they cannot adequately move air into and out of the lungs. In fact, excess oxygen may be dangerous, since it can suppress the normal increased respiration response to excess carbon dioxide in the lungs.

Much rarer are systems that rhythmically change the pressure around a patient's chest when the pressure is low, air flows into the lungs, and when it increases, air flows out. Ventilators Ventilators can either deliver a set volume with each cycle, or can be set to a specific pressure regimen.

Both are in common use. Volume ventilator settings are adjustable for total volume delivered, timing of delivery, and whether the delivery is mandatory or determined by the patient's initial inspiratory effort. Pressure ventilators deliver one of two major pressure regimens. Continuous positive airway pressure (CPAP) delivers a steady pressure of air, which assists the patient's inspiration (breathing in) and resists expiration (breathing out).

The pressure of CPAP is not sufficient to completely inflate the lungs; instead its purpose is to maintain an open airway, and for this reason it is used in sleep apnea, in which a patient's airway closes frequently during sleep. Bilevel positive airway pressure (Bi PAP) delivers a higher pressure on inspiration, helping the patient obtain a full breath, and a low pressure on expiration, allowing the patient to exhale easily.

Bi PAP is a common choice for neuromuscular disease. The choice of ventilator type is partly determined by the knowledge and preferences of the treating physician. Settings are adjusted to maintain patient comfort and appropriate levels of oxygen and carbon dioxide in the blood.

Masks vs. tracheostomy Delivery of air from a ventilator may be either through a mask firmly held to the face, or through a tube inserted into the trachea toward the bottom of the throat.

A mask interface is called noninvasive ventilation, while a tracheostomy tube is called invasive ventilation. Until the mid-1990s, invasive ventilation was the option used by virtually all patients requiring long-term mechanical ventilation. For some patients, tracheostomy continues to be a preferred option. It is commonly used when 24-hour ventilation assistance is required, and may be preferred by patients who find masks uncomfortable or unsightly.

Some patients feel ventilation through a ""trach tube"" is more reassuring. Tracheostomy is also the preferred option for most patients with swallowing difficulties.

The potential to choke and suffocate on improperly swallowed food is avoided with a tracheostomy. Tracheostomies may require more frequent suctioning of airway secretions, produced in response to the presence of the tube and the inflatable cuff that some patients require to hold it in place. The risk of infection is higher, and air must be carefully humidified and cleaned, since these functions are not being served by the nasal passages.

Tracheostomies do not prevent speech, despite misinformation to the contrary that even some doctors believe. Speech requires passage of air around the trach tube, which can occur either with an uncuffed tube, or with the presence of a special valve that allows air passage past the cuff.

Noninvasive interfaces come in a variety of forms. A simple mouthpiece may be used, which a patient bites down on to seal the lips around the tube as the pressure cycle delivers a breath. Most masks are individually fitted to the patient's face, and held in place with straps. A tight fit is essential, since the pressure must be delivered to the patient's lungs, and not be allowed to blow out the sides of the mask.

Masks may be used around the clock. Nasal masks do not prevent speech, though the tone may change.

Oral or full-face masks do interfere with speech, and are typically used at night or intermittently throughout the day, for patients who do not need continuous ventilation assistance. Other alternatives The iron lung was an early mechanical ventilation device, and is still in use in some hospitals.

The patient's head remains outside of it, while the interior depressurizes. This allows air to push in to the lungs. Repressurizing deflates the lungs again. A device that works on the same principle is the chest shell (something like a turtle's shell swung around to the front). The pneumobelt applies pressure to deflate, and relaxes it to allow inflation. A rocking bed is used for nighttime ventilation. Tilting the head of the bed down deflates the lungs by allowing the abdominal contents to press against the diaphragm.

Reversing the angle reverses the process, allowing inflation. Preparation Patients with diseases in which mechanical ventilation may be required are advised to learn as much as possible about treatment options before they become necessary. In particular, it is important to learn about and make decisions about invasive vs. noninvasive ventilation before the time comes. Many patients who begin ventilation with emergency tracheostomy have a difficult time switching to noninvasive ventilation later on (though it is certainly possible). It is often a good idea to try out different masks and other interfaces before their need arises, and to have these fitted in preparation for a planned transition to the ventilator.

Patients can find support groups and other sources of information to learn more about the options and the features of each means of ventilation. Patients may have to help educate their doctors if they are not familiar with noninvasive options.

Patients with neuromuscular disease may have as much or more need for a deep cough as they do for ventilatory assistance, and many patients who undergo emergency tracheostomy do so because their airways have become clogged with mucus build up. Physical therapy cough assistance and a cough assist device are important options for full respiratory health.

Normal results Mechanical ventilation is a life saver, and provides comfort and confidence to patients who require it. Proper ventilation restores levels of oxygen and carbon dioxide in the blood, improving sleep at night and increasing the ability to engage in activities during the day.

When combined with proper respiratory hygiene, it can prolong life considerably. Patients with progressive diseases such as ALS may wish to consider end-of-life decisions before commencing mechanical ventilation, or before the ability to communicate is lost. Resourcesbooks Bach, John R. Noninvasive Mechanical Ventilation . Hanley and Belfus, 2002. Kinnear, W. J. M. Assisted Ventilation at Home: A practical Guide.

Oxford: Oxford Medical Publications, 1994.periodicals Robinson, R. ""A Breath of Fresh Air."" Quest Magazine 5 (October 1998) [cited July 1, 2003]. http://www.mdausa.org/publications/Quest/q56freshair.html . Robinson, R. ""Breathe Easy."" Quest Magazine 5 (October 1998) [cited July 1, 2003]. http://www.mdausa.org/publications/Quest/q55breathe.html .organizations ALS Association. 27001 Agoura Road, Suite 150 Calabasas Hills, CA 91301-5104.

(800) 782-4747. http://www.alsa.org . Muscular Dystrophy Association. 3300 E. Sunrise Drive Tucson, AZ 85718. (800) 572-1717. http://www.mdausa.org . Richard Robinson Also read article about Mechanical Ventilation from Wikipedia User Contributions:1hebatallah Aug 1, 2007 @ 1:01 am I would like to see an image of the rocking bed as I need it in my thesis discussion .

( I'm a critical care medicine resident at Alex university hospital in Egypt)2mary (from New Zealand) Aug 12, 2007 @ 6:06 ami would like to know any implications that result from the use of michanical ventilations.3Carole Dilger Aug 19, 2012 @ 1:13 pm Our son is in the ICU dept as we speak, he has been on the ventilator for over one month now.

He recently just had a trac. done ""temporary"" until he can make the decision as what he wants to do. He also has diabetes too, plus a lung embolism is what put him in the hospital as he could not breath and was gasping for air. He also has a PEG in for the feeding,they did that the same time when they did the temporary trac.

Plus on lot of antibotics as he has been having a low grade fever off & on. He has the electrical stimulators on his legs for circulation.

The phlem that he keeps coughing up is greenish/yellow. They keep taking CScans and Xrays but do not really say what is going on, unless it is the combination of diabetes & pneumonia, or bronchitis.

The nurse said they did not think it was emphazma (sp)? He was a smoker many yrs ago, plus did other things too. He is now going to be 57 this coming week. He keeps wanting to take the tubes out and get up to walk so they have him on Ativan to keep him from becoming so anxious, they told me that he is ""confused"".

I know that they recently just took him off of the 3 pain medicines at the same time so all he has now is the antibiotics and insulin.

He is also on a bed that turns from side & side, very nice bed. They are doing the best of what they can.

His b/p is now normal but has been going up & down low. Pulse rate has been pretty high, 103 I believe. He is also overweight too. But his blood toxiogy report was clean. Please send me any ideas or effects that can happen as a result of being on the ventilator for over one month.

The tube was in his mouth but his airways were getting bad from so long of time. Any advise of any kind would be very helpful. He has no children, and is not married any longer. He has had a very sad life and I as his mother feel very bad that this has happened to him.

Thank you so very much, Carole Dilger...4Chrystal Mar 8, 2016 @ 4:16 pm Looking for any helpful information! My mother had throat cancer a few years back. Now the doctors have been having issues with the trach not staying in.

They wanted to close the hole up a few months ago,but realized she wasn't getting enough air flow. I want to know what options there are for my mom. Should they close the hole and have her on oxygen? Should she get on a ventilator? Should she get a second opinion from another doctor? Comment about this article, ask questions, or add new information about this topic: Name: E-mail: Show my email publicly Type the code shown: Public Comment: (50-4000 characters)Send comment Mechanical Ventilation forum Mechanical Circulation Support Meckel's Diverticulectomy "

A basic distinction in mechanical ventilation is whether each breath is initiated by the patient (assist mode) or by the machine (control mode). Dynamic hybrids of the two (assist-control modes) are also possible, and control mode without assist is now mostly obsolete.

Modes of mechanical ventilation

"From Wikipedia, the free encyclopedianavigation search Modes of mechanical ventilation are one of the most important aspects of the usage of mechanical ventilation. The mode refers to the method of inspiratory support. In general, mode selection is based on clinician familiarity and institutional preferences, since there is a paucity of evidence indicating that the mode affects clinical outcome.

The most frequently used forms of volume-limited mechanical ventilation are intermittent mandatory ventilation (IMV) and continuous mandatory ventilation (CMV). [1] There have been substantial changes in the nomenclature of mechanical ventilation over the years, but more recently it has become standardized by many respirology and pulmonology groups.

[2] [3] Writing a mode is most proper in all capital letters with a dash between the cycle and the strategy (i.e.

Inspiratory time is defined as the period from the start of positive flow to the start of negative flow. Expiratory time is defined as the period from the start of expiratory flow to the start of inspiratory flow.

The flow-time curve is the basis for many variables related to ventilator settings. A breath is assisted if the ventilator does work on the patient.

An assisted breath is one for which the ventilator does some portion of the work of breathing. For constant flow inflation, work is defined as inspiratory pressure multiplied by tidal volume. Therefore, an assisted breath is identified as a breath for which airway pressure (displayed on the ventilator) rises above baseline during inspiration. An unassisted breath is one for which the ventilator simply provides the inspiratory flow demanded by the patient and pressure stays constant throughout the breath.

A ventilator assists breathing using either pressure control or volume control based on the equation of motion for the respiratory system. Providing assistance means doing work on the patient, which is accomplished by controlling either pressure or volume.

A simple mathematical model describing this fact is known as the equation of motion for the passive respiratory system: Pressure = (Elastance × Volume) + (Resistance × Flow)In this equation, pressure, volume, and flow are all continuous functions of time.

Pressure is actually a pressure difference across the system (e.g., transrespiratory pressure defined as pressure at the airway opening minus pressure on the body surface). Elastance (defined as the change in pressure divided by the associated change in volume; the reciprocal of compliance) and resistance (defined as a change in pressure divided by the associated change in flow) are parameters assumed to remain constant during a breath.

Volume control (VC) means that both volume and flow are preset prior to inspiration. In other words, the right hand side of the equation of motion remains constant while pressure changes with changes in elastance and resistance. Pressure control (PC) means that inspiratory pressure is preset as either a constant value or it is proportional to the patient’s inspiratory effort.

In other words, the left-hand side of the equation of motion remains constant while volume and flow change with changes in elastance and resistance. Time control (TC) means that, in some rare situations, none of the main variables (pressure, volume, or flow) are preset.

In this case only the inspiratory and expiratory times are preset. Breaths are classified by the criteria that trigger (start) and cycle (stop) inspiration. The start of inspiration is called the trigger event. The end of inspiration is called the cycle event.

Trigger and cycle events can be initiated by the patient or the machine. Inspiration can be patient triggered or patient cycled by a signal representing inspiratory effort. Inspiration may also be machine triggered or machine cycled by preset ventilator thresholds. Patient triggering means starting inspiration based on a patient signal independent of a machine trigger signal. Machine triggering means starting inspiratory flow based on a signal from the ventilator, independent of a patient trigger signal.

Patient cycling means ending inspiratory time based on signals representing the patient determined components of the equation of motion, (ie, elastance or resistance and including effects due to inspiratory effort). Flow cycling is a form of patient cycling because the rate of flow decay to the cycle threshold is determined by patient mechanics.

Machine cycling means ending inspiratory time independent of signals representing the patient determined components of the equation of motion. Breaths are classified as spontaneous or mandatory based on both the trigger and cycle events. A spontaneous breath is a breath for which the patient both triggers and cycles the breath. A spontaneous breath may occur during a mandatory breath (e.g. Airway Pressure Release Ventilation). A spontaneous breath may be assisted or unassisted. A mandatory breath is a breath for which the machine triggers and/or cycles the breath.

There are 5 basic ventilatory patterns: VC-CMV, VC-IMV, PC-CMV, PC-IMV, and PC-CSV. The combination VC-CSV is not possible because volume control implies machine cycling and machine cycling makes every breath mandatory, not spontaneous.

A sixth pattern, TC-IMV is possible but rare. Within each ventilatory pattern there are several variations that can be distinguished by their targeting scheme (s).

The targeting scheme (or combination of targeting schemes) is what distinguishes one ventilatory pattern from another.

There are 7 basic targeting schemes that comprise the wide variety seen in different modes of ventilation: Set-point: A targeting scheme for which the operator sets all the parameters of the pressure waveform (pressure control modes) or volume and flow waveforms (volume control modes). Dual: A targeting scheme that allows the ventilator to switch between volume control and pressure control during a single inspiration. Bio-variable: A targeting scheme that allows the ventilator to automatically set the inspiratory pressure or tidal volume randomly to mimic the variability observed during normal breathing.

Servo: A targeting scheme for which inspiratory pressure is proportional to inspiratory effort. Adaptive: A targeting scheme that allows the ventilator to automatically set one target (eg, pressure within a breath) to achieve another target (eg, average tidal volume over several breaths).

Optimal: A targeting scheme that automatically adjusts the targets of the ventilatory pattern to either minimize or maximize some overall performance characteristic (eg, minimize the work rate done by the ventilatory pattern). Intelligent: A targeting scheme that uses artificial intelligence programs such as fuzzy logic, rule based expert systems, and artificial neural networks.

A mode of ventilation is classified according to its control variable, breath sequence, and targeting scheme (s).

The preceding 9 maxims create a theoretical foundation for a taxonomy of mechanical ventilation. The taxonomy is based on these theoretical constructs and has 4 hierarchical levels: Control Variable (Pressure or Volume, for the primary breath)Breath Sequence (CMV, IMV, or CSV)Primary Breath Targeting Scheme (for CMV or CSV)Secondary Breath Targeting Scheme (for IMV)The “primary breath” is either the only breath there is (mandatory for CMV and spontaneous for CSV) or it is the mandatory breath in IMV.

The targeting schemes can be represented by single, lower case letters: set-point = s, dual = d, servo = r, bio-variable = b, adaptive = a, optimal = o, intelligent = i.

A tag is an abbreviation for a mode classification, such as PC-IMVs,s. Compound tags are possible, eg, PC-IMVoi,oi. How modes are classified [ edit]Step 1: Identify the primary breath control variable. If inspiration starts with a preset inspiratory pressure, or if pressure is proportional to inspiratory effort, then the control variable is pressure.

If inspiration starts with a preset tidal volume and inspiratory flow, then the control variable is volume. If neither is true, the control variable is time. Step 2: Identify the breath sequence. Determine whether trigger and cycle events are patient or machine determined. Then, use this information to determine the breath sequence. Step 3: Identify the targeting schemes for the primary breaths and (if applicable) secondary breaths.

Example mode classification is given below [ edit]Mode Name: A/C Volume Control (Covidien PB 840)Inspiratory volume and flow are preset, so the control variable is volume. Every breath is volume cycled, which is a form of machine cycling. Any breath for which inspiration is machine cycled is classified as a mandatory breath.

Hence, the breath sequence is continuous mandatory ventilation. The operator sets all the parameters of the volume and flow waveforms so the targeting scheme is set-point. Thus, the mode is classified as volume control continuous mandatory ventilation with set-point targeting (VC-CMVs). Mode Name: SIMV Volume Control Plus (Covidien PB 840)The operator sets the tidal volume but not the inspiratory flow.

Because setting volume alone (like setting flow alone) is a necessary but not sufficient criterion for volume control, the control variable is pressure. Spontaneous breaths are allowed between mandatory breaths so the breath sequence is IMV. The ventilator adjusts inspiratory pressure between breaths to achieve an average preset tidal volume, so the targeting scheme is adaptive. The mode tag is PC-IMVa,s. Descriptions of common modes [ edit]Assist mode, control mode, and assist-control mode [ edit]

A basic distinction in mechanical ventilation is whether each breath is initiated by the patient (assist mode) or by the machine (control mode). Dynamic hybrids of the two (assist-control modes) are also possible, and control mode without assist is now mostly obsolete.

Airway pressure release ventilation [ edit]Airway pressure release ventilation graph Airway pressure release ventilation is a time-cycled alternant between two levels of positive airway pressure, with the main time on the high level and a brief expiratory release to facilitate ventilation. [5]Airway pressure release ventilation is usually utilized as a type of inverse ratio ventilation.

The exhalation time (T low) is shortened to usually less than one second to maintain alveoli inflation. In the basic sense, this is a continuous pressure with a brief release. APRV currently the most efficient conventional mode for lung protective ventilation. [6]Different perceptions of this mode may exist around the globe. While 'APRV' is common to users in North America, a very similar mode, biphasic positive airway pressure (BIPAP), was introduced in Europe.

[7] The term APRV has also been used in American journals where, from the ventilation characteristics, BIPAP would have been perfectly good terminology. [8] But Bi PAP (tm) is a trademark for a noninvasive ventilation mode in a specific ventilator (Respironics Inc.).

Mandatory minute ventilation [ edit]Mandatory minute ventilation (MMV) allows spontaneous breathing with automatic adjustments of mandatory ventilation to the meet the patient’s preset minimum minute volume requirement. If the patient maintains the minute volume settings for V T x f, no mandatory breaths are delivered. If the patient's minute volume is insufficient, mandatory delivery of the preset tidal volume will occur until the minute volume is achieved.

The method for monitoring whether or not the patient is meeting the required minute ventilation (V E) differs by ventilator brand and model, but, in general, there is a window of monitored time, and a smaller window checked against the larger window (i.e., in the Dräger Evita® line of mechanical ventilators there is a moving 20-second window, and every 7 seconds the current tidal volume and rate are measured) to decide whether a mechanical breath is needed to maintain the minute ventilation.

MMV is an optimal mode for weaning in neonatal and pediatric populations and has been shown to reduce long-term complications related to mechanical ventilation. [9]Pressure-regulated volume control [ edit]Pressure-regulated volume control is an IMV based mode. Pressure-regulated volume control utilizes pressure-limited, volume-targeted, time-cycled breaths that can be either ventilator- or patient-initiated.

The peak inspiratory pressure delivered by the ventilator is varied on a breath-to-breath basis to achieve a target tidal volume that is set by the clinician.

For example, if a target tidal volume of 500 m L is set but the ventilator delivers 600 m L, the next breath will be delivered with a lower inspiratory pressure to achieve a lower tidal volume. Though PRVC is regarded as a hybrid mode because of its tidal-volume (VC) settings and pressure-limiting (PC) settings fundamentally PRVC is a pressure-control mode with adaptive targeting. Continuous positive airway pressure [ edit]Continuous positive airway pressure (CPAP) is a non-invasive positive pressure mode of respiratory support.

CPAP is a pressure applied at the end of exhalation to keep the alveoli open and not fully deflate. This mechanism for maintaining inflated alveoli helps increase partial pressure of oxygen in arterial blood, an appropriate increase in CPAP increases the Pa O 2.

CPAP is not technically a mode of ""ventilation"" as it does not directly affect the minute volume.

Automatic positive airway pressure [ edit]Automatic positive airway pressure (APAP) is a form of CPAP that automatically tunes the amount of pressure delivered to the patient to the minimum required to maintain an unobstructed airway on a breath-by-breath basis by measuring the resistance in the patient's breathing. Bilevel positive airway pressure [ edit]Bilevel positive airway pressure (BPAP) is a mode used during non-invasive ventilation (NIV).

First used in 1988 by Professor Benzer in Austria, [10] it delivers a preset inspiratory positive airway pressure (IPAP) and expiratory positive airway pressure (EPAP). BPAP can be described as a Continuous Positive Airway Pressure system with a time-cycled change of the applied CPAP level.

[11] CPAP, BPAP and other non-invasive ventilation modes have been shown to be effective management tools for chronic obstructive pulmonary disease and acute respiratory failure.

[12]Often BPAP is incorrectly referred to as ""Bi PAP"". Bi PAP® is the name of a portable ventilator manufactured by Respironics Corporation; it is just one of many ventilators that can deliver BPAP. High-frequency ventilation (Active) [ edit]The term active refers to the ventilator's forced expiratory system.

In a HFV-A scenario, the ventilator uses pressure to apply an inspiratory breath and then applies an opposite pressure to force an expiratory breath. In high-frequency oscillatory ventilation (sometimes abbreviated HFOV) the oscillation bellows and piston force positive pressure in and apply negative pressure to force an expiration. [13]High-frequency ventilation (Passive) [ edit]The term passive refers to the ventilator's non-forced expiratory system.

In a HFV-P scenario, the ventilator uses pressure to apply an inspiratory breath and then returns to atmospheric pressure to allow for a passive expiration. This is seen in High-Frequency Jet Ventilation, sometimes abbreviated HFJV. Also categorized under High Frequency Ventilation is High Frequency Percussive Ventilation, sometimes abbreviated HFPV. With HFPV it utilizes an open circuit to deliver its subtidal volumes by way of the patient interface known as the Phasitron.

Volume guarantee [ edit]Volume guarantee an additional parameter available in many types of ventilators that allows the ventilator to change its inspiratory pressure setting to achieve a minimum tidal volume. This is utilized most often in neonatal patients who need a pressure controlled mode with a consideration for volume control to minimize volutrauma. Spontaneous breathing and support settings [ edit]Positive end-expiratory pressure [ edit]Positive end expiratory pressure (PEEP) is pressure applied upon expiration.

PEEP is applied using either a valve that is connected to the expiratory port and set manually or a valve managed internally by a mechanical ventilator. PEEP is a pressure that an exhalation has to bypass, in effect causing alveoli to remain open and not fully deflate. This mechanism for maintaining inflated alveoli helps increase partial pressure of oxygen in arterial blood, and an increase in PEEP increases the Pa O 2. [14]Pressure support [ edit]

Pressure support is a spontaneous mode of ventilation also named Pressure Support Ventilation (PSV). The patient initiates every breath and the ventilator delivers support with the preset pressure value. With support from the ventilator, the patient also regulates their own respiratory rate and their tidal volume.

Mechanical ventilation is the medical term for artificial ventilation where mechanical means is used to assist or replace spontaneous breathing.

Mechanical ventilation

"For the use in architecture and climate control, see Ventilation (architecture). Mechanical ventilation Diagram of an endotracheal tube used in mechanical ventilation. The tube is inserted into the trachea in order to provide air to the lungs. A) Endotracheal tube, which sits in the trachea.

B) Inflatable Cuff, which facilitates the inflation of the balloon at the end of the tube to allow it to sit securely in the airway. The balloon can also be deflated via this cuff upon extubation. C) Trachea D) Esophagus ICD-9 93.90 96.7Me SH D012121OPS-301 code 8-71 [ edit on Wikidata]

[1] This may involve a machine called a ventilator or the breathing may be assisted by an anesthesiologist, certified registered nurse anesthetist, physician, physician assistant, respiratory therapist, paramedic, EMT, or other suitable person compressing a bag or set of bellows.

Mechanical ventilation is termed ""invasive"" if it involves any instrument penetrating the trachea through the mouth, such as an endotracheal tube or the skin , such as a tracheostomy tube. [2] There are two main types: positive pressure ventilation, where air (or another gas mix) is pushed into the trachea, and negative pressure ventilation, where air is, in essence, sucked into the lungs.

There are many modes of mechanical ventilation, and their nomenclature has been revised over the decades as the technology has continually developed. Contents [ hide ]1 Uses2 Associated risk2.1 Complications3 Application and duration3.1 Negative pressure machines3.2 Positive pressure3.2.1 Transairway pressure3.3 Intermittent abdominal pressure ventilator4 Types of ventilators4.1 Mechanical ventilators5 Breath delivery5.1 Trigger5.2 Cycle5.3 Limit6 Breath exhalation7 Dead space8 Modes of ventilation9 Modification of settings9.1 Weaning from mechanical ventilation10 Respiratory monitoring11 Artificial airways as a connection to the ventilator12 Ventilation formulas13 History14 See also15 References16 External links Uses [ edit]Respiratory therapist examining a mechanically ventilated patient on an Intensive Care Unit

Mechanical ventilation is indicated when the patient's spontaneous ventilation is inadequate to maintain life. It is also indicated as prophylaxis for imminent collapse of other physiologic functions, or ineffective gas exchange in the lungs.

k. A short tube is inserted through the opening directly into the patient’s windpipe. The tube is connected to the breathing machine which pumps air through the tube into the patient’s airway. A patient on either kind of mechanical ventilator must either be lying in bed or sitting in a chair, and movement is restricted. While using an endotracheal tube, the patient is unable to speak or swallow.

Mechanical Ventilation

Mechanical Ventilation Is Mechanical Ventilation Always Appropriate? Rarely are there black and white answers about whether mechanical ventilation is appropriate. The decision depends on many factors including the patient’s basic state of health, chances of recovery, will to live, and the benefits and burdens of further treatment.

You can talk with your health care team if you are unsure about the appropriateness of using mechanical ventilation. They can give you information to help guide your decision. As you think about mechanical ventilation, your head as well as your heart will help you decide.

This information is a “starting place” for conversations among patients, families, and caregivers. It can prepare you for talking with health care providers when a patient has very serious medical problems.

Keep in mind that the best time to discuss these issues is before a crisis occurs. Many People Ask. . . How does a ventilator work?”What are its benefits and burdens? Is a ventilator always appropriate? What happens if I don’t want mechanical ventilation? Where Do You Turn For Answers? Facing decisions about using mechanical ventilation can be terribly difficult. Often, it is a time of emotional confusion and suffering for families and caregivers, as well as for patients.

Your health care team can help you learn more about the benefits and burdens of using mechanical ventilation. How Does A Ventilator Work? A ventilator, sometimes called a respirator, is a machine that pumps air into and out of a patient’s airway and lungs.

It is a mechanical substitute for normal breathing. It is important to keep in mind that a ventilator is not a cure in itself: It can only “buy time” to see if the patient can resume breathing naturally.

There are three ways that patients can resume breathing naturally. There are three ways that patient can receive mechanical ventilation: (1) through an endotracheal tube (2) through a tracheostomy or (3) through a face mask. An endotracheal tube is a plastic tube passed through the patient’s nose or mouth into the windpipe. The tube is connected to the breathing machine which pumps air through the tube into the patient’s airway. This method is generally used for short-term ventilation. A tracheostomy is a surgical procedure where a small opening is made in the patient’s nec

“Non-invasive positive pressure ventilation” is a short-term technique where a mask is strapped over the patient’s nose, and oxygen is pumped through the patient’s nose, and oxygen is pumped through the patient’s airway. This method is sometimes sued to get a hospitalized patient through a short-term, acute episode without placing the endotracheal tube or performing the tracheostomy procedure. Patients may have some ability to speak or swallow. Some individuals, however, may find the treatment uncomfortable, and it is not always successful in providing adequate ventilation.

As You Think About Mechanical Ventilation. . . The following summaries are taken from medical journals. We encourage you to discuss these statements, and other viewpoints as well, with your health care providers.“There are patients who enjoy life with mechanical ventilation, and their rights must be recognized.

It must also be recognized by patient and family that living in a hospital or at home for months or years supported by a mechanical ventilator creates its own burdens.

There can be no clear-cut guidelines in making this difficult medical decision, because the considerations are almost endless and the complexities profound.” Source: Petty T, Clinics in Ger Med 1986; 2:535-545. In general, communication between patients and their families about end-of-life care is not very good.

For example, in a 1988 study, 64% of patients said that they would not want to continue living if they had a severe heart attack that required the use of continual mechanical ventilation for survival, but only 36% of the patients’ spouses accurately predicted what their loved one would want in this situation.

Source: Uhlman R, Pearlman R, and Cain K, J Gerontology 1998; 43:115-121.88% of elderly patients in several Denver clinics said they would want short-term ventilator support if they had a sudden, severe illness or heart failure; 95% said they would not want long-term ventilator support to keep them alive, however, if their medical condition did not improve.

Source: Murphy D, Santilli S, Arch Fam Med 1998; 7:484. After the patient is in a permanent vegetative state, a “Do Not Resuscitate” order is appropriate. Source: Am Acad Neurology, Neurology 1995; 45:1015. “Medical treatment that offers some hope of recovery should be distinguished from treatment that merely prolongs or suspends the dying process.” Source: Am Acad Neurology, Neurology 1989; 39:123.

What Happens If Mechanical Ventilation Isn’t Used? Patients whose lungs and breathing functions improve can sometimes be “weaned” from the ventilator and gradually begin breathing again on their own.

For patients who cannot recover, stopping the ventilator leads to a natural death. Drugs and comfort measures can be used to prevent patients from experiencing pain or distress while dying. What Are Some Benefits Of A Ventilator? Mechanical ventilation can save lives when used for patients recovering from a short-term illness or accident.

During surgery, mechanical ventilation is used to keep patients breathing who have been given a general anesthetic. What Are Some Burdens Of A Ventilator? Mechanical ventilation cannot restore a patient’s lungs; it cannot prevent the death of a person with an incurable, fatal disease or condition; and it cannot cure a permanent coma.

Patients on mechanical ventilators have difficulty coughing, and fluids can build up in their lungs. This greatly increases the risk of developing pneumonia. Important Words Of Caution Short-term “trial periods” of ventilation can sometimes show whether longer periods will lead to recovery, or just prolong the patient’s dying. As You Think About Mechanical Ventilation. . . You can take comfort in knowing you are not alone.

Other people have had to make these important decisions. It may help you to keep these questions in mind:* “What are our goals for medical treatment?” * “How often should we re-evaluate using mechanical ventilation?” * “What would my loved one choose?”Resources You Can Use American Lung Association of Colorado (303) 388-4327 or (800) LUNG-USA web site address: www.lungusa.org Offers supportive assistance and information for persons with, or those who are interested in learning more about respiratory and lung disease.

National Hospice and Palliative Care Organization (703) 837 – 1500 web site address: www.nhpco.org Promotes quality comfort care, pain relief, and emotional and spiritual support for dying patients and their families. *Information on this page was created by and obtained with permission from the Colorado Collective for Medical Decisions, Inc. (CCMD), 1999, and Hospital Shared Services of Colorado.

Mechanical ventilation is indicated when the patient's spontaneous ventilation is inadequate to maintain life. It is also indicated as prophylaxis for imminent collapse of other physiologic functions, or ineffective gas exchange in the lungs.

Mechanical ventilation

"For the use in architecture and climate control, see Ventilation (architecture). Mechanical ventilation Diagram of an endotracheal tube used in mechanical ventilation. The tube is inserted into the trachea in order to provide air to the lungs. A) Endotracheal tube, which sits in the trachea.

B) Inflatable Cuff, which facilitates the inflation of the balloon at the end of the tube to allow it to sit securely in the airway. The balloon can also be deflated via this cuff upon extubation. C) Trachea D) Esophagus ICD-9 93.90 96.7Me SH D012121OPS-301 code 8-71 [ edit on Wikidata]

Mechanical ventilation is the medical term for artificial ventilation where mechanical means is used to assist or replace spontaneous breathing.

[1] This may involve a machine called a ventilator or the breathing may be assisted by an anesthesiologist, certified registered nurse anesthetist, physician, physician assistant, respiratory therapist, paramedic, EMT, or other suitable person compressing a bag or set of bellows.

Mechanical ventilation is termed ""invasive"" if it involves any instrument penetrating the trachea through the mouth, such as an endotracheal tube or the skin , such as a tracheostomy tube. [2] There are two main types: positive pressure ventilation, where air (or another gas mix) is pushed into the trachea, and negative pressure ventilation, where air is, in essence, sucked into the lungs.

ier. It may be given through your nose or through a plastic mask over your trach tube. Your trach tube may be connected to a ventilator if you cannot breathe well on your own. A ventilator is a machine that gives you oxygen and breathes for you. You will not be able to speak for many days after your surgery.

Tracheotomy

Tracheotomy Care Notes More Overview Aftercare Instructions Discharge Care Inpatient Care Precare En Espanol WHAT YOU NEED TO KNOW: A tracheotomy is surgery to help you breathe through an opening in your trachea. WHILE YOU ARE HERE: Before your surgery: Informed consent is a legal document that explains the tests, treatments, or procedures that you may need.

Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done.

Make sure all your questions are answered. An IV is a small tube placed in your vein that is used to give you medicine or liquids. Antibiotics may be given to prevent a bacterial infection. Anesthesia is medicine to make you comfortable during your surgery. Healthcare providers will work with you to decide which anesthesia is best for you. Local anesthesia is a shot of medicine put into your neck.

It is used to numb the area and dull the pain. You may still feel pressure or pushing during surgery. General anesthesia will keep you asleep and free from pain during surgery. Anesthesia may be given through your IV.

You may instead breathe it in through a mask or a tube placed down your throat. The tube may cause you to have a sore throat when you wake up. During your surgery: Your healthcare provider will make a small incision in front of your neck and in your trachea. Your healthcare provider may instead use a needle to put a small hole into your trachea. He will then place a guidewire into your trachea and widen the hole.

He may use a bronchoscope to take pictures of the inside of your airway. A bronchoscope is a tube with a light and camera on the end. A metal or plastic tube will then be placed into the incision or hole in your neck. This tube is called a tracheotomy tube or trach tube.

After your surgery: You will be taken to a room to rest until you are fully awake. You will be monitored closely for any problems.

Do not get out of bed until your healthcare provider says it is okay. You will then be able to go home or be taken to your hospital room. Deep breathing, coughing, and suction may help prevent a lung infection. Take deep breaths and cough 10 times each hour. Take a deep breath and hold it for as long as you can. Let the air out and cough strongly. Deep breaths help open your airway. You may be given an incentive spirometer to help you take deep breaths. Put the plastic piece in your mouth and take a slow, deep breath, then let the air out and cough.

Repeat these steps 10 times every hour. Healthcare providers will help remove any mucus if you have trouble getting it out of the trach tube. This is done by putting a plastic suction tube down into your trach tube to get the mucus out. You may be fed liquid nutrition through a plastic tube put into your nose or mouth.

The liquid nutrition will give you all the vitamins, minerals, and protein you need to help you heal. You may also be able to eat by mouth starting with blended foods. Mouth care will be given to keep your mouth clean and moist after your surgery. Healthcare providers may use special swabs to care for your mouth. Oxygen may be given to help you breathe eas

Your healthcare provider will help you learn how to let others know what you need. When you are able to speak, air will be released from the cuff around your trach tube. You may need to cover the trach tube with a finger while you breathe out. This will let air pass into your voice box and allow you to speak in a whisper.

A special one-way valve may also be used to help you talk. Wound and tube care will help decrease your risk of infection. Your healthcare provider will make sure that the hole in your neck and your trach tube are clean and dry.

Your trach tube will have inner and outer tubes called cannulas. The inner cannula may need to be changed daily. RISKS: You may bleed more than expected or get an infection. Air may get trapped under your skin through the opening in your neck.

You may have trouble breathing if the trach tube is blocked by blood clots or mucus. You may have trouble swallowing after surgery. Your trachea may narrow and decrease the amount of air that gets into your lungs. The trach tube may also rub on your trachea or the blood vessels in your neck.

This may create an abnormal hole that could cause bleeding or allow food and fluid to get into your lungs. Your body may react to the tube by forming tissue lumps around or near the opening. The trach tube may come out on its own.

CARE AGREEMENT: You have the right to help plan your care. Learn about your health condition and how it may be treated.

Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.© 2018 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in Care Notes® are the copyrighted property of A. D. A. M., Inc. or Truven Health Analytics.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you. Next → Precare Learn more about Tracheotomy (Inpatient Care)Micromedex® Care Notes Tracheotomy

n). The Bird VIP Infant ventilator A medical ventilator (or simply ventilator in context) is a mechanical ventilator, a machine designed to move breathable air into and out of the lungs, to provide breathing for a patient who is physically unable to breathe, or breathing insufficiently.

Medical ventilator

"From Wikipedia, the free encyclopedianavigation search""Ventilator"" redirects here. For the 2016 film, see Ventilator (film). For other uses of the term ""ventilator"" in non-medical fields, see Ventilation (disambiguatio

While modern ventilators are computerized machines, patients can be ventilated with a simple, hand-operated bag valve mask. Ventilators are chiefly used in intensive care medicine, home care, and emergency medicine (as standalone units) and in anesthesia (as a component of an anesthesia machine ).

Medical ventilators are sometimes colloquially called "" respirators "", a term stemming from commonly used devices in the 1950s (particularly the "" Bird Respirator ""). However, in modern hospital and medical terminology, these machines are never referred to as respirators, and use of ""respirator"" in this context is now a deprecated anachronism signaling technical unfamiliarity.

In the present-day medical field, the word ""respirator"" refers to a protective face mask. [1]Contents [ hide ]1 Function1.1 Life-critical system2 History3 See also4 References Function [ edit]In its simplest form, a modern positive pressure ventilator consists of a compressible air reservoir or turbine, air and oxygen supplies, a set of valves and tubes, and a disposable or reusable ""patient circuit"". The air reservoir is pneumatically compressed several times a minute to deliver room-air, or in most cases, an air/oxygen mixture to the patient.

If a turbine is used, the turbine pushes air through the ventilator, with a flow valve adjusting pressure to meet patient-specific parameters.

When over pressure is released, the patient will exhale passively due to the lungs ' elasticity, the exhaled air being released usually through a one-way valve within the patient circuit called the patient manifold. Ventilators may also be equipped with monitoring and alarm systems for patient-related parameters (e.g.

pressure, volume, and flow) and ventilator function (e.g. air leakage, power failure, mechanical failure), backup batteries, oxygen tanks, and remote control. The pneumatic system is nowadays often replaced by a computer-controlled turbopump. Modern ventilators are electronically controlled by a small embedded system to allow exact adaptation of pressure and flow characteristics to an individual patient's needs.

Fine-tuned ventilator settings also serve to make ventilation more tolerable and comfortable for the patient. In Canada and the United States, respiratory therapists are responsible for tuning these settings, while biomedical technologists are responsible for the maintenance. The patient circuit usually consists of a set of three durable, yet lightweight plastic tubes, separated by function (e.g.

inhaled air, patient pressure, exhaled air). Determined by the type of ventilation needed, the patient-end of the circuit may be either noninvasive or invasive. Noninvasive methods, which are adequate for patients who require a ventilator only while sleeping and resting, mainly employ a nasal mask. Invasive methods require intubation, which for long-term ventilator dependence will normally be a tracheotomy cannula, as this is much more comfortable and practical for long-term care than is larynx or nasal intubation.

Life-critical system [ edit]Because failure may result in death, mechanical ventilation systems are classified as a life-critical system, and precautions must be taken to ensure that they are highly reliable, including their power-supply.

Mechanical ventilators are therefore carefully designed so that no single point of failure can endanger the patient. They may have manual backup mechanisms to enable hand-driven respiration in the absence of power (such as the mechanical ventilator integrated into an anaesthetic machine ). They may also have safety valves, which open to atmosphere in the absence of power to act as an anti-suffocation valve for spontaneous breathing of the patient.

Some systems are also equipped with compressed-gas tanks, air compressors, and/or backup batteries to provide ventilation in case of power failure or defective gas supplies, and methods to operate or call for help if their mechanisms or software fail.

History [ edit]The history of mechanical ventilation begins with various versions of what was eventually called the iron lung, a form of noninvasive negative pressure ventilator widely used during the polio epidemics of the 20th century after the introduction of the ""Drinker respirator"" in 1928, improvements introduced by John Haven Emerson in 1931, [2] and the Both respirator in 1937.

Other forms of noninvasive ventilators, also used widely for polio patients, include Biphasic Cuirass Ventilation, the rocking bed, and rather primitive positive pressure machines. [2]In 1949, John Haven Emerson developed a mechanical assister for anesthesia with the cooperation of the anesthesia department at Harvard University. Mechanical ventilators began to be used increasingly in anesthesia and intensive care during the 1950s.

Their development was stimulated both by the need to treat polio patients and the increasing use of muscle relaxants during anesthesia. Relaxant drugs paralyze the patient and improve operating conditions for the surgeon but also paralyze the respiratory muscles. An East-Radcliffe respirator model from the mid-20th century In the United Kingdom, the East Radcliffe and Beaver models were early examples, the latter using an automotive wiper motor to drive the bellows used to inflate the lungs.

[3] Electric motors were, however, a problem in the operating theatres of that time, as their use caused an explosion hazard in the presence of flammable anesthetics such as ether and cyclopropane.

In 1952, Roger Manley of the Westminster Hospital, London, developed a ventilator which was entirely gas driven, and became the most popular model used in Europe. It was an elegant design, and became a great favourite with European anesthetists for four decades, prior to the introduction of models controlled by electronics.

It was independent of electrical power, and caused no explosion hazard. The original Mark I unit was developed to become the Manley Mark II in collaboration with the Blease company, who manufactured many thousands of these units.

Its principle of operation was very simple, an incoming gas flow was used to lift a weighted bellows unit, which fell intermittently under gravity, forcing breathing gases into the patient's lungs. The inflation pressure could be varied by sliding the movable weight on top of the bellows. The volume of gas delivered was adjustable using a curved slider, which restricted bellows excursion. Residual pressure after the completion of expiration was also configurable, using a small weighted arm visible to the lower right of the front panel.

This was a robust unit and its availability encouraged the introduction of positive pressure ventilation techniques into mainstream European anesthetic practice. The 1955 release of Forrest Bird 's ""Bird Universal Medical Respirator"" in the United States changed the way mechanical ventilation was performed, with the small green box becoming a familiar piece of medical equipment. [4] The unit was sold as the Bird Mark 7 Respirator and informally called the ""Bird"". It was a pneumatic device and therefore required no electrical power source to operate.

Intensive care environments around the world revolutionized in 1971 by the introduction of the first SERVO 900 ventilator ( Elema-Schönander ). It was a small, silent and effective electronic ventilator, with the famous SERVO feedback system controlling what had been set and regulating delivery.

For the first time, the machine could deliver the set volume in volume control ventilation. Ventilators used under increased pressure (hyperbaric) require special precautions and few ventilators can operate under these conditions. [5] In 1979, Sechrist Industries introduced their Model 500A ventilator which was specifically designed for use with hyperbaric chambers. [6]In 1991 the SERVO 300 ventilator series was introduced. The platform of the SERVO 300 series enabled treatment of all patient categories, from adult to neonate, with one single ventilator.

The SERVO 300 series provided a completely new and unique gas delivery system, with rapid flow-triggering response. In 1999 the LTV (Laptop Ventilator) Series was introduced into the market. The new ventilator was significantly smaller than the ventilators of that time weighing ~14 lbs and around the size of a laptop computer.

This new design kept the same functionality of the in hospital ventilators, while now opening up a world of opportunity of mobility for the patients.

A modular concept, meaning that the hospital has one ventilator model throughout the ICU department instead of a fleet with different models and brands for the different user needs, was introduced with SERVO-i in 2001. With this modular concept the ICU departments could choose the modes and options, software and hardware needed for a particular patient category.

See also [ edit]Artificial ventilation Mechanical ventilation Respiratory therapy Robert Martensen References [ edit]Wikimedia Commons has media related to Medical ventilators. This article needs additional citations for verification. Please help improve this article by adding citations to reliable sources.

Unsourced material may be challenged and removed. (November 2007) ( Learn how and when to remove this template message)^ Health, Center for Devices and Radiological. ""Personal Protective Equipment for Infection Control - Masks and N95 Respirators"". www.fda.gov. Retrieved 2017-03-08.^ a b Geddes LA (2007). ""The history of artificial respiration"". IEEE Engineering in Medicine and Biology Magazine : the Quarterly Magazine of the Engineering in Medicine & Biology Society.

26 (6): 38–41. doi: 10.1109/EMB.2007.907081. PMID 18189086.^ Russell WR, Schuster E, Smith AC, Spalding JM (April 1956). ""Radcliffe respiration pumps"". The Lancet. 270 (6922): 539–41. doi: 10.1016/s0140-6736 (56)90597-9. PMID 13320798.^ Bellis, Mary. ""Forrest Bird invented a fluid control device, respirator & pediatric ventilator"". About.com. Retrieved 2009-06-04.^ Skinner, M (1998). ""Ventilator function under hyperbaric conditions"". South Pacific Underwater Medicine Society Journal. 28 (2). Retrieved 2009-06-04.^ Weaver LK, Greenway L, Elliot CG (1988). ""Performance of the Seachrist 500A Hyperbaric Ventilator in a Monoplace Hyperbaric Chamber"". Journal of Hyperbaric Medicine. 3 (4): 215–225. Retrieved 2009-06-04. Authority control NDL: 00976855Categories: Respiratory therapy Medical pumps "

cle Ventilator or breathing machine What is a ventilator? The ventilator is also sometimes called a breathing machine or life support machine. The ventilator is a machine that helps the patient to breathe while they are very ill or too sleepy to breathe by themselves e.g. after a general anaesthetic. How does a ventilator work?

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The ventilator or breathing machine is connected to the patient via a tubing system and a tube (breathing tube, endotracheal or ET tube) that is inserted into the patient's mouth and windpipe. Sometimes the patient is connected to the ventilator via a tube that is inserted through the neck and into the windpipe (a tracheostomy or ""tracky"" tube).

This tubing allows the ventilator or breathing machine to push air and oxygen (under varying amounts of pressure) into the patient's lungs. Patients are given drugs to make them sleepy and comfortable before being connected to the ventilator. Patients rarely remember this procedure. How can you tell if the patient is getting the right amount of help from the ventilator? The ventilator is a very sophisticated piece of equipment which can also monitor how deeply and efficiently the patient can breathe by themselves.

It also has an alarm system that can tell us whether the patient is struggling or coughing. The nurses and doctors use this information, along with the patient's other vital signs, to make sure that the patient is getting the right amount of help with their breathing.

They also take blood samples to check the oxygen levels in the bloodstream. How do patients get off the ventilator? Our aim is to disconnect the patient from the ventilator or breathing machine as soon as it is safe to do so.

This depends on a number of things, such as how ill,stable or awake the patient is and how well they are able to breathe by themselves. ""Weaning"" is the process through which we gradually reduce the amount of pressure and support delivered by the ventilator. It can be either a straightforward or a complicated process which requires careful monitoring and skill.

As soon as the patient is able to breathe well enough by themselves, the breathing tube will be removed (this procedure is called ""extubation"").breathing machine life support tracheostomy ventilator weaningrelated resources: Weaning from the ventilator CPAPVoice changes Skin and nail changes "