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Mechanical Ventilation Waveform Analysis

This document discusses assessing mechanical ventilation waveforms. It provides normal patterns and measurements, identifies different breath types and modes of operation, and identifies potential problems such as changing respiratory mechanics, overdistention, dynamic hyperinflation syndrome, and dys-synchrony. Graphs and diagrams are used to illustrate measurements, breath sequences, and different modes of mechanical ventilation including mandatory, assisted, supported, and spontaneous breaths.

Uploaded by

Luis Lopez
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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348 views30 pages

Mechanical Ventilation Waveform Analysis

This document discusses assessing mechanical ventilation waveforms. It provides normal patterns and measurements, identifies different breath types and modes of operation, and identifies potential problems such as changing respiratory mechanics, overdistention, dynamic hyperinflation syndrome, and dys-synchrony. Graphs and diagrams are used to illustrate measurements, breath sequences, and different modes of mechanical ventilation including mandatory, assisted, supported, and spontaneous breaths.

Uploaded by

Luis Lopez
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
  • Mechanical Ventilation Graphical Assessment: Introduction to the graphical representation of mechanical ventilation assessments.
  • Assessing Mechanical Ventilation Waveforms: Overview of mechanical ventilation waveforms and common patterns used to assess patient status.
  • Waveform Analysis: Detailed analysis of ventilation waveforms including pressure, flow, and volume graphs.
  • Characteristic Changes in Injured Lungs: Assessment of pressure-volume characteristics in injured lungs and protective lung strategies.
  • Effectiveness of Medical Education: Study results on medical education's effectiveness in managing mechanical ventilation settings.
  • Response to Bronchodilators: Visualization of patient responses to bronchodilator treatments in ventilation settings.
  • Dual Pump System: Illustration of a dual pump system used for respiratory support and its mechanical dynamics.
  • Expiratory Volumes and Air Leak: Analysis of expiratory volumes and detection of air leaks in ventilation systems.

Mechanical Ventilation Graphical

Assessment
Mazen Kherallah, MD, MHA, FCCP
Assessing Mechanical Ventilation Waveforms

Normal Identifying Identifying Identifying


patterns, breath types breath
measurements sequence and problems:
mode of • Changing respiratory
operation mechanics
• Overdistention and
protective lung
strategy
• Dynamic
hyperinflation
syndrome
• Dys-synchrony
Assessing Mechanical Ventilation Waveforms

Normal Identifying Identifying Identifying


patterns, breath types breath
measurements sequence and problems:
mode of • Changing respiratory
operation mechanics
• Overdistention and
protective lung
strategy
• Dynamic
hyperinflation
syndrome
• Dys-synchrony
50

Peak PAW
cmH2O Plateau PAW PAW
PRAW End Expiratory PAW

0
60 Inspiratory Flow Time Peak Inspiratory Flow

Inspiratory Hold Time Zero Flow at Plateau Phase

L/m 0 V°

Peak Expiratory Flow


-60
1

Inspiratory Time Expiratory Time Tidal Volume


L V

0
30

End Inspiratory Esophageal Pressure


cmH2O
Pes
0

End Expiratory Esophageal Pressure


-20
0 2 4 6 8 10 12 14 16 Seconds
50

cmH2O PAW

0
60

L/m 0 V°

-60
0 2 4 6 8 10 12 14 16
Seconds
0.7 80

Flow (L/min)
Volume (L)

0 0.8

0
-80
-5 0 35
PAW (cm H2O) Volume (L)
Peak Airway Pressure
Plateau Airway Pressure

0.7 80

Peak Inspiratory Flow


VT

Flow (L/min)
Volume (L)

Tidal Volume (VT)

Peak Expiratory Flow


0
End Expiratory Pressure
-80
-5 0 35 0 0.8
PAW (cm H2O) Volume (L)
Assessing Mechanical Ventilation Waveforms

Normal Identifying Identifying Identifying


patterns, breath types breath
measurements sequence and problems:
mode of • Changing respiratory
operation mechanics
• Overdistention and
protective lung
strategy
• Dynamic
hyperinflation
syndrome
• Dys-synchrony
50
A B C D

cmH2O Pressure Limited PAW

0
Patient Triggered Patient Triggered Time Triggered
Patient Triggered
60
Flow Control Flow Control
Flow Cycled

L/m 0 V°

Patient’s Flow
-60
1

Patient’s Cycle Volume Cycle Time Cycle


L V

0
30

cmH2O
Pes
0

-20 Spontaneous Breath Supported Breath Assisted Breath Mandatory Breath


1 second
Assessing Mechanical Ventilation Waveforms

Normal Identifying Identifying Identifying


patterns, breath types breath
measurements sequence and problems:
mode of • Changing respiratory
operation mechanics
• Overdistention and
protective lung
strategy
• Dynamic
hyperinflation
syndrome
• Dys-synchrony
50

cmH2O PAW

0
Continuous Mandatory Ventilation
50

cmH2O PAW

0
Intermittent Mandatory Ventilation
50

cmH2O PAW

0
Continuous Spontaneous Ventilation
50

cmH2O PAW

0
60

L/m 0 V°

-60
1

L V

0
2 4 6 8 10 12 14 16 18

Seconds
50

cmH2O PAW

0
60

L/m 0 V°

-60
1

L V

0
0 2 4 6 8 10 12 14 16

Seconds
50

cmH2O PAW

0
60

L/m 0 V°

-60
1

L V

0
0 2 4 6 8 10 12 14 16

Seconds
Assessing Mechanical Ventilation
Waveforms

Normal Identifying Identifying Identifying


patterns, breath types breath
measurements sequence and problems:
mode of • Changing respiratory
operation mechanics
• Overdistention and
protective lung
strategy
• Dynamic
hyperinflation
syndrome
• Dys-synchrony
50

cmH2O PAW

0
60

L/m 0 V°

-60
1

L V

0
30
↑R ↓Ccw ↓CLung ↑Flow ↓Clung+ ↑R
cmH2O
Pes Pes
0

-20 Before A B C D E
0 2 4 6 8 10 12 14 16 Seconds
Assessing Mechanical Ventilation Waveforms

Normal Identifying Identifying Identifying


patterns, breath types breath
measurements sequence and problems:
mode of • Changing respiratory
operation mechanics
• Protective lung
strategy
• Dynamic
hyperinflation
syndrome
• Dys-synchrony
Characteristic PV Changes in Injured Lungs
Optimal PEEP Pressure Limit

Protective Lung Strategy

Normal Lung
Volume (L)

C=dV/dP

UIP

ARSD

-5 0 LIP 40
PAW (cm H2O)
50 Pressure Limit
Pressure Alarm Limit

cmH2O Pressure Adjusted 2-3 cm H2O each PAW


Pressure Maintained Pressure Decreased
5 cm H2O Test Breath breath to Achieve Target Volume

0
60

L/m 0 V°

-60
1

Higher Tidal Volume


Set Tidal Volume Tidal Volume Still Target Tidal Volume
L Lower than Target Achieved V
Low Tidal Volume

0
2 4 6 8 10 12 14 16 18

Seconds
Assessing Mechanical Ventilation Waveforms

Normal Identifying Identifying Identifying


patterns, breath types breath
measurements sequence and problems:
mode of • Changing respiratory
operation mechanics
• Overdistention and
protective lung
strategy
• Dynamic
hyperinflation
syndrome
• Dys-synchrony
Effectiveness of medical resident education in
mechanical ventilation

33%

67%

Unable to Mange Auto PEEP Able to Manage Auto PEEP

Cox CE, Shannon S, Carson E, et al. Effectiveness of medical resident education in mechanical
20
ventilation. Am J Respir Crit Care Med 2003; 167: 32±8
50

cmH2O PAW

0
60

L/m 0 V°

-60
1

L V

0
30

cmH2O
Pes Pes
0

-20
0 2 4 6 8 10 12 14 16 Seconds
Paw Tracing in Dynamic Hyperinflation

50

es
cmH2O aews Pr PAW
PPr Pel
es
Pr Pel
PEEPi
0
0 2 4 6 8 10 12 14 16
Seconds
Normal Pattern Increased Airway Resistance Dynamic Hyperinflation

In the absence of patient’s efforts


Dynamic Hyperinflation
80
Flow (L/min)

Volume (L)
Trapped Volume

Persistent Flow

-80 0.8
Response to Bronchodilators
80
Flow (L/min)

Volume (L)

Before

After

-80 0.8
Assessing Mechanical Ventilation Waveforms

Normal Identifying Identifying Identifying


patterns, breath types breath
measurements sequence and problems:
mode of • Changing respiratory
operation mechanics
• Overdistention and
protective lung
strategy
• Dynamic
hyperinflation
syndrome
• Dys-synchrony
Dual Pump System

Pump #1
MV

Pres

Pel

Pump #2
Patient
Schematic of inspiratory muscle activity (Pmus) on airway pressure and
Fow during mechanical ventilation in a volume preset mode.

20

(cm H2O)
Pao
10

0 Pump #1
MV
60
(liters/min)

Pres
Flow

-60
Pel
10
(cm H2O)
Pmus

Pump #2
0
Patient

-10
Assessing Mechanical Ventilation Waveforms

Normal Identifying Identifying Identifying


patterns, breath types breath
measurements sequence and problems:
mode of • Changing respiratory
operation mechanics
• Overdistention and
protective lung
strategy
• Dynamic
hyperinflation
syndrome
• Dys-synchrony
• Air Leak
Expiratory Volumes and Air Leak

0.7 80

Inspiration

Flow (L/min)
Volume (L)

Volume
of Leak Expiration
Volume
of Leak
0

-80
-5 0 35 0 0.8
PAW (cm H2O) Volume (L)
Thank You

Normal Identifying Identifying Identifying


patterns, breath types breath
measurements sequence and problems:
mode of • Changing respiratory
operation mechanics
• Overdistention and
protective lung
strategy
• Dynamic
hyperinflation
syndrome
• Dys-synchrony

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