How Ventilators Work Chapter 3 To care for a ventilator patient, you need to know: The various functions of the ventilator used
How the ventilator interacts with the patient How changes in lung condition can alter the ventilators performance Ventilator Classification: The terminology employed by the different manufacturers is confusing!
Internal Ventilator Function black box Plugged into a power source User interface to set the controls Control system to interpret the operators settings to produce the desired output
Power Source : provides the energy to perform the work required to ventilate a patient
Powers internal motors which provide gas flow to the patient High pressure gas source Usually 2 -50psi sources, air and oxygen
Built in reducing valves Pneumatic Fluidic Combined Power Ventilators Pneumatically powered 50 psi gas sources
Mixture of air and oxygen allow variable FiO2 Energy to deliver the breath Electrically powered Controls the internal function May be controlled by a microprocessor
(1980s) Clinical Rounds 3-1 A patient who requires continuous ventilatory support is being transferred from the ICU
to a regular patient room. The regular hospital rooms are equipped with piped in oxygen but not piped in air. What type of ventilator would you select?
You would need an electrically powered ventilator with a built- in or external compressor. The availability of oxygen would allow you to provide
oxygen as necessary for the patient. Pressure Delivery Positive Pressure Negative Pressure
Pressure Delivery Combined pressure devices HFV Oscillating gas pressure waveforms, positive and
negative pressure Control Systems Decision making systems Regulates ventilator function internally Open loop versus Closed loop
Control Systems Open Loop Closed Loop unintelligent systems Does not respond to
changes in patient condition Does not measure variables or change them intelligent systems Compares the set variable
to the measured variable Clinical Rounds 3-2 A ventilator is programmed to monitor SpO2. If the SpO2 drops below 90% for longer than 30 sec the ventilator is
programmed to activate an audible alarm that cannot be silenced and a flashing red visual alarm. The ventilator also is programmed to increase the oxygen percentage too 100% until the alarms have
been answered and deactivated. Is this a closed loop or an open loop system? Do you think it is a good idea for a ventilator to have such a system?
This is a closed loop system. The ventilator is providing a specific FiO2 and monitors SpO2. The ventilator can detect changes in SpO2 and change the FiO2 setting. It can be argued that this
would provide a safeguard for patient who suddenly became hypoxemic. It could also be argued that oxygen saturation monitors are not reliable enough and could result in erroneous readings resulting
in an inappropriate ventilator response Control Panel Pneumatic Circuit Pathway of gas flow
Pressure gradients created by the ventilators power source generates this flow Internal pneumatic circuit From generating source through the inside of the ventilator External pneumatic circuit
Patient circuit Flow between the ventilator and the patient Single Circuit Design - Internal Double Circuit Design Internal
Basic Elements of a Patient Circuit Main inspiratory line Adapter Expiratory line Expiratory valve
Adjuncts Device to warm/humidify air Thermometer Nebulizer Bacteria filters
Power transmission and conversion Converts the electrical or pneumatic energy into a breath to the patient Consists of: drive mechanism mechanical device that
produces gas flow to the patient output control mechanism one or more valves that determine the flow to the patient Categorized as volume controllers or flow controllers
Compressors Used as either a power source or to convert and transmit a power source Reduce internal volumes (compression) resulting in a change in pressure Piston driven, rotating vane (blades),
moving diaphragms or bellows Volume displacement designs Bellows Pistons Concertina bags bag in a chamber
Flow control valves Control and direct flow by opening and closing Complete or incremental movement Rapid response time Great flexibility in flow control
Proportional solenoid valve Stepper motor with valve Digital on/off valve configuration Expiratory Valves Allow exhalation to occur naturally Also applies positive pressure during
exhalation to increase the FRC Flow resistance Threshold resistance CPAP Devices Spontaneously breathing patients Often provided through ventilators
Originally and still may use free standing systems Common features of Ventilators Rapidly changing environment
Important to distinguish between different models/versions from the same manufacturer Common internal mechanisms Patient monitoring Parameters and displays Alarms
Infant Ventilators Different approaches to ventilation regardless: must monitor parameters closely provide the appropriate level of support respond to physiologic changes quickly
Two different choices for ventilators Ventilators designed exclusively for infants and small children Single ventilator for all ages Transport Ventilators
Requires great care and skill; same level of care and monitoring throughout the transfer Gray area of risk versus benefit Physiologic changes due to gravity of condition not the transport itself Requires preparation and communication Ventilator should be compact, lightweight,
reliable power source (internal battery or gas source) Able to function in extreme conditions Home Care Ventilators One of the fastest growing areas of healthcare, home care is a viable
alternative to hospital or extended care facilities Increased ability to support diseases once thought incurable Ventilators must be simple, operator friendly with clear alarms Main caregivers are family!
Noninvasive Ventilators Increased usage in the last 15 years Portable, safe, user-friendly interfaces Requires properly fitting interface Negative Pressure Ventilators
Attempts to mimic normal respiration Applies negative pressure to the outside of the chest The greater the pressure applied the greater the gradient, the greater the volume delivered 3 basic modes: inspiratory negative
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