Rapid interpretation of ventilator waveforms

Author(s)

Bibliographic Information

Rapid interpretation of ventilator waveforms

Jonathan B. Waugh ... [et al.]

Pearson Prentice Hall, c2007

2nd ed

Other Title

Ventilator waveforms

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Note

Includes bibliographical references (p. 147-148) and index

HTTP:URL=http://www.loc.gov/catdir/toc/fy0708/2007295765.html Information=Table of contents only

Description and Table of Contents

Description

Designed for courses in Mechanical Ventilation and/or Ventilation Graphics, this text introduces ventilator waveforms. It is intended to serve as a complement to a mechanical ventilation textbook and as a reference convenient to carry in the clinical environment. The first chapter provides clean, easy-to-read conceptual illustrations to aid in comprehension. Examples of real waveforms are provided next to the conceptual renderings to allow the learner to become comfortable with viewing waveforms with normal artifact present. The following chapters utilize mostly real recordings of ventilator waveforms. The rationale behind the format of this text is to provide a simple, portable reference and workbook that can be used at the bedside as well as the classroom. Descriptions and commentary are kept to a minimum to enhance clarity and readability. Ventilator waveform topics that are experimental, in limited use, or not considered mainstream are not included in keeping with this book's introductory theme. It would be impractical and ponderous to attempt to include all possible examples of ventilator waveforms that can be seen in the clinical setting. The goal of this book is to impart an understanding of how waveforms are generated, which will allow the practitioner to deduce the cause and implications of previously unseen as well as familiar waveforms. Understanding waveforms, instead of memorizing many patterns, aids in problem solving and correction of abnormal conditions and prepares clinicians to adapt to future yet unknown modes of ventilation.

Table of Contents

CONTENTS PREFACE vii 1. VENTILATOR GRAPHICS AND CLINICAL APPLICATIONS 1 I. Basic Concepts, 1 II. Effect of Setting Changes on Waveforms, 2 III. Effect of Flow Rate on Inspiratory and Expiratory Time, 4 IV. Effect of Resistance and Compliance Changes, 6 V. Scalars, 8 VI. Modes of Ventilation and Corresponding Scalars, 10 Control Mode Ventilation, 10 Assist Mode Ventilation, 13 Sychronized Intermittent Mandatory Ventilation (SIMV), 15 SIMV with Pressure Support Ventilation (PSV), 17 SIMV with PSV and Continuous Positive Airway Pressure (CPAP), 19 Pressure Control Ventilation (PCV), 21 2. PRESSURE-VOLUME AND FLOW-VOLUME LOOPS 23 I. Total Lung Compliance, 23 II. Pressure-Volume Loops, 27 III. Work-of-Breathing, 32 IV. Flow-Volume Loops, 34 V. Interpretation of Loops, 36 3. WAVEFORMS FOR COMMON VENTILATOR MODES 53 I. Volume-Targeted Scalars, 55 Volume-Targeted Control Ventilation, 55 Volume-Targeted Assist Control Ventilation, 55 Volume-Targeted SIMV, 55 II. Pressure-Targeted Scalars, 57 Pressure-Targeted Control Ventilation, 57 Pressure-Targeted Assist Control Ventilation, 57 Pressure-Targeted SIMV, 57 III. Spontaneous Scalars, 59 Continuous Positive Airway Pressure (CPAP), 59 Pressure Support Ventilation (PSV), 59 PSV with CPAP, 59 Setting Rise Time for PSV, 60 Bilevel and APRV, 61 iii table of contents rev.qxd 4/12/06 2:24 PM Page 1 IV. Combination Modes: Volume-Targeted Scalars, 63 Volume-Targeted SIMV with CPAP, 63 Volume-Targeted SIMV with PSV, 63 Volume-Targeted SIMV with PSV and CPAP, 63 V. Combination Modes: Pressure-Targeted Scalars, 65 Pressure-Targeted SIMV with CPAP, 65 Pressure-Targeted SIMV with PSV, 65 Pressure-Targeted SIMV with PSV and CPAP, 65 VI. Volume-Targeted Pressure-Volume (P-V) and Flow-Volume (F-V) Loops, 67 Volume-Targeted Controlled Ventilation with a Constant Flow, 67 Volume-Targeted Assisted Ventilation with a Constant Flow, 67 Volume-Targeted SIMV, 67 VII. Pressure-Targeted P-V and F-V Loops, 69 Pressure-Targeted Controlled Ventilation, 69 Pressure-Targeted Assisted Ventilation, 69 Pressure-Targeted SIMV, 69 VIII. Spontaneous Ventilation P-V and F-V Loops, 71 CPAP, 71 PSV, 71 PSV with CPAP, 71 IX. Combination Modes: Volume-Targeted P-V and F-V Loops, 73 Volume-Targeted SIMV with CPAP, 73 Volume-Targeted SIMV with PSV, 73 Volume-Targeted SIMV with PSV and CPAP, 73 X. Combination Modes: Pressure-Targeted P-V and F-V Loops, 75 Pressure-Targeted SIMV with CPAP, 75 Pressure-Targeted SIMV with PSV, 75 Pressure-Targeted SIMV with PSV and CPAP, 75 4. MONITORING PRESSURE AND VOLUME VENTILATION 77 I. Volume vs. Pressure Ventilation Scalars, 78 II. Inspiratory Pause During Volume and Pressure Ventilation, 79 III. Effects on Increased Airways Resistance on Volume- and Pressure- Targeted Ventilation, 81 IV. Effects of Decreased Compliance, 84 V. Three conditions for Pressure-Targeted Breaths, 85 VI. Descending Ramp Flow in Pressure Control, Pressure Supported, and Volume-Targeted Breaths, 85 iv CONTENTS table of contents rev.qxd 4/12/06 2:24 PM Page 2 5. COMMON CLINICAL FINDINGS 86 I. Changes in Respiratory System Compliance, 87 Decreased Compliance and Inflection Points, 87 Overdistension, 90 Active Exhalation, 91 II. Airway Obstruction, 92 Bronchospasm: Bronchodilator Benefit Assessment, 92 Air-trapping from Dynamic Hyperinflation, 94 Air-trapping from Early Small Airway Collapse, 96 Kinked Endotracheal Tube, 98 III. Patient-Ventilator Dyssynchrony, 99 Inadequate Inspiratory Flow Rate, 99 Inappropriate Trigger Sensitivity, 100 Patient and Ventilator Rates Out of Synchrony, 102 IV. Leaks, 103 6. NEONATAL APPLICATIONS 104 I. Introduction, 105 II. Normal Infant Pulmonary Functions, 106 III. Normal Scalars, Flow-Volume (F-V), and Pressure-Volume (P-V) Loops, 107 IV. Abnormal Waveforms, 114 Improper Sensitivity Scalars, 114 Large Air Leak and Autocycling Scalars, 115 A/C Pressure Control Asychrony Scalars, 116 A/C Pressure Control F-V and P-V Loops, 117 Inadequate Flow Scalars, 118 Inadequate Rise Time or Flow, 118 Excessive Inspiratory Pressure and Flow Scalars, 119 Effect of Excessive Inspiratory Pressure on the P-V Loop,119 Reduced Compliance F-V and P-V Loops, 120 Excessive Inspiratory Time Scalars, 121 Inspiratory Flow Termination Scalars, 122 Termination of Inspiratory Flow, 122 Breath-Stacking (Auto-PEEP) Scalars, 123 Breath-Stacking F-V and P-V Loops, 124 Obstruction to Expiratory Flow Scalars, 125 Obstruction to Expiratory F-V and P-V Loops, 126 Right Mainstem Intubation Scalars, 127 CONTENTS v table of contents rev.qxd 4/12/06 2:24 PM Page 3 Right Mainstem Intubation F-V and P-V Loops, 128 Progression to Extubation Scalars, 129 Turbulent Baseline Flow Rate Scalars, 130 High Frequency Ventilation, 131 Appendix A: CASE STUDIES 134 Appendix A: VENT WAVEFORMS CHECKLIST 144 BIBLIOGRAPHY 145 INDEX 147

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