Transcript No Slide Title

How to set Ventilation Parameters?
Efficiency
Comfort
Safety
Versatility
Prediction
S/T mode - Titration
 Ask the patient to sit or lay comfortably
 Adjust the mask
 Initial settings
•
•
•
•
IPAP = 8-10 cmH2O
EPAP = 4 cmH2O
Respiratory rate = 4-8 BPM
Ti = 1 sec.
 Look at the patient!
Titration – Set IPAP
O2 saturation (< 90%) due to
hypoventilation events
PaCO2 > objective
Patient Vt < target (7–12 ml/Kg)
Patient wants more air
 IPAP objective:
‐ COPD patients
•  Ventilation to avoid hypoventilation at night
•  PaCO2 (« realistic »)
‐ Restrictive patients
• Provide the right patient Vt (8-12 ml/Kg)
• Guarantee a minimum ventilation
Increase IPAP
Titration – Set EPAP
Patient uses his respiratory muscles
Patient hardly triggers to inspiration
Increase EPAP
Expiratory time too long
Obstructive apnea events
 EPAP objective:
‐ Remove obstructive apnea events and reduce arousals
‐ Compensate intrinsic PEEP to reduce respiratory work
‐ Increase alveoli recruitment (for COPD) to improve oxygenation
Titration – Set Respiratory Rate and Ti
Set back up rate 2 to 3 breaths below patient
spontaneous breathing
 Respiratory rate back up objective:
‐ Maintain efficient ventilation during central episodes
‐ Decrease respiratory work: the patient tends to rely on his ventilator at night
Obstructive Patient
Ti from 25 to 33%
Restrictive Patient
Ti from 33 to 50%
Ti (Second) = (60 / RR) x % Ti
Ti Setting
Respiratory Rate BPM
I/E 1/3, Ti/Ttot 25%
I/E 1/2 , Ti/Ttot 33%
I/E 1/1, Ti/Ttot 50%
10
1.5 s
2s
3s
11
1.4 s
1.8 s
2.7 s
12
1.3 s
1.7 s
2.5 s
13
1.2 s
1.5 s
2.3 s
14
1.1 s
1.4 s
2.1 s
15
1.0 s
1.3 s
2.0 s
16
0.9 s
1.3 s
1.9 s
17
0.9 s
1.2 s
1.8 s
18
0.8 s
1.1 s
1.7 s
19
0.8 s
1.1 s
1.6 s
20
0.8 s
1.0 s
1.5 s
21
0.7 s
1.0 s
1.4 s
22
0.7 s
0.9 s
1.4 s
23
0.7 s
0.9 s
1.3 s
24
0.6 s
0.8 s
1.3 s
25
0.6 s
0.8 s
1.2 s
Titration – Set Rise Time
 Rise time: time from EPAP to IPAP
‐ Obstructive patients : prefer short rise time from 100ms to
400ms (from 1 to 4)
‐ Restrictive patients: prefer longer rise time from 300ms to
600ms (from 3 to 6)
‐ Warning: long rise time with high respiratory rate may be not
compatible
IPAP
EPAP
Titration – Ramp
 Ramp: comfort feature to progressively provide pressure to the patient
‐ Starting pressure: EPAP starts at the set starting pressure and IPAP at set
starting pressure + 2 cmH2O
‐ Time
 EPAP and IPAP gradually increase up to the prescription during the set time.
Titration – Set Alarms
 Alarms:
‐ For more safety, a disconnection alarm and a minimum minute
ventilation alarm can be set (usually for dependant patients)
‐ Apnea Alarm: to detect when patient does not trigger. When a
safety respiratory rate is set, then the ventilator controls patient
ventilation
‐ With AVAPS, an additional alarm on the tidal volume can be
turned on.
Titration Guidelines