Ventilator Modes (Mechanical Ventilation

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Ventilator Modes (Mechanical Ventilation - Lecture 7)

Рет қаралды 444,936

Strong Medicine

Күн бұрын

Пікірлер: 72

@rbekele 12 жыл бұрын

Great video and thanks for sharing. I don't know why anyone would dislike any kind of helpful video on youtube. This is a guy who put his time and effort to help others and he gets a " dislike" from somebody.

@abdulrhmanalzoman1169 8 жыл бұрын

Thank you so much doctor, this video helps me a lot as biomedical engineer responsible of anesthesia machine. Wish you all the best

@Tararrtma777 12 жыл бұрын

This man is GREAT! Easy to understand, thorough and to the point.

@sunving 3 жыл бұрын

Thank you Dr Strong ,this is my second time watching this. Your lecture series are the best out there.

@ventilator98 12 жыл бұрын

HIS VIDEOS ARE JUST THROUGH THE ROOF. I speak for all the students of him, and anyone who knows him when I say, "HE IS JUST PURELY GENIUS!!!!." We need more people like this, and MUCH MORE videos like this on YOuTube.

@StrongMed 11 жыл бұрын

Adding some clinical scenarios is a great suggestion! I'm adding it to my to-do list, though it may take a while to get to it...

@agd712 2 жыл бұрын

bump !

@StrongMed 12 жыл бұрын

goerizal1, thanks for your comment. Don't worry, I don't take the "dislikes" personally. Not every lecture resonates with every viewer. Glad you enjoyed it though!

@StrongMed 11 жыл бұрын

Traditionally, "assist control" mode implied a volume-targetted form of ventilation, however, many modern ventilators have a "A/C pressure control" mode which is similar to what I refer to as "pressure control" ventilation in the video. In general, for most patients, volume-targetted ventilation (e.g. "A/C volume control") is preferred since it will guarantee a certain minute ventilation. In pressure-targetted ventilation, unnoticed changes in lung compliance can result in hypoventilation.

@goerizal1 12 жыл бұрын

i would like to be nonderogatory to the three who dislike this but they are really unfortunately putting it kindly. this is teaching only for the sake of teaching, free to be taken in any way. his students are most fortunate. what i would give to have him as an attending in my internship/resident life.. but that was very long ago. thanks for the post

@StrongMed 11 жыл бұрын

J Kaur, I'm glad you found these videos helpful. To be honest, the reason that the series of videos on mechanical ventilation are among the earliest I've posted is because I couldn't find a good general resource for this information already out there (either on the web, or in print). I'm not convinced there is any one great up-to-date ICU textbook out there, and much of the info in these videos is taken from literature. If anyone has suggestions for books, please feel free to post them here.

@slraccord99 12 жыл бұрын

OMG!!! I find this video very easy to follow and understand. I have to read certain chap of Egan 2-3 times at least, just to absorb the concept. This is in like 20 min versus 8 hours X 3 days! lol. Anyhow, my sister is currently a RCP at the VA Palo Alto and she has done her clinical rotations at Stanford also. I get some help from her but I rarely see her since she works FT at VA and PT at UCSF, so I read solo, study w/ classmates, and youtube videos. Thank-you in posting these helpful videos.

@katieoldham804 3 жыл бұрын

Hard to hear what is being said

@tobym6491 12 жыл бұрын

thank you so much, lucky are your students( i am a med student) and people working around you! you are a wealth of knowledge,!

@StrongMed 11 жыл бұрын

...To be honest, I can't remember the last time I did not defer the trigger setting to respiratory therapy, but I'm fairly certain that non-synchronized breaths in SIMV can be either flow or pressure triggered. (By definition, non-synch'd breaths can't be time triggered, so they must be either flow and/or pressure triggered.) If there are any RTs here that know for certain, feel free to comment!

@yusranaz2872 Жыл бұрын

This video is very informative

@dr.nageshparekar3869 4 жыл бұрын

Amazing. Thanks

@dann_2016 6 ай бұрын

I like those historical pecture videos

@sunving 4 жыл бұрын

Thank you Doctor Strong ! may be i need to watch couple more time .

@strings11235 11 жыл бұрын

Thank you very much Dr. Strong for the answers. I'm terribly sorry to bother you by asking many questions. I really do appreciate your help. Once again, thank you Dr. Strong!

@paygondapatil8341 7 жыл бұрын

strings11235 Matingtimeinbodyproses

@gaiaderegibus8837 10 жыл бұрын

Thank you from Italian Med Students too! :D

@StrongMed 11 жыл бұрын

strings11235, great question! There is a relationship between pressure, flow, and resistance that is analogous to Ohm's law in electricity, whereby (airway pressure - intraalveolar pressure) is approx. equal to (flow x resistance). As the lungs expand during inspiration, the increase in volume is proportional to the increase in intraalveolar pressure in a ratio that is defined by the respiratory system's (lung + chest wall) compliance...

@mohammedalameen4540 Жыл бұрын

Good teaching method 10q

@StrongMed 11 жыл бұрын

It's impossible to generalize how to manage a situation in which a traumatic brain injury pt also has high risk of barotrauma. Most of the time, these patients will probably be treated with volume-targetted ventilation with an eye on the pCO2 (and also on O2 sat and PEEP), but it's all dependent on how difficult ventilating the patient is, what the peak pressures are like, and how high risk the pt is for barotrauma. Best advice is to consult a neuro-critical care specialist or experienced RT.

@blaschito1 3 жыл бұрын

outstanding resource

@criticalmass500 5 жыл бұрын

Pressure control assist control mode is common. You should specify while describing assist control that you are describing volume controlled assist control mode.

@jkaur5246 11 жыл бұрын

i just joined icu 2 months ago and seriously im in a shock state. im a registered nurses and im trying to catch up with icu setting esp the ventilators. this really helps. please do send me more on this and books if there is any to my email.

@StrongMed 11 жыл бұрын

...As the intraalveolar pressure increases, as airway resistance is roughly constant, in order to maintain constant flow, the airway pressure must increase by the same amount as intraalveolar pressure (in order to satisfy the Ohm's law relationship). So with the most basic approximation, when the flow is constant, airway pressure should increase linearly with delivered volume...

@limmeilanlim3216 3 жыл бұрын

Excellent!

@StrongMed 12 жыл бұрын

slraccord99, I'm glad you found the videos helpful. I know just about all of the RTs at the Palo Alto VA, so I'm sure I know your sister too.

@knunniek.9304 3 жыл бұрын

Thanks

@StrongMed 11 жыл бұрын

In SIMV, if the patient triggers a breath that the vent decides (based on an algorithm) to synchronize with the "mandatory" breaths, the vent will give a breath that is flow controlled (guaranteeing a specific volume for that breath). If the vent decides that the breath will be non-synchronized (i.e. it is a breath above the vent's set respiratory rate), it is pressured controlled...

@pavasphysio 10 жыл бұрын

So helpful in my physical therapy review!

@Stonefalconetti 4 жыл бұрын

You should improve the volume of sound in your videos..... I'm on my laptop and my volume is at Max and still can't hear well.... Lol

@sabrinarosli366 7 жыл бұрын

Helpful for physiotherapist working in the ICUs =D

@myradeleon8618 4 жыл бұрын

thank you so much for this great lecture

@strings11235 11 жыл бұрын

Dear Dr. Strong, thank you very much for your amazing lectures and for the time you've spent to create all of this lectures. If you don't mind, I have a question regarding Assist/Control mode. You said that A/C mode is flow (volume) control, so can I assume that the pressure value will be determined by airway resistances,compliance and patient's inspiratory effort? If I'm correct, then doesn't the pressure waveform in the A/C chart wouldn't remain the same through all of the ventilation process?

@StrongMed 11 жыл бұрын

...Pressure-targetted ventilation (e.g. A/C pressure control) is better when a patient is at uncommonly high risk of barotrauma.

@strings11235 11 жыл бұрын

Maybe, such in a patient with the high risk of barotrauma then it's better to control the pressure? If we encounter some situations which changes in both pressure and volume is undesirable, such as in a patient with severe traumatic brain injury patient and high risk of barotrauma, in that patient shouldn't we limit the tidal volume so that CO2 level wouldn't be too high to cause increase in intracranial pressure ; but shouldn't we limit the pressure applied too.

@StrongMed 11 жыл бұрын

...In reality, the increase in airway pressure isn't as perfectly linear as the volume delivered because both lung compliance and airway resistance vary at different lung volumes.

@purnashrestha2377 11 жыл бұрын

u presentation is nice

@drrevision964 4 жыл бұрын

Thank you sir

@strings11235 11 жыл бұрын

So, which mode and variable should we control in those situation? If I may suggest, could you add some clinical scenario like in your ABG's lecture so we can know which mode is better in some patient should we encounter those situation.

@strings11235 11 жыл бұрын

Thank you Dr. Strong! Your explanation is really great. I have another question. I've read that some book say that in A/C mode we can choose to set the pressure instead the volume, so from what I understood that in A/C mode there is pressure control too. Is that right, Dr. Strong? If that's right, then when should we choose to control the volume or pressure? Is it just for the reason when the change in volume or pressure is undesirable?

@letouh 11 жыл бұрын

thank you very much for you answer...it's very clear now...

@cedomird.petrovic9687 5 жыл бұрын

I have difficulties with terminology. What is synchronized with wich? And what is nature of that synchronization?

@Suzi_P 6 жыл бұрын

Thank you so much for this

@tammiewanless4899 10 жыл бұрын

Hi Eric, I'm a new RN and I would like to print out the graphs on the modes to use as a reference while on the floor. Is their a way to print a slide?

@StrongMed 10 жыл бұрын

If you send me a personal message through KZfaq and include your email, I'll be happy to send you a pdf version of the video from which you can print off whichever diagrams/charts you find most helpful. (Be sure to not post your email as a public comment unless you love getting spam...)

@subtoneskumalo2875 7 жыл бұрын

buddyaid02xolani@gmail.com

@Suzi_P 6 жыл бұрын

Thank you so much

@letouh 11 жыл бұрын

thank you for this video, excuse my english, I am from france... in SIMV mode, when the patient triggers , the machine give him a flow or pressure control? and in 13:35 non-synch.breaths , trigger: pressure or flow? i thought that pressure and flow triggers are always associeted with synchronized cycles thank you for response

@ithagonimallikarjun4198 10 жыл бұрын

Thanx for lecture it is informative and useful.

@lenalidayag2717 9 жыл бұрын

Dr.i am a rt student can i ask how does the PIP and Pplat of the NMD affected when there are hook in MV it i will increase or decrease!thnks

@GJKSTUDIO 10 жыл бұрын

can someone help me... If the machine is controlling pressure is it always " time cycled "? If the machine is controlling volume is it always "volume cycled"?

@jbeckwithnbacer 10 жыл бұрын

Is there a maximum flow that you can not go beyhound . And if there is what would be theses figures . I know there's a lot of factors dead space injury ect , just was wondering .

@StrongMed 10 жыл бұрын

I'm not familiar with any specific number for a maximum flow in conventional mechanical ventilation. Increasing high flow is typically limited by high pressures, with higher pressures (high plateau pressure probably more so that high peak pressures) being predictive of increased risk of barotrauma. In other words, it's usually the max desired plateau pressure that determines the max flow. Although there isn't even any specific cutoff for max recommended plateau pressure (it's just higher numbers lead to more barotrauma), but around a plateau pressure of 35 H2O is where the risk of barotrauma is anecdotally found to start to increase significantly in ARDS. Some experts recommend trying to keep P plateau below 30 H2O in ARDS.

@jbeckwithnbacer 10 жыл бұрын

Thank you that helped with the question I was having .

@shadow33abram 7 жыл бұрын

Thanks!

@ravindrasinghchouhan8712 4 жыл бұрын

nice

@ResidentSIAnes 9 жыл бұрын

Great

@ahmology 7 жыл бұрын

in AC why does the airway resistance increase and what does airway resistance have to do with hypotension? pls help

@StrongMed 7 жыл бұрын

What specific part of the video are you referring to? Do you actually mean auto-PEEP instead of airway resistance?

@ahmology 7 жыл бұрын

Strong Medicine to the disadvantages of AC, here in hyperventilated pat. Hypotension occures. The mechanism is rather Not clear. Thanks alot and sorry for the disturbance