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Basics of Home Ventilation

Robin Kingston, CRNP

Pediatric Home Ventilator Program

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LTV 1200/1150 Ventilator

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Trilogy 100/200

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Astral Ventilator

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Respiratory Failure

  • C – CNS
  • A – Airways
  • L – Lung Tissue
  • M – Muscles

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Positive Pressure Ventilation

  • Artificial airway
  • creates pressure at airway opening that is greater that intraalveolar pressure.
  • As a result, pressurized gas forced from vent into lungs.
  • Results in increased airway pressures and intrathoracic pressures
  • Time, pressure, volume cycled
  • Exhalation passive

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Pressure Ventilation

  • Pressure cycled vents use a preset peak inspiratory pressure (PIP) at which inspiration is terminated
  • Gas is delivered until the peak pressure is achieved without regard for the amount of volume delivered.
  • The preset pressure is maintained for the prescribed inspiratory time or IT
  • PIP = PC setting + set PEEP (LTV)
  • PIP = TIP setting (Trilogy)

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Definitions

  • Tidal Volume: the amount of gas expired during normal ventilation at rest
  • This is measured on the as Vte
    • Is given as a number in ml exhaled through the tracheostomy tube
    • Can be affected by how much of an air leak there is around the tracheostomy tube.

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Pressure Ventilation

  • Factors affecting tidal volume:
    • Inspiratory pressure level
    • Inspiratory time
    • Compliance
    • Respiratory system impedance (secretion, edema, structural narrowing, water in tubing, kinks)
    • Patient resistance
    • Air leaks

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Other terms

  • Pressure Support: Added support during spontaneous respirations that overcomes resistance created by the tracheostomy tube and the demand valve on the ventilator. Helps to decrease the work of breathing and is often used during weaning.
  • PEEP – Positive end expiratory pressure: a small amount of pressure kept in the lungs after expiration that helps to keep alveoli open and O2 levels in the blood normal
  • IMV – intermittent mandatory ventilation
  • SIMV – synchronized intermittent mandatory ventilation

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Other Terms cont.

  • CPAP: continuous positive airway pressure
    • Just like PEEP, this maintains a certain pressure (cm H2O). It can only be used when the vent is not delivering breaths.
    • Bi-PAP: bi-level positive airway pressure
      • Form of non-invasive ventilation
      • Similar to CPAP, but instead of 1 pressure there are 2
        • IPAP – inspiratory pos. airway pressure (~ 12-20cm H2O)
        • EPAP – expiratory pos. airway pressure (~ 2-5cm H2O)

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Components of Ventilation

  • Physician ordered:
    • Mode: for our kids PC/SIMV
      • Pressure control: pressure limit
    • Rate
    • Inspiratory time
    • PEEP
    • FiO2 – will give % or order to wean for O2 Sats

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Trilogy

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Astral

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Pressure support with safety tidal volume

Single limb circuit

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  • Astral with PS/SVt Pressure Support with Safety Tidal Volume (PS/SVt) mode is a Volume Assured Pressure Support (VAPS) mode.

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  • The PS/SVt mode offers users a volume guarantee with every breath.

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  • PS/SVt is now available on the Astral™ series leak circuit, which enhances leak compensation with Vsync technology for patients with persistent leak.

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Astral

  • PC/SIMV mode
    • Dual limb

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Nursing Considerations

  • Physician ordered:
    • Mode: SIMV or pressure control
      • SIMV: tidal volume
      • Pressure control: pressure limit
    • Rate
    • Inspiratory time
    • PEEP
    • FiO2 – will give % or order to wean for O2 Sats

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ALWAYS CHECK PT. 1ST

WHEN IN DOUBT

BAG AND SHOUT!!!