Mode

Description

Pro’s

Con’s

Initial settings example

Monitor

SIMV VC

Volume Control

Every breath delivered (mandatory & patient triggered) deliver a set volume

Peak pressure (PIP) varies with resp system compliance

Guaranteed min ventilation

No real advantage over PRVC

Can get high peak pres in sick lungs better to use PC in these patients

TV 6-8 cc/kg RR dependent on age at minimum PEEP = 4, higher if poor oxygenation or atelectasis

↑Oxygenation -↑PEEP, itime

↑Ventilation - ↑TV ,RR

Pressures

Ppeak, Pplat avoid > 30

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ABG/VBG

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SIMV PC

Pressure Control

Every breath delivered (mandatory & patient) deliver a set pressure –

TV varies with resp system compliance

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💡 Consider for patients with poor

compliance e.g. ARDS

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Good for limiting pressure; better gas distribution due to decelerating flow pattern which delivers initial high flow rate( which decreases during inspiration) when lungs are most compliant. This leads to lower peak pres

Requires you to monitor volumes to avoid volutrauma or opposite prbl- low volumes

Peak pres to achieve TV approx. 6-8cc/kg * RR dependent on age ,minimum PEEP =4, higher if poor oxygenation or atelectasis

Volumes (TV, MV)

ABG/VBG

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Pplat avoid > 30

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↑Oxygenation -↑PEEP, itime

↑Ventilation - ↑PIP, RR

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PRVC

Pressure Regulated Volume Control

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Hybrid PC mode that dynamically changes inspiratory pressure to deliver a desired volume

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💡 Most used mode in PICU

Good all- purpose mode –delivers guaranteed TV with same flow pattern as PC.

In severe ARDS consider PC instead as MAP better maintained i.e. less variable

TV 6-8 cc/kg RR dependent on age, minimum PEEP= 4 ,higher if poor oxygenation or atelectasis

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↑Oxygenation -↑PEEP, itime

↑Ventilation - ↑PIP, RR

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Pressures & volume

ABG/VBG

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Pplat avoid > 30

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CPAP/ PS

CPAP /Pressure Support

All breaths are patient initiated; this is a support mode

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💡 Good mode to consider in patient to trail for extubation readiness

usually used as NIV mode (not intubated) or weaning mode prior to extubation or for “sprints” to test extubation readiness

Patient must initiate all breathes or will hypoventilate

PS 10 if intubated minimum CPAP 4 ,higher if poor oxygenation or atelectasis

↑Oxygenation -↑PEEP,

↑Ventilation - ↑PS

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Volumes (TV, MV-might be too low if resp drive poor

ABG/VBG

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Mode

Description

Pro’s

Con’s

Initial settings example

Monitor

HFOV

High frequency Oscillatory Ventilation provides high rates 3-10 Hz (Hz = 60/min)

tidal volumes < anatomic dead space

mechanism of gas exchange unclear

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💡Consider patient with severe ARDS refractory to CV who does not need much airway clearance

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Excellent low tidal volume & lung recruitment strategy for ARDS

Poor airway clearance

MAP ≅ 4 above current MAP

Hertz range term infant 10 adult 5

Delta P ≅

10 > most recent c02 on most recent ABG

Oxygenation ↑MAP, Fi02

Ventilation – ↑delta P , release air around ETT cuff, or last ↓Hz

Lung expansion on CXR want ≅ 9 ribs –avoid overexpansion ,

ABG

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VDR

Volumetric Diffusive Ventilation

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💡 Consider Patient with refractory hypoxemia and hypercarbia who needs airway clearance

Lung recruitment + allows continuous airway clearance (like IPV)

Labor intensive – need experienced RT , risk pneumothorax

Pulsatile flow rate- set to current PIP

OCPAP –set to current PEEP

RR set to current CV settings

PULSE Freq- 500-600 (higher better lung protection But need lower if hypercarbic

Oxygenation by ↑OCPAP and PIP, Fi02

Ventilation ↑ pulsatile flow rate or ↓ Pulse frequency

Same as HFOV + increased risk pneumothorax due to regional hyperinflation

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APRV

Airway Pressure Release Ventilation

(a.k.a. Bi-Vent)

Inverse ratio ventilation (e.g. I time > E time) improves lung recruitment

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💡Consider for patient with atelectasis or patient with ARD NOT on NMB agents

An option for ARDS patients who are spontaneously breathing (e.g., not on NMB); or patients with severe atelectasis

More complex mode need assist of experienced RT to measure peak exp flow and set up vent correctly

Set P high 2-3 > current MAP on CV Plow =0

T high 2-5 ( 4-6 adults ) T low 0.2-0.8 set based on when peak expiratory flow 25-50%

Improve Oxygenation by ↑P high, Fio2 Ventilation by ↓ T high or ↑ P high

Same as HFOV

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TERM

DEFINITION

PIP = Peak Inspiratory Pressure

The maximum pressure delivered by ventilator (you set this in PC . It is variable in VC depending on compliance of airway and lung.

PEEP = Positive End Expiratory Pressure

Set by provider. It is the pressure maintained at end expiration in the lung.

Vt = Tidal Volume

The volume of gas delivered to the lungs during inspiration ( you set this in VC, variable in PC depending on lung & airway in compliance.

It =Inspiratory time

Time spent in inspiration (set by provider in PRVC & PC & VC. Determined by patient in PS /VS).

et = Expiratory time

Time spent in expiration ( set by provider in PRVC & PC.& VC . Determined by patient in PS/VS).

I:E Inspiratory expiratory ratio

The ratio between it and Et usually 1:2 but may need longer in patients with airway obstruction e.g., asthma.

RR= Resp rate

Set by provider to provide min RR in all modes (except PS/VS) . Patient can breathe above this on their own.

PS= Pressure support

The amount of pressure you set to help patient overcome resistance of ETT (often 10 (usual range 5-10 depending on patient ETT size) for spontaneous breaths above set RR.