Synchronized Intermittent Mandatory Simulation

Synchronized Intermittent Mandatory Ventilation (SIMV) mode: SIMV is considered a weaning mode, and the patient is placed on this mode when he or she shows evidence of improvement. In SIMV, the machine delivers a set rate, and the patient is allowed to breathe spontaneously. The patient has more freedom, which means that when he takes a breath, the machine allows him/her to take a breath of his/her own tidal volume. Even though the tidal volume is set in the control panel, it does not kick in the tidal volume because the ventilator senses an inspiratory effort by the patient. Conversely, if the machine does not sense an inspiratory effort by the patient, it will deliver the tidal volume set in the machine’s control panel. Therefore, you will

The purpose of using pressure early in inspiration and then throughout the inspiratory phase is to reduce patient effort and promote patient comfort. There is no set rate or tidal volume in PSV. Pressure support added to the ventilation enhances the patient’s respiratory effort. to help the patient during inspiration. Inspiration is cut off when the beginning gas flow reduces to 25% of the initial flow and pressure backs down to PEEP. Then the patient exhales passively. Increasingly, PSV is used in ICUs as the primary ventilation mode. PSV is thought to improve the endurance of respiratory muscles (Morton & Fontaine, 2013). This mode is not for patients who are sedated, or receiving neuromuscular blockade or having any pathological conditions that leads to unreliable breathing PSV is used as a weaning mode, or a recovery mode to boost the patients effort in maintaining a tidal volume. and tidal volume and RR should be monitored to detect any decreased compliance of the lungs. When compliance decreases (stiff lungs), the rate increases, and the tidal volume decreases. Always compare the patient’s data with the machine’s data. The pressure support needed is based on the patient’s condition. When the patient gets stronger the pressure support can be dialed down and vice versa. If the respiratory rate is going high and the tidal volume is coming down patient is becoming tired and in need of more pressure support. When the patient is demonstrating

HFOV aims at accomplishing ultra fast tidal volume that are less than patients anatomic dead space. A mechanical diaphragm oscillates between 3-15 times a second which creates a push and pull effect on the airway from the endotracheal tube to alveoli. HFOV is useful in severe hypoxic respiratory failure and inpatient with large bronchopulmonary fistula where a tidal volume is lost through the chest tube. The advantage of HFOV is that it can increase the mean airway pressure and oxygenation without high subjecting lung tissue to distending pressures and volume. In essence, HFOV can prevent barotrauma as well as volutrauma. Here the ventilation is regulated by number of oscillations (f)measured in Hertz or oscillation per second. The higher the frequency the lower the tidal volume that leads to a rise in PaCO2. Likewise, lowering the frequency will lower the PaCO2. Another important factor in HFOV is amplitude ; that refers to the pressure of the oscillating diaphragm 8-90cm H2O. When the amplitude is increased oscillation is increased resulting in improved gas mixing. Increasing the altitude will lower PaCO2 and decreasing the amplitude will increase PaCO2. Inspite of the promising therapy the HFOV can provide, there are many drawbacks: 1) need special ventilator, 2) can not switch from this mode to another 3)there are no alarms in this type of ventilator and therefore frequent assessment is needed, 4) mucous plugging is common,