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Objectives

  1. Compare pressure-controlled (PCV) and volume-controlled ventilation (VCV).

  2. Distinguish between continuous mandatory ventilation (CMV), continuous spontaneous ventilation (CSV), and synchronized intermittent mandatory ventilation (SIMV).

  3. Compare continuous positive airway pressure (CPAP) and pressure support ventilation (PSV).

  4. Compare full and partial ventilatory support.

Introduction

The relationship between breath types and phase variables is the mode of ventilation. During mechanical ventilation, the mode is one of the principal ventilator settings. Although many modes are available, the choice of mode is usually based on the clinician’s preference or institutional bias, since evidence is lacking that one mode is clearly superior to others. This chapter describes traditional ventilator modes (Table 6-1), which include continuous mandatory ventilation (CMV), continuous spontaneous ventilation (CSV), and synchronized intermittent mandatory ventilation (SIMV).

Table 6-1Ventilator Modes

Volume-Controlled Versus Pressure-Controlled Ventilation

The two general approaches to ventilatory support are volume-controlled ventilation (VCV) and pressure-controlled ventilation (PCV). At any time, the ventilator controls either volume (flow) or pressure applied to the airway. Some volume-targeted modes such as adaptive pressure control (eg, pressure-regulated volume control, volume support) actually adjust the level of pressure control to achieve the set tidal volume. Although the term volume control is usually used, most modern ventilators control inspiratory flow. The important variables for VCV are shown in Figure 6-1. During PCV, the inspiratory flow decreases as the alveolar pressure approaches the pressure applied to the airway. The important variables affecting PCV are illustrated in Figure 6-2.

Figure 6-1

Important variables and their interaction during volume-controlled ventilation. (Adapted with permission from Chatburn RL. A new system for understanding mechanical ventilators. Respir Care. 1991;36(10):1123-1155.)

Figure 6-2

Important variables and their interaction during pressure-controlled ventilation. (Adapted with permission from Chatburn RL. A new system for understanding mechanical ventilators. Respir Care. 1991;36(10):1123-1155.)

Continuous Mandatory Ventilation

A minimal rate is set with CMV (Figure 6-3). The patient can trigger the ventilator at a more rapid rate, but every breath delivered is a mandatory breath type. Note that the mandatory breaths can be either volume-controlled or pressure-controlled. CMV is commonly called assist/control (A/C) ventilation—the terms CMV ...

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