SOP Selection of ventilation mode Initial Ventilation Settings Pressure control? YES Maintain spontaneous breathing and diaphragmatic activity? Ensure CO2 washout by specifying target tidal volumes? YES NO NO NO YES Spontaneous breathing with pressure support? Spontaneous breathing with pressure support? Spontaneous breathing with pressure support? Spontaneous breathing with pressure support? YES YES NO VCV SIMV-VC P-SIMV YES NO PCV BiLevel with PSV settings NO BiLevel without PSV settings YES NO Dyn.-BiLevel with PSV settings Dyn.-BiLevel without PSV settings Description of ventilation modes VCV P-SIMV Volume controlled ventilation Pressure synchronized intermittent mandatory ventilation • Prevents high tidal volumes (volutrauma) • Prevents low tidal volumes (dead space ventilation) • Suitable for application of therapeutic hypocapnia • Prevents high ventilation pressures • Can be combined with pressure support • Risk of dead space ventilation and volutrauma • Greater need to respond to varying compliance • Not suitable for application of therapeutic hypocapnia • Spontaneous breathing at any time not possible • Prevents high ventilation pressures • No spontaneous breathing possible during inspiration • Requires deeper sedation than BiLevel / Dynamic BiLevel Dynamic BiLevel BiLevel • Prevents high ventilation pressures • Allows spontaneous breathing at any time • Requires less sedation than VCV • Can be combined with pressure support Additionally, in case of prolonged inspiration: • Improved oxygenation / recruiting function • Better alveolar ventilation • "selective alveolar" PEEP (with short expiration times) • Risk of dead space ventilation and volutrauma • Greater need to respond to varying compliance • Not suitable for application of therapeutic hypocapnia SALVIA medical GmbH & Co. KG Niederhöchstädter Str. 62 61476 Kronberg / GERMANY T +49 (0) 6173 9333-0 F +49 (0) 6173 9333-29 [email protected] www.salvia-medical.de • Prevents high tidal volumes (volutrauma) • Prevents low tidal volumes (dead space ventilation) • Suitable for application of therapeutic hypocapnia • Allows spontaneous breathing at any time • Prevents high ventilation pressures • Less need to respond to varying compliance • Can be combined with pressure support • Spontaneous breaths shown (comparable to P-SIMV) Additionally, in case of prolonged inspiration: • Improved oxygenation / recruiting function • Better alveolar ventilation • "selective alveolar" PEEP (with short expiration times) PCV Pressure controlled ventilation • Prevents high ventilation pressures Additionally, in case of APRV: • Improved oxygenation / recruiting function • Better alveolar ventilation • "selective alveolar" PEEP • Risk of dead space ventilation and volutrauma • Greater need to respond to varying compliance • Not suitable for application of therapeutic hypocapnia • Cannot be combined with pressure support • Spontaneous breathing at any time not possible Source: Kremeier, P.; Woll, C. (2014): SOP Klinische Beatmung, Karlsruhe
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