About Ventilator Machine

A ventilator is a machine that provides mechanical ventilation by transferring breathable air in and out of the lungs, causing a patient unable to breathe or inadequately breathing. Modern ventilators are computerized microprocessor-controlled machines, but patients can also be ventilated with a simple, hand-operated bag valve mask. Ventilators are mainly used in intensive-care medicine, home care and emergency medicine (as standalone units) and anesthesiology (as components of an anesthesia machine).

How a ventilator works

According to Gating, "mechanical ventilation can be either invasive, through a tube in the airway, or non-invasively through a face mask or nose lining. It also differs from our own. But how to breathe. During natural breathing. The main respiratory muscle shrinks as the diaphragm, and the chest wall expands. It creates a negative pressure that draws air into the lungs. When the respiratory center breathes Left to rest, the air leaves the lungs inactive. Designed for a ventilator. Give the lungs a mechanical breath until a user reaches the chosen criterion, which, in time, The flow may occur depending on the volume or the patient's own neural respiratory activity. Once the lung is filled, inspiration stops, and expiration begins. The use of masks is usually preferred. Because it maintains the body's natural barrier to lung infections. However, in many cases, the patient's condition may increase. May be For example, when it needs to be sealed. Lung injury or disease. For patients with severe oxygen loss (eg ARDS), it is important to use a ventilation strategy that has the potential to improve patient outcomes and optimize the benefit-to-cost ratio for lung, heart, and respiratory muscles. . An example of such a strategy is the assessment of lung recruitment to select ventilator settings that reclaim the lost effective lung volume as well as the small cells in the lungs responsible for gas exchange, alveoli. Does not cause over-stretching. "Do you know other ventilator manufacturers that should be included in the list, let's know. Again, these are the list of global ventilator manufacturers with broad brand story, wide reach, top of mind and global after sales.

Top Ventilator Machine Brand 

1.Getinge(Sweden )
2.Hamilton Medical(USA, Switzerland )
3. Dräger(Germany)
5. Medtronic(Ireland, USA )
6.Löwenstein Medical(Germany)
7.Vyaire Medical(USA )
8.GE Healthcare(USA )
9. Philips Respironics (Netherlands)

TOP Model  of  Ventilator

  1. Philips Respironics V60 Ventilator 

  2. Siemens 300A Servo Ventilator  

  3. Drager Savina ICU Ventilator

  4.  Mindray SV300 Ventilator  

  5.  GE Healthcare  CARESCAPE R860 Ventilator

  6.  HAMILTON-T1 transport ventilator

  7.  Getinge Servo-s  ventilator

Mode of Ventilator

Volume mode

Aid-Control Ventilation (ACV)

Also known as continuous compulsory ventilation (CMV). Each breath is either an auxiliary or control breath, but they are all of the same volume. The larger the quantity, the more time is required. If the I: E ratio is less than 1: 2, progressive hypertrophy may occur. ACV is particularly undesirable for patients who breathe rapidly - they can induce both hyperinflation and respiratory alkali. Note that mechanical ventilation does not terminate the work of breathing, as the diaphragm may still be very active.

Synchronized Intermittent-Compulsory Ventilation (SIMV)

Guarantees a certain number of breaths, but unlike ACV, the patient's breath is partially their own, reducing the risk of hyperflans or alkalis. Essential breaths have to coincide with spontaneous respiration. Disadvantages of SIMVs are a tendency to increase breathing function and decrease cardiac output, which can prolong ventilator dependence. In addition to pressure support on top of smooth breaths, some breathing work can be reduced. SIMV has been shown to decrease cardiac output in patients with left-ventricular dysfunction 


Individual preference prevails, except in the following scenarios: 1. Patients who breathe rapidly on ACV should switch to SIMV. Patients with respiratory muscle weakness and / or left-ventricular dysfunction should be switched to ACV

Pressure mode

Pressure-controlled ventilation (PCV)

Lower risk of barotrauma than ACV and SIMV. Does not allow for patient-initiated breaths. The respiratory flow pattern decreases rapidly, reducing peak pressure and improving gas exchange [Chest 122: 2096, 2002]. The major disadvantage is that there is no guarantee for volume, especially when lung mechanics are changing. Thus, PCV has traditionally been preferred for patients with neuromuscular disease, but otherwise normal lungs

Pressure Support Ventilation (PSV)

Allows the patient to determine the amount of inflation and respiratory frequency (but not pressure, as it is pressure controlled), thus it can only be used to increase spontaneous breathing. In another cycle, pressure support may be used to overcome resistance to ventilator tubing (5 - 10 cm H20 is commonly used, especially during weaning), or to increase spontaneous breathing. . PSVs can be accessed via special face masks.

Pressure Inverse Ratio Ventilation (PCIRV) Controlled

Pressure controlled ventilatory mode in which most of the time is spent at high (inspection) pressure. Initial tests were promising, however, because of the short time, there was an increased risk of auto-PrEP and hemodynamic deterioration, and the increased airway pressure usually reduced the small capacity for improved oxygen.

Airway Pressure Release Ventilation (APRV)

Airway pressure release ventilation is similar to PCIRV - instead of being a variation of PCV in which the I: E ratio is inverted, APRV is a variant of CPAP that temporarily exits pressure when exhaling. This unique mode of ventilation results in a higher average airway pressure. Patients are able to ventilate spontaneously at both low and high pressures, although most (or all) ventilation usually occurs at high pressures. In the absence of breathlessness, APRV and PCIRV are similar. Like PCIRV, hemodynamic compromise is a concern in APRV. Additionally, APRV usually requires increased sedation.

Dual mode

Pressure Regulated Volume Control (PRVC)

A volume target backup is added to a pressure assisted-control mode

Interactive mode

Proportional Assistance Ventilation (PAV)

During PAV, the physician determines the percentage of breathing function provided by the ventilator. The PAV uses a positive feedback loop to accomplish this, requiring knowledge of resistance and elastance to properly engage the signal

Compliance and resistance must therefore be calculated periodically - this is accomplished using uninterrupted end-respiration and end-respiration maneuvers (which also calculate auto PEEP). In addition to percent support, the therapist sets the trigger and cycle (which actually ends the breath)

The theoretical benefit of PAV is increased compared to PAV, which provides the same support to the patient no matter how much effort).

Proportional Assistance Ventilation: Summary

  1.     Independent variable:% WOB; Trigger; wheel
  2.     How it works: Positive feedback loop (requires resistance and destruction)
  3.     Theoretical advantage (s): better synchronization

Naturally adjusted ventilatory assist (NAVA)

Addtional Modes, Strategies, Parameters

Inverse ratio ventilation

Inverse ratio ventilation (IRV) is a subset of PCVs in which inflation time is prolonged (IRV, 1: 1, 2: 1, or 3: 1 may be used. Normal I: E is 1: 3). It reduces airway pressure, but increases airway pressure. Oxidation may improve results but at the expense of compromised venous return and cardiac output, thus it is unclear whether this method of ventilation leads to better survival. The major sign of IRV is refractory hypoxemia or other forms of ventilation in patients with ARDS with refractory hypoxemia

Adaptive support ventilation

Calculates the respiration time constant to guarantee sufficient respiration time and thus reduces air entrapment
Tube compensation

Positive End Respiratory Pressure (PEEP)

Note: PEEP is not a ventilatory mode by itself

Does not allow atmospheric pressure to balance with the atmosphere. PrEP displaces the entire pressure wave, thus increasing intrathoracic pressure and increasing the effect on cardiac output. Low levels of PrEP can be very dangerous, even at 5 cm H20, especially in patients with hypovolemia or cardiac dysfunction. When measuring the effectiveness of PEEP, cardiac output should always be calculated because at high saturation, the change in Q will be more significant than SaO2 - never use SaO2 as the endpoint for PEEP. The effect of PEEP is not only due to PEEP but also to its effects on Pepeak and Pmean, both of which increase. The risk of barratroma is dependent on Ppeak, while the cardiac output response depends on Pmean. In fact, in a recent study of ARDS patients, it was shown that decreasing PEPE elicits 0 to 5, 10 and 15 cm H2O in COE

PEEP is clinically indicated for 1) low-volume ventilation cycles 2) FiO2 requirements> 0.60, especially for rigid, significantly injured lungs such as ARDS and 3) resistant lung disease. Do not use in pneumonia, which does not diffuse, and where PrEP will adversely affect healthy tissue and worsen oxidation. One way to measure the effect of PEEP is to look at peak inspection pressure (PIP) - if PIP increases less than paired PEEP, then PEEP improved lung compliance.



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