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Diagnosis and Treatment of Inhalation Injury in Burn Patients
Published in Jacob Loke, Pathophysiology and Treatment of Inhalation Injuries, 2020
Khan Z. Shirani, Joseph A. Moylan, Basil A. Pruitt
Intermittent mandatory ventilation (IMV), first introduced as a weaning technique (Downs et al., 1973), is much preferred over the CMV mode for providing ventilatory support in the spontaneously breathing patient exhibiting respiratory insufficiency. Since IMV produces lower inflation pressures and permits a lesser number of CMV breaths per unit time, it interferes less with the normally negative intrapleural pressures and thus impedes venous return and cardiac output to a lesser degree (Downs et al., 1977; Kirby et al., 1975). In spontaneous breathing, ventilation and perfusion are closely matched and the dependent regions of the lung are preferentially perfused (West, 1974). Thus IMV, which allows spontaneous respiration, permits an optimal ventilationperfusion matching, reduces intrapulmonary shunt, and improves oxygenation.
Equipment
Published in Sarah Armstrong, Barry Clifton, Lionel Davis, Primary FRCA in a Box, 2019
Sarah Armstrong, Barry Clifton, Lionel Davis
IMV (intermittent mandatory ventilation) – the ventilator allows breaths from the patient and may synchronise them with the mandatory breaths. Spontaneous breaths can be augmented with pressure support (SIMV-PS)
Equipment and monitoring
Published in Brian J Pollard, Gareth Kitchen, Handbook of Clinical Anaesthesia, 2017
Baha Al-Shaikh, Sarah Hodge, Sanjay Agrawal, Michele Pennimpede, Sindy Lee, Janine MA Thomas, John Coombes
SIMV (Synchronised Intermittent Mandatory Ventilation). Similar to AC but ventilator provides a preset mechanical breath (the mandatory breath) every specified number of seconds (e.g. for 12 breaths per minute this is a 5-second cycle). Ventilation is synchronised to the first patient breath in the set cycle. Additional patient breaths after the first in the cycle are not supported, though PSV is commonly added to support these breaths (PSIMV).
Care of children with home mechanical ventilation in the healthcare continuum
Published in Hospital Practice, 2021
Benjamin Kalm, Khanh Lai, Natalie Darro
There is limited evidence to inform the in-hospital care of children with new tracheostomies who require long-term mechanical ventilation. HMV is usually initiated in the hospital in consultation with pulmonary and otolaryngology teams. Discussion on optimal home ventilator, modes, and settings is beyond the scope of this article and varies based on local clinicians’ experience, preference, and availability of various equipment brands for both home health companies and hospitals. Home ventilators work in various modes including pressure or volume-controlled modes. Monitoring of ventilator parameters includes assessment of peak inspiratory pressure, positive end expiratory pressure, exhaled tidal volumes, respiratory rate, minute ventilation and leak. Home ventilators are set to alarm if there are high or low respiratory rates, minute ventilation, or pressure, as well if there is a circuit disconnect. At our institution patients utilize Trilogy ventilators as their home ventilator (either Trilogy 100 or Trilogy EVO). While modes of ventilation at other institutions may vary, children with HMV at our institution are preferentially placed on pressure control-synchronized intermittent mandatory ventilation (PC-SIMV), primarily for a standardized and consistent approach across providers. Newer ventilator modes such as pressure regulated volume control (PRVC) are not supported by our home ventilators.
Advanced mechanical ventilation modes: design and computer simulations
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2021
Figures 13 and 14 show the simulation results for the partial and fully active patient cases, respectively. In these presented cases, the ventilator starts with the estimation process again and then operates as the optimal respiratory rate and tidal volume are satisfied. When the patient is active, the inspiration time is determined by the patient and the ventilator setting of ETS. It is possible to say that if the patient is partially active, ASV mode is similar to the synchronized intermittent mandatory ventilation (SIMV) mode and if the patient is fully active, ASV mode is similar to the pressure support ventilation (PSV) mode. However, the control/support pressures are regulated breath-by-breath in order to provide the target tidal volume. It can be concluded that the designed simulation environment is able to simulate the ASV mode with different cases successfully.
Acute respiratory distress syndrome following a biphasic anaphylactic reaction to morphine: a case report and review of the literature
Published in Southern African Journal of Anaesthesia and Analgesia, 2018
KU Tobi, G Kirenga, S Muhmuza, P Ruhato
On arrival in the ICU, he was put on a mechanical ventilator in pressure-regulated synchronised intermittent mandatory ventilation (PRCV/SIMV) mode. He was also commenced on adrenaline at 0.2 µg/kg/min. The chest radiograph showed bilateral infiltrates of the lung fields (Figure 1) and an arterial blood gas analysis obtained on arrival in the ICU revealed severe hypoxaemia with a partial pressure of arterial oxygen and fractional inspired concentration of oxygen ratio (PaO2/FiO2) of 90 mmHg (Figure 2). Thus an impression of severe acute respiratory distress syndrome following biphasic anaphylactic reaction to i.v. morphine was made.