Skip to main content

Assisted and Spontaneous Modes

  • Chapter
  • First Online:
  • 4679 Accesses

Abstract

In pressure support mode, flow curve informs about the patient effort and the patient-ventilator synchrony. Observation of flow and pressure curves at the onset of inspiration assesses the patient-ventilator synchrony to trigger the breath and help to optimize inspiratory trigger setting. Observation of the initial increase in flow informs about the setting of pressure rise time. Flow during insufflation informs about the patient’s effort and the adequacy of cycling setting. Observation of pressure and flow at the end of insufflation helps to optimize the expiratory trigger sensitivity. In volume assist control mode, pressure curve informs about the adequacy of inspiratory flow setting.

This is a preview of subscription content, log in via an institution.

Suggested Readings

  • Aslanian P, El Atrous S, et al. Effects of flow triggering on breathing effort during partial ventilatory support. Am J Respir Crit Care Med. 1998;157:135–43.

    Article  CAS  PubMed  Google Scholar 

  • Chiumello D, Pelosi P, et al. Effect of different inspiratory rise time and cycling off criteria during pressure support ventilation in patients recovering from acute lung injury. Crit Care Med. 2003;31:2604–10.

    Article  PubMed  Google Scholar 

  • Dhand R. Ventilator graphics and respiratory mechanics in the patient with obstructive lung disease. Respir Care. 2005;50:246–61.

    PubMed  Google Scholar 

  • Du HL, Yamada Y. Expiratory asynchrony. Respir Care Clin N Am. 2005;11:265–80.

    Article  PubMed  Google Scholar 

  • Fernandez R, Mendez M et al (1999) Effect of ventilator flow rate on respiratory timing in normal humans. Am J Respir Crit Care Med 159:710–9.

    Google Scholar 

  • Georgopoulos D, Prinianakis G, et al. Bedside waveforms interpretation as a tool to identify patient-ventilator asynchronies. Intensive Care Med. 2006;32:34–47.

    Article  PubMed  Google Scholar 

  • Grinnan DC, Truwit JD. Clinical review: respiratory mechanics in spontaneous and assisted ventilation. Crit Care. 2005;9:472–84.

    Article  PubMed  PubMed Central  Google Scholar 

  • Hess DR. Ventilator waveforms and the physiology of pressure support ventilation. Respir Care. 2005;50:166–86.

    PubMed  Google Scholar 

  • Hoff FC, Tucci MR, et al. Cycling-off modes during pressure support ventilation: effects on breathing pattern, patient effort, and comfort. J Crit Care. 2014;29:380–5.

    Article  PubMed  Google Scholar 

  • Kondili E, Prinianakis G, et al. Patient-ventilator interaction. Br J Anaesth. 2003;91:106–19.

    Article  CAS  PubMed  Google Scholar 

  • Mojoli F, Iotti GA, et al. Is the ventilator switching from inspiration to expiration at the right time? Look at waveforms! Intensive Care Med. 2016;42:914–5.

    Article  PubMed  Google Scholar 

  • Nilsestuen JO, Hargett KD. Using ventilator graphics to identify patient-ventilator asynchrony. Respir Care. 2005;50:202–34.

    PubMed  Google Scholar 

  • Parthasarathy S, Jubran A, et al. Cycling of inspiratory and expiratory muscle groups with the ventilator in airflow limitation. Am J Respir Crit Care Med. 1998;158:1471–8.

    Article  CAS  PubMed  Google Scholar 

  • Prinianakis G, Kondili E, et al. Effects of the flow waveform method of triggering and cycling on patient-ventilator interaction during pressure support. Intensive Care Med. 2003;29:1950–9.

    Article  PubMed  Google Scholar 

  • Prinianakis G, Plataki M, et al. Effects of relaxation of inspiratory muscles on ventilator pressure during pressure support. Intensive Care Med. 2008;34:70–4.

    Article  PubMed  Google Scholar 

  • Racca F, Squadrone V, et al. Patient-ventilator interaction during the triggering phase. Respir Care Clin N Am. 2005;11:225–45.

    Article  PubMed  Google Scholar 

  • Tassaux D, Gainnier M, et al. Impact of expiratory trigger setting on delayed cycling and inspiratory muscle workload. Am J Respir Crit Care Med. 2005;172:1283–9.

    Article  PubMed  Google Scholar 

  • Thille AW, Rodriguez P, et al. Patient-ventilator asynchrony during assisted mechanical ventilation. Intensive Care Med. 2006;32:1515–22.

    Article  PubMed  Google Scholar 

  • Thille AW, Cabello B, et al. Reduction of patient-ventilator asynchrony by reducing tidal volume during pressure-support ventilation. Intensive Care Med. 2008;34:1477–86.

    Article  PubMed  Google Scholar 

  • Tobin MJ, Jubran A, et al. Patient-ventilator interaction. Am J Respir Crit Care Med. 2001;163:1059–63.

    Article  CAS  PubMed  Google Scholar 

  • Tusman G, Suarez-Sipmann F, et al. Pulmonary blood flow generates cardiogenic oscillations. Respir Physiol Neurobiol. 2009;167:247–54.

    Article  PubMed  Google Scholar 

  • Yamada Y, Du HL. Analysis of the mechanisms of expiratory asynchrony in pressure support ventilation: a mathematical approach. J Appl Physiol. 2000;88:2143–50.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

4.1 Electronic Supplementary Material

PS (AVI 13838 kb)

Ineffective effort in PS (AVI 347930 kb)

Autotriggering in PS (AVI 235030 kb)

Double trigger in PS (AVI 255763 kb)

Expiratory trigger sensitivity (AVI 576042 kb)

Volume assist control (AVI 317975 kb)

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Arnal, JM. (2018). Assisted and Spontaneous Modes. In: Monitoring Mechanical Ventilation Using Ventilator Waveforms. Springer, Cham. https://doi.org/10.1007/978-3-319-58655-7_4

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-58655-7_4

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-58654-0

  • Online ISBN: 978-3-319-58655-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics