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Breathing-Book - 1

The Breathing-Book Spontaneous breathing during artificial ventilation Ernst Bahns Drager. Technology for Life

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Breathing-Book - 3

The Breathing-Book Spontaneous breathing during artificial ventilation Ernst Bahns

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Breathing-Book - 4

Publisher Dräger Medical GmbH Moislinger Allee 53–55 23558 Lübeck, Germany Important note Medical expertise is continually undergoing change due to research and clinical experience. The author of this book intends to ensure that the views, opinions and assumptions in this book, especially those concerning applications and effects, correspond to the current state of knowledge. But this does not relieve the reader from the duty to personally carry the responsibilities for clinical measures. All rights to this book, especially the rights to reproduce and copy, are reserved by...

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Breathing-Book - 5

Introduction 06 The significance of spontaneous breathing 88 Spontaneous breathing and artificial ventilation 08 Misinterpretation of spontaneous breathing as an interference factor 10 The development of spontaneous breathing as a treatment goal 12 The technical principal of respiratory gas dosage 14 Spontaneous breathing with conventional artificial ventilation 14 Side channel compressor with auxiliary circuitry 22 Control of respiratory gas delivery during mechanical ventilation 24 Spontaneous breathing in new ventilation modes 26 Spontaneous breathing during mechanical...

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Breathing-Book - 6

Introduction Modern ventilation systems offer various measures for the treatment of respiratory disorders. Today these devices do not only enable sufficient respiratory gas delivery for keeping up the gas exchange in the lung; thanks to advanced pneumatics, electronics and especially due to the implementation of computer technology, artificial ventilation may nowadays be specifically adapted to the respective gas exchange disorder. Artificial ventilation still remains to be a serious intervention for the patient. Specifically, the pressure conditions generated in the process differ...

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Breathing-Book - 7

The ventilation system must adapt to the patient and not vice versa. Disturbance of spontaneous breathing by artificial ventilation must be reduced to the absolute minimum. Spontaneous breathing must be promoted whenever possible. This applies not only to the period of weaning, but also to the complete process of artificial ventilation. We have known about ventilation procedures that allow spontaneous breathing at any time since the 1980’s . We introduced the first mode of this kind in our book „BIPAP/PCV+ - two steps forward in intensive ventilation“. Meanwhile, intensive ventilation has...

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Breathing-Book - 8

THE SIGNIFICANCE OF SPONTANEOUS BREATHING The significance of spontaneous breathing SPONTANEOUS BREATHING AND ARTIFICIAL VENTILATION Natural spontaneous breathing increases the inner thorax volume by contracting the respiratory muscles. This creates a negative pressure in the lungs resulting in air being drawn in. However, artificial ventilation employs a reverse principle. The ventilator creates a negative pressure and thus pushes the respiratory gas into the lungs. The gas transport is called lung ventilation during both spontaneous and artificial ventilation. The breathing apparatus...

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Breathing-Book - 9

Ventilator: pressure Respiratory muscles: Inspiration The single compartment model of the breathing apparatus. Two forces take effect during ventilation of the lung. The ventilator causes a positive pressure and the respiratory muscles cause a negative pressure. Both forces add up and cause a volume shift. The breathing-related changes of the pulmonary pressures indicate that lung ventilation during artificial ventilation differs considerably from spontaneous breathing. The question of whether it is inferior has been an object of long-standing debate ever since the first implementation of...

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Breathing-Book - 10

THE SIGNIFICANCE OF SPONTANEOUS BREATHING MISINTERPRETATION OF SPONTANEOUS BREATHING AS AN INTERFERENCE FACTOR An exceptional change in dealing with the patient‘s spontaneous breathing is currently taking place in the development of artificial ventilation. In the early years, keeping up the vital gas exchange function during abnormal breathing conditions stood at the center of attention. In those earlier days, mechanical ventilation was a measure in which the focus was on the lung. Potential negative effects to the lungs and other organs were accepted, if they were understood at all. The...

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Breathing-Book - 11

Ventilation with the Spiromat Suppression of spontaneous breathing is necessary for disturbance-free mechanical ventilation. A smooth transition to natural spontaneous breathing is impossible. An additional serious problem occurred, especially if chemical paralysis was applied as a routine measure: This routine sedation impeded the patient‘s preparation for the time after artificial ventilation and thus delayed weaning from mechanical ventilation (10). The patient‘s personal contribution in this pre-weaning phase in the form of spontaneous breathing is a mandatory requirement

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Breathing-Book - 12

THE SIGNIFICANCE OF SPONTANEOUS BREATHING THE DEVELOPMENT OF SPONTANEOUS BREATHING AS TREATMENT GOAL One of the first attempts to prepare the patient for the time after artificial ventilation was undertaken in the middle of the last century. The effort necessary for the patient to trigger the mechanical breaths was increased. The intention was to train the patient by continuously increasing the respiratory effort for triggering a breath (no s). The trigger threshold was increased for this purpose. The goal was to prepare the patient for spontaneous breathing. As soon as the patient was able...

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Breathing-Book - 13

Ventilation with the Evita 2 The ventilation curves in the background demonstrate the development of the mechanic procedures. Bottom: controlled ventilation without spontaneous breathing, top: mechanical ventilation with uninterrupted spontaneous breathing.

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Breathing-Book - 14

THE TECHNICAL PRINCIPAL OF RESPIRATORY GAS DELIVERY The technical principle of respiratory gas delivery SPONTANEOUS BREATHING WITH CONVENTIONAL ARTIFICIAL VENTILATION In the diagram, valve control during inspiratory pauses of conventional ventilation is simplified for a device without showing the additional function „base flow“. This function will be explained later. The first step is to describe a ventilation with parameters set by the operator and without the capability of adapting the ventilation pattern by the patient. This is controlled ventilation. The inspiratory valve opens during...

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