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Ventilator-induced lung injury such as Acute lung injury (ALI) /Acute Respiratory Distress Syndrome (ARDS) can be caused by ventilation with very large tidal volumes in normal lungs, as well as ventilation with moderate or small volumes in previously injured lungs, and research shows that the incidence of ALI increases with higher tidal volume ...
The RSBI is defined as the ratio of respiratory frequency to tidal volume (f/VT). People on a ventilator who cannot tolerate independent breathing tend to breathe rapidly (high frequency) and shallowly (low tidal volume), and will therefore have a high RSBI. [1] The index was introduced in 1991 by Karl Yang and Martin J. Tobin.
Transtracheal jet ventilation refers to a type of high-frequency ventilation, low tidal volume ventilation provided via a laryngeal catheter by specialized ventilators that are usually only available in the operating room or intensive care unit. This procedure is occasionally employed in the operating room when a difficult airway is anticipated.
Tidal volume increases by 30–40%, from 0.5 to 0.7 litres, [9] and minute ventilation by 30–40% [9] [10] giving an increase in pulmonary ventilation. This is necessary to meet the increased oxygen requirement of the body, which reaches 50 ml/min, 20 ml of which goes to reproductive tissues.
The peak inspiratory pressure delivered by the ventilator is varied on a breath-to-breath basis to achieve a target tidal volume that is set by the clinician. For example, if a target tidal volume of 500 mL is set but the ventilator delivers 600 mL, the next breath will be delivered with a lower inspiratory pressure to achieve a lower tidal volume.
TLC: Total lung capacity: the volume in the lungs at maximal inflation, the sum of VC and RV. TV: Tidal volume: that volume of air moved into or out of the lungs in 1 breath (TV indicates a subdivision of the lung; when tidal volume is precisely measured, as in gas exchange calculation, the symbol TV or V T is used.)
The theory is to ensure that the lowest inspiratory pressure necessary to achieve the desired tidal volume is used. As a safety feature, the ventilator will not increase the pressure beyond a predetermined high pressure limit. This is usually tied to (but not the same as) the operator-set high pressure alarm setting.
The most commonly used high frequency ventilator and only one approved in the United States is the 3100A from Vyaire Medical. It works by using very small tidal volumes by setting amplitude and a high rate set in hertz. This type of ventilation is primarily used in neonates and pediatric patients who are failing conventional ventilation. [46]