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https://rebelem.com/simplifying-mechanical-ventilation-part/

 
Volume Assist/Control
Advantage is that you will have more control over minute ventilation
Use this mode in severe obstructive disease patients (Asthma & COPD)

Disadvantages : inspiratory flow rate is a constant flow (uncomfortable)
improve patients comfort by increasing their inspiratory flow rate
Normal inspiratory flow rate can range between 60-90 L/minute
Remember to keep the PPlat <30 mm Hg to avoid barotrauma
知道 Volume 但不知道 Pressure
Compliance is simply the change in volume divided by the change in pressure (C=V/P)
Plateau Pressure : the pressure needed to overcome the elastic forces of the lung alveoli and chest wall

Peak Inspiratory Pressure (PIP) overcome resistive forces of the endotracheal tube and upper proximal airways
Normally the difference between your PIP and PPlat is usually <5 cmH20 (PIP always > PPlat).
 
 
Pressure Assist/Control
limit your pressure delivery therefore prevent barotrauma.
Patient comfort
Should pay close attention to the tidal volume being delivered to make sure that the volume is not too high or too low, especially in the setting of someone with changing lung compliance or bronchospasm.
ensure that your patient is getting an adequate tidal volume
 
 
SlMV + PS
when I wean the rate on the ventilator, I am actually weaning the assisted or controlled breaths only,
so that my patient should be getting the majority of their breaths as spontaneous, supported breaths.
When my rate is weaned to a minimum, and my patient is taking adequate supported breaths,
then they are likely ready to extubate.
 
Can lead to ventilator-patient dyssynchrony and patient agitation and discomfort.
Increase their pressure support breath to achieve at least ½ to ¾ of their assisted or controlled tidal volumes
 
 
Severe Metabolic Acidosis
DKA, Ingestion, renal failure
are trying to compensate by maintaining extremely high minute ventilations. 
 
為了 protect airway intubation, but set up with a “normal” minute ventilation,
(much too low to adequately compensate and may lead to a cardiac arrest)
 
 
 
 
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