Forum Crew Member
This more pertains to critical care paramedicine, but I was wondering: how do you remember what each vent mode (A/C PRVC SIMV etc) does when ventilating a patient? Any tricks (or charts) to remembering what each one does?
There are apps that I carry, and peruse from time to time on my phone (basics of mechanical ventilation is the one I review the most from time to time, and it has the modes you've listed in your post). Just know with ventilator management there is no one-size fits all approach.This more pertains to critical care paramedicine, but I was wondering: how do you remember what each vent mode (A/C PRVC SIMV etc) does when ventilating a patient? Any tricks (or charts) to remembering what each one does?
I think it's a fail safe option for providers lacking the dual encompassing PRVC mode, however, I think you're right in that it should not be used on every patient given the likelihood of damage that one can inflict with the incorrect mode of an acutely ill patient that may require more ventilator dependency; he's a big proponent of patient comfort, and what I would presume to be less ventilator dependency in an effort to encourage weaning sooner rather than later, which I don't necessarily disagree with, but each mode is certainly circumstantial to the patient at hand.That said, I don't agree with his SIMV only strategy for all patients.
(e.g., never not transport your vented patients without a BVM/ mask at the ready, and easily accessible to you),
I like threading the oxygen tubing through the mask itself and setting it on their lap, and/ or next to my person in flight; it serves as a good visual reminder for me. We do have the BVM behind the paramedic seat, but it can be a PITA for me to reach, so I try and leave the BVM where myself, or partner(s) can grab it in a pinch.I learned the importance of this the other week. I had a BVM, I keep a mini airway bag stocked on the stretcher all the time anyway. However, we ended up needing to pull out the BVM for quite a while. Definitely an important reminder for me. Otherwise, I am going back to lurking, because I am interested in seeing what pops up here.
In what respect does pressure control allow you to give more volume for a given pressure or make it easier to overbreathe?
Compared to VCV, the decelerating flow pattern in PCV allows for the earlier dissipation of flow resistance which results in lower peak pressures for the same volume. This has all kinds of consequences, not the least of which is lower intrathoracic pressure, better venous return, and less intrapulmonary shunting.
As to the second point, it depends on your ventilator, but when the machine sees the set pressure on bucking, it stops cycling a breath, whereas in VCV (not SIMV) it will continue to attempt to give the set volume until it does. I realize that some ventilators are more sophisticated than others and the ones I use are more forgiving of a breathing/bucking patient. Your results may vary.