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Table of modes of mechanical ventilation

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In medicine, mechanical ventilation is a method to mechanically assist or replace spontaneous breathing. Spontaneous breathing requires the rhythmic alteration of inhalation and exhalation to achieve its purpose: exchange of carbon dioxide with oxygen. In disease, the natural process of that rhythmic alteration may be replaced by an external device, a Ventilator, and the clinician has to control the following on the Ventilator to achieve gas exchange:

  • Composition of gas mixture delivered (Setting: fraction of inspired oxygen, FiO2)
  • Pressure at the end of exhalation (Setting: Positive End-Expiratory Pressure PEEP)
  • Control of Breathing Activity

FiO2 and PEEP settings are common to most Ventilators. Control of Breathing Activity methods, however, can be done in different ways and are called "Modes of Mechanical Ventilation".[1] The settings to control breathing follow the phases of breathing,[2] i.e., inhalation and exhalation:

  • Inhalation:
    • Trigger: Start of inhalation (Settings: time or patient Trigger)
    • Limit: Time and delivery of gas mixture (Settings: pressure or flow)
  • Exhalation:
    • Icycle: Cycling from inhalation to exhalation (Settings: time or pressure or volume or flow)
    • Pcycle: Time and control of exhalation (Settings: time)


CAVEAT: Although manufacturers may offer identical Control of Breathing Activity methods, the names of the ventilation mode may be different.

A breath by breath trigger, limit, cycling (TLC) classification of the common modes of ventilation. (V = ventilator; P = patient)[3]

Mode Trigger Limit Icycle Pcycle Servo
CMV (VCa, AC) V or P Flow Volume Time no
PCV or PCIRV V or P Pressure Time Time no
SIMV (volume cycled) V or P Flow Volume - no
SIMV (pressure limited) V or P Flow time - no
SIMV+PS (volume cycled) V or P Flow Volume - no
SIMV+PS (pressure limited) V or P Pressure Time - no
CPAP P Pressure Flow - no
CPAP+PS P Pressure Flow - no
BPAP 1 (CPAP+PS) P Pressure Flow - no
BPAP 2 (PCV) V or P Pressure Timed - no
BPAP 3 (CPAP) V Pressure Time - no
BPAP 4 (SIMV) V or P Pressure Time (IV) Flow (IP) - no
BPAP 5 (APRV) V or P Pressure Flow (IP) Time (IV) - no
APRV V or P Pressure Flow (IP) Time (IV) - no
IMPRV V or P Pressure Time - no
PRVC[3] V or P Pressure Time - Yes (VT)
Automode V or P Pressure Flow (IP) Time (IV) - Yes (VT)
Volume Support[3] P Pressure Flow - Yes (VT)
Minimum minute ventilation[3] P Pressure Flow - Yes (VE)
Mandatory rate ventilation[3] P Pressure Flow (IP) Time (IV) - Yes (Vf)
Proportional assist P Pressure/time Flow - Yes (Flow+VE)
Mandatory minute ventilation[3] V or P Flow Time - Yes (VE)

See also

References

  1. ^ Esteban A, Alía I, Ibañez J, Benito S, Tobin MJ (1994). "Modes of mechanical ventilation and weaning. A national survey of Spanish hospitals. The Spanish Lung Failure Collaborative Group". Chest. 106 (4): 1188–93. doi:10.1378/chest.106.4.1188. PMID 7924494.
  2. ^ Brunner, J.; Wolff, G.; Langenstein, H.; Cumming, G. (December 1985). "Reliable detection of inspiration and expiration by computer". International Journal of Clinical Monitoring and Computing. 1 (4): 221–226. doi:10.1007/BF01720186. ISSN 0167-9945.
  3. ^ a b c d e f Navalesi P, Costa R (2003). "New modes of mechanical ventilation: proportional assist ventilation, neurally adjusted ventilatory assist, and fractal ventilation". Curr Opin Crit Care. 9 (1): 51–8. doi:10.1097/00075198-200302000-00010. PMID 12548030.
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