Present


Resuscitation devices

Current guidelines recommend the use of a T-resuscitator to achieve stable airway pressure (PEEP) with the aim of restoring FRC.  

Resuscitation devices

Current guidelines recommend the use of a T-resuscitator to achieve stable airway pressure (PEEP) to restore FRC. 

For safe operation

• It is necessary to check the settings of the entire assembly:
  • Connect air and oxygen, adjust the flow rate
  • Check PIP and PEEP pressure settings
  • If a thermal humidifier is available, add water and turn on the heating in time 
    • It takes about 15 minutes to achieve optimal parameters

CPAP 

Ventilators to ensure NIV(S) 

• N - nasal
• C - continuous
• P - positive
• A - airway
• P - pressure

Ventilators to ensure NIV

• Division according to the nature of generation of overpressure in the system

Overpressure is generated by the flow of the gas mixture. 

BiPAP

• Multi-level pressure support
• Secured by increasing the flow rate

• Multi-level pressure support
• Secured by increasing the flow rate
• Goal: increasing FRC

Conclusion

• CPAP = positive pressure ventilatory support
• The pressure in the airways is generated by the flow of the gas mixture
• Constant/variable flow
• One/two level pressure support 

Lung ventilators

Ventilator for artificial lung ventilation


Ensuring ventilation of the patient

• Fully patient-substitution modes
• Breath, patient activity toleration modes
• Non-invasive ventilatio

  

Humidifier


Thermal humidifier
Nebulizers
Ultrasound

Adjustable ventilation parameters

• FiO2
• PEEP
• PIP
• VT
• RR (Ti/TE)
• Flow insp.  

Capnometer 

• Measurement of CO2 concentration in the breathing mixture
• etCO2 evaluates the maximum concentration of CO2  in breathing cycle
• Measurement principle: measurement of gas permeability by IR light
• Values – normal 36-46 mmHg
• etCO2 is not the same as PaCO2

CO2 monitoring in clinical practice


Non-invasive CO2 monitoring

etCO2 vs. paCO2

•  is a sovereign method of verifying the position of the ETC and the effectiveness of the ventilation
•  normal value is 4.5–6% or 35–45 mmHg

Mainstream method 

• Intubated  patient
• Instant  etCO2 values
• Dead space of the measuring cuvette
• With knowledge of  VT and measurement of etCO2 it is possible to calculate VetCO2

  

  
  
  

Sidestream/microstream method

• Intubated patient
• Suction with a tube approx. 120 mL/min, or 50 mL/min 
• Small armature dead volume
• Delay
• Condensation in the sampling circuit
• Prone to obstruction
  
  

  

Sidestream/microstream method

• Monitoring of a  spontaneously breathing patient
• Suction with a tube approx.50 mL/min 
• Small armature dead volume
• Possible  in  low-flow O2 therapy
• Delay
• Condensation in the sampling circuit
• Prone to obstruction
  

  

Colorimetric capnometry

• Sensitive method
• Limited time of use
• “Value” only
• Single use – e.g. resuscitation

  

Anaesthetic machine

• Anaesthetic machine (AM) is a therapeutic device that serves to ensure ventilation of the patient during surgery and, if necessary, also enables the administration of inhalational (volatile) anaesthetics to the patient.
• For its proper function, the anaesthetic machine requires a connection to the anaesthetic circuit, which is connected to the tool for securing the patient's airways (orotracheal cannula or other supraglottic tool) using a so-called Y-connector.This arrangement represents a so-called closed system in which a gas mixture with oxygen and possibly anaesthetics circulates.

• The movement of the gas mixture is generally ensured by an electrically or pneumatically driven bag (ventilator), or also by a manual bag (applied, for example, at the beginning and the end of the procedure). The movement of the gas mixture ensures ventilation of the patient.
• Oxygen, medical air and nitrous oxide (laughing gas) are fed into the circuit via flowmeters (so-called rotameters) – the total minute consumption of these gases is usually set according to the type and technical capabilities of the device, typically between 6 L/min and 0.5 L/min (when reducing power consumption is economically advantageous, but places higher demands on the technical results of the device). Oxygenation of the patient is affected by the dosing of oxygen into the ventilation circuit.

• If a volatile anaesthetic is used, then this is released into the circuit from the vaporizer (the percentage of the resulting mixture is usually set by the anaesthetist using a rotary scale).
• In the closed system described above, an absorber of exhaled CO2 (a product of the patient's metabolism) is included, which is in the form of a canister with soda lime granules.
• Monitoring of AM operation is also an essential part of the anaesthetic machine. Monitoring can be integrated into the AM or handled by an external device. 
• The most important monitored parameters include the fraction of oxygen in the circuit, the maximum overpressure in the airways and also the level of carbon dioxide (a high level indicates either some life-threatening conditions in the patient or the exhaustion of soda lime, a low level not only indicates a possible circulatory arrest, but also for example disconnection of the circuit). Part of the monitoring system is the so-called alarm management, where pre-defined limit values are signaled optically and acoustically. General alarm conditions include low values of medical gas inlet pressures, disconnection of the ventilation circuit, occlusion of the ventilation circuit, high or low pressure in the ventilation circuit, etc. The range of monitored parameters depends on the specific type of device or the specifically used assembly.
• AM user settings are performed by the anaesthetist both in the area of ventilation mode (type, number of breaths, used tidal volume), and in the area of gas inflow (adjustment of flowmeters and rotameters of individual gases) and dosing of volatile anaesthetics (using a vaporizer) into the ventilation circuit.
• The basic risks of AM arise both from the incorrect setting of the ventilation mode (not turning on the ventilator, small or large tidal volume, etc.), incorrect dosage of the mixture (small amount of oxygen in the mixture, large amount of volatile anaesthetic), but also from the possibility of disconnecting the tubes of the ventilation circuit, Y-couplings or points of connection of devices for securing the airways. Dislocation of the airway device itself is also an associated risk.
• To ensure the adequate safety of the patient during the anaesthesia procedure, the manufacturers of anaesthetic systems point out the need for adequate monitoring of vital functions. The user of the medical device is responsible for choosing the appropriate monitoring.