Four Truths of Mechanical Ventilation and the Ten-Fold Path to Enlightenment

Robert L. Chatburn

Abstract

The Four Truths

1. The truth of confusion

2. The truth of the origin of confusion

3. The truth of the cessation of confusion

4. The truth of the path leading to the cessation of confusion

The 10-Fold Path

1. A breath is one cycle of positive flow (inspiration) and negative flow (expiration) defined in terms of the flow-time curve.

2. A breath is assisted if the ventilator does work on the patient.

3. A ventilator assists breathing using either pressure control or volume control based on the equation of motion for the respiratory system.

4. Breaths are classified by the criteria that trigger (start) and cycle (stop) inspiration

5. Trigger and cycle events can be initiated by the patient or the machine.

6. Breaths are classified as spontaneous or mandatory based on both the trigger and cycle events.

7. There are 3 breath sequences: Continuous mandatory ventilation (CMV), Intermittent Mandatory Ventilation (IMV), and Continuous Spontaneous Ventilation (CSV).

8. There are 5 basic ventilatory patterns: VC-CMV, VC-IMV, PC-CMV, PC-IMV, and PC-CSV:

9. Within each ventilatory pattern there are several variations that can be distinguished by their targeting scheme(s).

10. A mode of ventilation is classified according to its control variable, breath sequence, and targeting scheme(s).

Keywords

Breath. Trigger, Cycle, Breath sequences, Ventilatory patterns, Mode of ventilation

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