7.19
Mechanische beademing II: Invasieve beademing
Beademingsapparaten zijn essentiële medische apparatuur die wordt gebruikt om patiënten met ademhalingsproblemen te helpen. Hun primaire functie is om…
Invasive ventilation uses a mechanical ventilator connected to an endotracheal tube or tracheostomy to support breathing.
One common type is positive-pressure ventilation, which inflates the lungs by applying positive pressure to the airway, causing air influx and alveolar expansion during inspiration. Expiration occurs passively.
Positive pressure ventilation is further classified as follows:
First is the volume-cycled ventilator. It delivers a preset air volume with each inspiration.
The ventilator cycles off after delivering this volume, allowing passive exhalation.
They provide consistent breaths but can cause barotrauma due to excessive pressure.
Next, a pressure-cycled ventilator delivers airflow until a preset pressure is reached, then cycles off for passive expiration.
Changes in airway resistance or lung compliance can affect air volume, leading to inconsistent tidal volumes and potentially compromised ventilation.
Lastly, high-frequency oscillatory support ventilators deliver exceptionally high respiratory rates while maintaining low tidal volumes and high airway pressures.
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Q1: How does positive-pressure ventilation inflate the lungs?
Positive-pressure ventilation applies positive pressure directly to the airway, forcing air into the lungs and causing alveolar expansion during inspiration. After the preset volume or pressure is delivered, expiration occurs passively. This method requires an artificial invasive airway such as an endotracheal tube or tracheostomy to function effectively.
Q2: What is the difference between volume-cycled and pressure-cycled ventilators?
Volume-cycled ventilators deliver a preset air volume with each breath, ensuring consistent tidal volumes but risking barotrauma from excessive pressure. Pressure-cycled ventilators deliver airflow until a preset pressure is reached, but air volume varies with changes in airway resistance or lung compliance, potentially causing inconsistent ventilation and compromised breathing support.
Q3: When are high-frequency oscillatory ventilators used?
High-frequency oscillatory ventilators deliver exceptionally high respiratory rates while maintaining low tidal volumes and high airway pressures. They are used to open collapsed alveoli in conditions like atelectasis and acute respiratory distress syndrome, and are believed to protect lungs from pressure-related injury during mechanical support.
Q4: What are the main advantages and disadvantages of volume-cycled ventilators?
Volume-cycled ventilators provide consistent, predictable breaths with preset air volumes, making them reliable for maintaining adequate ventilation. However, they may cause barotrauma because excessive pressure is sometimes needed to deliver the programmed volume, potentially damaging lung tissue and causing complications.
Q5: How do pressure-cycled ventilators respond to changes in patient lung compliance?
Pressure-cycled ventilators cycle off when a preset pressure is reached, regardless of how much air has entered the lungs. If airway resistance increases or lung compliance decreases, less air enters before the pressure limit is reached, resulting in lower tidal volumes and potentially inadequate ventilation for the patient.
Q6: What airway access is required for invasive mechanical ventilation?
Invasive mechanical ventilation requires an artificial airway, typically an endotracheal tube placed through the mouth or nose, or a tracheostomy created surgically in the trachea. These invasive airways allow direct connection of the mechanical ventilator to deliver positive pressure ventilation and support breathing in critically ill patients.
Q7: How does passive exhalation work during mechanical ventilation?
During passive exhalation, the ventilator cycles off after delivering air, allowing the elastic recoil of the lungs and chest wall to naturally expel air without active machine assistance. This passive process occurs in all positive-pressure ventilation modes and relies on the patient's natural lung elasticity to complete the breathing cycle.