There are 4 different Ventilation modes available on the RTX.
Control Mode
This mode provides full control over the patient’s
respiration
1.
Mandatory respiratory rate is set and delivered;
patients do not fight against the mandatory breaths as the
RTX uses their own respiratory muscles to breath. This is a
unique function of the RTX as it mimics physiological
respiration.
2.
Controls both inspiratory and expiratory phases and
you have control over the I:E ratio
3.
Commence rate at 2 above their own current
spontaneous rate, then can slowly decrease the rate as
patients breathing controlled by RTX
4.
If PaCO2 increases alter I:E ratio to 1:1.2 - 1:1.5
5.
At frequency’s over 60 the inspiratory pressure and
the expiratory pressures should set at the same figures i.e.
-15 and +15
6.
At frequencies of 240-1200cpm you can only preset
frequency and inspiratory pressure parameters
7.
It is in this mode that you are able to oscillate the
patient from 1-20Hz with pressures up to +/- 50 cmH2O
There are 2 modes which are triggered by the patients’
respiratory effort. These modes can be used as pressure
support modes and an aid to weaning.
Respiratory triggered
1.
Provides triggered ventilation with the respiratory
cycle triggered by the patient’s actual respiratory
requirements
2.
The frequency is determined by either the patients
rate or the minimum frequency set by the physician
3.
The I:E ratio is determined and set by the physician
4.
The trigger can either be through the cuirass or
through the airway tube placed at or near the patients
airway e.g. by the patients nose or mouth. Cuirass trigger
will pick up more vigorous spontaneous breathing, whereas
airway mode can be triggered by smaller, shallower
respiratory effort.
5.
As the respiratory cycle is triggered by the
patient’s own respiration, this allows better adjustment to
the patient’s actual requirements. The respirator will wait
for a period for the trigger; this is dependent on the
trigger sensitivity set. If no trigger is detected during
this period then the respirator will begin another cycle. In
the event of apnea the RTX will deliver the set back up
rate.
6.
Trigger % should be 80-85% if higher you may need to
adjust sensitivity, this is to ensure false triggers are
prevented
7.
Minimum backup rate is 6 per minute i.e. 1 every 10
seconds
8.
Maximum backup rate is 60 per minute i.e.1 per second
Respiratory synchronized
1. This mode is fully synchronized with the patient’s
own respiration, automatically adjusting the arte and shape
of breathing in sympathy with the natural breathing
adjustments being made by the patient themselves.
2. The patients’ inspiratory effort creates an initial
trigger which is followed by a further trigger by the
initial effort of expiration. The trigger can be either
through the cuirass or airway.
3. Difference between this mode at respiratory triggered
is that on this mode the support is timed with patients own
respiratory pattern, so no I:E ratio is set by the physician
4. The I:E ration will be calculated and displayed
5. This mode will allow the patient to breathe both at
their own rate and determine their own shape.
6. In
the event of
apnea the RTX will deliver the set
back up rate delivering fully controlled ventilation at the
pressures set
ECG Triggered
1.
This mode takes into account the capability of the
RTX to improve both cardiac output and circulation by
including the capability of ECG trigger
2.
Frequency is determined by the patients’ heart rate,
and all other parameters are preset.
3.
Ventilation is synchronized to the patient’s cardiac
cycle, augmenting the effect on circulation and cardiac
output. If no cardiac activity is detected (e.g. there is a
bad contact with the ECG probes) the RTX will alarm and
operate at predetermined default settings for frequency set
by the physician.
4.
Inspiration activated on T wave and expiration on R
wave
5.
Clinician set inspiration pressure and this then
defaults the exp to the same
The cause of respiratory failure will determine the mode
chosen and the settings programmed.
Normal lung:
Neuromuscular conditions, ventilation during anesthesia, and
ventilation post cardiac surgery (especially in Children),
Head and Spinal Injuries
Inspiratory: -21
Expiratory: +7
I:E Ratio: 1:1
Frequency: * see below
* When using synchronized mode set a minimum backup
frequency at 10 less than the patient’s spontaneous
breathing rate (lowest is 6cpm).
* When using control mode begin by setting frequency at 2-4
breaths above patient’s own spontaneous breathing rate.
Sick lung:
Restrictive
Bronchiolitis** Cardiogenic Pulmonary Edema, Chronic
Obstructive Pulmonary Disease (COPD), Emphysema, CF
Inspiratory: -18
Expiratory: +6
I:E Ratio: 1:1
Frequency : 60 cpm in control mode (can be increased up to
120 to improve results where necessary), 40 cpm backup in
synchronized.
If necessary it is also possible to increase span and
pressures keeping a pressure ratio 3:1
e.g. change -21 +7 or -24 +8
Obstructive
Asthma, bronchiolitis**, PCP, TB Pneumonia
Inspiratory: -24
Expiratory: +8
I:E Ratio: 1:1 or 1:2
Frequency: at spontaneous respiratory rate of patient in
control mode, or respiratory rate of patient -10pcm as
backup in synchronised mode
Low Compliance/Low Lung Volume
Respiratory Distress Syndrome
Inspiratory: -30
Expiratory: +10
I:E Ratio: 2:1
Frequency: 40, 50, 60cpm up to 120cpm depending on patient
** The pathophysiology of bronchiolitis means that there are
both restrictive and restrictive phases during the disease
process.
Secretion Clearance
It should be used when there is atelectasis, excess
secretions or CO2 retention.
Divided into two parts
Vibration mode
This mode shakes and thins secretions
Insp/Expiratory: -8 +8
I:E Ratio: 1:1
Frequency: 800cpm *
Time 3-4minutes
* decrease the frequency for more tenacious secretions
Expiratory pressures in vibration mode are defaulted to the
same as inspiratory pressures. Higher pressures are
tolerated well e.g. +/- 15
Cough mode
This mode assists with expelling the secretions and can act
as a mini sustained inflation.
Inspiratory: -25
Expiratory: +15
I:E Ratio: 4:1
Frequency: 50
Time: 3minutes
The negative pressure can be made more negative as required.
Completion of both modes represents one cycle of secretion
clearance mode
Each secretion clearance session should last between 30-60
minutes
It is possible to use higher pressures in cough mode e.g.
-35 +25 as tolerated by the patient
It is helpful to introduce one or two cycles every few hours
for most infants with bronchiolitis. The number and
frequency of cycles can be adjusted according to the
severity of the infant’s condition. Occasionally some
infants cannot tolerate a full 3 minutes of cough when it is
first introduced, in which case the mode setting can be
changed earlier. They usually do get used to it fairly
quickly.
