Al-Balqa Applied University

“ventilator”

Edit by :
1-Mohmmad Saad Yousef Bsileh
2-Mahmoud Ali Hasan Qunees

Mechanical ventilator
Actually is According to the definition offered by Chatburn, a
mechanical ventilator is an automated machine in which

“...energy is transmitted or transformed (by the ventilator’s drive

mechanism) in a predetermined manner (by the control circuit) to
augment or replace the patient’s muscles in performing the work of
breathing.”

This definition must be qualified by mentioning that the mechanical

ventilator should be automated. The self-inflating bag-valve-mask
resuscitator is a ventilator by the above definition, as the user’s muscle
energy acts as a drive mechanism and is used to augment or replace the
patient’s muscles. However, it would be plainly mad to consider that a
mode of mechanical ventilation. Thus, a mechanical ventilator needs to
be a device which you can set and walk away from, knowing that it will
continue to safely perform its role.

Ventilator can do Four key Things :

1. Help get oxygen into the lungs and body
2. Help expel carbon dioxide
3. Help Ease the work of Breathing for people who are having
trouble
4. “BREATHE” for people cant do it themselves.
-A short summary of the currency method, after which we will separate
each part ) A tube is placed in a critically ill patient's windpipe, which is
called intubation. Tubes attach that tube to the ventilator. The
ventilator puches air and oxygen into a person's lungs, Allowing carbon
dioxide to leave. The ventilator Controls mandatory breath rate,
amount of flow and pressure of air and oxygen moving into the lungs.
Micro sensors constantly detect and determine breathing, breath rate
and when the carbon dioxide sensor is attached, it detects dioxide
levels. The ventilator is able to sense and adjust to a patient's effort to
breathe. Software analyzes data and sounds alarms if adjustment are
required
Work principle
-A ventilator uses pressure to blow air into the lungs. This pressure is
known as positive pressure. A patient usually exhales the air on their
own, but sometimes the ventilator does it for them too.
The amount of oxygen the patient receives can be controlled through a
monitor connected to the ventilator. If the patient’s condition is
particularly fragile, the monitor will be set up to send an alarm to the
caregiver, indicating an increase in air pressure.
The machine works by bringing oxygen to the lungs and taking carbon
dioxide out of the lungs. This allows a patient who has trouble
breathing to receive the proper amount of oxygen. It also helps the
patient’s body to heal, since it eliminates the extra energy of labored
breathing.

A ventilator blows air into the airway through a breathing tube. One
end of the tube is inserted into patient’s windpipe and the other end is
attached to the ventilator. The breathing tube serves as an airway by
letting air and oxygen from the ventilator flows into the lungs.
Depending on the patient’s medical condition, they may be able to use
a respiratory mask instead of the breathing tubes.

Input
Mechanical ventilators are typically powered by electricity or
compressed gas. Electricity, either from wall outlets (e.g., 100 to 240
volts AC, at 50/60 Hz) or from batteries (e.g., 10 to 30 volts DC), is used
to run compressors of various types. Batteries are commonly used as
the primary power source in the home-care environment but are
usually reserved for patient transport or emergency use in hospitals.
These sources provide compressed air for motive power as well as air
for breathing. Alternatively, the power to expand the lungs is supplied
by compressed gas from tanks, or from wall outlets in the hospital (e.g.,
30 to 80 pounds per square inch [psi]). Some transport and emergency
ventilators use compressed gas to power both lung inflation and the
control circuitry. For these ventilators, knowledge of gas consumption
is critical when using cylinders of compressed gas.

The ventilator is generally connected to separate sources of

compressed air and compressed oxygen. This permits the delivery of a
range of oxygen concentrations to support the needs of sick patients.
Because compressed gas has all moisture removed, the gas delivered to
the patient must be warmed and humidified so as to avoid drying out
the lung tissue.

Conversion and Control

The input power of a ventilator must be converted to a predefined
output of pressure and flow. If the only power input is electrical, the
ventilator must use a compressor or blower to generate the required
pressure and flow. A compressor is a machine for moving a relatively
low flow of gas to a storage container at a higher level of pressure (e.g.,
20 psi). A blower is a machine for generating relatively larger flows of
gas as the direct ventilator output with a relatively moderate increase
of pressure (e.g., 2 psi). Compressors are generally found on intensive
care ventilators whereas blowers are used on home-care and transport
ventilators. Compressors are typically larger and consume more
electrical power than blowers, hence the use of the latter on small,
portable devices.
Flow-Control Valves
To control the flow of gas from a compressor, ventilator engineers use
a variety of flow-control valves, from very simple to very complex. The
simplest valve is just a fixed orifice flow resistor that permits setting a
constant flow to the external tubing that conducts the gas to the
patient, called the patient circuit. Such devices are used in small
transport ventilators and automatic resuscitators. Manually adjusted
variable-orifice flow meters have been used in simple infant ventilators
in the past (e.g., Bourns BP-200) . Such valves in photo are used in most
of the current generation of intensive care ventilators.

Directing flow from the source gas into the patient requires the
coordination of the output flow-control valve and an expiratory valve or
“exhalation manifold” . In the simplest case, when inspiration is
triggered on, the output control valve opens, the expiratory valve
closes, and the only path left for gas is into the patient. When
inspiration is cycled off, the output valve closes and the exhalation
valve opens, flow from the ventilator ceases and the patient exhales
out through the expiratory valve . The most sophisticated ventilators
employ a complex interaction between the output flow-control valve
and the exhalation valve, such that a wide variety of pressure, volume,
and flow waveforms may be generated to synchronize the ventilator
output with patient effort as much as possible.
Controlled system
The ventilator can be scheduled to “breathe” for the patient a set
number of times each minute, or it can be set so the patient can trigger
the machine to deliver air. If the patient fails to trigger the machine
after a set period of time, the ventilator will automatically blow air into
the breathing tube.
Output
Output waveforms are conveniently graphed in groups of three. The
horizontal axis of all three graphs is the same and has the units of time.
The vertical axes are in units of pressure, volume, and flow. For the
purpose of identifying characteristic waveform shapes, the specific
baseline values are irrelevant. What is important is the relative
magnitudes of each of the variables and how the value of one affects or
is affected by the value of the others.

photo illustrates the typical waveforms available on modern

ventilators. These waveforms are idealized; that is, they are precisely
defined by mathematical equations and are meant to characterize the
operation of the ventilator’s control system. As such, they do not show
the minor deviations, or “noise,” often seen in waveforms recorded
during actual ventilator use. This noise can be caused by a variety of
extraneous factors such as vibration and flow turbulence. Of course,
scaling of the horizontal and vertical axes can affect the appearance of
actual waveforms considerably

Components are usually seen in a modern mechanical ventilator:

a)Sources of power:
Gas supply
Power supply
Pressure generator
b) Control of gas delivery:
Gas blender
Gas accumulator
Inspiratory flow regulator
Humidification equipment
Patient circuit
Expiratory pressure regulator (i.e PEEP valve)
Monitoring

c) Sensors
Gas concentration
Flow
Pressure
Volume
Safety features

d) Filters
Gas intake particle filters
Pre-circuit bacteria filters
Moisture traps and heat/moisture exchange systems
Expired gas filter

Basic ventilator components

If one were to behold a ventilator with a critical eye, one would find
that it is really composed only of four main parts:
Power source
Controls
Monitors
Safety features
1) The power source consists of something to supply the gas which
will be delivered to the patient, as well as the energy required to run
the ventilator components. Thus, this category encompasses the gas
supply system, the batteries and power source for the mechanical
ventilator.

2) The controls are some means of regulating the timing and

characteristics of the delivered gas. These components consist of an
entire array of parts, each of which probably merits an entire chapter of
their own:

A gas blender is required to control the mixture of air, oxygen,

anaesthetic gas or whatever else you might be using the ventilate your
patient. One may not need any such gas blender if one is discussing
some sort of stripped-down domiciliary model which runs on room air
alone, and which does not accept an exogenous oxygen source.
A gas accumulator might be a component of a ventilator which requires
a precise control of gas mixtures and which cannot rely on
proportioning valves to produce this level of precision, eg. where the
gas flows are very low. An example of this is the accordion like
“bellows” of an anaesthetic machine; it is used to maintain a reservoir
of a stable gas mixture.
Inspiratory flow regulator – basically, any device which ensures that the
respiratory circuit receives the prescribed gas flow. This is usually a
solenoid valve. This thing sits in front of the gas supply (either from the
wall or from the compressor turbine) and ensures that the patient is
only exposed to carefully measured amounts of that gas. Given that the
wall gas in ICU piping outlets is supplied at a standard pressure of
400kPa (approximately 4 atmospheres), it is obviously an essential
component.
Humidification equipment is a requirement in most settings. This can
take the shape of an active humidifier (i.e. a device which heats and
evaporates water into the supplied gas mixture) or a passive humidifier
like a heat/moisture exchanger. Generally, domiciliary CPAP machines
which supply room air via some sort of face mask can rely on the
patient’s own upper airway for humidification.
The circuit, that wobbly mess of corrugated tubing, is often forgotten in
discussions of ventilator equipment, but it plays an important role (try
to ventilate the patient without one). Its characteristics, for example its
compliance and resistance to air flow, are important features.
Expiratory pressure regulator (i.e PEEP valve) is a means of maintaining
and controlling positive airway pressure. These are basically carefully
controlled expiratory flow obstructions, usually in the form of a
solenoid valve (though crude mechanical models also exist for old-
school ventilators).
3) The monitors are means of sensing and presenting the
characteristics of gas delivery so that one might be able to assess the
ventilator’s performance (and probably also the patient’s condition).
Gas concentration is usually measured by either voltaic cells or
spectrophotometers. For example, the oxygen supply sensor is usually
an oxygen cell, which produces an output voltage proportional to the
partial pressure of oxygen in the inspiratory gas pipe.
Flow is pretty much the main thing the ventilator supplies, so it makes
sense to want to monitor it in some way. All commercially available
mechanical ventilators have some method of monitoring flow. These
methods include:
Hot wire anemometry, where the effect of gas flow on cooling a heated
platinum wire is detected as a change in the wires' resistance
Variable orifice flow meters, where a pressure drop across a narrow
pipe is used to calculate flow
Screen pneumotachography, where a pressure drop across a mesh
screen is used to calculate flow
Ultrasonic flow meters, where two transducers are used to analyses
changes in ultrasound wave transit time caused by the velocity of the
intervening medium.
Pressure in the circuit had historically been accomplished by means of
aneroid manometers, i.e. pressure sensors that measure air pressure by
the action of the air in deforming the elastic lid of an evacuated box. In
modern ventilators, these have been superseded by integrated silicon
wafer pressure transducers, at a fraction of the cost and with greatly
improved accuracy.
Volume is not measured directly in modern ventilators it is calculated
from flow measurements. In older ventilator designs (eg. the bellows
and the piston models) a directly measure volume was the main
variable over which the intensives had any control.
4)The safety features are some devices and measures which ensure
that the patient does not come to any additional harm from being
ventilated (beyond the already brutal effects which are integral to the
process). These consist of filters and alarms.

Inspiratory filters of the ventilator promote purity of inspired gas (eg.

by removing airborne particles and bacteria from the inspired gas
mixture).
Expiratory filters protect the ICU staff. Expired gas is filtered to prevent
the ventilator from constantly belching out great clouds of aerosolised
pathogens generated in the horrific toilet-like bog water of the
patient’s airways.
Expiratory filters are also usually needed to protect the ventilator
components from the necessarily hot and humid expired gases, which
would degrade the quality of sensor measurements and decrease the
lifespan of the device
Alarms are usually integrated into the software as safeguards against
unintentional changes to the ventilator settings and weird
misapplications of ventilation. Broadly, these are systems to let you
know that the patient condition or ventilator performance has
trespassed the parameters which (you decided) are safe. Non software
alarm-like features are also integrated into ventilators, for example
mechanical blow-off valves to release excess pressure when the patient
coughs.
Classification of ventilator system designs
The more mature taxonomy offered by Chatburn is used here to classify
ventilators according to the mechanisms and principles of their
function. It omits such anachronisms as the inevitable discussion of
positive and negative pressure ventilators (of course these days they
are all positive pressure devices). The model is extensive, as it covers
not only engineering aspects of mechanical ventilator design but also
such detail as flow waveform shape and different possible alarm
settings. It is reproduced here with minimal modification:

1) Input
Pneumatic
Electric
AC
DC (battery)
2) Power conversion and transmission
External compressor
Internal compressor
Output control valves
Control scheme
Control circuit
Mechanical
Pneumatic Fluidic
Electric
Electronic
Control variables
Pressure
Volume
Time
Phase variables
Trigger
Target
Cycle
Baseline
Modes of ventilation
Control variable
Breath sequence
Targeting schemes

3) Output
Pressure waveforms
Rectangular
Exponential
Sinusoidal
Oscillating
Volume waveforms
Ascending ramp
Sinusoidal
Flow waveforms
Rectangular
Ascending ramp
Descending ramp
Sinusoidal

4) Alarm
Input power alarms
Loss of electric power
Loss of pneumatic power
Control circuit alarms
General systems failure
Incompatible ventilator settings
Warnings (e.g., inverse inspiratory-to-expiratory timing ratio)
Output alarms (high/low conditions)
Pressure
Volume
Flow
Time
Frequency
Inspiratory time
Expiratory time
Inspired gas
Temperature
FIO2

Type ventilator
1) Negative Pressure

Negative pressure ventilators function by alternatively applying

subatmospheric (negative) and atmospheric (zero) pressures around
the thorax and the abdomen. The result is negative intrathoracic
pressure that simulates spontaneous inspiration with airflow into the
airway and lungs. Three categories of negative pressure ventilators are
available.19 With the typical iron lung, the entire body, except the
head, is exposed to negative pressure. The chest cuirass (a rigid shell)
and wrap-type system (nylon poncho surrounding a semicylindrical
tentlike support) are simply enclosures that allow application of
negative pressure to the thorax. Because the efficacy in generating tidal
volume is related to the degree of body surface area that is exposed to
negative pressure, it is greater with the iron lung type than with cuirass
or poncho type of negative pressure ventilators.

Negative pressure ventilation was successfully and predominantly used

for long-term mechanical ventilation until the mid-1980s,3,20,21 but
then interest waned, partly because NPPV is more efficacious in
patients with altered pulmonary or chest wall mechanics and in those
who have comorbid obstructive sleep apnea–hypopnea. In addition,
negative pressure ventilation may precipitate upper airway obstruction
(i.e., obstructive sleep apnea–hypopnea).22 Furthermore, from a
patient-use perspective, negative pressure modalities are cumbersome
and relatively impractical.

2) Positive pressure

*The design of the modern positive pressure ventilators were based

mainly on technical developments by the military during world war I I
to supply oxygen to fighter pilots in high altitude

*such ventilator replaced the iron lungs as safe endotracheal tubes with
high –volume/flow-pressure cuffs were developed. The popularity of
positive pressure ventilators rose during the palio epidemic in the 1950.

*positive pressure through a tracheostomy tube led to a reduce

mortality rate among patients with polio and respiratory paralysis.
*Some defects and problems appear in the rapid
manufacturing ventilator
1. How much oxygen is consumed by Rapidly Manufactured Ventilator
System. Preference is given to designs consuming the least oxygen,
but a mixture of designs is needed, and some designs fundamentally
limit the minimum oxygen flow.
a. Absolute minimum oxygen requirement is the human consumption
of about 250 mi/min in a healthy person but up to 500 ml/min in severe
sepsis. However, achieving this is only possible if certain breathing
system designs are used and ‘driving’ gas is air. Specifically, would have
to use circle breathing system with active CO2
absorption. Is sufficient soda lime available?
b. If consumption in the range 1-6 /min is acceptable then a wider
range of designs is possible, but some very basic designs are not.
c. If consumption in the range 10l/min is acceptable then any
possible design can be considered.
2. Is there any need to consider running from only low-pressure oxygen
e.g. from a concentrator? This makes design more complex.
3. How plentiful is the supply of syringe drivers and drugs for sedation?
a. If limited, then a vaporiser could be used to vaporise Isoflurane for
sedation.
b. This would need certain breathing system designs, mandatory
AGSS and a supply of vaporisers.
4. If monitoring can be done by another machine it could be left out of
the ventilator, but essential parameters must be available to the
clinician.

Risk
The main risk of mechanical ventilation is an infection, as the artificial
airway (breathing tube) may allow germs to enter the lung. This risk of
infection increases the longer mechanical ventilation is needed and is
highest around two weeks. Another risk is lung damage caused by
either over inflation or repetitive opening and collapsing of the small air
sacs Alveoli) of the lungs. Sometimes, patients are unable to be weaned
off of a ventilator and may require prolonged support. When this
occurs, the tube is removed from the mouth and changed to a smaller
airway in the neck. This is called a tracheostomy. Using a ventilator may
prolong the dying process if the patient is considered unlikely to
recover.

To avoid injury to the patient and/or possible damage to the ventilator:

before using the ventilator, use a flow meter (flow regulator) to
regulate the oxygen supply to specifications before connecting the
ventilator to the oxygen supply.

The hose connecting the ventilator to the oxygen source must be

designed exclusively for use with medical-grade oxygen. Under no
circumstances should the oxygen hose be modified by the user. In
addition, the hose must be installed without the use of lubricants.