เวชบำบัดวิกฤตพื้นฐาน Fundamental in Critical Care

396 rrr:rirrioinqndu5'ru

t. tfilirnr:oe pressure support fl{tfifro 5-7 tr.rir rnrn{ilrunru'lcldviorruhdra

o'n1nr:vrulod rflu nfi llRq':'jrrvoiti pressure support drff,ili4':rfiu1t] rirtfild tioat votume
1rnrfiu rittfirfio respiratory alkalosis 6{n1'tc alkalosis etnnflllni.'r'rulooqurinrrvrutr rirtfi
{rhunruledrnwriarqnnrulc 1apne") {ilfnrfi aduluru:fi firhurd:: nr:rrfifl qnrdraffi dfi nfl il

drn'qriiamtnrdarfioflrynr tow respiratory rate alarm lio apnea alarm lrncrtuqd orct{rtl

narn rndauir{rJrunrutchilyr 6':lirn'r:nJduuqrn spontaneous mode tflu control mode ner'lfi

vraralonra'lunr:ld spontaneous mooe hl

2. l1n1ilntlfln pressure support flnl 60 s-z tu.rirrrdr{rJra'lrifirulcniori.rnrulodril
dn:rn, :nlahddr uan.:ir{ilrtnrutilrjlur lfirirnr:rrJduurflu control mode dru patameter

settings fr rtrr:cr d.:ar wqaotnr:d{:hunruledr orctfl oernorlrtnsial d
t ) nrrdo tri gger dilr n rfi uh rirtri{nrunrulelrib'rr

e1 uarionrnfi::lutJ:;arldru nlu (peripheral nervous system) ttiu tdu:l::crvt
:auoia:vrjrttdu :valnua:ndrltda (neuromuscular iunction) ndu tdo alnqfrrwldriau rdu

hypokalemia, hypomagnesemia. hypophosphatemia, hypoalbuminemia, hypothyroidism'
myasthenia gravis

S1 ru'rBanrnfi::u:J::f,rldrunnt{ (central nervous system) ore rfiacrnnr:-[65u
sedation rrnrfiul uiafinuricnrud4utinr:nrulolu:vd'ufiruola.t

Low respiratory rate alarml

pressure support
r?1da 5-7 tt|.tJ't

{rJ: u n aiu lrur ulotdla ': {thud'rn'rurulodr/ ao alarm respiratory rate
ar xr s n n air rrvr uto ta old
AlLfiq: mlnUte atuq, {rJruHrulohtur a'r Inudir:hiriaundr
respiratory rate dfi'rli
ventrlation 6'11l

rliurilr control mode

ua:r.ls:lfiumarrrq

e,uupi ufro,tuuzntiluntturt}z{tltufifiilryn low respiratory rette alarm/ apnea alarm

nr:udtrf,ryntdotrdurn'oldra4o,rdraurala nn?unf nfiftntg 397

g. 'lfirirnrtdolnnoiol:J.ir:lrgr.rr low respiratory rate alarm rfiqoo-ln'li high respiratory

rate atarm niaki rj.ruas,l'ird ru ru'lorirdrnn'uri'u oYurfludnuru:nrrfirulcluru cheyne-stokes

respiration ru'ld'lururionrmo':r;lru:lr;f,1vnarod diencephalon v5o uil6'1u diffuse brain
lesion uonrrndti,rur-rld1u{rJru heart faiture nlo COpo

uurrr.r'lun, :ufib{rJru low respiratory rate alatm/ apnea atarm rflulild'rrrnru4fiii a

High respiratory rate alarm

flrynr nign respiratory rare ararm rflurlqurdnu'ldriou rfinduldrzltu contror mode r!fl:
spontaneous mooe }irirdrnr:lrfilnTnu disconnect-ir bag-suction-fl,r lung 3 :J::l6u-crep-
wheez-decrease breath sound rrnrfiojrrniUirynl high airway pressure alarm, low airway
pressure alarm, low tidal volume atarm }iufiflqltroruifif,r,rdu ar.ir,,rl:fiqrilfirnlrildrfierirrrTl
alarm n'lnEht i['ttxE!a{ high respiratory rate alarm orotfinldlrn

t. nr:nt{rnia.rrirsyrutrlrjrnn:mr lourarrynr:sfu trigger c'r ourirtfi{rhguruhr5r
lfiooonu:,: rfis.:rfinriou 6unnrr:d.j.t auto-triggering r?o auto-cycting ntfi:it:rrnr'lunr:
rrutloonlrirfiu.:uo aunulooonlrinn rir}irficr auto-pEEp ufiirynrld'lnunrrrJfil trigger lfi

rvtJ't:61

z. nurisnrvr'lu:Joo rdo{r.rrJon uo:ar"ur:{r{ r6u,,.: orerfioldcrnolnqrio}Jd
1) Lung parenchyma orerfluuurisnutu atveoti fiia tnterstitium fild r:iu tett-

sided heart failure, pneumonia, ARDS

2) Airway arlfieotn airway 'tun'rftJrurol niu bronchospasm mnattqeirll uia

a1n artificial airway niu iqtrlrn endotracheal tube

3) Pulmonary vessels niu pulmonary embolism, pulmonary artery hypertension
4) Pleura t?il-t pneumothorax, hemothorax. pleural elfusion
5) Chest wall niu massive subcutaneous emphysema

6) Abdomen tdu ileus, hollow vjscous pertoration

3, yrur6flnruuanrlon rda{r:Joo un;ailr:drt16u,r arerfioldernnrnrqoio}ld

t) tlqurn'ruftorjnfi 't.r metabotism Hiu metabolic acidosis, hyperthyroidism

2) flr!fl1n1lrJfi6iln6rorr:utrl::oryd'lunnrl rtiu centrat hyperventilation tir:rflu
uurignrnlu brain stem

3) :lrpnrnrufin:Jnhaoo:clu:J:vnrtdru aru ttju rdurl:carfl raufi'a:cy,i,t{rfiu
:yorvr [nsndr$ rdo (neuromuscutar juncrion) ndurdo cr nrqdnuldrjol niu

hypokalemia, hypomagnesemia, hypophosphatemia, hypoalbuminemia, hypo-

thyroidism, myasthenia gravis dldr-hao;rilfiarnrrnruhrtrriol yrn:JsjouJrJ
riro::uvrrnrud.r oirirfl fi rcilrutcd1n,lrun::rt:nrltclrilyrllnrufi n'.,t

+1 flrynrdu1 rriu nrrrr{u:Jrn nrr rniuo

398 ntrirtininqndugru

+. 'lfirirnrrf-r rnnriallt'j, :lqrr low respiratory rale alarm rfinod!1fu high respiratory

rate atarm r?01il d'ruaotir{rl':uvru'lor5rfilna1Jniu durflun'nuru:nr:mutcuu! cheyne-Stokes

resDiration rlild'lunuT 6onrvso,it;lJ lttfl'tvtnfl'lofr diencephalon rio nu\d'lu diffuse brain

tesion uonerndu-,,rruiri'lu{r-hu heart failure fiio coPD

ruuur untufilt:ftgrr{rJrudfiflq 1 high respiratory rate alarm rflutlftueru4fifi s

High respiratory rate alarm

ufindryurirrrTl lrJlilftnrlrgrn

alarm 6t 1 irld'r alarm 6u 1

a{Br:fr o tf, u'l r{ulBatr,{?an{on

- Lung - Metabolic /

p€renchyma endocflne

- Ait,way disorder
- Pulmonary
.- CNS
vessers PNS

- Pleura
- chest wall
- Abdomen

sllrlluqsi usa rutn1ulunttufllfilEnfiiltuifiilryffi high rcspintory nte alatm

fl qnr 6u1 iinulf,rias rdolf; raioteie unruh

irgr, dul dvruldrialdrnio.rrjruvru'h d.rorrhi rfr urfi'u respiratory alarm loun:.J fi fi u

ldriou'lduri

t. nrr n"uTafi qsrhtruc'ldrn{o.'rdruvruh

2. Hypoxemia'fl .u:ldrnio':rirurnu'lo
3. Hypercapnia truddtnio.rrjruvruh
+. {:-hudru (fighq rnda.idrurflute

ne'udulafi n Crrnrclf, mio'rri'lsr,t1s'le
ilqrrnrT ldulnfinqtrtru:ldtn€ordrunT uhvrulddaudl,tilou itturnrtlunr:urolrqd,:d

tnlirrflflflryuirda'rfi rdoldrnia,r{raurul r;lniwf nfifiwg 399

t. lfi rilrirnr: resuscitation n1xn1tfnu1nrly6onr,r"'rliriou niu nrr'lfiar:fi nr:'lfi
vasopressor fitl'ttfu

2. yrinr:rrdrrunoio.[rl.irnrriler''uTafifisr:1rfiur{o{nirnr:tdrnSo{druyruteToser:,]yial
fiiorc rfi n'tdcrnsr rrr4dr.ry d'.,rd

1 ) Hypovotemia rdo.lernnri'ldrndo{tirurru'tq[fltln1:uil intrathoracic pressure tu
r:'xon rirbi venous retum non.: dr'lfinrrudu1nfinonnt a.rlr:nufihr1dTaanr:1fiar:u*r

2) Auto-pEEp lflnldo.tqrnnr#nlrru'haonhjqotu:irurruttoonno d{orqrfiocrn
bronchospasm fiiarfinernnr:ns,J expiratory time furfiul:l ii.ohvrr,:nfiinwl.n:nn:reldlo!

Flow

Flow

Ipli uaat flow-time cu*e lu n. VCV mode i'\fr flow waveform uyy square waveform, hatf

u*decelenting wavefom uaz totat deceterating waveform atatha'u fl. pCV mode Lfruld

iteaduqanounta'ltoan Gnd ot expintion) flow nauntaltaananlitntdaui uantitfi ftow

m1adNnautitwtule aonqn d,tulatinaunat auto-pEEp luitzadwJttidoxlaL fjnl,u

nt,tnfrfrnfrtxttoazlclfrTaunltfru6aoaanlulq1u,riltnta'haanqo lend of expiratiofl fi,slnu

nfiudtcz ad fitfraraavta'lq7uli1,rntu'lcaonaa uanqtniffiJudfi auto-pEEp wfint{lfi

nitutinizunttntu?eludz,lntt dun'nnt |c dwtnni-nJn|

400 rrtrirrininqnfrugrl

n1ifl{rdutnxy'rti1c1udrtilr!1caonq0 (end of expiration) d,l1otlJndrrfirocfia.ilrifilf,u.toil
nrulc'ludr.rilruhrrnqo uane.nd4:hufifi auto-PEEp r:finr:lfindtrrdoti?trnrrYru'le'ludr',l
nr:ltiunr:vru'lq rd'rlrnn'ir:.1nfi rioarcn:rcvrntrtftdo'tn flow-time curve

rdamffl'r#fiflcgnl a'rto-PEEP'lfid1nr':inurorttqriou miu nrtnqlrn bronchcspasm
'hirirnrrins'rdruu'rru1!vnoon r'rn bronchospasm tfiacrn cardiac asthma h{rirnr:inur

druar?i:Jfl corr: uiorriujirrnia.rri?unru'lc[doonnr:tf, n auto-PEEp d'':d

1 - aq tidal volume tiionq irrruolddr,,,:sraurir*tru'looonqo

o VCV mode lfirirnr:ao tidal volume o,'l

a PCV mode'htdlnl:flFr inspired pressure flion9r inspired time

o PSV mode lfinern, rflq pressure support nSorfjl expiratory trigger sensitivity

(ETS)

2. nir expiratory time rfi o nir.r nnr'lfi nuru'lcoon:vuruaonld

o VCV mode 'lfilirnr:rdr peak inspiratory flow rate nioninr:rlil flow

waveform lflu half decelerating waveform ttSo square waveform udnll

il tflt square waveform fidonr::ci't6o1ir1fi peak inspiratory pressure

g,iIflu

. riaPCV mode Lhi1n1?no inspired time n.,: iu expired lime 'lfiul?oon

. PSV mode tfirirn't:ni expiratory trigger sensitivity (ETS)

3. nn respiratory rate {i,:fiotflunr:tfir expiratory time i6ld.l

r VCV mode tta: PCV mode 5[''] 'l?fla9r respiratory rate ldlgrun:.J iJ'otir.r

n{,rorrd'a.:'ld sedation iltrdttl

. PSV mode Lin1 l:nflo respiratory rate ld

3) Pneumothorax tfintda,lcrnnr:dttniolti':anru'h1auld pbteau pressure tl\:fl'j'l
so tu.tir rirlfirfia barotraumas enrJrJ'r 'birirnr:intrlount:1d intercostat drainage

rio?11nf,lrfifr1la\ln?1&suTnfingirrfigrcrn hypovolemia auto-PEEP alcllhnrr:Jnn

{lJruoontrn lnda.:rirutruh (disconnect patient from ventilator) tltc rru 1-2 uTfi riiorir
nr::JnntnColtiraflru'h rrdr ririfi intrathoracic pressure nerns rir'lfi venous return rfiudu

r,rlfinrl.rdulofinrfirdu uoncrnfunr:rlan{draoonernrnSo.,njruvra'h rirtfiolnrul#firdu

rnnonrJlr'rdaanlrld rirlfi auto-PEEP nnn.r rirtfinrrrq'u1afinrfiurtuld ueinr:'ldiirlnorfirjru

ooncrn rnCo,,rdrurrutr do.ruull'ir{rhrlrjlddsrnrr parameter setting ta,rrnio,rtirerrlrulodga

nju dottd eeee n?an:dd{:-truyru'lero.ilrild nrn{rJT ufio.:nr: parameter setting ra,:rn{a,:

ti'unrulofrgr nr::Jao{!ruaonmnrn{a,rdruvruhorlrirtfi{rJrurfluduq:rucrn nypoxemia ld

3. lfintrnr:uln

6['[Xqfh-]xu 'llndlurqta.rnluri'ulafinc"rlrjldrfinrrnnr:ldrnsordrufiruh1nun:.0

wgnnrrrdlfl fl ryu1rd0\rfiurdo1drn4o.:riraursl nn?uni nfrft 401

1) 6Ilrlre!!fino1nfiur6snrn'lurJon uo;rdo{ rJoor r.r"nfinruriruitfivnroonficrJn6 ndrd
0'retfl a hypotension rSorliu atarm dr.t1 fiIfi najrrfiouifirriolyrjrd

1. Lung parenchyma t:iu

. Pneumonia. nnOS Tourfinirln"u septic shock
. Pulmonary edema lqutfiodrtnil cardiogenic shocr
o Massive hemoptysis

2. Pleura ltiu

. Pneumothorax Ifrurfi qdriln",u obstructive shock
. Hemothorax Tqutfinix fl! hypovolemic shock yio obstructive shock
. Empyema thoracis lnarfietdrtJfiu septic shock

21 oltnrfioernnutidnl uon an uoirhoatun:r.oan
t , rJoo lduri tu'tidnlfltu pulmonary vessel niu pulmonary embotism. pulmonary

artery hypertension fi Turrr'r

z. r.rrtl ldud

r Endocardium Ltju valvular heart disease, congenital heart disease. infective

endocarditis

. Myocardium ltiu acute coronary syndrome, myocarditis. cardiomyopathy
. Pericardium td! cardiac tamponade
. l\4ediastinum Ld! acute aortic dissection, mediastinitis, esophageal perforation

3) lnaern u,)Eflnlviuan .r?,0an lduri
1. Low cardiac output shock (hypodynamic shock) tilunrr:6onfi pulse pressure
ltn!fr.I rAnncln6t'tttstlton :?.1ofl !d! gastrointestinal hemonhage
2. High cardiac output shock (hyperdynamic shock. distributive shock) tijun.lly
6and putse pressure niNfr rdnflnfl1n{nuonrr':.ron ldrrri

. Septic shock ndtn'nilnf,1tfiquanfllx.ron t?iu hepatobiliary tract infection, urinary

tract infection

. Anaphylactic shock
. Endocrinologic shock rdu adrenal insufticiency, thyroid strom
. Neurogenic shock
r Drug and toxin tti! nr:'Ifi{ urturEjfinoorfion (vasodilator drugs)

uurm,r'lunr:rfibilrynrdiflryn'rnmilri'ulofinoirtrucldrnio.njramru'lo rflu}Jd'.: uar unfi

fio

402 rrtrhriolnqndugrl

HvooEnsion ro€li mechanical ventilator

ABC management

aoo disconnect {d?uaann'ln ventilator
(dl'r setting rniardrurnulnhi{o)

filrildrfiafln nr:15 -Pulmonary embolism/ -Hypovolemic shock
rnlaorhgmulc purmonary anery eg. GI bleeding
-Tension - Dis'bibutive shock
pneu mothorax hypertension
-Herrt : endocardiurn/
-Pneumonia / ARos/ pulmonary edema
-Mediast num : aortic
/-Hemothorax / pneumothorax
disseclorv mediastinitis /
empyema thoracis
esopha8Bal pe.foration

auruauln Lfl6\t t u2n1nlun17ufrbilrynSthudfi az'ta dulafinh da'ld talosizuntu'lt

Hypoxemia reuddrnCocrirulnute
:Jqrrr hypoxemia trruddrnlo,,nirumulo riluilqnrfin rios!!avrio'hlrhflaiuo:ruuri{rhu

fl1n{il?ufioonireudro.rlur6on rirlfi{:Jrunr:drnlidlu 1:d:rn2'r Johnnn': firar nnrflrmn
n?1! n"u1nft ne i mn n rir'tfiu'rk rdufi q{'lvr:ld

'lfiri rhnr:rrfibd?u disconnec't-:ll bag-suction-tr1': fung 3 tJ:r6u-crepwheez-decrease

breath sound uovvrinr:nortrapiol:J

nalRta\tnrc hypoxemia llavllutilrolunrtttfrh

1. Ilocreaso RiO. r,ru1d"1il{:Jrufidrn'nniu1r,t (smoke inhalation inlury) f,1wqfid$r[uf
rfunT :lfi rnCoorirunru'lc rdu rnio,,nirufirulcfi il't)r1nr1unr:iruoonfi nu

nrr/f'l lrynrdo,rfirulo'ldrnioorjr0u.rslt nnianl gfifittg 443

2- cer'''rall neuromuscurar hypoventiration rfia{rJrufinrr: hypoventiration etr:{ri
PaCO, a'r f,ur:nuri,: hypoventilation oonldrflu 2 r.hyrn 60

1) centrar/ neuromuscurar hypoventiration tr.,rfi A-a gradient lrnfi drnoj,dr:Iilfi

vrurinnrn'lurioo rriu myasthenia gravis, Guitian-Bane syndrome firyrn'lsroio,:drunrfl'lcufir

fnlilriourfiq hvpoxemia o'rnfl'rll,rnd uoivrnfi nypoxemia lunEjiltod'hifiufio targe aretectasis
ttio pneumonia r'':arerfiorrnnr:ondrn-n (aspiration pneumonia) niorflu:Jandnrarqrnnr:6a ldo

2) Arveolar hypoventiration {i,ri A-a gradient mnnir:J:n6 drnajldlvfir,rurBonrn

'lurl o nfi':uur,r rdu ARDS nq'rlddotlfi pEEp'lun1 ?ffl u.t

Llt3. V/O mismatch rccr dlnrr: hypoxemia fr

tfioqlnar lvmdrvsrououo.:r''ilornurfri,t,t:{ atetectasis. bronchosDasm
ventilation un: perlusion

100o/o oxygen mi! pneumonia,

fififlurBonrillililrnfn

tun{rdfiuoi perfusion ugilrifi venritation :-itfi,r.jrfiylurBnnrrtunrnld:un:,rrrn

fi{Jl'r?: hvpoxemia d rfinernorurqdovlrinarguaroionr:lfi t oo"z" oxygen o:do,lufib&'unl:

td ppEp (positive end expira'tory pressure) n?aldnr:tirunra'lci6du rdu rRV (inverse ratio

ventilation) rianr:uoun'ir (prone posirion) donurionrrlunrllddeo{lun{ intraputmonary

snunl

. lundlfildfi perfusion fiutn' ventitation rj., anfi,rjrvrurBon.rnrfiodud putmonary

vessels ttilt'lufitJru purmonary emborism, severe pulmonary artery hypertension nq'rdo:

srououorrionr:rfj! Fro, f1\r rrdc:lrjnouauo.odonrrtd peep da.::*nurTnunr:uficrruq miu
nrrlfi anticoagutanl rlio thrombotytics dlrurianrulunajldfiun.lr dead space

4. Shunt rflu v/Q mismatch ::Juuund,liifiusi perfusion udlrifi venribtion fi z :J::mr
'1) Intrapulmonary shunt rflururif,nrufinrar ri.::lsnfi,ruurinn11ltuqtn}|dluu:,:

rirn nr:rfir.r Fio, ovlrjorrr:nufihnrrv hypoxemia ld do,,r ufilld.rlnr:lfi peep n5onr:fnxr
lnuii'6u niu tRV linverse ratio ventilation) nio prone position

2) Extrapulmonary shunt rfruuu,tidR,tlrtu8nqnflr| ttiu cynanotic heart disease.

pulmonary AV fistuta ftdolnfilflrnntrfluarrnnMtfi.r nr:lfir Fio, rianr:'Ifi peep'lriour:n
ufil:r snunt tindld

5' Ditfusion defect riJun{rdfi perrusion rrn; ventiration lnG nrirrfio hlti vlo mismarch

uoin?.l fiq :nfiadfi alveolar capillary membrane triu pulmonary fibrosis, interstitial lung disease

Inq'rdo; nor.rnuo.,roionr: lfi rio, rir.,r usi'lrjn olnuo,: sionr:lfi prrp

6' Low svoz tMu0.J venous saturation dr grrr:ntfirrfionnidrq:'nldrrn centrat

vein q1fl superior vena cava (a1nfl1ir central line fi5of,1u venous cutdown) vSoorn pulmonary

artery (tlnf,'rti pulmonary adery catheter, distal portl drnr:ii venous saturation ntrficlrorotd

404 renirrialnqordlpu

a-a gradient
PoOr /Fio,

Normal A-a gradient (Fio? 0,2) wide A-a gradient (Fio, o.2)
near normal PaoJFio, (Fio.>0.2) Low Pao, /FiO, (Fio>o.2)

central / neuromuscular

hypoventilation

minute ventilation

{rfiil ticlal volume, tfir nR)

. PEEP rutllunraz low
. Inverse ratio
O, delivery /
ventilation
high oxygen
Prone
position consumption

Dead space {nur ar ru q
(eg. pulmonary

embolism / severe

pulmonary artery

hypertension)

-Thrombolytics /

antrcoagulant
-Pulmonary vasodilator

wu4frl z uflntuutn$luntturtlfiryn$huifiilryni hypoxemia

nliri'luflryi,flld0rldurdolrirado,lrie€,utfli oniunf nfrf,wg 4OS

1) Oxygen delivery n'r 6.,rfierrrE16orn cardiac output e..l (hypovotemic shock.
cardiogenic shock, obstructive shock), n1'1c6fi (anemia) [tRvn1.]r arterial hypoxemia

tf2) Tissue consumption r.ln firJ'rudnn'r1d rdardodruiloru (peripherar tissue)

oon6rcutrn niu nrr:f,o, fu (shivering). dn

f,1lilnro.{r hypoxemia fi nurjasuovuurnr{'l,unrudls

t. arrnqfr rfiarda.rfiuroio,:tjrsvru'lq riuarriloiifia,rlfie{:'u uunlrnifilddouarmndu

t1 rnio.lrirarruhnloriododrol rir,,:rufin,rln6 niu {oriolo,raruoirrr lriurjutirlfi
rfiernnfrernr.lq: nr:fi lo:rvynlori.rc'ruru rn'horuro{rn*o,nirflyruh

z) flrgn'o,rriorirurru'lo (endorrachear rube) niu viarirav-ru'lcaqifinrfiu}j viodru
rruhldounqo riotirrvrutlfirornvoonsu ilqnrrndrdorrr:nsrrroco fiTounrion"rrmrj,: lmart<;
ta,:vioriruvra'h lun:nidchrfluarcdo.r'ldorugo roruvrfrogirriorirunrutlfinr:qorYlnialri

3y nr:or'rrnio,:tirafi rulolrj6ra nju nrrn'.r Fio, def1Lfi ill:J

Hypoxemia zrwl8rn4 a,r dau wr ulo

ntuln n:tos;uuta,: oti.tuurdo lrinu'Jrym

urBanrn16rrflnmndu finurBanrr^rftarirfiqdu ldurrio,rrir nrs?ir finnnrs
-chest physical therapy
-ARDS / pulmonary -Aspiration / pulmonary -ET-T suction
edema / pneumonia / edema / nosocomial -Bronchosopy
-Peritoneal dialysis
atelectasis pneumonia
-Pnemothorax
-CoPD/ asthma
-Bronchospasm
-s n0ck

euwgfifr usa,tuunx'lunttufillf,rynfiJaufrfiilryn1 hypoxemia $ialrtndoidunta'lc

406 rrtdrrininqmdu5ru

2. flu1fidnlY{tfiuflux,lndu t?iu ARDS, pulmonary edema, pneumonia, atelectasis, coPD,

astnma nr:ufilt'tririrnr:rrfi1torrtqfl0,ilafirB nSorrfirirnrlrfilnn'1l; hypoxemia du fi'ln
rflu ARDS, pulmonary edema dootd ptep lunrrinur n:nito': pneumonia. atelectasis' coPD,
asthma'lfirirnr:rfi il Fio, lildau udrvrinr:inurnuortn4

g, firu16onrifivil rfiodl niu pneumothorax, aspiration' pulmonary edema' nosocomial
pneumonia, bronchospasm, snock do.:ordu:Jfgifi nllgll??d'l'tnru nr:rriduulL!f illo.tlitlll

fi sfl1 rflr::l': (monitoring system) tto:nrrinul0'ltJf,1lfi E
q. rdurdo{nrnr?Ythrinnnr: trju nr:oo!fltJfiJ mfli1nlunlflril:ioll'lo ao (chest physical

therapy) n,l?do.rnfio,:m,tt6urrulc fl1flih peritoneal dialysis nr:t duuriruouto.tfitlru

rur.r'ryr'r,'t'lun1rLLfiltflrgrrfi:Jrufififlryv1 hypoxemia flilrdl{rnio{tixunrfllq rflu.hld't

rmu4fiii a

Hyperca p nia srirrjldrnCo"?i'lsrns18

nrrsdfinrSuouloroonltdqt (hypercapnia) lruvldtnio,:tjruvruhriu rflunrrvfrdun:ru

rdo.rcrnvrnfinrfiroulnaonltdq,'rrrnlurfioo rirlfi{rlT un:vff!n::dru nrr d'u1nfinq.r firrflurrn

rvfinrud'uIofinn'r r{rtfinrud'ulundnanfi:utqltdo.rornrdutdandalo,rsurudr {:-hufiln.r
runvrrnoftld

luurm,:tunrdfirihtdar:.rnrSlaulooonltr{4'rtu6ao arqfirrrurldlnnrutfitfiuf,io,l

rnrir oulrr o o n'lt6'1i! n'r rurltdr.: q''t or nr:

PaCO2aCO, production Minute ventilation - Dead space ventilation
alveolar ventilation (V,x RR) - po x RR)
Alveolar ventilation k x CO, production
{v, xRR)-{%xRR)
PaCO,
= kx CO2 production

FR (V, - Vo)

K= 0.863

tidal volume

dead space volume

RR= respiratory rate

a wgnr:rui'lrf, ryvT rdorfiurdolrirnComi.ravrst wn'zuni qfifr 402

{.0rfi uld'jriir paco, Irrj.lnfl ?oriotrduaEjn-r:)e{u 4 trrnli 60

1) carbondioxide producrion o'n:rnr:ciroflrrnr{uaulooanlsd'urnrfulwl6'1u{,:_rr#

ldifuor:ornr':nrfl arsr:nrJTrf,u}l Toufirir respiratory quotient (Re = co, production/ o"xygen

consumptionl.6,':rlfiruar],lnlufirhrfifi resptratory acidosis oriufit niu {:-Jru copo uanrrnd
utlu'.:r,rl'lufi rJr ud fi ur.r
a fi r'u o.r t'n du ls n iveri n g)

2) Tidal votume lmafi,: 3lrq:o.rnradnruhr{r'luudoyni.,r dr tidal votume F,n ei.t
Pa.CO, ?:ni rrocfir tidal votume s,t"t rir paCO, e:cr

3) Respiratory rate d1 respiratory rate fi,i fi.t paCO, Eyn'l un:fit respiratory rate n"r rir
PaCO, 3;d,t

i4) Dead space vorume v',lufi.r rnflo{ornrfidlrilfirrnnurduuflrr fir dead space

volume 6[,1 9il Paco, csg,'r llacfir dead space volume o{t Fir paco, cvntr d.:n'r dead space

votume rvmntufi:Jxudfi auro-pEEp dwtrrgfiorir,:r.rruhoonqodrinrcr.,,:o{ ftvrildtu{nru
fifinoaonrnoln5.r (bronchospasm) tuftn copo n?o asthma uone.'rndu-onuutaiufi,r,runrirlu

rirunru'hrourrrfiulil ridrlieiruno,'rarnrsii'lrildunnr:Jduurrns*u r'rtfi oead space ,]orume rrn

dulildrEr

f1$r4!o\r hypercapnia iiuuriouriiolfin4sfiiesilrs'le
t. nrrf,,rrnco'rdruuru'lclostri minute ventiration lrilfiuiro0ianrr fio,rnr:ro,:{rhu lu

niirdor*rrrnrui'hldlnrLntrnt: minute ventitation tfirfiu,Jvlo Tnunrr :'u tidat volume rrnc/l4io
respiratory rate d'\tdlnr:

(PaGO" x MV), = (PaCO, x MV),
lniifi NaV rltsfi.: minute ventilation wirdr v, x Rn

rttrdnrnJfu rnCs,,rtirufi ralcnr:ilfiitifi ::oriunriraulooanlrd'lur6aa eacor) :J?y 1ru
40 tJ. r0r unr'lutu{rhudfiflqfi'r chronic respiratory acidosis l.nriou fiar:JfirnCo..rti.lry.lfltrht
Pacorlndrdulfitlrou6r loruuurrnr unr:rliurnioui'ruvrulo niolfi paco, ann{ arm:nrirld
Tnrnr:rJir tidat votume ua;/r?o resptratory rate d'.:fiuurmrttunr.:rfion:Jfi r;t"'od

t1 rfionrlfl tidat votume nrfid peat< inspiratory pressure lrio.rrfil ss rlJ.ti1 filo

tplateau pressure lrjrfiu 30 .uYr

z; 16on:Jil respiratory rate nrrfifi dil?u'lilfin.t?y auro-pEEp
drlrifi peat< inspirarory pr"rrrr" dgl fiiolilfi auto-pEEp eyrfionii:J ridat votume
ttio respiratory rate fild lrjfinruuornrhrfumn

r()8 r'lnirfainqnfiuS'tu

dlu2, nre;nriuouleroonltri'4,:1u{:-lrufi fi severe intrapulmonary shunt drjoulu nnos

rdatqln atveolar hypoventitation d,tfinrfladtrnil hypoxemia tunr:ttfibn'l?c alveolar ventilation

frrfiniT rn'l hypoxemia do,:ld posirive end expiratory pressure (PEEP) 'lunr:innr rfio'omn
pEEP eylh'hi alveolar ventilation 6du n'rifi eao, rdmsu rrnvrirli Paco, oo8{ tun:ridlri

fl.trJ.no iu tidat volume rfiilri rdOoorn{rhu ARDS do.:nrr tidal volume !?Vl'tfu 6:Js-/nn,

fry1n fiJ tidal volume rrnn'jt 8 tJn-/nn. orlrirtfi plateau pressure l.l"lflflj'l so ttJ dtrdut

rianrlfio barotraumas ld 1ilnrrfid6ililfl1il1i01d4n: (eaco, x MV), = (Paco" x MU,ld rti

Ii,:n 'rillu lfrr.r respiratory rate'ld

Expiratory

pon open to

atmosphere

A
l\4anomgter

Airway
obstruction

B

Iti ou uan,nJaotJnhddtifr lower airway ohstructlon dnlsifi auto-PEEP B. usnnJaodtfr tower

airway obttuction ttsi auto-PEEP :fruflutf rfl71l auto-PEEP tfiu pr"orre iltiuan stflu PEEP

diliin c. mauJanilufi bwer airway obstruction frfrntzla auto-peeP Tnunzfln @cclude)
exphatory valve tuti:,untu'lcatflqa end ot expiration) i'flfi now dtriuqui 6'ttndaanaa'u

i'xogiiqtax dshliawnnia auto-PEEP ld

nr:rrrl'lnrlrgvrrdo,rdurdol{rn{ord1u?rul n onfuni nftfimn 409

3. n1?:n'r5!au'i6aanlrridolu{rrrun'fi auto-pEep drnuldrioutu{:rrudfi uronchospasm

riafr exphatory time lrigrrno 'lunrrifnriusuloaanlrdidr rfllqrn oeao space dlrnrfil d.r

nr:rliulnio'rtjruvruhlu{:-hadfi auto-pEEp usu do.,rrirnr.lnn tidar vorume Rn respiratory rate
un:nir expiratory time d'rriurdaurnrfuauloaonlzdri',r1u{drudfi auto-eeepfthjoln:oilfurdr
tidal vorume rlov/uia respiratory rate ld rda.:rrnrcdrlfi auto-pEEp rflufrndu d,:nrolfi eaco,

eil lun:rfid6.,llrjs.un:nldgn: (paco, x MV). = (paco, x MV), ld
nrrli externar pEEp fi6?1&.ilriulu{rLrudfi auto-pEEp dfi wo* or breathing 'lutir,r

6lnr:vruterdrdnr:rliurnio.rdrufirutlrfronn auto-pEEp Lildaa Iaunfild externar pEEp
e:l'rbI work ot breathing nrrfincrn auto-pErp aon.rd,rlrildaonulona{ auto-pEEp n.r oioriu
6ilrifinrtnhrflufio.r'ld externar eeee lu{rtruftrifi work of breathing drfiolrn auto-pEEp
niu lu{rlrufildirul sedation rn;uldoundurdodolril work of breathing drfinorn auto-

PEEP 6nr!d? nT fr.r extemal pEEp rdoocr work of breathing nrrfior?in auto-pEEp 'lfid.rrrl:yrrru

80% 1to\r auto-pEEp dinld
ruurnr',,:'lunr:ufilrflqJflr{ilrudfiiruilrnrir.roulooanltddl,rrruvdldrnia,,:rirunrltl rfiu

lrld',ruau4fifi s

lli e uant pnoure-lme curve uf,t flow-time curve tlafrnlJio auto-pEEp \fr{lmn pressure-time

curve (n1wd1uuu) tt end of expiration qJfr squarc war. 6aiu diot.txoigat square wave
dasunsa,t auto-pEEp iinld uazli&nn ftow-time cuNe O.ln61u6i1 ?wuziin.tz
occlude expintory vatve tvillfr now fiuqui\ufiufi ftfiunnanatntalti?riaanttnnxdu

vtalc i,ts'1u'ttoin auto-pEEp 16 qanugwo,sdmdaxnit pressure-rme curve cycte tialtJi

thld 6a tdna,t auto-pEEp)

410 rrtd'rrTnl n q nfru5'tu

E

Eo^

or 5

ge

-9 0

Time

-nfr 7 uantttaza,t externa! PEEP'luntna work of breathing fitfiactn autoPEEP dufiuuaa,t{tJtu

ilttl\ffid ertemat PEEP Lfruldilgilxadorannulffiln autoPEEP to tu,it awfrtgui uaz
t ,da'taanux trigget inspirctory valve 6n 1-12 rltt.it
tz tu.it dtfra{li work of breathing

a'tn duJtuan $tltsfifr *topeep flldiunlld exBmat PEEP uh fiuldi'tShufr autoPEEP

ail 10 flN)h ld erternat PEEP 5 wt.it dastluaanut,tcud,t s zx.Jtud'ad,tfr,tttolLsat exter'
w.itnat PEEP fre:aanffirsiaIsfl figger inspintory valve 6n 6n Q2
saa t ru.it dili wo*

of breathing anat ltfiuldin'ttlai externat PEEP tfiuntna work of brathing iaaetn

auto-PEEP

-ShiverinE rdr minuie ventilation
-convulsnn Inunrrfirr tidal volume +/-
-High carbohydrate
riil n R
intake

da!5:in aveolar -ufibarnrq
hypoventilation lH -diu ventilator

intrapulmonary 1.v tidalvolurne
shunt eg. ARDS
2.+ RR

3-+ E-time

Apply external PEEP
r$iano work oJ breathing

?r.rtir': ripnrs rato

wugfii e usaututntduntzufrlnilryn{tTz#fi atiuaulnaanlsrtfrnru:l#ndasinnnlle

4tln1iudluf,rur41ldocdurdalrirada{cirarrel a nn?uni pfrfiwg

d.:rfrd'tpdnr:::f,nfi0 rdar,!! paco, oi rflo,:qrnfi:Jruyrulo fircurfiFrn.rr: respiratory

talkalosis ad'rt'ru1u.rtJfl0 respiratory rate rfiofi'r-r!,rn ufillnrt: respiratory alkalosis :rlfidru
c;lnulq r5rdunir rfi rdo{e1no-er:lnr':v,ulqfrrnio,rtfilriniu,:lrosionlrJfio{nrr,go.:fifiu fitru

l:nrutlrirl*uIil6n drunrran tidar votume rfroufiIl respirarory atkarosis lurrwdfrrlrurr.uh

rflfu evdrififiilrun'rulqro.rrdsliild ridar vorume rrn,r,*u.[rr6n nr:ufilnnrr;dd6fiqo6on.rrnr

orurqro':nr:r'nulo 6rdrai6nr:uflltriruo,:rfiarfunrlrfibflqnr high respiratory rare ararm
h'ltinr:rlfuno respiratory rate fi?anlflliunn tidal votume

firJeadru (righq riiofli?ur41sh
r)qrrfiilrudu (fight) rnia-td?urlrulrludd :ariirnrry abdominat paradox d?u Tou

:Jnhrdo rn{0.:rirayrutldrflarnrflrf,.il! yn?t0nq:?ulurLn:rla.:o;rurudulufiarr,: rn-urriu d.ru
lurir.rrral,raan r:r.:ono:fiqm-?n.,rua:fior rMrnrtufiRlru6urfiu urnr:roongurulurru:fifio.,t
tur'lu yion:r.tonuo6'r'l!rrucfi ltro,tr fl r u ri un.jr abdom i nat paradox

ilqnr{ilradrurnia':nia figm rniamirauralo riuilcgmrfruuldr-iou d.rr"nrfinitrniu alarm

rirtl lrudr 1nv{! ararm o"rnsirr trilirn'r:rfibnrr ararm rir.r1 dn:rrur uongnrir,rrnlri'ld

rfioorn ararm rirrl uoinhtfi{r-hudruraiar ni! hypoxemia, hypercapnia odr,:bfinrlarrr:n

rrruurrnrrtunr:rrorrrnrda''rdulnunrr disconnect-iu bag-suction-ihr tung 3 rJ::r6u-crep-

wheez-decrease breath sound

drrynro,,rnr:firrlrnio.rtirur.rrulqrYurrnFa orrnqdvr.rlfilfio atarm tfiorpir,rl itrn'lormq

ra\t hypoxemia ttnv hypercapnia ttsilnrrqrornrtdrum{o.nirufiruloini{fiarnr:[dn,:atir{:rqr5.]
frfi0'r16irnr:rirrinlnruirdru 6o tension pneumothorax, endotracheat tube obstruction.
displacement of endotracheal tuoe (vioriruuruho{o'nnioo$durfiu}J niaviorirunra'lenno;,

massive pulmonary embolism, severe metabolic acidosis

r.rrnhififlqrr atarm'hiyrinr:n.lrcoa!ilnrrfr,rrniartjruyrfl'lefun',:arir,r rylr;orriaki
niu tu merabolic acioosis rtdttmndns.t tidal volume n'r {r-hul:ninrrfirslo ra.rrfjobild ticat
votume rfiu,rvroni:lnrrr6ornr: n:rfidfrqsrfier dyssynchrony duld drorrr:o ufiblfiloflnr:lf!

tidal volume tfimju

uanorndortrnto,Jnr tight ventitator rft fiamn patient-ventilator dyssynchrony d,,rfi

fl1r14qa1n

1- Trigger dyssynchrony a'ntfiqtrn
11 nr':n"t trigger turoo.,:rfiul:J 'lfirirnr:nolure?o{ trigger fl\t
2) Auto-pEEp drlfi{:Jruu.ruloniratrr-rrnrdom.rndo,,:tdndrtrdoilrulotunlt figger

rndo'stiruurulqlrntsu trlntrnr:fnurlsrunr: i:Jrnsootiruuruhrfronnrurnla-r auto-pEEp firn
lrildruntfirirnr:ld externar pEEpl d:yrJ'rru B0% flo.r auto-pEEp d;nrlalun:rf,dtld1l.rr:n{o

412 rrtrirriolnqndugru

auto-PEEP ld trtr"ld exernat PEEP eun'jl peak inspiratory pressure (ete) o:rfirdu rrdran

nu1n1ro,t e)dernal PEEP a{tJ'llfinflOU lfidornnir{rhuaon!r:n trigger lnig,Jrirunra'hnna.,rnidbi

2. Ftow dyssynchrony riunrr:d{rlruinrulolournioo:irurrslodru ttow la,ln'lfllulc
rfililno rirtri{:hrda' ru'len-*tornratdr rstou rulqtdr {itorotflunrrttqno.! low aiway pressure
alarm vrntflu VcV mode tfiri'rnrlrfilslounrrt$il peak inspiratory tlow rate l1n :-l peak

Fighting of ventilator ABC

lflnirrril.: hypoxemia Disconnect, flu self inflating

hypercapnra bag endotracheal suction

fisir flu alarm oir''r 1

Trigger Flow Volume cycle Mode
dyssync h rony dyssynchrony
dyssynchrony dyssyn c h rony dyssynchrony

rJfu tidal rJfurtlu conkol mode /

volume rfirdrl sponmneous mooe

lnnlridriEr

-uriluarruq wrnlrifrrEr
-U{u ventilator
sedati0n +
1.+tidal volume muscle relaxant

2,ORR

3.i'E-time

Apply external PEEP
$iaan work of
breathing
luda,:ldlnrsvnglorf,r

uaa7fri to uf,n'tuuznttlunttuil$1ryn#a$ilnfrtumif,,r'ti7un'!q

a gin 1rrri'lfl fl ru1'r1 rdo{ fi uw' ol{rn{o,:rir or rol n n'zun 4 frfiw 4LB

inspiratory flow rate fl\:rJlnLld'x Lriu 120 Umin hirirnr:rrlduurflu pcV mode rflo,rlrnrncor
drryru'loarlr:no1u ftow ldn.t n?1 do,rnrr1o.Jfi:Jru (ftow on demand)

3. votume dyssynchrony rflunrt:d{il.:unrl'loToBrn?a,,:drunrfltlira votume'lunr:

il1ute rfi'il rfiu,rr0 dllfif,il?ufio,J14ru'Iafi.,:ornrnrd.turnouyrulsrdr r"oore rfluorrrqro*r low
ainruay pressure atarm rrnrflu VCv moOe lfirrfiblqunllfr tidal votume yrnrflu pCV mode
hiufihtcrunr:nr't inspired pressure vrnrfiu psv mooe lfiufibTounr:rfil pressure support

24. Cycle dyssynchrony OrlrT :nurj\:ldrilu :yrnyl

1) Premature breath termination fitl'tufin nr:vrtrnio.rt'rflyru'hl duu phase nt:
rruhrilflunr:nralooon lurruvfi firhutirda.,rn.r:u.rslordrad o-.:riudaujiu
hinr:n, Uhrdrun oon

r VCV mode tJilno peak inspiratory flow rate
r PCV mode :Jilrfil inspired time
r PSV mode i!fla expiratory trigger sensitivity

2) Delayed breath termination finrtn'.r {rhafia.,rnr:l:rrlfiuu phase nr:mu'hrdr

rflunr:Hrglcaan udr urirn*a,,rti.lunrutlri.,,rn{ti.lufiru'hrdrciolil n"rrfudo,rrJi:r

1finr:yrulqrdr#unu

o VCV mode tJfl nir.r peaX inspiratory flow rate
o PCV mode lli:JflR insDired time

. PSV mode :Jilrfiru expiratory trigger sensitivity

5. Mode dyssynchrony oreovrfiorfiorniouirunrulelldnuruynrrnrshdsirwfioniu rdu
lu synchronized intermittent mandatory ventitation (StMU dnn1flixEyruloryfifr.J mandatory
breath rny spontaneous Ureatn d.:{rJruLiarlr:nrji:Ld'rbinr:urulofi Z a'nunr:rdrd'u'ld i.l

tflq mode dyssynchrony du our:oufibldtoranr:ulduurflu spontaneous mode lru psv

mooe lunrnidlrjarrlr:n'td spontaneous mode .[d lfinlfiuurflu conrrol mode louo.rq'16 vcv

mode lio PCV mode n'ttJn11 lt4rJ-t:flll

uur r.,,r'lunl:ufibirprl$afirJradrurnio,,.rrirufi rBtl rfl ulJrf,'.lrnu4fi fr t o

f,?rj

nrrrl'tunr:ufilliqJfi1 atarm un:nr:ufihrrlrynrdu1tru;dtdrnia.nirufira'lofinrr ohflu

orir.rd,rdrvilunnrn:vrrrrrui'liorinqor rdo.rernflryrrn-.rnEiT rlrilldrjofl un:trntai.:finrru:uu:.r
y.n?erlrrr?ru?un{ \rlrns?n
n?'t ta t?n- ,Jtl-1]?r']n ,n.!-a?ntunrrrnd tniqlrufi-t$16.i1J cy?itu tfr{ilru:oafrTn dftti
rn']

{ilrutd:;u; rrnrlunr:daoo{rir rnCa,,:drufirutqnnn,r rda1,rlf,:Jr u:oor{uornnr:vinqnlnufi

nr'::rm:ndourioufido

414 lrtdrrininqndunru

rEnf,1?!ot, ltoa\t
1. Pinsky lVlF. Cardiopulmonary interacions: the effects of negative and positive chaflges in pleural pressures on

cardiac output. In: Dantzker DR. Eds. Cardiopulmonary critical c€re Philadelphia: WB Saunders 1991:87 120.

2 Tobin MJ. Mechanical ventilation. N Eng J Med 1994:3301056-61.
3. oczeflski W, Werba A" Andel H. Breathing and mechanical support. Blackwell Science 1997143-7.

4. Aldrich TK, Prezaflt DJ. Indication for mech€nic€l ventilation. In:Tobin MJ. Eds Principle and practice of mechanical

ventilation. New York Mc Graw Hill 1994155-S0.

5. Gattitoni L, Pelosi P, Suter PM et al. Acute respiratory distreGs syndrome caused by pulmonary and extrapulmonary

diseas€s: Different syndromes? Am J Hespir Crit Care lvled 1998:158:3-11.

6. Tobin MJ. Advances in mechanical ventilation. N Eng J Med 2001:3441986-96.
7. Esteban A Frutos F, Tobin MJ. Et al. A comparison of lour melhods of weaning patients from mechanical ventilation.

N Eng J Med 1995:332:3,15-50

8. Sessler CN. Mechanical ventilation of patients with acute lung injury. Critical care Clinics 1998J4i707-29.

L Jain g, Hanania N. Guntapali KK. Ventilation of patients ,rith asthma and obsrtuctive lung disease. Critical cate

Clinics 1 99814i685-705.

10. Ruiz Sontana S, Gancia A Estchon A et al. ICU pneumonias : a multiinstitutional study. Crit Care Med 1s87:15:

930-2.

11. Erochafd L, Rauss A, Benito S. Comparison of three methods of gradual withdrawal from ventilatory support during
weaning from mechanical ventilation. Am J Respk Crit Care Med 1994J 50:896-901 .

12. Thomas AR. Bryce TL. Vertilation in the patient with unilateral lung disease. Critical care Clinics 1998:14:743-73.

13. Pressure control ventilation. Nichols D - Crit Care Clin - 01 -APR-2007:23{2): 183-gg.

14. lvladni J. J., Wheeler A P.: Respiratorymonitoring. Inr Marini J. J., Wheeler A. P..ed. Critical care medicinE-the
essentials, 2- edition Williams & Wilkins Baltimore (M0)1997:9G91.

15. Noninvasive ventilation. Barreiro TJ - Crit Care Clin - 01-APR-2W7''2312]-''201-22.

16. Mode of mechanic€.| v8ntilation: volume controlled mode. Koh SO -Crit Carc Clin - 01-APR-2007;23(2)161-7.

17. Conventional mechanical ventilation in acute lung injury and acute respiratory distress syndrome. Ramnath VR -
Clin Chest Med - 01-DEC-2006:27(4):60113.

18. Mechanical ventilation tor cardiac support. Baikhelkar JK - Crit Care Clin - 01-APR 2007;23(2):291-8.
'19. Ventilatory management in patients with chmnic airflow obstruction. Koh Y - Cfit Care Clin - 01-APR-2007:23(2):

169-81.

20. Basic ventilator management lung protective strategies. Donahoe M - Su€ Clin North Am - 01-DEC-2006:86(6):

'1389-408.

24

Respiratory'Waveform Interpretation'

mnM qffiwy

nr:ldrniootiearnuh rflunrrlnurdf,nT udrd'4ariroti,:lufiilrudntrvnr:rruhfirrfinr
{respiratory taiturey {ionr:lf,rnda,rdruilru'teiir"nq:Jr;ardddrf,q,rJrlnrrnfi,l6a nrramrudfin

mnnrturuh (work ot breathingl ttrfiolrfinmnnr:drrnloflirunrstttrtfi rcf, ttn:nrr rule
'ivt'jr*:fidrurl'urnia,rdrunu'lcdolfintlrfrlnlufriu (patient ventitator synchrony) nllflunr:

dru[ncurlnflan:rllturniootirumu'h (respiratory waveform) 6lfin':urhrfrufrtnir'lfiirrq
rflrn*nuar',,:ndrrld .t.lvlnrudirrorcuoiinr:drunnc[[ Rfln respiratory waveform lourriuirgrr

druldri a a rioldrn4o.rrir um a'h

rfi mosfl rmr{crn rnia.rdrurtrste
1. r'ljnnlrltturtflnn (scalar graphic) rr '!!iu

1) Pressure-time curve tfluRmrifuit'u5:sljr.lnmlnuun;trnr
2) Flow-time curve lflunttldrrtuf,rvy'jr{dflrrnr:ltnro{arnrnrrncrrnr
3) Volume-time curve rijunrufirrYuf,ryndtiliurnuonolfl 1fl !!0s1?fl 'l
;:Jn:rr'lrurra (loop graphic) u:-iltflu
1) Pressure-volume loop tfiuRm$Ilfufr:rjrln'ntduuny:J?ltnaralorntfi
2) Flow-votume toop riunrrlitrrfuf:vu'jrudn:rnrrhaso{ornrR[ncil3rrnfli0\t

E1n1Fl

' uarruio,t resphatory rta\€fom intetpfgt*ion ilrFuf.l qtmnarrulol basic reepiratory wawi m intspretation

dof,filfll ronlunl 4fifir4.1rufnri rfirfi4n. u::rurinrr criticat care : Tow?rds optirnat prefsction. n1,ltyt r :

:r.iuouf r6lrvraflurd irn-n: zsoz. nfir 3lg.38+

416 rrudrfalnqnfiugru

-t '6XlXiiYrUSTrt:0{',lilclfl 1?Yir.otra{m4a\tdxu}nuh

tunr:druunlt:Jnrus respiratory waveform ohrfludotfinrtrf tiol'l':l: (phrase) fl0',1

nrrril{ruso.: tndoodrunr uh dt cur':n rrri.ildrfl u o :ie,r o-.:d
1. Start of inspiration lflutir',llrnrnr:n:;{u1fi inspiratory valve tiln
2. tnspiration phase tflurirm;uvtrn1vn":fi inspiratory valve tio 6'l parameter setting

'lu pnase dl vsir,:fl"ulu uda: g"tJ ttll nrtit unr:rr uto 1tode1

3. Inspiratory pause tfllrixtvu;nar'iunr:firu1er{T udeLiiornrsuir d.rlunrr:Jfu$

rinrfi nriurdafi n'rtior plateau pressure

4. Cycling from inspiration to expiration (l to E) rfludxn:lu;ttord inspiratory vavle

iolrns expiratory valve tiltiin fi.:fudq:rirli inspiratory vatue floo:inm.lmndllfiulurrtiav

modelqu Volume control ventilation (VCVJ mode tflu volume cycling, pressure conirol ventilation

(PCV) mode tflu time cycling ttflv pressure support ventilation (PSV) mode tiu flow cycling
5. Expiration phase tiutirltrarlunr:lra'tloan d,l rflunr:nrulcdru elaslic recoiltgu

n ruhqrnr:r',toncvd.:DJru1t.Jfl'r expiratory port

6. End of expiration rfiuritduqnao.,lnrr rutoaon ntoorlrudlunrrlniuouti lzero end
expiratory pressure, zeee; nialldrunrrld'u::ln (positive end expiratory pressure, PEEP)

frtfi

qiolJdq:nritfio respiraiory waveformluf,,:h#:JonrJnfiriiofio,:ldlLrnr:tirunrulclu moce

6'l{di

:t,:lnrrrrlernrfiiruillshf,xs VCV mode

nr:riri,rralcdru Vcv mode tflunrairwrulolcru'ld votume controt {fudtrir tioal volume
n,# iofirir peak inspkatory pressure (PlP) ul6uuttiln.,rlJ rrnvduqonr:nrulolflrtrto tidal volume
'ldo'.crirrrru (volume cycling)

1. Pressure-time cu*" lou pressure o{unudt: ([rnu y) rrnt time adunr.ruau 0lnu x)
lunms:Jn6 nrn{:-lruhjn'r:{urn{sotirunruhroo d'nuruvts,': pre$sure-time curve e;tiutdu

lfudul Tnulnglqn:ro.rn:rlrl6a peak inspiratory pressure (PlP) d.,lfionrru;ndrunrtrinronu

(gtlfi t1

nroii{il?ufin1rnr;{u (vigger) rnlo,trjrufilutl 1: u negative deflection turir'':

fiuro,: pressure-time curve d,: negative deflection dr:iinrrlfinrrnriourfiu,:10 duaqjniuurn

flo\: pressure trigger fiifill t,un".ndri,:d,]riruroifirirudo.:oonu:,: rdo{n-lnr,:lio inspiratory

valve 6r ?u ld,rr qlu4ei"l'lufJr.S auto-PEEP

nrrffirnq negative deflection ii firJ:;lffidtufi:Jru'iifi neuromuscular disease !?iu
myasthenia gravis, Guillian-Bane syndrome, severe electrolyte imbalance (l!u hypokalemia

Respiralory Wa\.€form Interpreradon rsn?uni nfrfifig 417

t

gli t uan,tanualnan pressure-time curve lu vcv moae daffiJealtildmtfiu (trigger) miBndvr

nlalc

afr z uaa,t pressure-time curve Iu vcv mode dfinzntfiu ftrigger) niBnduttu'lq '!fi#,tnn

negative deftection ul nra:"tnaxdutlzz diuss,tdinttntz u niaitjtavlulq

hypomagnesemia. hypophosphatemla) 1n pressure-time curve tirfi negative deflection r!fl6.1

'jr{:-hufindrllrdolunl:n1!'ledr\:luldn'du rdo.rornour:nnr:durnio',rdrurruhld 1;rlno zy

tln:rfififinr:ld pEEp ?; uj1 pressure-time curve evg{dun.j'tnuf rfiomrn peep

rflunrrrdudrirtrunooari.rtudlunlrfi,tul,?rd.iuayfi,tuhoan Tnurio pEEp ri'r.,:ru'lud.l,rnr:

vrulordl c:drlfi ptp gdu turru;d pEEp n'1.:1u'lud?{n1s .ru'hoon ccyl:1'lfin{flrJ (atveoti)

nouuru'hoonqolrirM:Lnr 1g,rJi sl

n:nififin, *fi pEEp lu VCV mooe dfinr.iqyr pressure trigger deu rdu n:rfiiifinr:d,l
PEEP 1O tr,rir rrnlsrs,: pressure rrigger -2 mr.rir n-rriu{:-hUruoon rn,)qln pressure 10 rr.r.fr

run:;r'l pressure rrfio g m,rir rniasiruuru'lcfil:iraarnrnlfi 1;rld +1

2. Ftow-time curve lnu flow otjunl y unt lime sriunu x firrflu ttow l,urir.ryrahrdr
n?1y'lcsogtuunulrn dru flow luti.rryruhssn n:.tvleroEi'l LLfluflu ldo.:crn itow dld'lunr:
muhrdrun:ntlnu'lcoonlsufifinvrr,ifin:tdrlriu lttow rfrurJlrrrunrfifiqvro {oLflur]irJr[u vector)

418 rlnirrioinqnduSrr.r

PEEP in VCV mode

sVli uaat pressure-time curve lu vcv mode dfinnit peep

PEEP in VCV mode pressure triggering
P

IgJi uaat pru"ure-time curve lu vcv mode ifrnzatt peep 'luzrutistltuoanunnxEu (tnggeo
n72a,nn1afl1an

lnunir,rucr'lfifiqvrr{fl0n ttow'lunr:rrutor{r {itfifinvr*rrrnrnCo.,:rirunruh r{r{n-r{rJrufifinrflu

lrn uo:fi6mrwo.,l flow'lunr:mutrDsfl dlfififlntornri'rdrtrslilftii'unrsloaonfifinriun! lu

VCV mode atqn.: flow waveform [:.Ju square waveform, deceleraiing waveform, sine waveform

tuvrr,:rJilGrinfiuuld square waveform flia decelerating waveform fitorotflu half deceleraiing
waveform fiia total decelerating waveform

dru flow tudrrrru'loaon'lurfl mode riu uia'rernnrfl,rrulqoonrflunrrr.r'ru'lcdrfl
etastic recoil to,rd ru lunm;:lnfi nr.rtrutoaan'lutir*r:no;fi flow 10.i0'rn'rfioon:J1fl 'lusru:fi

0lm1uleoondtfid.,nvil flow n0{a1n1floonfiou d"rriud'nsnrvn:rvflurir,,:urotcaan6,rin'nusu:
tllutflutn{nu

Respimbry 'Wa.r'eform Interpreration on?uni *frfrfig 419

5srt utnt flow-time curve lu VCV mode dai,t "qu"n watufom

Flow

pi e unat flow-time curve lu vcv mode tda/,t harf decererating waveform'lrtilttnnitfuaduqn

to,tnttnlalcaan inspintory flow raa anaifln aaiwffu'/an pfrtk inspiatory flow ulte

grt z uaa,t flow-time curue 'lu vCV moa. da#t tulu,t decearuting wavefom lt&nni.filniiu

qarr^tntmll'le aan inspiratory flow rate flaan.fifrBfrud

4iX) ntrirriatnqmdunru
3. votume-time curvE lnu volume o{unu y rrnv tim€ olittnu x tfid,rrnn'irdloduqa

n0{n'ut11u'lcDon fl x'tuleoongsdDitoon n rirhl votume rr'l6o6urI

$l e uga,r volume-time curue Iu vcv mode

fi1n{thufi!t':,il1uleaonii rsru'jrnnr.uvtoit volume-tim" "rrv" iloiiuqoaolntmru'h
aonlsflofl.:n'rn'irguri d.rdioqa'nururrtnf,fin :vnorLdruir{ilrunruhflur{udniltnio*riolri

fin'nrru;so,"nrt'tsndrilrdonrulcoon (lorce exphation) riolri

Volume time curve

pfi e uaa$nriuzflan wlume-time curve 'lu vCV mode dfr active exhalation

Respiratory Vravefom Inrerpretation @nll!f'.Ii nfrfit1rg 421

grJn:tlcrnnrnirmnrsledrs pCV mode

nr:riru ralcdru pcv mode riunr:rirunrflleloulfi pr"ssur" contror iilfodr inspired

pressure (lP) n,'rfi 6.,rfieir tidat volume rrjduuu:ln.,r}.jnrunur6cnry|tar on llncdugnnr:rlrij'le
t{rrfio inspiratory time ldfi,:rfl1xrJ.ru (time cycting)

1. Pressure-time curve dnurunrar pressure-time curve lvtflurdulfi.:dul:J lr,ur:uy

nnrfil'fifi.:uci inspired pressure rrirn'uquffio inspired pressure riryrrri riunir pressure rise

time (P-ramp) rfiald inspireo pr"""ur" mrrdfr.,rrrdr rnio':dru?rutrq:finrunrrrtnlunr:at

peak inspiratory pressure ouR?vri'.'rfi'uqctrrormulorfir o',lriun-nuruvrot pressure-lime curve
cyfi a"nu yndruyr,:!aranlrd"n

Pressure

nfi tO uaa,t pressure-time curve'lu pCV mode

vrnfi ruaur:nn:vdulnCa.rriruvralold fil:ula-nuuvro,0 negative defrection rrjur6br

riu'lu VCV mode

ttttlii u*a,t pressure-time curve Iu pcv moae i{thua'tunnnz:(umladntw?sld 'lrtilonn

antnJt' an negative deflection uittruNnaudutlzz i,luaa,tfnvanat prcssure triggering

422 rrr:rirfoinqnfrugrl
lun:niiinrdd PEEP fie:fidnrru:niurdurriu vcv mode tfiu,tttdn'ncru:ta'l pressure-

time curve r:fi n'nuruvlfl u;:Jfi l'laoltJn'6

tzgrli uauo pressurc-time curve'lu PCV mode fifint{li peep

2. Flow-time curve tiiolernlu PCV mode Ljf,1 r:nrirruo peak inspiratory flow rate

ldrvfiou vCV mode o-.,ttiu inspiratory flow rate 6.:duo{rYlnxltJdo.:nmflo,:di2! (flow on demand)
or-uriu flowtime curve irfinnuru;lflu decelerating exponential curve dtloduqola.:nr:lruleoon
low e:riluquriniolilflld duriu inspired time drfioli nrnsr",il{6iurfiu'l:J ttow d1u#t qnla,,rnr:

nrfltcrirfic:lrirfluqud n'rnfi inspired time vto[l'ttJ1: now dXnduqcrno.rnr:nrltq r{lfio: lflu
qutiuad rrn inspired time dertoHuurhuh ttow ot rfluquridriouloduqototn.:vruhudr eu
n::fi.rduqo inspired time firf,rli d.,:lurir.ldol1rifi ornrerr{{il

Flow

nXtJii unat flow-time curvelu PCV mode dtmndtJcln vcv modelaa'lu PCV mode invuvta,t

flow cziuirJanxfran'nn$tha fftow on demand) fuia'nuruztfiuduldlarluthtutalc

dt Gunh decelerating exponential curue

Respiraton \ff'avcfbrm lnterpretati(ln nn?Uki nfrfrHlr 423

pd u uaw flow-time curve'lu pcv mode'lrtdtnnrtnaazsa,t decerenting exponential curve fit
fiutia,t[d,ta,tluzruyiifrntznt lcdt aixti, vCV moael d,tfifnunzfiudusz,r uaz'\fr

ffin adladuqanatntzntu'le d1 raw bi iluguti fi,t6nc.tnntznt, inspired time iiiiurfiuhL

ttJi ts uaat flow-time curve lu pcv mode flfrnzdt inspirea time u.rufiul ?frdtnni't ttow 'lu

tiz,tna'lst$naaufluauririnunniuqanulodt latcwulffiu inve*e ntio ventiration 6ntfru

iufin t t ntt mi o,td n n t u'l qTo uI n a n e n rt'l q tfit u t n n i 1 n s tI u n n n t u?e a o n,t
3. Votume-time curve lu VCV mode fio'nuruyndrun6,,rfi'! vcv mode
;:Jn:rrrlernnrnirsillstef,?s pSV mode

nr:rirsuru'lofiru psV mode fi.ofiarflu spontaneous mode nr:#{rnio,,rtirarnrfltlc:frY..l
rir pressure support (ps) {i.:q;ld tioat vorume uqndr*lflul:Jor:lvrurBonrvrzo',:llon rnio'ltirr

vru'locsm"o fiuri uruhoonoiardo row non,Jtuti.lJyrutrrdrfurnrursfirilruo1ounr:ns,r expiratory

trigger sensitivity 6,: tflun'nsrucla.t flow cycling

ro4 renirrialnqndugru

1. Prossure-time curve ovfidnurucnf,rulYu pressure-lime curue 'tu PCV mode 6.rii
dnuruv lflqrJn, ,,:rJfl1ofl1 n"o

+P ramp' +P ramp)

rc7B uaminuusla,t ptssure-time curve Iu PSV node filifrnt& ?PAP 'rJaz.7a171n pres-
i*dl issurE sopp ott titn'uquhu6't ptessu/e support
6snh pressrre time (P-rarnp)

n:rf,dfinrrfr.r continuous positive airway pressure (CPAP) Qv u'i1 pressure-time curve

unq\rn'j1dil baseline nnofi d-rldnnrzlh,lrulo{ CPAP lu PSV mode l;rir':1uRfirun6l{fiu

PEEP.Iu VCV fi38 PCV mode

PS = Pressure suppod, CPAP = Continuous positive airh€y pressure
PIP = Peak Inspiratory pressure

gld t umt p*r**-time curve 'lu Psv mode ifrntit cpep i'tudttt '\fr#tnnh p/€ssur* time

cuve c:;unnintfru ba*line tts\nat rlrlssure support (PS) lf,lui,tttrrl;rrt'anao CPAP wfrn

PIP

Respimtory waveform Interprcration nnTuni {frfiarr ,l2S

lrtrrirnr:nl3Elurfiuui:J pressure-time curve tun:dntd,rrflu non-invasive positive
pressure ventilation (Nppv) drfio'nr*rus pressure-time curve niur6urri:.1 psV mode dfinrrffi
CPAP i,trJdlu ud::n"rrgr inspiratory positive airway pressure (rpAp) lilriud,rudEuftufi,r
PIP do[nnoir{crn pressure support drilsY,r ud:co-u cpnp qufio prp d?u expirarory positive
airway pressure leenc; o;rurufi'r:;d'u pressure 'lurir.lrrutroanr rusu d,,runnrir.olrn cpnp
d,: tfl u pressure finodnooern".r:ir.onr:uruhrdr un:nr:rrs'hoon

IPAP = Inspiratory positive airway pressure
EPAP = Expiratory positive airway pressure

ttli tB uaat pressurc-time cuve dalfr uppv

lunmidinr:nh pressure trigger rio{r]rrarrr:nn::{u (trigger) [a?o,lri?u]fl0'le

'tdro.,: ocfiohcfu: pressure-time curve niurfitrnil pCV mode
2. Flow-time curve rf,o{Qtn pSV mode Lif,1t|r:nd,r peaf inspiratory flow rate -ld, s-,1

riu inspiratory flow foduriunrudo,lnrrla':{r-hl (frow on demand} r'rfidnrru:rflu cecererating

exponential curve tfiotltn psv tfu flow cycling ventilator d,rnrnualnunr:si.r expiratory
trigger sensitivitv (rrs) TotLJn6l;n11in' 2s% rrrrnrrrirriio flow'lulrucyru'lqrdlann,:ou

tnda 25o/o nan p€ak inspirarory flow n"{du Tat inspiratory varve q:ilollov expiratory varve ?:

rfln 6,11nfi*uonuaonr:muhrdr flow o:do.,.rflrnn'jrfiutreila rfroscrnlilfinr:dz,r exprratory trigger
sensitivity MrrYuquri

tdof,,r expiratory trigger sensitivity rirdrll riu rvrirerolfi inspired time llflv tidal

votume sirtniu ei,rd

t) rhd.: expiratory trigger sensitivity go rtiu#l ETS 30% eJ !i.t ftow cycting d'a

rirn'jrnr:otl Efs 25o/o n-lucu inspired tme ryduao drHohi tioat volume dld,

n9fl{

z) dr#,l expiratory trigger sensitivity dr njun&.r ETS 20% i;yttljr ftow cycting n-or
Srn'irnr:rY,r ETS 25% ohiu inspired time lcurrdu d,:ru0lfi tiOat volume ndld

ltrnt*u

426 rlud1dninqfifiu$1

gtli tS utat flow-time a)Ne Iu pSV mode Tau PSV mode tflu flow cycling ventitator frtriuuo
Iauil expiratoty tigger sensitivg ETs, E-tngger) Iaatlnhqzit ers lid zsv" 14u'tsn21u

i'ttia no* ana,tqum1a 25% lon initial peak inspiratory ftow urt'l inspiratory valve 7Jf,n

ual expintory vatve cztfla

Flow

pld zo u*ntnetJ{u Ers ririt,t l dwtfranriarit inspiratory time LLsr tidat volume:fro1Jiu ETs gn
t-time iu tidal volume aoa,t tia iu ETs i1 Hime utt tidat volume tiuiu
3. volume-time curve fidlnuruvniut6utn":..1 volume-lime curve lu Pcv mode

nflr{no.lffiD.rrirurnutelulfucdfi nrr{o lung mechanics

n'nio tung mechanics finrrldrn'rglunr:finerr*rrHrr;r"':{rhuiildrolo'rtrufiru'[e rfia
iarn'ulltirfln ven'tilator induced lung injury UlLl) ddlargl;ltri nr:,tTo phleau pressure ttov
nr:q:min auto-PEEP

Respiratory \Ya\.€fo.m Interprerarion $n?unf rfrftftg tnj

nfl rlrro\r mio{riea}r,lshlusil# fi nr:e-a plateau press ure

nr:sr:rtio prateau pressure l4io arveorar pressure tflunrtnfleionrrrnriui::ri'lqtnr|
drfifflr.uuflnd6ofi'un1l!fin barotraumas hnrttilr:;{.:{rrrui'ldrn3o,:rirurrulo lilnrrlfi prareau
pressure rfirn'ir so r:J.ti', Iou prateau pressure finrrrdlrriuf,riu pear insprratory pressure
1Pte1 d':ctnr:

PIP = Plateau pressure + Airway pressure

Airway pressure ludfllildnlnufi.r peak airway pre""rr" fiirfl unlr:.rvrraoeirun{r,r

!!d ain*ay pressure'lufrdfinrunrruadr,runl ndrr6oumufionndr,.:ro,r pea* inspiratory pressure
l!flY plateau pressure

'lunr:io ptateau pressure r.r'u ormtnnhnrrtnlAaid

t , r:Jfiuurlur:.lnr:rirunrEJhrflu VCV mode ldo,rernfio.{finr:nhfiuari.r inspiratory frow

rate Trucrint:io prateau pressure ttwflnld pr"ssur" contror mode e ;'hiour:nrirrun
inspiratory flow rate ld

dul2, il5! high alarm pressure ?Jx.tru ss-oo su.tir rrnnrniifia,:r'nr:rjiu high alarm

pr""rur. dul rdo',ro'rn anr:iifinr:iq prateau pressure da.,r :1u inspiratory waveform rflu square

waveform fr.,rner'hi peaf inspiratory pressure nln.ir nfi

3. rJSr-r inspiratory waveform riln square waveform tdollrndo.rnr:tfirfiunrurrondr,,r

::'tlit.l peak inspiratory pressure tlfly plateau pressure oritetotou

4. nhrun inspiratory pause (ptateau time) :y 1ru o.s-j.o iil1fi dwirlfi tow'luvrr.l

r6unru'lcrflufiud nhtfi airway pressure rflufiuf 6{rrfio uninrrro'rdq,oar (atveotil rvirriu rirtfi

ntuo'ttvtn::n"u peak inspiratory pressure nflfl{ 1fi prateau pressure'hid.,:rnn,jrtruvfilirnr:1ai
nllplateau time
flow-time curve ltfi flow tyirrYldurj

5. dlud1 plateau pressure

rdarirnt:n:rer'a ptateau pressure udr orvnnrjurirurrurirrirrl ldo-.rd

1. Lung compliance
2. Airway resistance

nr:a'rurorcir Lung compliance

Lung compliance lfluortlflrlr:ntunr:rutEJn-r10,: oo d{nr:fi:Jonezturud'xldq:

fi o.rfi nr:rtu1udrta.rruri.,ryr:.:tondrrd.la ololnr:

1/Crs = 1/Cl + l/Ccw

428 rrttirfnlnqotdugru

Io

OJ

.E

{l

tl)

o-

o
?(f )

(D

.E

3

tr

ali zt uaa,tnzin plateau pressure 'lrtfunnitdaitnttlai pl"tt , time (inspiratory pause) 1z
i fi ttow'luzzutanaun1agui uaztiavhnnln plateau pressure dtufrtflu plateau pres-

sure iufraufruduntt vtnlifiwfrunzr cvlrildqit ptateau pressurc frufrci,J 6,latq6ann
ntzld otateau time ltiuuua nia 'flnc1n nltitto,tztoztiwnlml alc

Ierui Cr" nlrafi,': respiratory system compliance, Cl fiulun-\t lung compliance LLn:
Ccw mlrufil chest wall compliance

eir plateau pressure dinld rfl unnr,]1ln Bn r!aYellf':1tl?"on ldo,J?1n'tur'lo:Jfr n61ri
dtrt:nt-ff compliance 1o{:Joettn: compliance lo'tnti'ttl:':,tgnuuunElnfiu'lfi tulr'rili:lfiilin
tfll respiratory system compliance il''rriun:rl'jr lung compliance

Lung compliance tflunruour:ntunltfiolu"lunoirloo lflunr:r iu:Lrfi ul ilrn:tol

rlondulduuurJn.,reioallrrd'uiinJduuurln{ drnr:uJduuu:larrflunr:r 3uu rfiuulurir.nrru'hrirqn
(end of inspiration) llffvd'l\:v'lU tcoon6[6 (end of expiration)

Respiratorv Waveform Interpfemtion nn:Tuni nfrftfiT 429

Lung compliance = AVlAp
= lung volume at end ol inspiration - lung volume at end ol expiration

(pressure at end of inspiration - pressure at end of expiration)

= exhaled tidal volume

(pressure at end of inspiration - PEEP)

Tcufiar rtnu ud1 pressure at end of inspiration lddru6'r z eir6o phteau pressure
fi,lfiorflu static pressure ttfly peak inspiratory pressure (plp) fifiarflu dynamic pressure n''.r
riuqn:lunr:ntrurlu lung complian"" nt'ld pt"tea, pressure dltflu static pressure 6,rr3un.jr

static lung compliance unvgn:lunr:riru?au tung comptian"e d'lfi ptp 6.,,rriun.jr dynamic tung
compliance

Static lung compliance = exhaled tidal volume/ (plateau pressure - pEEp)

LjITTIT ""mFliance = exhated tidar votume/ (ptp- pEEp)

Iaufi ptp fio,ro.ln'jr ptateau pressure rcuo vti'hidr slatic lung comptiance f,\rn.j1

dynamic lung compliance ri, n6tal static lung compliance 6a 80-100 riayll.rjr si,rurir

!nfi1on dynamic lung comptiance 6o SO-8O ilo./fl .li1
lu{r]ru oUstructive lung disease e:fid'r ptp q{rlfly ptateau pressure nh d'rriu static

lung comptiance l;fi rdrrq'oudroilnfi lu:rru:d oynamtc comptiance o:fi rdrst"r
tuoit-hu restrictive lung disease ryfirir ptp d\r[[ay plateau pressure 6hr loud ete g.,r

n'lt plateau pressure rfintiou d'ofu static tung comptiance d.:fipirsth lugru:d dynamic tung

compliance fi rirn"rnirrfi nriou

nTn"1u?6un"l ailway resistance

'lunr:n'ru':ruiir airway resisrance lawn; ldnmrf rdo.rduornirr\,ifl rn::uc

u=; -l

e"rn v {i.r!flu6x1rlsirldndtuitildfi"lnrtrrfi luiili V 60 oressure i nnnsir,,:rYu::y.irl

PIP [tRs pialeau pressure dtu I iiunrrufi,rntsrrob'{flr luidnmufi.: inspiratory ftow rare rLflt
R fi.rvlrtfilntrlfirltrulatnron-rutr luirtdvilrfl n'.t airwav resistance

PIP - plateau pressure = flow x airway resistance

---lAirway resistance -- (PlP - plateau pressure)/ inspiratory flow rate

430 rrttirtiolnqmdugru

14 ?ura.i airway resistance 11rld n1l91-nfld1?d1,odu6o gil,fvfin:Alrfi uoivr-irulrnqru

roi airwav resistance 6o tu.r.hrdnyiurfi s',lliuioortJr:nn'rurruldrrnolnr:

Airway resistance = (PlP - plateau pressure) x 60/ inspiratory flow rate

firngruvfi'l-n plateau pressure 'lu vcv mode riiafinr:gts.triu square waueform lounsl
ri1 peak inspiratory flow rate lvirr.ll oo fin:,rurfi rfiofr'l:Juludro n'r:ir.:du f,ur:nniurrudr

airway resistance ldu"',rd

AiMay resistance = PIP - plateau pressure

rir airway resistance ii4t rilu:lrymrfirfiqe'tn airuay touorqrflu artificial airway rio

rfior, n natural airway dltiuul,tt6urnu'h'luo"r{rJru niu bronchospasm nfi airway resistance

dfiorlfiilnr:ufib6ol'rnn'jr 12 rl.r,uYrlfin:/iurfi nt{dtririrnr:sr:rtgrhlu ventilator circuit,
secretion. trrolarviodrut'tfltq rtocltrtrfifl,i!onldoifiqdu bronchospasm

nx'rr'lno{ raio\:tiesilrs'le'lutru#fi nrdn auto-PEE P

tu{rhufifi auto-PEEP ar r:oq:rcificduldqrndn}rucarnr:rr.rn6fin irlri:t

'1. Pressure-time .rrv" fifinlirsilduto{ peak inspiratory pressure otjlrdardo,t
2. Ftow-time curve ii{d.:rnsrldrrnloduqototnrrfirulcosn now rvhjrfluquf

r3. Volume-time curve d{ecfin fir,r'ludr,:vruhoon rda':crnn aonl a

rdomrn auto-PEEP tflu pressure filriuaqooanrflu extemal PEEP urn'trifinr:io rui

auto-PEEP rflu pressure dttoor.:oonufru peak inspiratory pressure iirfjllrrnt*uadr'rrio rda.r o'''r
r2iu,1luvrr'r:Ji:JFnrndo':nrris auto-PEEP firniuau ocdo.tlirnr':ilnrSoqa (occlude) expiratory

vatve 'luriro'lnfinr:nruhoonqc louri'rlilldrra'rrJrc 'rru 0-5-1.0 iurfi rijorirnr:flo expiratory
vatve qvdr'Ifi ftow rs.,rarnrfirfluquJ drtfiornrnnqofir lrifinr:lnaflo.ro'rn'rfi itour:nior
pr"""ur" ld d,r6rn pressure diald'j1 auto-PEEP (gilfi 22. 23)

nxlilfio:Jnf,na{ pressure-time curve iiuu:jou
1. Force inspiration lfinrdolern votume fiia flow dldcrnrnia{tiruvru'lqbjrfiu'Jv{a

flinrrrdatnr:la.,r{ilra nilfirihrru: pressure-time curve fin"nuruvtirnJ lrilflulilnril curve ii
n1:c: rflu toud'ttfiliro,,tto.: pressure-time curve ore tfinlu?ie,:tono,tnr:uru'lo tf,rfi^1d nrtinur
riorlnm;dlfiinrrorrorrnq Tnuravn:orrnqfirfinorn metabolic acidosis irrrfunr:rhluraia.:
rirunu'h'hirnr;flr Tqunrilix tidat votume'hlndrdu nn!5u tidat votume udrlri\dHo 1'frr{r

Int: tfi inspi ratory f I ow rate rriinfi qt:n-lrldo-{d

Respiratory Ii'ar.eform Interpreration aon?uni gfrfrtry 43l

Zg.fr uant p/ese/re- time cuve, flow-time curve, volurne-time cwve dugwa-ntuJaot auto

PEEP Tna pressure-time curue duaadlnaru;lllamtzrixiura,t ptp atjwaiatdar @$a,tlil

tJuznalulu) Ii{tnndtuil pressure trigger watniuntul dzu ija,ntn auto-pEEp iirt

Lfrn wort< of breathing xlnfu'lutiNntzntalcd't dtntuJdauutha,tsat pressure-time curve

a m 6a di n atu.tu tiu fi nhIx,t

1) VCV mode rJil nir tidat volume rrnlrilfirualfirfil peak inspiratory flow rate
2) PCV mode rJfurdl inspired pressure r.flotfirfinn11rJll6ftd.]n:i i,t.tntrJ6'ura.rlnio.t

rirnl:rn"u'lut:r,ronta.:firirulrnrlu lrjctrr:orliu inspiratory flow rate ld rfi8.,:?1n

inspiratory ftow 1u pcv mode durir-rnruds{n1:no{fi .1u

432 rettirrial n q nfrunru

Exf irator{ pause (hold)

gli n uant p/essure-time curve tta.- flow-time cuwe tiofrnnia auto-PEEP 1fr#tnn pressure'

time cuue lnlndluuul d end of expiration otfi square wave fioiu d,tnztxgwa,t sqrare
wave floflutn'iat auto-PEEP frinld uav'liffinn flow-time curue (n1nd1ud1,i.) 'lutrufifi
n1i occlude expintory valve czrtt'\fi ttow duquiluriufr fiuntzqnatntal Trtaannn

nttfiuntult irauttoia auto-PEEP ld ntnlilfrfrnfia auto-PEEP'lwh,sntaltaon4n

now frwhiuafigui

3) PSV mode rJiurdr pr"""ur" support rfio'lfirfionmetunnsiro:sv'ir.:nrrlduto't

rn4o.r firnrun'u1ur?x\torlto{{i?uundu hifl'urltotJil inspiratory flow rate
ld rda.,rrrn inspiratory ftow'lu PSv mooe dun'lnrrldo',rnrrto.rflrhu
x1nd1n1?ufil nunrrrjirrfir tidal volume rtatfir peak inspiratory llow rate ttfi1

hilfiHn oredorflinr:lfiu'ruou a-u (sedative drugs) n?otfiurttiaunfirl ldo (muscle relaxant)
firoirflu 1plfi e+1

2. Inadequate flow fl'ngruvlon pressure-time curve'lurjrl inspiration c:tiJutdun:.t
v6orfiorriutdusr:,,1 r'rdu vcv mooe }irirnr:rrfiblounr:ni:t peak inspiratory flow rate (l

fi zs)

Respiratory \[ra],efom Ifferpretation 6n?unf nfrfifir 431

zlgtlfr uant pressure-time curw lwiNnu'lltil *f,n.naaawat pressure ntwdtuuu uflnnn.R

f,ndrttart p/essure tuzix mia-inspiratory phree nlwfrludtt u&atnttaoattat pre""ure lu
i?n aatly inspintory phase

pl ii,tZe umt pressure-time curve lu VCv noae paak inspkatory flow taa litfrHnflo 6u

tzuant inspiratory curve ialnztfru

434 remirrialnqnduyl
3. Upper airuay obstruction dnr*ru;to'o pressure-time curve lu:irt inspiration tilu

rfiun:.oniorfislrflurfiun:r tdamrn pr.""ur" e;duldfirdoi obstruction d.lnlldlu4n mooe

To{rnio,rti?8fl'lulc

+p On PCV. PSV
I

I
I
I

npii uant pnoure-time cuNe d6n\u upper airway obstruction tdutl*uaat inspiratory cuve

fiattczfiu
4. Lower airway obstruction n'nururta.l pressure-time curve ttfi o't1tJfi qrJn6lurir.:
nrtnutcoon 1qu6'nuru; curve elliutdrnrn i,ltJtY:J expiratory time u'r?oon ruidlufi,:Jrufifi

bronchospasm

ztgrli utat prcssure-time curue 'tu{iltufifi lower airway obsttuction '1fr{,stnni'fiudt,tnizn'tu1q

Bfrn curve lZaUULilUnln

Respirator Waveform Interpretation nnirlai nfrfing 435

5. Inadequate pressure dse time tun:rfldns,,: pressure rise time dlrfiu}J er li1fi

nr:rfirzluzo,: peak inspiratory pressure turiltu:nrornr:fitu'lo rfit ufihld'TnrrJlu pressure

rise time (P-ramp) 'hiorroan

P

t

i*tglid ze umr pressure-time curve lu pcv. psv mode pr"""ure rise time bifiltna ?fi#,tnn

uinruztaautrtu ez druaotit pressure ydunitiinnwtfru

6, Too long pressure rise time hn:riiiifinr:gr".,t pressure rise time ttrurfiul ecfl!,j.l
f<inr:rfdiglfiutar peak inspiratory pressure drn'jrfrnrfi:rflu rrfiltloun15fln pressure rise time

On PCV. PSV

I

I

tI,

8Fr,t.1 $f,n,t pressure-firne curve fifinttff't pressurc rise time utufiultl 'biffitnndu tzdiugntfr,J

curue nanalliJIUU

7. Too long inspired iime a-nuuvdrwlu pressure-time o:finr:tfiltil,rjo,l oeak
"r,"ve
inspiratorv pressure 'ludrlE'uqqnlrflru'hldl rda.:rrn{rhunra'haon'lunru;drnCa,:rirarrulq

iollitiruarnrqr'ru'hrdrati orrlr:nrrfiblnun'l?on inspired time'lu pcv mode expiratory

trigger sensitivity (ETS) 'lu PSV mode

436 rrtdlinlnqorCug, u

ugtlfi fuinton,ttiparc{susmuret-tipmeeak"uins*p"iraiftoinrynpirtesinssup,eirc'ludztiiNmdeutqt1n2tt;afiu,shnlf'llnidu'tlcndwt inruxnaudu ttii

n"lilfinilnf,to\r flow-time curve drturiss

1. Bronchospasm dnurucflo,t flow-time curve ev11!'j1 curve'lurir,tnr:trrL'lcoontflu
ldun?.,: ttas expiratory time ulxoan tda.:?']nnux'tuh0onflflnd1 ttiludlitililtduld.it*unuiln6

uptd uaat ftow-time curve luSttzuifr tronchospasm'llf;thuili vcv mode, sguare wavefotm

'lfid'tnni't curve'lutit,t expintory phase cvtfludunlt
2. Auto-PEEP a'nuru;:rs't flow-time curve vtlJil curve tudr.ofirutqoonqolrjtfluguri

lnu .uro-PEEP arlfinrtnntln"l expiratory time durfiu'bj tidal volume rrnrfiul tioaro

tfinttn bronchospasm flld
rfreru{:haiifiiryfl'r auto-PEEP 'hhi'tnr:inurartrqriau nir.r nrmqlrn bronchospasm

tfirirnr:fnurdruulflu'rufiflonnr rl1n bronchospasm tfiotctn cardiac asthma tfirirnr:inur
draard'rf, ocmv nialriurjiurnio.:rirunrshtdooonrlfi q auto-PEEP d.ld

Respiratory \;raveform Interpretation nneufii nfrfiljJg 432

tlfi 32 u*a,r frow-time curue ifr .uto-peep Lu{,tltufrfr vcv mode, squarc waveform ?rtffinqi-r
nrtcurve luri^sma'lcaanqohitflugui luinruzonaudu tzl
auto-pEEp lufihanuil*i
'ldfinetn bronchospa". uialcln curve TuriatntzntalqaanhtfruduTfu
rtadfinctnntznto expiratory time lsjtfru,twa ud "rto-peep ?u

7ld ss uaoo fl'oluwd-tzimoneluculcruaeoinfai n"uliftiou-aputtipn1lu1hzJuatudt?of-ipEvEcpv mode, square waveform ?rtdttnnit
curve 'lufritzafladhnctn bronchospasm

tfra,tqtn cuNe ?utitinmtsle aoniotflwiuaz,t

1. an tidal votume rsiann:l5rrmo fifir,:stoudrrrruleaonoa

VCV mode'hidrnltnq tidat volume o{

PCV mode hirirnrroo inspired pressure fiioRn inspired time

PSV mode 'hin"rnrrnn pressure support riatfil expiratory trigger sensitivity

(ETS}

ltfi expiratory time rfi arfi trrndtiolmahoon.:arloanld
. VCV mode lfidtnr:rfil peak inspiratory flow rate yiorirnr::Jfr.r ftow waveform

liatfru half decelerating waveform square waveform ttrinr: illflu square

waveform fidanr::vr"t6arirtfr peak inspiratory pressure g,rdu

438 ntdlininqndugru

. Pcv mode tfiri'tn11on inspired time nl nio:1fi-r expired time'lfiurroon
. PSV mode'hirhnlrtfi expiratory trigger sensitivity (ETS)

3. oet respiratory rate dliatflunrrrfil expiratory time i6ud',r

o VCV mode uflY PCV mode f,1x1?0aq respiratory rate ldtetun:{ {i,rur.rnir

orodoold sedation drrfira

. PSV mode Linur:nna respiratory rate ld nr:rclu moce ftrifinr':ns'r

respiratory rate

3. Secretion n'nuru:to.l flow-time curve ?;1!!'i1 cu*e hiriul fin'nugu:nfiraflurdou

ii.rarcrfintulirrnrrfilule r{1 nlff1uhaan nions.iao,tdr.rfld lou secretion dvuorlfluflqnr

ornrir'lu ventitator circuit ria secretion tu r.tlfiunrulolo'r{rhuffld droronuld"lu{ilru neart

failure, pneumonia, lung abscess, massive hemoptysis

aJd 31 uaar fto*-time cuNe'lu$|ndfi secretion otnp)fiu{ilxi\i vcv mode, square waveform

Latfr secretion luzht nn nl als o a n

4, Shorten o{ inspired time tflunr:ns.: inspired time dnYufiuh ritnnlfi{rlruvrutrrdr
dnriioaflurirrrnultaon dnn v {low-time curve ?:vt! positive deflection lurir.,rriunrmrs'looan
f,rilrrnltfibld1nulfi inspired time'lfiul?oon

1) VCV mode trinn peax inspiratory flow rate vio:Jiue'tn square waveform Lflu

hal{ deceleraiing rio total decelerating waveform 'lunrrf,fitiu half decelerating

waveform rfiu total decelerating waveform
2) PCV mode 'lfitfir.t inspired time
3) PSV mode tfioq expiratory trigger sensitivity (ETS)

Renpirutory }lrayeform Inrerpretadon toniunf Tfifirxg 4Ag

tt|fi 35 uant ftow-time curve iffiaotnntt*t inspired time iubl lfid,tnna-ntucaan Dositive
atidefI ectio n d6 o du'lu d x dut a i n t t n t u\,q a a n
5. Failure to triggering a'flBfug flow-time curve ?ylt!,ilfi xrlriour:n trigger ld Tou

?:vfl defrection lurirrnr:uratroondlrittidr.rqoufiu fnrfi odlrrir auto-pEEp dfi wo* ot
breathing lutjrrrirn'r:nru'hr{r fi rrvrurrun:;{uraiortirunrfllq ueifrLjdrr5c nr:ufibirt
nllen figger riau'jror3.rnrin rfiuljnioLi nrnuriuri! auto-pEEp bhirnr:ufilt auto-pEEp
trn|!filzlridrr5o tfifiorril+fi externat pEEp lnu'ld exemat pEEp u::rJlru Soro ro\r auro-
peep fiinld

i 6 uaar ftow-time cuNe luSthu rature to tigtseing lu$1tuiifi auto-nete {,iltntud'lfr vcv
mode' square waveform qjv'tu positive defrection 'luti't,tnzxtu'lcaandltihinaufru d.t
&aauilrt tawutallrnlrEu ftrigger) Mlaritunrlh usiiiltjd.i5c

440 ntrirriolnqndugru

nl1tfi nilnfim{ volume-time curve finuilEU

1. Volume leakage dnuutra.r votume-time curve rynu'lurjrlnr:yruhoonlrirrnyfi.r
basetine n'rdrfirnrnnr:dnlrv'ruhoonoon'lrinlo touoro rfind':ulugluqdrfindruriu

t1 nrrtqdlfiodrlril high ainvay pressure alarm ttiu pneumothorax, auto-PEEP
rfl unr:dnluruhsenlilviloloufi r.:o{nrulufi 'rto.r{ilru

it,z) n'r $r4drfiadr fli low airway pressure alarm niu rr ruqcrn ventilator circuit

ftendotracheal cuff

pi el uow volume-time cu:e fifidnaanat volume leakage

2. Bronchospasm dnurucliao volume-time curve {Yvlll curve lurirlnrttrulcoontflil

rda,:crnarvr utqoonoanldf dr

uryld uaro volume-time "u*" dfifnvutrat bronchospasm li{,tnnh cu*e lutia,tnttnlulc
aanrflwdum,t

Respirarory \Valefolm Inrerprerarion $n:Tunf nfrftmg 441

n1?uilafla pressure-volume loop
Pressure-vorume loop tflu respiratory waveform fifi pressure ailrrnu x rtnl vorume od

ttn! y d,rnrru:lnfla pressure-vorume roop fi:J:: 16urn'nfifio,orirnr:rrrjannfio comoriance ttfl:

work of breathing

gt!fr W um,tdnuo)JlJl\t pressure-votume toop nE

Tau pressure atittnuuau (unu n ual

votume aiunufi prnu v1

1. Comptiance rijunrrlnrr:r:n'lun1lnu'tud?ra,r:lao din"rurnrldcrn AV/Ap fl1rJ1rn

rirurruldlrnTnrgn'r'lJ!-ufla{n?'r1i filnnrrvld'r{ n3lri:.lunu p uflo,r.jr compriance ki6 r.nn

nmlr/riruo.:riuunu p uflo.o'ir comptiance 6 nsirr6nriurnfio urnnlyrhl::Bqun p {i,Jlflumuusu

tuflg"'j1 comptiance ro'::Jaolrjd nrnnlllfic6n nu v {i.rriuunuoi.r [r6[n{i1 comptiance fla.l

rlaod

2. Work of breathing

?1 nfl 't't'J:tnnfl 't f, ntayZ.lu!.tu

W ('llu) = F 1t:'r) x S (:;u:?t'r,l)
rir A/A grunl z drrtolor.rnrr lna n 6a dufr

W= AxFxS

W= Fx(AxS)

A

ilq ufi ur,r 0i oyd,tyilr Erdud Fonmiloiu ( p) ua vdufr nrurfi r u: : rr:yrr,:ld r m: (v)

W(.r1l1)=e1nflloiu1 x V (ilitilni)

442 reuthrioinqndugru

rdorrurornr':vrulo d'ltJltnt' fic'tne,loeruno{rl3x1nrttnt6't1ils'u d.t!dodornrrvr$ud
dnndourordrurdulf,.,.r rdalinmrfvnrnrfinnroni or rrnair',rdrrdulfiufitdn1 nnrul ;rl rrdr

rirr.5:1rfi'u do'luvr1'rngigtff1dfi5ri0n'j1 integration ,i1uro.:nr:firu'tq (work of breathing) d1u1.ln
vrlfiqrndudld curve lJo{ pressure-volume loop d.:f,rrr:nuf,nilddt;:Jfi +o

pli eo uootfnile cule lunrdtuzu work of
br@thing lu pressurc-volume loop

lunr:nhurru work of breathing lln pressure-volume loop rfioh{irugisnr:drnrril

rir'lc firtrauunrfludud A a. c. o o"td
duii n rurufir work of breathing drortuv tissue resistance lnuufilrloorrn:rfarda

{ru6u.r)'ludrrnr:nruto ld'l

dud g rrJrufit work of breathing dlartu: u"ii**""yy resistance ludl,,tnr:vru'lct{'l
dud work of breathing resistance
c tlrufi.: vtttortu: 1u:iton1:nru'lqoan

fufr o rurufil work of breathing fitottu: tissue resistance 1url,lufilrJanrrnlrfordo

ir.:16ur)'lutjrtnr:rt,rulnosn

ileytu{rJrudfinrrtd PEEP dnbru:tot pressure-volume loop pressure lilldfirfi

quti un:fi1ni,iuqnto,,rnr:vrutcoon pressure o:lrjnni:Lqjqufrrnv votume lrjno"l{4ud rda.rqln

ovdaofi votume rnfi odrra gjturJaodrund.r 1gr.tfr +t I

a?1ilfi nilflfino{t pressure-volume loop duurjas

c:1. Lower ain ray obstruction u'i1 work of breathing dto'ttu; .i*"y resistance 1u

drffluhaanrrnnidnfi dud c) urnn'irrlnfi n"nuutu{rl':udfi bronchospasm niu copo.

asthma (gl.lii 42)

Respimtory V'ayeform Inrerpretation tfrn€ffiIi nfrfit1Jg 442
Pressure.volume looo with pEEp

Bronchospam

gtd a umt prosure-votume toop dfintli lcgtli uow prwure-votume tcnp ifi Orcn-

extemal PEEP chospas/r f,trnaitiuii c xtnninhnfr

t Bz comptiance agilutnufiJn*nio

utnninJn6

2. Upper airway obstruction ayfl!'i1 work ot breathing filo,trl.l! airway resistance'lu

dr'.:nruln r{'u{rnnir:Jn6 1#ufi B) xlnn'j1ilna niu tracheal stenosis. tracheomaracia. tracheal

tumor, foreign body ob$truction (::Jfi €)

Upper airway obstruction

l3Etffi usn't pressure-vorume roop iuaatdnaunat upper aitway obstruction ffinniliud g xln

nidn6 uat comptiance o{'lwnwfilnf,nionnnh n6

444 rrrnilioinqndugru

3, Combine upper and lower airway obstruction eYvt!'j1 work of breathing frtortug

iairway resistance 'lurjr{fir8'le r{r rnn'jlilnfi ldud e; 1rnnirilfl6 rrai work of breathing

ro.rtl-lg airwav resistance lurjr.ttruloaon lnnj1ilnfi 1dufr C1 lrnn'J11nfi rir}ifidnu.uv

nfiT ug:Jdrnfiu n:.r16'1u{nrudfi bronchospasm ?11!t:\:Y;o refractory bronchospasm

urnurirrfiunrrro''ulofistui lfirirnrlrundo'ltl'lrrflunrir pulse pressure unltria
putse pressure nir.r nrnrflun{r.r pulse pressure rrnu nuldlune]l coPD' asthma fi54

bronchospasm fifigr:rirlunnan16oon'l nrnliunrjr.r pulse pressure nir.: 1fi6n6',r anaphylactic

snocK

nlVlii mot pressure-volume toop frifl"nEuzflBn combine

upper and towet ai(way obstruction lfi&mnitdui

B, c ulnninJni uat compliance agnlwnuritJninla
utnn'itJn6

4. Restrictive lung disease c3vlu'j'l work of breathing drartuc tissue resistance'tu
rjr.rrlu'hoon rnnir:Lnfi (dufi D ilT nni1ilnfi) ltot compliance drn'jrrJn6 lruld'lun{il lung
parenchyma disease, pleural disease, chest wall disease niat:ntutiolr{aa

u7ti uaa,t pressure-volume loop'lu restictive lung disease 'lrti,ttnai'tiud o xtnnirlnfr uaz

comDliance ahninlnfr

Respirarory \Yar,eform Inrerprerarion $nlunf 1frftMg 445
5. Restrictive lung disease with bronchospasm o;1t!'i1 work of breathing fito,ttuv
tissue resistance tutjr{nrutoaanrJrnn'jriln6 ldud o:rrnnir:Jnft; d.:rriu work of breathing d
[o1tu; airway resistance 'lurir,ruruhoonrrnnirrlnfi (rfud c) rrnnirrlnfi uonqrndly u.ir
comoliance sl'rnirtjn6

Restrictive lung disease with
bronchospam

ali 16 uan,t pns"ure-volume loop ?u restrictive tung disease with bronchospasm lrtffitnnitiui
c,D utnninlnh 'lutati comptiance aaa,t

6. Acute respiratory distress syndrome (ARDS) a"ngruvlo.,t pressure-volume loop 'tu

rjrul:nsornr:yrutq r{r c; rfir.jrn:rliq:duriorT:.runu p rdo.,rc1n pressure d'l{tud.xftrjnllr:n
rhlfiq.rmrflold itLivr..r'lrild votume fin-r:qrnd pr"..ur" drrnntuarlrrnrir'lfiq.rnrflold n:11.|

6,:flnorntrnu F trtff{rnn'jr:Janfirflu IRDS o:fi comp ance n''t a'fluruslo,lntrvl{,triul:l::6nunu

p arir,:l:figru pressure-volume toop 'lu nROS arrlttrnrrlutll restriciive lung o::lorld

lzttlii uaat pressure-wlume toop Iu enoi