MECHANICAL VENTILATOR
• A ventilator is a machine designed to support or replace
spontaneous breathing. It is commonly used in critical care
settings to assist patients who are unable to breathe effectively
on their own due to illness, surgery, or trauma.
Definition
A mechanical ventilator is a device that helps move air
in and out of the lungs of a patient who is physically
unable to breathe or breathing insufficiently.
Indications for Ventilator
• Acute respiratory failure
• Chronic respiratory disease exacerbation
• Neuromuscular disorders (e.g., Guillain-Barré)
• During general anesthesia
• Post-operative respiratory support
• Trauma (e.g., head injury, chest injury)
• Comatose patients – who are not able to maintain patent
airway.
Types of Ventilators
Ventilators are classified in several ways based
on invasiveness, portability, mechanism of action,
and clinical use.
1. Based on the Method of Ventilation
a) Positive Pressure Ventilators
• Push air into the lungs using positive pressure.
• Most commonly used type in hospitals today.
• Examples: ICU ventilators, BiPAP, CPAP.
b) Negative Pressure Ventilators
• Pull air into the lungs by creating negative pressure
around the chest.
• Rarely used now.
• Example: Iron Lung (used during polio epidemics).
Based on Mode of Delivery
a) Invasive Ventilators
• Air delivered via endotracheal tube or tracheostomy.
• Used in ICU and during surgery.
• Provides full respiratory support.
b) Non-Invasive Ventilators (NIV)
• Air delivered via a mask (nasal or full-face).
• Common in sleep apnea, COPD, and heart failure.
Types: CPAP (Continuous Positive Airway Pressure), BiPAP
(Bilevel Positive Airway Pressure).
A CPAP (continuous positive airway
pressure) machine helps treat sleep
apnea. This device delivers
continuous air through mouth and/or
nose to help keep the airways open
while sleep.
A CPAP machine includes:
• A mask that fits over nose or both nose and mouth.
• Straps to position the mask on the face.
• A tube that connects the mask to the machine’s motor.
• A motor that blows air into the tube.
• An air filter that purifies the air entering the nose or mouth
•BiPAP (Bilevel positive airway pressure) machines deliver
pressurized air through a mask that fits over the nose and/or mouth.
•The machine alternates between two pressure levels:
•Inspiratory Positive Airway Pressure (IPAP): Higher pressure
during inhalation to help move air into the lungs.
•Expiratory Positive Airway Pressure (EPAP): Lower pressure
during exhalation to help keep airways open and prevent them
from collapsing.
Based on Portability
, a) Stationary (ICU) Ventilators
• Large, complex, and used in intensive care units.
• Highly customizable and advanced monitoring.
b) Transport Ventilators
• Portable, battery-operated.
• Used during patient transfer or emergencies.
c) Home Ventilators
• Designed for long-term use in home care.
• Compact and user-friendly.
Based on Control Variable
a) Volume-Controlled Ventilators
• Deliver a fixed tidal volume. (Tidal volume is the amount of air inhaled
and exhaled during a normal breath)
• Airway pressure varies. (the force exerted by the weight of air above a
given point)
b) Pressure-Controlled Ventilators
• Deliver air until a preset pressure is reached.
• Tidal volume may vary.
c) Hybrid Modes
• Combine volume and pressure features (e.g., PRVC – Pressure
Regulated Volume Control).
MODES OF VENTILATOR
CMV (Controlled Mandatory Ventilation)
• Machine does all the work.
• Delivers a preset number of breaths with a preset
volume or pressure.
• Use: For sedated/paralyzed patients or those not
breathing spontaneously.
Assist-Control (A/C) Ventilation
• Patient can trigger a breath, but each breath
(spontaneous or machine-initiated) gets full support.
• Delivers preset tidal volume or pressure.
• Use: For patients with weak respiratory effort but some
spontaneous breathing.
Synchronized Intermittent Mandatory Ventilation
(SIMV)
• Delivers mandatory breaths at a preset
rate, synchronized with patient’s effort.
• Patient can breathe spontaneously between
mandatory breaths, with or without support.
• Use: Weaning, or when encouraging spontaneous effort.
Pressure Support Ventilation (PSV)
• Only supports spontaneous breaths.
• Machine gives a set pressure during inspiration to reduce
work of breathing.
• No set rate or volume.
• Use: Weaning from the ventilator.
Pressure-Controlled Ventilation (PCV)
• Delivers breaths to a set pressure, not volume.
• Volume varies depending on lung compliance.
• Use: ARDS, or stiff lungs where limiting pressure is
important.
Continuous Positive Airway Pressure (CPAP)
• Applies constant pressure to keep airways open.
• Patient breathes spontaneously throughout.
• Use: Obstructive sleep apnea, weaning, or mild
respiratory failure.
Volume-Controlled Ventilation (VCV)
• Delivers breaths to a set tidal volume, pressure varies.
• Use: When maintaining consistent minute ventilation is
important.
PEEP (Positive End-Expiratory Pressure)
• PEEP is the pressure that stays in the lungs at the end of exhalation when the
ventilator prevents the alveoli from collapsing.
• It keeps the airways open, improving oxygenation.
Parts of a Ventilator
Part Function
Touchscreen or knobs used to set and adjust
1. Control Panel / Interface ventilation settings (e.g., mode, tidal volume,
FiO₂, PEEP).
Shows real-time waveforms, pressure, volume,
2. Display Screen respiratory rate, alarms, and other monitoring
info.
Carries oxygen + air mixture from the
3. Inspiratory Limb (Tubing) ventilator to the patient.
Carries exhaled air from the patient back to
4. Expiratory Limb (Tubing) the ventilator for monitoring or filtering.
5. Humidifier Adds heat and moisture to gases before
they reach the lungs, preventing
dryness.
6. Filter (HEPA/Bacterial filter) Filters out bacteria, viruses, and
particles in inhaled and exhaled gases.
7. Alarm System Alerts for issues like disconnection, high
pressure, low volume, or apnea.
8. Oxygen Blender Mixes air and oxygen to achieve the set
FiO₂ (fraction of inspired oxygen).
9. Flow Sensor Measures how much air is moving in and out of the
patient.
10. Exhalation Valve Controls release of exhaled gas and maintains set
pressures like PEEP.
• 11. Power Supply Usually electric with battery backup for use during
transport or power loss.
• 12. Nebulizer Port (optional) Allows delivery of medications in
aerosol form through the circuit.
PHASES OF VENTILATION
Phase Key Event Triggered by
Trigger Start of inspiration Patient or ventilator
Delivery Air pushed into lungs Ventilator mechanism
Cycle/End Transition from inhale to Set limit (time,
exhale volume…)
Expiration Air leaves lungs Passive (or assisted)
