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A Taxonomy for Mechanical Ventilation: 10 Fundamental Maxims

Robert L Chatburn, Mohamad El-Khatib and Eduardo Mireles-Cabodevila
Respiratory Care November 2014, 59 (11) 1747-1763; DOI: https://doi.org/10.4187/respcare.03057
Robert L Chatburn
Respiratory Institute, Cleveland Clinic, Cleveland, Ohio and the Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio.
MHHS RRT-NPS FAARC
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  • For correspondence: [email protected]
Mohamad El-Khatib
Department of Anesthesiology, American University of Beirut Medical Center, Beirut, Lebanon.
PhD MD RRT FAARC
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Eduardo Mireles-Cabodevila
Respiratory Institute, Cleveland Clinic, Cleveland, Ohio and the Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio.
MD
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  • Fig. 1.
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    Fig. 1.

    Pyramid of skills required to master ventilator technology. The terms in green are from Bloom's revised taxonomy of learning objectives.

  • Fig. 2.
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    Fig. 2.

    Building blocks for constructing a mode. CMV = continuous mandatory ventilation; IMV = intermittent mandatory ventilation; CSV = continuous spontaneous ventilation.

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    Fig. 3.

    A breath is defined in terms of the flow-time curve. Important timing parameters related to ventilator settings are labeled.

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    Fig. 4.

    Trigger and synchronization windows. If a patient signal occurs within the trigger window, inspiration is patient-triggered. If a patient signal occurs within a synchronization window, inspiration is ventilator-triggered (or cycled if at the end of inspiration) and patient-synchronized. Note that, in general, a trigger window is used with continuous mandatory ventilation, a synchronization window is used with intermittent mandatory ventilation.

  • Fig. 5.
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    Fig. 5.

    Rubric for classifying trigger and cycle events. Courtesy Mandu Press.

  • Fig. 6.
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    Fig. 6.

    Rubric for determining the control variable of a mode. Paw = airway pressure, SIMV = synchronized intermittent mandatory ventilation; VT = tidal volume; P = pressure; E = elastance; V = volume; R = resistance; V̇ = inspiratory flow. Courtesy Mandu Press.

  • Fig. 7.
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    Fig. 7.

    Rubric for determining the breath sequence of a mode. Courtesy Mandu Press.

  • Fig. 8.
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    Fig. 8.

    Venn diagram illustrating how the mode taxonomy can be viewed in terms of discriminating features and defining features. VC = volume control; PC = pressure control; CMV = continuous mandatory ventilation; IMV = intermittent mandatory ventilation; CSV = continuous spontaneous ventilation; PETCO2 = end-tidal partial pressure of carbon dioxide; a = adaptive targeting; s= set-point targeting. Courtesy Mandu Press.

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    Table 3.
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  • Table 4.

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Respiratory Care: 59 (11)
Respiratory Care
Vol. 59, Issue 11
1 Nov 2014
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A Taxonomy for Mechanical Ventilation: 10 Fundamental Maxims
Robert L Chatburn, Mohamad El-Khatib, Eduardo Mireles-Cabodevila
Respiratory Care Nov 2014, 59 (11) 1747-1763; DOI: 10.4187/respcare.03057

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A Taxonomy for Mechanical Ventilation: 10 Fundamental Maxims
Robert L Chatburn, Mohamad El-Khatib, Eduardo Mireles-Cabodevila
Respiratory Care Nov 2014, 59 (11) 1747-1763; DOI: 10.4187/respcare.03057
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  • Article
    • Abstract
    • Introduction
    • What Is a Mode of Mechanical Ventilation?
    • The 10 Maxims
    • Application of the Taxonomy
    • Discussion
    • Conclusions
    • Footnotes
    • References
  • Figures & Data
  • Supplemental
  • Info & Metrics
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Keywords

  • taxonomy
  • ontology
  • mechanical ventilation
  • mechanical ventilator
  • modes of ventilation
  • classification
  • ventilator
  • survey
  • standardized nomenclature
  • controlled vocabulary

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