SIMV PC (Synchronized Intermittent Mandatory Ventilation - Pressure Control)

This weeks tutorial is on SIMV-Pressure Control. Although this is one of the lesser used modes of ventilation, I sometimes see my colleagues using it in the operating room. And for good reason. Anesthesia ventilators are not set up in the same way as ICU vents. In particular - if you choose "PC" Pressure Control - that is what you get - pressure control; NOT pressure assist control. Hence there is no real provision for patient ventilator interaction. If you choose "SIMV" as pressure control, volume control or volume guaranteed pressure control, then the patient can breath and interact with the ventilator and receive pressure supported breaths. Consequently, conventional SIMV modes, these days, are far more likely to be used in the operating room than in the ICU.
The second reason that I wanted to cover SIMV Pressure Control is to set the groundwork for a different mode "BiLevel Pressure Control" that is built on a similar platform, looks a bit like SIMV, and has significant benefits for those of you who might choose SIMV-PC in ICU.
Most modes of ventilation offer two ways of supporting the spontaneous breath - assist control and SIMV. In SIMV-PC the spontaneous breath can be unsupported, pressure supported or partially supported using Automatic Tube Compensation (ATC). This tutorial covers the type of patient to whom you might deliver SIMV-PC; how to set up the mode; what it looks like on a ventilator screen and the strengths and weaknesses of the mode. @ccmtutorials www.ccmtutorials.org
00:08 Introduction
00:30 Revies of Previous Tutorial
01:00 Explanation of SIMV
02:00 SIMV versus Assist Control
03:00 Clinical Scenario - Michael Post Op
03:35 Clinical Scenario - Michaela Traumatic Brain Injury
04:30 Setting Up SIMV-PC (Puritan Bennett - Medtronic Ventilator)
06:00 Setting Up SIMV-PC (Drager Evita Ventilator)
07:45 SIMV PC + Pressure Support Waveforms
09:35 SIMV-PC with CPAP
10:40 How SIMV-PC Works
18:40 What SIMV-PC Looks Like on the Ventilator Screen
22:00 The Strange Situation of Pressure Support in SIMV-PC
23:00 When I Might Use SIMV-PC
23:51 How Much Pressure Support?
25:00 Automatic Tube Compensation
26:00 The Flow Waveform In Pressure Control - and why you must look at it
29:00 Review of Tutorials and Preview of the Next Tutorial