Page 398 - Clinical Application of Mechanical Ventilation

364 Chapter 11

60

40

20

V (L/min)

· 100 200 300 400 500 600 700
Volume (mL)
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240

Resistance
260 Reduced

Figure 11-43 The effect of airflow resistance on the flow-volume loop. A reduction in airflow
resistance increases the peak expiratory flow rate.

SUMMARY

In summary, if graphics of flow-, volume- and pressure-time waveforms, pressure-
volume loop, and flow-volume loop could be saved when patients were first placed
on a ventilator, ventilator management of patient’s progress could be studied and
greatly enhanced. Follow-up graphics could be saved and superimposed over the
initial copies for comparison, similar to what has been done with the figures throughout
this chapter. This can now be done on a minimal level on some ventilator graphics
packages. Disk files or printed copies of therapeutic interventions (i.e., bronchodila-
tors, changes in mode of ventilation, chest physical therapy, etc.) and improvements
could be documented. Graphic analysis could be used to facilitate discussion and
be shared with colleagues and physicians. Outcome assessments of the performance
of therapists and respiratory care departments in the area of ventilator management
could be documented. A higher quality of ventilator-patient assessment and care is
being carried out by practitioners with sufficient expertise in graphics analysis on a
day-to-day basis. The sophisticated level of software needed for documentation of
these improvements in practice, however, is not readily available. There have been
some improvements, but many more are needed to collect and analyze patient clinical
status via ventilator waveforms. The technology is available, and it will be exciting to
see the eventual changes as the professionals demand further improvements from the
ventilator manufacturers. Expertise in waveform analysis at a high level is not required

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