Assist control (AC) and synchronized intermittent mandatory ventilation (SIMV) modes

[@Bill.R.124]

Nice simple video with great illustrations. Seeing the comments, I understand the complexity of this issue. It depends on when and why the patient was intubated. For a pt going to OR, it seems that AC is the go-to, same if initially intubated for respiratory failure (e.g., PNA/COPD), but as pt awakes or is weaning (early extubation is the key), SIMV (plus PS as many have pointed out) is the go-to, then transitioning to PSV (pressure support ventilation). Plus, most places use other hybrid-type modes, too, such as PRVC (pressure-regulated volume control).

[@jaquelinemanuel5716]

Thank you for this video series on mechanical ventilation. All the explanations are easy to understand.

[@ronaldshiffman9120]

I have 34 years of RT experience. This discussion is simplistic and I never would ventilate a patient the way it is described. First of all, if a therapist saw the patient initiating ineffective, extra breathes, it is very simple to increase the set rate to 17, or more, to satisfy the patients' gas exchange needs. There is no downside to a patient taking 1 or 2 small spontaneous breathes to minimize muscle atrophy. The 1 or 2 spontaneous breathes indicate the PaCO2 is where it should be.

[@condythefox]

Also keep in mind Simv comes with pressure support which will help spontaneous breaths.

[@Secret-j9o]

Tell me about ivaps mode in BIPAP and how to use this.

[@ZunshineArmy]

Omg! Finally! I understand the difference clearly! 💖 Thankyou! It’s helpful 💖

[@Jamesbradley001]

All of the videos in this series are extremely helpful. Thank you!

[@keerthikalabathula379]

what an explanation,.... crystal clear...thank you

[@dralemsegedlecturessimplif4870]

Excellent and articulated presentation. One of the channels encourage me to open mine. Thanks

[@emadalmehmal8781]

also u can have SIMV +PS so any effort done by the patient to trigger the inspiration he will not fully depending on his muscle power he will get the amount of support you set in term of pressure and u can start with high PS to correlate the measuring exhaled tidal volume of his effort to your set mandatory tidal volume and gradually decrease the support so u can exercise his respiratory muscles until u reach 0 support and then decrease your set respiratory rate of mandatory tidal volume and the end extubate your patient. from all of these features mentioned above Assist Control mode from my opinion should not be used anymore as initial setting

[@saikatchakrabarti4176]

In assist control mode.... There's a high chance of hyperventilating//

[@rawdonwaller]

Finally, someone has created hand-drawn lessons where the explanation is as well-developed as the artistry/design itself. Too often hand-drawn lessons are presented in a way that the author seems to treat the drawing as an end in itself. And that's a mistake, i feel. Well done to the creators of this series.

[@miketaiwanwalkcity6355]

Very clear to understand! Thanks!

[@shiuantzer]

Very helpful and cute comics, thank you!

[@Secret-j9o]

What is ivaps mode in bipap and when to use this?

[@riccardorizzo380]

Yea, in the OR our SIMV is essentially SIMV-PC where you can support spontaneous breaths with enough pressure to reach desired Vt . Non supported SIMV seems to be a ICU only thing and probably on older machines

[@Ect4health]

nit sure you are correct in your differenciation of AC and SIMV when you assert that the SIMV mode can cause hypoventilation. In converse to your error, the SIMV mode will actually allow for a greater MV if the patient tries to trigger. Noone would be plaved on SIMV without some pressure support .

[@DrRahul_Dixit]

How do you then differentiate bw simv plus volum guarantee vs ac

[@jojo009911]

Thank you so much, helpful explanation

[@charlynewilliams5189]

Thank you!

[@sowmiyathamizhan7404]

Post vedio about pressure support ventilation

[@sordinkalib4797]

But in SIMV you are also giving mandatory minute ventilation... so hypoventilation is not necessarily happening The shallow breaths are few and distributed throughout the minute

[@emadalmehmal8781]

also u can have SIMV +PS so any effort done by the patient to trigger the inspiration he will not fully depending on his muscle power he will get the amount of support you set in term of pressure and u can start with high PS to correlate the measuring exhaled tidal volume of his effort to your set mandatory tidal volume and gradually decrease the support so u can exercise his respiratory muscles until u reach 0 support and then decrease your set respiratory rate of mandatory tidal volume and the end extubate your patient. from all of these features mentioned above Assist Control mode from my opinion should not be used anymore as initial setting

[@what_if_I_were_wrong]

@@emadalmehmal8781 do you mean the users will have breathing support such as volume, PS set according to the setting in simv mode when they trigger inspiration?

[@thoiroy5012]

Exactly already the mandatory required minute ventilation is already set in SIMV, so no qquestion of hypoventilation

[@DrRawaBahram]

thank you for your hard work it was amazing

[@CCai-yr5gr]

In what case do we use SIMV the we have the option of AC

[@levinaragu]

Thanks❤

[@MedMastery]

:)

[@tevinmwangi44]

Crystall clear

[@nursefayeeren5533]

You r the best

[@poincareconjecture5651]

Really well explained:)

[@learnsmart4189]

Nice!!!!!!

[@ozkandevran1089]

this video is not correct. SIMV PC and SIMV VC modes are different. volume-AC is not an ideal ventilation mode. If the patient want to breath more than 500 ml , ventilator dont let to do. So patients start to struggle with ventilator. This is useful for sedatized patients. But at this time sedation results with limitation of the breath triggering and it ends with hipoventilation. There is no ideal ventilation mode. Both SIMV and asist control modes have benefits. APRV, PRVC also good modes. Every patients needs are different. And solutions different too.

[@akhilprasad7350]

That was awesome

[@HockeyGuy_in_STL]

SIMV is commonly used in pediatric patients.

[@pssandhu9908]

Very very helpful video thanks

[@cyrilllouvalentino3766]

Hi. Is SIMV mode used for DNR patient in ICU?

[@vibinp9800]

If the total breath is 15 then the total IE time will be 4 (60/15) then how in this image expiratory phase ending before that?

[@CreationsByWally]

Great explanationn

[@CaptainVelveeta]

So in AC mode you monitor for hypERventilation and in SIMV mode you monitor for hypOventilation.

[@blujay9030]

With SIMV can't you get some pressure support with the spontaneous breaths as well?

[@amenRAamen]

Yes I thought so too, and my book says so as well. In an other video they mentioned the Vt was set in AC and SIMV mode but only in SIMV mode the patient is allowed to breathe above that set rate (for example 500cc). But it will always be at least 500cc in SIMV then.

[@BicycleCrossroads]

Patients can breathe above set rate in both AC and SIMV mode. However, in SIMV mode, when a patient triggers a breath the machine will give a spontaneous breath (with Pressure Support, if set). Whereas in AC mode, the machine will give a full machine breath (the Vt you have set) when triggered. I am a little bothered by this video because the narrative is slightly slanted Pro-AC vs SIMV. Both modes are great, and neither one is necessarily better than the other. There are even times when the modes are EXACTLY the same... so as you progress in your career, you'll understand what I mean when I tell my students to "Not be a Mode Bigot". Ventilator modes are all "Tools" of the trade. Each patient is different, and each situation has a slightly better "Tool" for the job. I can tell you there are some instances where SIMV is superior to AC (particularly when the tidal volume and rate are not set ideally for a patient's demand, which actually happens more often than folks think). Good luck to you in your studies.

[@randy6749]

Just depends on what you're trying to achieve. SIMV is great for trying to wean a patient while AC is primarily used to allow the patient to rest but also trigger their own breaths. This works great because you can tell your patient is becoming active and then you could switch to SIMV mode to help wean that patient down while offering some support.

[@JohnAK72]

I guess some ventilators do. Well, I'm not totally sure, but I guess Servo does some thing like that!

[@miraclemiracle9289]

Thanks !!!!

[@asmaalsheikh3367]

You are dealing with a patient in the ICU.The ventilator settings for the patient were synchronized intermittent mandatory ventilation (SIMV) at 10 breaths/min, VT 700 mL (9 mL/kg ideal body weight), pressure support 10 cm H2O, PEEP 5 cm H2O, and FIO2 0.60. The patient was mechanically ventilated through an 8.0-mm inner-diameter ETT. After 6 days of mechanical ventilation, his status suddenly worsened. Peak airway pressure suddenly increased from the low 20s to 48 cm H2O, respiratory rate increased from 18 breaths/min to 44 breaths/min, VT decreased from 700 mL to 200 mL, and SpO2 dropped from 99% to 88%. We increased the FIO2 to 1.0, but there was no change in SpO2. Increased use of accessory breathing muscles indicated increased respiratory effort. The attending respiratory therapist was unable to pass the suction catheter through the ETT. He found a large mucus plug. Explain what is your options? help me

[@dionnawalton6069]

Asma Al Sheikh make sure patient is receiving adequate humidification.

[@evanderhaven6547]

The mucous plug was increasing the pressure due to resistance and the patient could not receive the tidal volume.

[@lng8240]

place fisher pykel, regular salbutamol nebs. if there is air trapping alongside increased Rinsp then decreasing airway resistance is warranted

[@lng8240]

which the mucous plug and thick secretions being the main problem and cause of ventilation difficulties

[@RajeshYadav-fy5cb]

Ç

[@erickperez1302]

This is AWESOME!

[@ahmedhamma7455]

very helpful thank you

[@TyShep06]

So what the patient spontaneously breathes, does the 4 second pause restart..?

[@caressungria4831]

T Sqz i think the back up mode adjust when the patient’s breath triggers.

[@poorasslawstudent]

In AC mode if the Pt attempts a breath at the 2sec mark, will the machine still provide a breath at the 4 sec mark or will it wait until the 6 sec mark?

[@armandomeza5648]

no because the vent will recognize that the patient took a breath and it will count in its set RR of 15

[@nicolaeavram6072]

Best video.

[@bonob0123]

wrong on SIMV

[@arwinvicente]

SIMV will not cause hypoventilation because you already set the RR. The A/C might cause Hyperventilation if patient able to trigger more than the RR than it should.

[@jeremynormann5021]

IN AC mode could you not then have Hyper ventilation?

[@r8529]

Jeremy Normann aadarsha

[@JohnAK72]

The respiratory rate is always set according to patient demands, moreover, other measures like tidal value and FIO2 are intended to rich the best oxygenation and co2 elimination, which is the main goal in every respiratory care. Sometimes you have the option to use on-tube capnography on you're patient, as well as the spo2, just to make sure you provide the best gas diffusion and prevent hyperventilation and all the related complications associated with. I hope you find it helpful :)

[@firstaid1883]

best video on this

[@moazdarwish9360]

Nice video and very helpful

[@lamulata1azuquita128]

Thank you sir very well explained

[@VaibhavYawalkar]

Thank you very much for great video .

[@mohamedlotfee6300]

عظمة great

[@icudaily.1282]

From where u get these wrong information.

[@jasssingh5189]

Amazingg

[@sreenit4828]

Excellent

[@poorasslawstudent]

I feel like this video utterly neglects how the machine responds to PT initiated breaths.

[@4sapphireb]

Is AC equal to Liberal and SIMC a Conservative?

[@mehrabrajaby1646]

😮😮😮🎉😢😢❤❤❤❤❤❤❤❤❤❤❤❤

[@kelgk2086]

Wrong conceptualization of the modes!! Please revise this presentation.