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I'm good, thanks! Short runways - Long runways! That's I-time, How fast your plane takes off on that long or short runway is RISE TIME - the common sense take away folks.Let's not get too carried away into a messy rabbit hole. Thx again, Joe!
It’s basically a difference approach to the same destination. I-time is the freeway, and approach focused on the amount of time it takes to your destination. Rise time is the scenic route, focused more on the quality of the trip… I dunno, it makes sense to me. Lol
Towards the end of the video you are equating slowing down the rise time with decreasing the rise time which is confusing. Slowing down actually means increasing not decreasing rise time. Overall great content and kudos!
But when we use CPAP mode with invasive ventilation we have no option of ti. In Non invasive we have option to set ti. Ti we adjust as per spontaneous breath rate. Secondly in other invasive modes to adjust I:E Ratio. Same in PC mode ti is adjusted to set I:E ratio as I use dragger. I think rise time only works there where no option of ti.
Thank you for your video! I have some further questions related to your example patient. To my understanding if you have short rise time (fast acceleration), the peak inspiratory flow is typically higher. What type of inspiration termination (or expiration trigger) was in use? Was it flow or was it some percent (%) of the max inspiratory flow? If it was the latter, could it be that this setting was too sensitive and because of high inspiratory flow the inspiration was terminated too early before the decelerating flow pattern was formed leaving only the spiking high flow? Once the rise time was increased, the peak flow decreased and thus also the inspiration termination got less sensitive and allowed the the breath to last longer. I am not a clinician, but ventilator related engineer and hoping to get educated.
Hi, sometimes I found patients who looked more synchronized (from the pressure and flow scalars) with a low I:E ratio :1:7 ..now, this ratio is crazy low...So, should I keep the settings (I time and resp rate) so that the the I:E ratio keeps 1:7? Or should I follow the usual I:E 1:2 ratio even though it would result in patient-vent asynchrony? Thanks
No, rise time only effects how quickly pip is reached. This will have a minimal effect on actual the actual resulting tidal volume. Hope this helps. Please let me know if not. Best wishes!!!
So a faster rise time means a bigger peak inspiratory flow in pressure control mode? Is there a suggestion on the initial setting of rise time ?(Normal lung condition without any pulmonary history.)
You are exactly correct. Faster rise time = higher insp flow to reach set insp pressure quicker. There is no initial suggestion. Rise time should be assessed and tailored to the needs of each individual patient. I use it as a tool to help address flow hunger in my pressure control patients. I also use it during NIV (specifically bipap) to improve patient comfort. Don't forget about it with pressure support also. Sometimes the sudden rise to IPAP is too much for some patients, so if I slow that down, they'll be more compliant with the NIV attempts to avoid intubation. COPDers don't always need more PS, just a quicker rise time to satisfy their flow demands. You just have to play with it with the goal of making the vent breathe like the patient, not trying to make the patient breathe like the vent. Hope this helps and makes sense. Thank you for watching, Joyce. I appreciate you!
Nice explanation, Sir i would like to know about automatic tube compensation, if you can sir please do a video lecture about automatic tube compensation , concepts of automatic tube compensation, how does it affect different vent modes , how to apply it to different vent modes , how does it reduce work of breathing , concept of work of breathing .....etc . also i would like to know , about mean air way pressure , concept of mean air way pressure , how to calculate it , how does it affect different vent modes and patient conditions .
nice presentation I have 2 questions 1. In which type patients you would use shorter Rise time (faster rate)? 2. Does the Rise time affect peak air way pressure?
Good teaching; May I ask you some question? I’m pediatrics. In case of severe asthma, the rising time should be decreased, that’s right? (I used servo i ventilator, that was shown % rise time)
Your absolutely right. A slower rise time will promote more laminar flow through the airways, where as a quicker rise time will result in greater turbulent flow. In theory greater laminar flow should result in better volumes in PC or lower pressures in VC. The key with rise time is understanding that it does not affect I time, so you can still allow for an adequate expiratory time, so to avoid excessive airtrapping. Great question! Thanks for asking and watching.
Thanks you!! I really appreciate your efforts, I have a question, if I have a patient in 5 Cpap + 10 PSV that is 15 PIP, and another patient, that's in Bipap, 5 epap and ipap 15 That is 15 PIP. Then what is the diffrence between the two patients ? Although both have the same pressure support that play the role in elimination co2 😅.
True, Yazan. First, yes, they are the same in terms of pressure support being applied. The difference is that the I time and RR in bipap are only activated IF and WHEN the patient is not initiating spontaneous breaths above the set rate. The rate and I time in NIV is only active when the patient is not breathing above that set rate. In other words, a patient with a set rate of 10 and set I time of 1.0 sec in NIV, is only getting that set I time when they do not initiate a spontaneous breath within 6 seconds of the previous breath. Let me know if that doesn't make since. Thanks for the view and comment!!!
From what i understand, I time is the total time of inspiratory phase.. That makes sense, in control modes of ventilation.. But in assists modes like bipap/PSV Rate will be primarily determined by the patient..how does I time setting apply there? Rise time will apply there also..that is clear..
to reduce I time in an I:E ratio would you increase inspiratory flow, decrease tidal volume or decrease pressure. I know that by improving I:E ratios you would decrease the rate and increase inspiratory flow is that ultimately the same thing?
Okay, let's break this down. Sounds like your desire is to increase your I:E, which means you either have to make I time shorter or E time longer. So if you are in volume control with an I:E of 1:1, then you have three options to increase the I:E to a more reasonable 1:2 or 1:3, or maybe longer for severe obstructive lung disease. 1. Increased flow = decreased I time = increased I:E. 2. Decrease tidal volume = decreased I time = increased I:E. 3. Decrease frequency or rate = increased total cycle time = increased E time = increased I:E ratio. Those are your only options in VC. Now for pressure control you only have 2 options. 1. Decrease set I time = decreased I time = Increased I:E. 2. Decrease frequency/rate = increased total cycle time = Increased E time = Increased I:E. Decreasing pressure in PC will only affect delivered tidal volume, and have no affect on I:E. Remember that PC is time cycled, not pressure cycled, so the pressure setting has no bearings on when inspiration ends. I hope this makes sense. Thanks for watching and asking your question. I'm going to do another video over this topic. It's a great lesson that can be difficult for students to grasp in the beginning. Good luck!
I would adjust it to patient comfort. The more flow hungry, the quicker rise time. If they're complaining of too much pressure too fast, then slow rise time.
Great video but pb 980 uses the % of i time, rise time presuee to be delivered. That's a crazy sentence. So the smaller the % the faster (sooner) flow set pressure is delivered? I think i just hurt my brain...
Very nice... i read that patients with BPCO need rapid rise time and short inspiratory time...viceversa for obese and neuromuscolar patients...do you agree? Is there a rationale? What is the difference between BiPaP and PSV? (Forgive my lack of knowledge)
Hello again! So when you say BPCO, you are referring to COPD, correct? In that case, yes, quicker rise time and short I times. This allows for longer E times, which will allow these patients to exhale more fully. They have a tendency to air trap due to their anatomical alterations. Long I times with short E times only exaggerates the airtrapping, which leads to excessive autopeep. Your restrictive lung diseases don't have a problem getting air out of the lungs, so they can tolerate a shorter E time, without the risk of airtrapping. Bipap is a term related to noninvasive ventilation, where the practitioner sets an Inspiratory pressure (IPAP) and an expiratory pressure (EPAP). The difference betwee IPAP and EPAP = Pressure Support. Pressure support is related to a setting within mechanical ventilation, which aids the patient in overcoming the resistance of the artificial airway and larger levels augment spontaneous tidal volume. In short, when you think of pressure support, think of an inspiratory pressure set to assist spontaneous ventilation. Expiratory trigger relates directly to pressure support. Commonly, exp. trigger is set at 25%. This setting tells the vent when to turn off the pressure support and allow the patient to exhale. It functions off of an inspiratory flow decay. Let's say the patient generates a peak inspiratory flow of 40lpm. The vent will terminate pressure support when the inspiratory flow decays to 10lpm, and at this point the patient will be allowed to exhale. If you increase the expiratory trigger to 50%, then the pressure support will terminate at 20lpm, thus inspiratory phase will be shorter and expiratory will begin sooner. Hope all this makes sense!
@@RespiratoryCoach Thanks... i know what bpap and psv are...but you distinguish between bpap and psv so i thought you meant a difference... what about neuromuscolar/obese patient...what about I:E and cycling time?
It doesn’t make sense. Rise time- the rate at which the breath goes from baseline to targeted iPap would directly correlate to the duration of the that respiratory cycle. I don’t see how they can be independent of each other.
I'm good, thanks! Short runways - Long runways! That's I-time, How fast your plane takes off on that long or short runway is RISE TIME - the common sense take away folks.Let's not get too carried away into a messy rabbit hole. Thx again, Joe!
Thank you for doing this video. You explained exactly what I wanted on V60.
Fantastic! That's my goal, and you are very welcome. Thank you for watching and commenting.
Great explanation Mr. Rt coach. Just helped a coworker with this prob.
Well explain coach👌🏾👏🏽👏🏽
Thanks bro! It gives sense and helped me understand it more👍🏽😊
Thank you so much for watching and kindly commenting. I'm glad it helped!
You teach very well! Thanks much
You're very welcome. Thanks for watching and leaving the kind comment!
More content my guy! I just subbed
Thank you for your explanation
Very good one.. nice explanation..👍👍
It’s basically a difference approach to the same destination.
I-time is the freeway, and approach focused on the amount of time it takes to your destination. Rise time is the scenic route, focused more on the quality of the trip…
I dunno, it makes sense to me. Lol
Towards the end of the video you are equating slowing down the rise time with decreasing the rise time which is confusing. Slowing down actually means increasing not decreasing rise time. Overall great content and kudos!
Thanks for that contribution and feedback. Sorry for the confusion, and thank you for watching.
But when we use CPAP mode with invasive ventilation we have no option of ti. In Non invasive we have option to set ti. Ti we adjust as per spontaneous breath rate. Secondly in other invasive modes to adjust I:E Ratio. Same in PC mode ti is adjusted to set I:E ratio as I use dragger. I think rise time only works there where no option of ti.
Thank you!
Thank you for your video!
I have some further questions related to your example patient. To my understanding if you have short rise time (fast acceleration), the peak inspiratory flow is typically higher. What type of inspiration termination (or expiration trigger) was in use? Was it flow or was it some percent (%) of the max inspiratory flow?
If it was the latter, could it be that this setting was too sensitive and because of high inspiratory flow the inspiration was terminated too early before the decelerating flow pattern was formed leaving only the spiking high flow?
Once the rise time was increased, the peak flow decreased and thus also the inspiration termination got less sensitive and allowed the the breath to last longer.
I am not a clinician, but ventilator related engineer and hoping to get educated.
Nice explanation....
What would be the rise time in ARDS or restrictive lung disease and in COPD pt .....plz clarify ....thankyou
Thank you
Hi. I really enjoy ur videos. I really like to know how to make adjustments in rise time. There is also setting for % along with time in avea
This was a great explanation because I'm not the brightest light bulb in the toolshed. Thank you. But what are the normal parameters
Hi, sometimes I found patients who looked more synchronized (from the pressure and flow scalars) with a low I:E ratio :1:7 ..now, this ratio is crazy low...So, should I keep the settings (I time and resp rate) so that the the I:E ratio keeps 1:7? Or should I follow the usual I:E 1:2 ratio even though it would result in patient-vent asynchrony? Thanks
What is the role of inspiratory time in NIV, when patient is tachypnic and work load is high
Thank you very much for your video and your clarification in the comment. My question is, does changing Rise Time have any effect in Tidal Volume?
No, rise time only effects how quickly pip is reached. This will have a minimal effect on actual the actual resulting tidal volume. Hope this helps. Please let me know if not. Best wishes!!!
If they are in VC+, what does the p % thing mean. It just looks like it adjusts the flow of u change it.
On my vent rise time in m sec. Would 200 or 400 be the longer rise time .
What about PRVC on the Servo-I?
Thnx very well explain 🙂
Most welcome 😊
So a faster rise time means a bigger peak inspiratory flow in pressure control mode? Is there a suggestion on the initial setting of rise time ?(Normal lung condition without any pulmonary history.)
You are exactly correct. Faster rise time = higher insp flow to reach set insp pressure quicker. There is no initial suggestion. Rise time should be assessed and tailored to the needs of each individual patient. I use it as a tool to help address flow hunger in my pressure control patients. I also use it during NIV (specifically bipap) to improve patient comfort. Don't forget about it with pressure support also. Sometimes the sudden rise to IPAP is too much for some patients, so if I slow that down, they'll be more compliant with the NIV attempts to avoid intubation. COPDers don't always need more PS, just a quicker rise time to satisfy their flow demands. You just have to play with it with the goal of making the vent breathe like the patient, not trying to make the patient breathe like the vent. Hope this helps and makes sense. Thank you for watching, Joyce. I appreciate you!
So is slope the same as rise time?
Nice explanation, Sir i would like to know about automatic tube compensation, if you can sir please do a video lecture about automatic tube compensation , concepts of automatic tube compensation, how does it affect different vent modes , how to apply it to different vent modes , how does it reduce work of breathing , concept of work of breathing .....etc . also i would like to know , about mean air way pressure , concept of mean air way pressure , how to calculate it , how does it affect different vent modes and patient conditions .
Got you on the list, Waruna. Thanks for watching!
What is a good initial setting for the inspiratory time? On the servo and LTV vents I have started at .9.
Hey Nigel. Yes, .9 is a good starting point. From there assess your patient for asynchrony associated with flow hunger and adjust accordingly.
thank you for all your video classes...thank you...a question: so the rise time doesn't change, doesn't affect the I time? is that correct?
Hello Andre! That's 100% correct!
nice presentation
I have 2 questions
1. In which type patients you would use shorter Rise time (faster rate)?
2. Does the Rise time affect peak air way pressure?
Hello! 1. Flow hungry or neurally distressed patients. 2. No, becuase remember pressure is set when talking about rise time. Great questions!
Good teaching; May I ask you some question? I’m pediatrics. In case of severe asthma, the rising time should be decreased, that’s right? (I used servo i ventilator, that was shown % rise time)
Your absolutely right. A slower rise time will promote more laminar flow through the airways, where as a quicker rise time will result in greater turbulent flow. In theory greater laminar flow should result in better volumes in PC or lower pressures in VC. The key with rise time is understanding that it does not affect I time, so you can still allow for an adequate expiratory time, so to avoid excessive airtrapping. Great question! Thanks for asking and watching.
Respiratory Coach thank you very much, now my patient’s getting better. Thank you again
Thank you sir! You explanation is so helpful! May I ask a question? Is Rise-time a setting for pressure control, volume control or pressure support?
Pressure control and pressure support. Hope this helps, and thanks for watching.
@@RespiratoryCoach Can you apply the rise time to Volume control mode ? If not, what's the reason ?
I reduced my vertigo but lowering rise time on my bipap
Nice! Thanks for watching!
Thanks you!! I really appreciate your efforts, I have a question, if I have a patient in 5 Cpap + 10 PSV that is 15 PIP, and another patient, that's in Bipap, 5 epap and ipap 15 That is 15 PIP. Then what is the diffrence between the two patients ? Although both have the same pressure support that play the role in elimination co2 😅.
Is it just the rate and I time ? Because in BIPAP we can set the rate and i time unlike the cpap + PS
True, Yazan. First, yes, they are the same in terms of pressure support being applied. The difference is that the I time and RR in bipap are only activated IF and WHEN the patient is not initiating spontaneous breaths above the set rate. The rate and I time in NIV is only active when the patient is not breathing above that set rate. In other words, a patient with a set rate of 10 and set I time of 1.0 sec in NIV, is only getting that set I time when they do not initiate a spontaneous breath within 6 seconds of the previous breath. Let me know if that doesn't make since. Thanks for the view and comment!!!
@@RespiratoryCoachIt is crystal, Coach. your explanation is more than enough 👍
From what i understand, I time is the total time of inspiratory phase..
That makes sense, in control modes of ventilation..
But in assists modes like bipap/PSV
Rate will be primarily determined by the patient..how does I time setting apply there?
Rise time will apply there also..that is clear..
During spontaneous ventilation I time is determined by the patient.
Hi respiratory coach, I am still having trouble understanding this concept. Could you please share more examples? thank you
to reduce I time in an I:E ratio would you increase inspiratory flow, decrease tidal volume or decrease pressure. I know that by improving I:E ratios you would decrease the rate and increase inspiratory flow is that ultimately the same thing?
Okay, let's break this down. Sounds like your desire is to increase your I:E, which means you either have to make I time shorter or E time longer. So if you are in volume control with an I:E of 1:1, then you have three options to increase the I:E to a more reasonable 1:2 or 1:3, or maybe longer for severe obstructive lung disease. 1. Increased flow = decreased I time = increased I:E. 2. Decrease tidal volume = decreased I time = increased I:E. 3. Decrease frequency or rate = increased total cycle time = increased E time = increased I:E ratio. Those are your only options in VC. Now for pressure control you only have 2 options. 1. Decrease set I time = decreased I time = Increased I:E. 2. Decrease frequency/rate = increased total cycle time = Increased E time = Increased I:E. Decreasing pressure in PC will only affect delivered tidal volume, and have no affect on I:E. Remember that PC is time cycled, not pressure cycled, so the pressure setting has no bearings on when inspiration ends. I hope this makes sense. Thanks for watching and asking your question. I'm going to do another video over this topic. It's a great lesson that can be difficult for students to grasp in the beginning. Good luck!
YESSSSSSSS AHHHH THANK YOU THANK YOU!!!! @@RespiratoryCoach
if you could that would be amazing with some example problems and whenever i know youre busy but i appreciate it so much !
how does the ramp time effect Peak Pressure? Can decreasing ramp time help decrease peak pressure?
No, because rise time is related to how quickly the set pressure is reached.
so was she air-trapping before the change setting?
She was, due to the increased RR. After the change, her tidal volume increased, her RR decreased and the asynchrony and air trapping resolved.
Hi RC. What rise would you put on BIPAP mode for COPD patients?
I would adjust it to patient comfort. The more flow hungry, the quicker rise time. If they're complaining of too much pressure too fast, then slow rise time.
@@RespiratoryCoach Thank you so much. You are the best.
Great video but pb 980 uses the % of i time, rise time presuee to be delivered. That's a crazy sentence. So the smaller the % the faster (sooner) flow set pressure is delivered? I think i just hurt my brain...
Very nice... i read that patients with BPCO need rapid rise time and short inspiratory time...viceversa for obese and neuromuscolar patients...do you agree? Is there a rationale? What is the difference between BiPaP and PSV? (Forgive my lack of knowledge)
and what about expiratory trigger?
Hello again! So when you say BPCO, you are referring to COPD, correct? In that case, yes, quicker rise time and short I times. This allows for longer E times, which will allow these patients to exhale more fully. They have a tendency to air trap due to their anatomical alterations. Long I times with short E times only exaggerates the airtrapping, which leads to excessive autopeep. Your restrictive lung diseases don't have a problem getting air out of the lungs, so they can tolerate a shorter E time, without the risk of airtrapping.
Bipap is a term related to noninvasive ventilation, where the practitioner sets an Inspiratory pressure (IPAP) and an expiratory pressure (EPAP). The difference betwee IPAP and EPAP = Pressure Support. Pressure support is related to a setting within mechanical ventilation, which aids the patient in overcoming the resistance of the artificial airway and larger levels augment spontaneous tidal volume. In short, when you think of pressure support, think of an inspiratory pressure set to assist spontaneous ventilation.
Expiratory trigger relates directly to pressure support. Commonly, exp. trigger is set at 25%. This setting tells the vent when to turn off the pressure support and allow the patient to exhale. It functions off of an inspiratory flow decay. Let's say the patient generates a peak inspiratory flow of 40lpm. The vent will terminate pressure support when the inspiratory flow decays to 10lpm, and at this point the patient will be allowed to exhale. If you increase the expiratory trigger to 50%, then the pressure support will terminate at 20lpm, thus inspiratory phase will be shorter and expiratory will begin sooner.
Hope all this makes sense!
@@RespiratoryCoach Thanks... i know what bpap and psv are...but you distinguish between bpap and psv so i thought you meant a difference... what about neuromuscolar/obese patient...what about I:E and cycling time?
It doesn’t make sense. Rise time- the rate at which the breath goes from baseline to targeted iPap would directly correlate to the duration of the that respiratory cycle. I don’t see how they can be independent of each other.
Not exactly. I time is how long the insp phase lasts from trigger to cycle. Rise time only effects hoe quickly the insp pressure is reached.
so the rise time doesn't change the I time?
Make you video short and straightforward too much talking.