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Automatic Tube Compensation

This tutorial is about Automatic Tube Compensation (ATC). ATC is a setting that has been included in most modern ventilators. Its aim is to reduce the work of breathing associated with the drop in pressure across the endotracheal tube. The ventilator senses pressure, flow and resistance and changes the pressure during the breath to ensure that the patient has the sensation that they are breathing through their own airway. There are two configurations of ATC - one is as an alternative to pressure support in patients who are essentially weaned from mechanical ventilation: essentially a spontaneous breathing trial. The second configuration is as an accessory to all pressure limited modes - such that the pressure waveform is crafted in inspiration and expiration to reduce the workload of breathing during both phases of respiration. @ccmtutorials www.ccmtutorials.org Contents 00:06 Introduction 01:00 Clinical Scenario 01:40 A Quick Review of Inspiration & Expiration 02:22 Work of Breathing 02:56 Work of Breathing Diseased Lungs, Endotracheal Tube 04:15 Pressure Loss Along the Airway 04:50 Increasing Gas Flow Increases Resistance 05:30 Airway Resistance – Normal Airways vs Different Endotracheal Tube Sizes 06:45 Equation of Motion 07:45 Spontaneous Breathing Through Endotracheal Tube 08:30 Pressure Support and the Work of Breathing 09:30 How Do You Know If Pressure Support is Too Much OR Too Little 10:00 Pressure Support and Alveolar Pressure 10:40 Pressure Support and Tracheal Pressure 11:30 The Major Flaw with Pressure Support 12:00 Automatic Tube Compensation (ATC)– what it is 13:00 ATC Puritan Bennett Ventilator 14:15 ATC and Tracheal Pressure 15:30 Setting Up ATC (PB Ventilator) 16:56 ATC – Ventilator Waveforms 18:20 ATC as an Alternative to PSV 19:20 ATC on Drager and Hamilton Ventilators 20:00 ATC and Expiratory Support 21:45 ATC In Addition to Pressure Limited Modes 23:20 ATC on Drager Vent Screen 25:00 Clinical Scenario Resolution 25:25 Review of Tutorial