rt 210 lung expansion / hyperinflation tx rt 210 hyperinflation tx
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RT 210RT 210
Lung Expansion /Lung Expansion /
Hyperinflation TXHyperinflation TX
RT 210 Hyperinflation TXRT 210 Hyperinflation TX
Sustained Maximal Sustained Maximal Inhalation/Incentive Inhalation/Incentive Spirometry – SMI/ISSpirometry – SMI/IS
IndicationsIndications To improve atelectasisTo improve atelectasis To prevent atelectasisTo prevent atelectasis
Post‑opPost‑op COPDCOPD Other pulmonary complicationsOther pulmonary complications Mobilize secretionsMobilize secretions
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Sustained Maximal Sustained Maximal Inhalation/Incentive Inhalation/Incentive Spirometry – SMI/ISSpirometry – SMI/IS
ContraindicationsContraindications Patient unable to cooperatePatient unable to cooperate Patient unable to follow instructionsPatient unable to follow instructions Patient unconsciousPatient unconscious Patient unable to take deep breathsPatient unable to take deep breaths
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Sustained Maximal Sustained Maximal Inhalation/Incentive Inhalation/Incentive Spirometry – SMI/ISSpirometry – SMI/IS
HazardsHazards Ineffective unless performed correctlyIneffective unless performed correctly HyperventilationHyperventilation BarotraumaBarotrauma Discomfort secondary to painDiscomfort secondary to pain FatigueFatigue
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Sustained Maximal Sustained Maximal Inhalation/Incentive Inhalation/Incentive Spirometry – SMI/ISSpirometry – SMI/IS
ProcedureProcedure Slow deep inspiration Slow deep inspiration Inspiratory holdInspiratory hold Relaxed exhalationRelaxed exhalation Volume of gas moved should be Volume of gas moved should be
inspiratory capacityinspiratory capacity Maximum inhalation following a quiet Maximum inhalation following a quiet
exhalationexhalation
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Sustained Maximal Sustained Maximal Inhalation/Incentive Inhalation/Incentive Spirometry – SMI/ISSpirometry – SMI/IS
Procedure (cont)Procedure (cont) Coaching the patient is importantCoaching the patient is important
EncouragementEncouragement Insure proper techniqueInsure proper technique
FrequencyFrequency May be performed by patient after May be performed by patient after
instruction instruction Q 1 hour while awakeQ 1 hour while awake Follow‑up daily or PRNFollow‑up daily or PRN
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Sustained Maximal Sustained Maximal Inhalation/Incentive Inhalation/Incentive Spirometry – SMI/ISSpirometry – SMI/IS
EquipmentEquipment Most actually measure flow and timeMost actually measure flow and time
TriflowTriflow InspiRxInspiRx
Some measure volumeSome measure volume Bartlett Edwards (Bellows)Bartlett Edwards (Bellows) Inspiron (Vortex Principle)Inspiron (Vortex Principle)
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Sustained Maximal Sustained Maximal Inhalation/Incentive Spirometry Inhalation/Incentive Spirometry
– SMI/IS– SMI/IS Patient EvaluationPatient Evaluation
AlertAlert CooperativeCooperative Physically able to increase IC greater than Physically able to increase IC greater than
VTVT Should be 3 times predicted VTShould be 3 times predicted VT
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IPPBIPPB
Intermitent Positive Pressure Intermitent Positive Pressure BreathingBreathing
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IPPB IndicationsIPPB Indications
PrimaryPrimary If patient has inadequate VC to If patient has inadequate VC to
facilitate a cough, VC less than 3 times facilitate a cough, VC less than 3 times predicted VT then VC less than predicted VT then VC less than 15ml/kg of ideal body weight15ml/kg of ideal body weight
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IPPB IndicationsIPPB Indications
SecondarySecondary To deliver medicationTo deliver medication Improve I:E ratioImprove I:E ratio Improve cough and mobilize secretionsImprove cough and mobilize secretions Alter V/QAlter V/Q To improve or prevent atelectasisTo improve or prevent atelectasis To decrease CO2 temporarilyTo decrease CO2 temporarily
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Contraindications of IPPBContraindications of IPPB
Absolute Absolute An untreated closed pneumothorax An untreated closed pneumothorax
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Contraindications of IPPBContraindications of IPPB
Secondary ContraindicationsSecondary Contraindications ICP > 15mmHgICP > 15mmHg Hemodynamic instabilityHemodynamic instability Recent facial, oral, or skull surgeryRecent facial, oral, or skull surgery Tracheal-esophageal fistulaTracheal-esophageal fistula Active hemoptysisActive hemoptysis Active TBActive TB Blebs or bullaeBlebs or bullae
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Contraindications of IPPBContraindications of IPPB
Hazards/ComplicationsHazards/Complications Barotrauma - pneumothoraxBarotrauma - pneumothorax Nosocomial infectionNosocomial infection HypocarbiaHypocarbia HyperoxiaHyperoxia TachypneaTachypnea Gastric distensionGastric distension Impedance of venous returnImpedance of venous return Air trappingAir trapping
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Contraindications of IPPBContraindications of IPPB
Hazards/Complications (cont)Hazards/Complications (cont) Increased ICPIncreased ICP O2 induced hypoventilation in COPD O2 induced hypoventilation in COPD
patients patients Decreased cardiac outputDecreased cardiac output May cause or worsen hemoptysisMay cause or worsen hemoptysis
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Contraindications of IPPBContraindications of IPPB
Hazards/Complications (cont)Hazards/Complications (cont) HyperventilationHyperventilation
DizzinessDizziness Loss of consciousnessLoss of consciousness TetanyTetany Paresthesia: Decreased cerebrovascular Paresthesia: Decreased cerebrovascular
PCO2 during hyperventilation causes PCO2 during hyperventilation causes vasoconstriction and decreased cerebral vasoconstriction and decreased cerebral blood flowblood flow
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Physiologic Effects of IPPBPhysiologic Effects of IPPB
Increased intrapulmonary pressureIncreased intrapulmonary pressure Decreased venous return, worsened Decreased venous return, worsened
by increasing inspiratory timeby increasing inspiratory time May decrease cardiac outputMay decrease cardiac output Mechanical bronchodilationMechanical bronchodilation Altered I:E ratioAltered I:E ratio
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Physiologic Effects of IPPBPhysiologic Effects of IPPB
Altered V/Q ratioAltered V/Q ratio Mobilization of secretionsMobilization of secretions Generally increased PaO2 and Generally increased PaO2 and
decreased PaCO2decreased PaCO2 Decreased work of breathingDecreased work of breathing
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Administration of IPPB Administration of IPPB
Demonstrate set‑upDemonstrate set‑up Check for leaksCheck for leaks Patient instructionPatient instruction
Passive treatmentPassive treatment Slow deep inspiration with holdSlow deep inspiration with hold Maintain sealMaintain seal Explain nature of and expected results of RxExplain nature of and expected results of Rx Rx should be gentle start to inhalation, with Rx should be gentle start to inhalation, with
slow, deep breath, followed by passive slow, deep breath, followed by passive exhalationexhalation
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Administration of IPPB Administration of IPPB
Coaching patientCoaching patient Calm and reassure patient/relaxationCalm and reassure patient/relaxation Verbally instruct in timing of inspiration Verbally instruct in timing of inspiration
and expirationand expiration Total relaxed exhalationTotal relaxed exhalation
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Administration of IPPB Administration of IPPB
Monitoring patientMonitoring patient Breath soundsBreath sounds VT (3 times predicted VT)VT (3 times predicted VT) Respiratory rateRespiratory rate Pulse: Stop Rx when increased by 20 BPMPulse: Stop Rx when increased by 20 BPM Verbal responseVerbal response
Ask subjective responsesAsk subjective responses DizzinessDizziness TinglingTingling
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PAPPAP
Define & Physiologic PrinciplesDefine & Physiologic Principles IndicationsIndications ContraindicationsContraindications Hazards & complications of CPAP (Egan Hazards & complications of CPAP (Egan
mini clinic)mini clinic) EquipmentEquipment Administer Intermittent CPAPAdminister Intermittent CPAP Monitoring and TroubleshootingMonitoring and Troubleshooting
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Bird Mark 7 & 8 (10 & 14)Bird Mark 7 & 8 (10 & 14)
ClassificationClassification Positive pressure ventilator forces air into Positive pressure ventilator forces air into
lungslungs Pneumatically powered doesn't require Pneumatically powered doesn't require
electricity (gas powered)electricity (gas powered) Pneumatically driven Pneumatically driven
It's regulator is like a gauge regulators It's regulator is like a gauge regulators Pneumatically driven ceramic switchPneumatically driven ceramic switch
Single circuited: the same gas supply goes to Single circuited: the same gas supply goes to the patient that powers the machinethe patient that powers the machine
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Bird Mark 7 & 8 (10 & 14)Bird Mark 7 & 8 (10 & 14)
ModesModes AssistAssist
The only mode used for IPPBThe only mode used for IPPB Patient sets rate, then machine delivers ratePatient sets rate, then machine delivers rate
Assist ControlAssist Control Used for continuous ventilationUsed for continuous ventilation If patient fails to set rate, machine will deliver If patient fails to set rate, machine will deliver
preset ratepreset rate Control: machine set rate and does not allow Control: machine set rate and does not allow
patient to alter preset patternpatient to alter preset pattern
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Bird Mark 7 & 8 (10 & 14)Bird Mark 7 & 8 (10 & 14)
Pressure cycledPressure cycled Cycling is what ends inspirationCycling is what ends inspiration When set pressure is reached, When set pressure is reached,
machine ends inspirationmachine ends inspiration Other possibilities of cyclingOther possibilities of cycling
FlowFlow TimeTime VolumeVolume
Flow limit - can be setFlow limit - can be set
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Bird Mark 7 & 8 (10 & 14)Bird Mark 7 & 8 (10 & 14)
Flow patternFlow pattern Determined by 100% or air mix setting due to Determined by 100% or air mix setting due to
effects of back pressure on the Venturi gateeffects of back pressure on the Venturi gate 100% ‑ square wave, flow remains constant 100% ‑ square wave, flow remains constant
in the face of back pressure - "flow in the face of back pressure - "flow generator"generator"
Air mix ‑ decaying flow curve due to partial Air mix ‑ decaying flow curve due to partial closure of Venturi gateclosure of Venturi gate
Due to back pressure, flow decreases as Due to back pressure, flow decreases as pressure increasespressure increases
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Bird Mark 7 & 8 (10 & 14)Bird Mark 7 & 8 (10 & 14)
Pressure patternPressure pattern Determined by flow patternDetermined by flow pattern 100% source gas rectilinear100% source gas rectilinear Air mix parabolicAir mix parabolic
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Bird Mark 7 & 8 (10 & 14)Bird Mark 7 & 8 (10 & 14)
Internal resistanceInternal resistance How the flow curve is effected by back How the flow curve is effected by back
pressurepressure Air mix – low Air mix – low flow pattern is much effected by back flow pattern is much effected by back
pressurepressure
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Bird Mark 7 & 8 (10 & 14)Bird Mark 7 & 8 (10 & 14)
Principles of OperationPrinciples of Operation Magnetism versus gas pressureMagnetism versus gas pressure Two chambers of machine divided by a Two chambers of machine divided by a
diaphragm diaphragm Left side: same as atmospheric Left side: same as atmospheric
pressurepressure Right side - same as system pressureRight side - same as system pressure
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Bird Mark 7 & 8 (10 & 14)Bird Mark 7 & 8 (10 & 14)
On inspiration, diaphragm is drawn to the On inspiration, diaphragm is drawn to the right by decreased system pressure right by decreased system pressure when patient initiates a breathwhen patient initiates a breath
As pressure builds up on pressure side, As pressure builds up on pressure side, the diaphragm is pushed back to the left the diaphragm is pushed back to the left over‑coming pressure of the magnetic over‑coming pressure of the magnetic pull of the switch platepull of the switch plate
A ceramic switch is moved by diaphragm A ceramic switch is moved by diaphragm which turns gas flow on and offwhich turns gas flow on and off
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Bird Mark 7 & 8 (10 & 14)Bird Mark 7 & 8 (10 & 14)
SpecificationsSpecifications Flow is variable and adjustableFlow is variable and adjustable
Peak flows on 100% 0‑50 LPMPeak flows on 100% 0‑50 LPM Peak flow on air mix 0‑80 LPMPeak flow on air mix 0‑80 LPM
Venturi gateVenturi gate Open -2 cm H2OOpen -2 cm H2O Closes at 2cms H2O lower (Venturi gate Closes at 2cms H2O lower (Venturi gate
spring resistance) then peak or set spring resistance) then peak or set pressurepressure
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Bird Mark 7 & 8 (10 & 14)Bird Mark 7 & 8 (10 & 14)
Air Mix controllerAir Mix controller Determines 100% source gas or air mixDetermines 100% source gas or air mix Air mixAir mix
If O2 is the source gas, FIO2 will be 0.4 to 0.8 If O2 is the source gas, FIO2 will be 0.4 to 0.8 The machine functions as a pressure The machine functions as a pressure
generatorgenerator 100%100%
FIO2 will be FIO2 of source gasFIO2 will be FIO2 of source gas The machine functions as a flow generatorThe machine functions as a flow generator
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Bird Mark 7 & 8 (10 & 14)Bird Mark 7 & 8 (10 & 14)
Nebulizer driveNebulizer drive NonadjustableNonadjustable FIO2 will be FIO2 of source gasFIO2 will be FIO2 of source gas Breaks off gas flow before VenturiBreaks off gas flow before Venturi
PressurePressure Located on right side of ventilatorLocated on right side of ventilator Adjustable 0‑60 cmH2O (Mark‑7, 8, 10)Adjustable 0‑60 cmH2O (Mark‑7, 8, 10) In mmHg Mark‑14In mmHg Mark‑14 The closer the magnet to the clutch plate The closer the magnet to the clutch plate
the higher the pressure required to cyclethe higher the pressure required to cycle
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Bird Mark 7 & 8 (10 & 14)Bird Mark 7 & 8 (10 & 14)
SensitivitySensitivity Adjustable on ambient (left) side of machineAdjustable on ambient (left) side of machine The closer the clutch plate to the magnet, the less The closer the clutch plate to the magnet, the less
sensitive or more pressure required to initiate sensitive or more pressure required to initiate inspirationinspiration
Apnea TimerApnea Timer Works off of a small leak altering pressure Works off of a small leak altering pressure
internallyinternally Allows machine to be used for A/C or control modesAllows machine to be used for A/C or control modes Not used for routine IPPBNot used for routine IPPB
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Bird Mark 7 & 8 (10 & 14)Bird Mark 7 & 8 (10 & 14)
Bird Mark 8Bird Mark 8 Has negative expiratory pressure Has negative expiratory pressure
capabilitiescapabilities Used Q circuit set‑upUsed Q circuit set‑up Not normally used for IPPBNot normally used for IPPB
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Bird Mark 7 & 8 (10 & 14)Bird Mark 7 & 8 (10 & 14)
Bird Mark 10Bird Mark 10 Has flow accelerator Has flow accelerator Increases flow at end inspiration to Increases flow at end inspiration to
compensate for leakscompensate for leaks
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Bird Mark 7 & 8 (10 & 14)Bird Mark 7 & 8 (10 & 14)
Bird Mark 14Bird Mark 14 Has higher pressure capabilities, flow Has higher pressure capabilities, flow
acceleratoraccelerator No negative pressureNo negative pressure
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Bird Mark 7 & 8 (10 & 14)Bird Mark 7 & 8 (10 & 14)
CircuitCircuit Large bore tubingLarge bore tubing Side stream or mainstreamSide stream or mainstream Exhalation valveExhalation valve One small bore tubing with "Y" to allow One small bore tubing with "Y" to allow
delivery to exhalation valve and delivery to exhalation valve and nebulizer nebulizer
Mouthpiece, mask or trachea adaptorMouthpiece, mask or trachea adaptor
RT 210 Hyperinflation TXRT 210 Hyperinflation TX
Bennett Ventilators Bennett Ventilators ClassificationClassification
Positive pressurePositive pressure Pneumatically poweredPneumatically powered
AP series is electricalAP series is electrical Pneumatically driven Bennett ValvePneumatically driven Bennett Valve Single circuitedSingle circuited ModesModes
Assist: only for IPPBAssist: only for IPPB Assist/Control: not for IPPB treatmentsAssist/Control: not for IPPB treatments
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Bennett Ventilators Bennett Ventilators ClassificationClassification
Flow cycledFlow cycled Pressure causes flow to drop to 1‑3 LPM and Pressure causes flow to drop to 1‑3 LPM and
ends inspirationends inspiration PR‑2 can be time cycledPR‑2 can be time cycled
Pressure limited: Preset control pressurePressure limited: Preset control pressure Decaying flow patternDecaying flow pattern Parabolic pressure patternParabolic pressure pattern Low internal resistance: back pressure Low internal resistance: back pressure
greatly influences flow patterngreatly influences flow pattern
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Bennett Ventilators Bennett Ventilators ClassificationClassification
Method of OperationMethod of Operation Bennett valve ‑ a counter balanced drum with Bennett valve ‑ a counter balanced drum with
vanes and windows allowing rotation to permit vanes and windows allowing rotation to permit flow through the windows or to stop itflow through the windows or to stop it
Sensitivity Sensitivity Adjustment to regulate patient effortAdjustment to regulate patient effort Set as sensitive as possible to insure minimal patient Set as sensitive as possible to insure minimal patient
effort effort Less than ‑2cm H2O for assist modeLess than ‑2cm H2O for assist mode
NebulizationNebulization Is off air dilutionIs off air dilution May be continuous or intermittentMay be continuous or intermittent AdjustableAdjustable
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Bennett Ventilators Bennett Ventilators ClassificationClassification
Method of OperationMethod of Operation Circuit setup Circuit setup
Large bore tubingLarge bore tubing NebulizerNebulizer Adaptor to patientAdaptor to patient Expiratory valveExpiratory valve 2 small bore tubes ‑ one for expiratory 2 small bore tubes ‑ one for expiratory
valve and other for nebulizationvalve and other for nebulization
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Description of Bennett Description of Bennett Models Models
AP‑4 & 5AP‑4 & 5 Electrically poweredElectrically powered Compressor drivenCompressor driven Flow sensitiveFlow sensitive Flow cycled (1‑2 LPM)Flow cycled (1‑2 LPM) Single circuitSingle circuit Assistor onlyAssistor only Pressure limitedPressure limited Low internal resistanceLow internal resistance Decaying flow patternDecaying flow pattern Parabolic pressure patternParabolic pressure pattern
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Description of Bennett Description of Bennett Models Models
Venturi models ‑ PR‑1, PR‑2Venturi models ‑ PR‑1, PR‑2 Knob in ‑ room air entrained Knob in ‑ room air entrained Knob out ‑ 100% source gas Knob out ‑ 100% source gas Flow/Pres. characteristics same for Flow/Pres. characteristics same for
both settingboth setting Air mix delivers FIO2 above 0.40Air mix delivers FIO2 above 0.40
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Description of Bennett Description of Bennett Models Models
PR‑1PR‑1 No Adjustment of peak flowNo Adjustment of peak flow No negative pressureNo negative pressure No terminal flow (like flow accelerator No terminal flow (like flow accelerator
on Bird) to compensate for leakson Bird) to compensate for leaks
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Description of Bennett Description of Bennett ModelsModels
PR‑2PR‑2 Has terminal flowHas terminal flow Peak flow deceleratorPeak flow decelerator Negative pressureNegative pressure
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Description of Bennett Description of Bennett ModelsModels
AP SeriesAP Series Same Bennett valveSame Bennett valve Electrically compressor drivenElectrically compressor driven Used for home care frequentlyUsed for home care frequently
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General Considerations For General Considerations For IPPB Therapeutic UnitsIPPB Therapeutic Units
Increasing pressure will increase Increasing pressure will increase volume delivered and I:E ratiovolume delivered and I:E ratio
Increasing flow rate will decrease Increasing flow rate will decrease inspiratory time and decrease I:E inspiratory time and decrease I:E ratioratio
Increasing sensitivity is desirable Increasing sensitivity is desirable unless autocycle occursunless autocycle occurs
Rate control is not used during IPPB Rate control is not used during IPPB (pure assist mode)(pure assist mode)
RT 210 Hyperinflation TXRT 210 Hyperinflation TX
General Considerations For General Considerations For IPPB Therapeutic UnitsIPPB Therapeutic Units
Nebulizer should be adjusted to Nebulizer should be adjusted to create optimum aerosol production create optimum aerosol production without wasting medicationwithout wasting medication
Initial volume/pressure relationship Initial volume/pressure relationship is based upon normal compliance is based upon normal compliance value, and adjusted according to value, and adjusted according to patient response and therapeutic patient response and therapeutic goalsgoals
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