Mandatory Minute Volume Ventilation: Therapeutic Analysis

Mandatory Minute volume Ventilation or MMV is an advance mode commonly found in Dräger ventilators, including Evita XL ventilator. Some of the common names for MMV include Minimum Minute Ventilation (MMV), Augmented Minute Volume (AMV) and Extended Mandatory Minute Ventilation (EMMV). MMV can be categorized as volume controlled (VC)-IMV with adaptive and set-point targeting schemes. This mode guarantees the patient will receive a minimum minute volume based the set respiratory rate and tidal volume. Thus, the set breathing rate is the maximum number of mandatory breaths a patient can receive (Chatburn, Khatib, Mireles-Cabodevila, 2014). Furthermore, if the patient is able to breath spontaneously above the set rate and tidal volume, fewer mandatory breaths are delivered by the machine. The mandatory breaths are delivered will be machine triggered, and time cycled breaths (Mini Manual Brief explanation of ventilation modes and function, 2015 Dräger).These breaths will be synchronized with spontaneous breaths, thus MMV can be categorized as IMV. Furthermore, the spontaneous breaths will be pressure-supported breaths at the set PEEP level. One of the major advantages of using MMV in ICU settings is that MMV is a better mode to provide transition from mechanical support to spontaneous ventilation for patients recovering from surgeries, anesthesia and drug overdose. Furthermore, MMV allows greater control of PaCO2 than other modes of ventilation. It is recommended by the manufacturer, Dräger, to set the minute volume at least 90% of the delivered minute volume of the patient on IMV/SIMV mode (Lawson, 2001, p. 10). Furthermore, if the patient is transitioning from CMV/AC mode to MMV, it is recommended to set the minute volume 80% of the delivered minute volume (Lawson, 2001, p. 10). MMV is a unique mode in comparison to other modes in ventilators because, if the spontaneous breathing does not result in the minute volume necessary for the patient, the ventilator will trigger machine breaths (Dräger Ventilation Mini Manual Brief explanation of ventilation modes and function. 2015). This allows the patient a safety net during periods of apnea. These parameters not only control the patient’s PaCO2, but also avoid apnea and reduces possibility of high respiratory rates. Moreover, acute hypoventilation situations are less likely to occur during MMV mode when administration of sedatives and narcotics to a patient. This is because the ventilator will guarantee the patient will receive 80%-90% of their target minute volume, thus adequately …show more content…
Because the machine calculate whether the patient is generating adequate minute volume, not the rate or the tidal volume, it does not recognize any increase of respiratory rate and reduced tidal volume. This can be detrimental to the patient because increase in respiratory rate can increase the patient’s work of breathing which will make the respiratory muscles fatigue quickly. Increased work of breathing is not the outcome for patients who are qualified to be weaned from the ventilator and can increase the length of stay at the hospital. Although, the mode maintain minute volume at the set levels, it may not maintain alveolar ventilation to regulate patient’s PaCO2. In order to fix this problem, practitioners must set the low tidal volume alarm and high respiratory rate alarm appropriately to the patient’s needs. Furthermore, practitioners must be vigilant when using MMV to wean patients from initial full ventilatory