Developed by the Cleveland Clinic

RespiSim eLearning LMS grants you access to self guided e-learning courses including levels from the SEVATM program.

  • Standardized Education for Ventilatory Assistance (SEVA™) is designed to develop the practitioner’s knowledge of mechanical ventilation technology.
  • This Learning Path teaches basic concepts of physics and engineering, leading up to a complete taxonomy for classifying and comparing modes of mechanical ventilation.
  • Technical capabilities of modes will be described along with the basics of ventilator graphic interpretation to assess patient-ventilator asynchrony and optimal settings.

 

 

Want to become a SEVA™ Master?

 

Robert L. Chatburn, MHHS, RRT-NPS, FAARC

Prof. Chatburn has dedicated his career to research methodology and mechanical ventilation. He is the enterprise program manager for research in respiratory care at Cleveland Clinic and a professor of Medicine at Lerner College of Medicine of Case Western Reserve University. Previously, he served as director of the simulation fellowship at Cleveland Clinic’s Simulation and Advanced Skills Center and technical director of respiratory care at Rainbow Babies & Children’s Hospital/University Hospitals.

Professor Chatburn has authored six textbooks, 56 textbook chapters, and over 370 articles and abstracts in peer-reviewed medical journals. He serves on the Editorial Board of Respiratory Care Journal and is recognized internationally as a research scientist and authority on mechanical ventilation. Rob teaches classes in mechanical ventilation for Youngstown State University in the bachelor’s and master’s level programs.

Rob was among the first 13 people awarded a fellowship in the American Association for Respiratory Care in 1998 and was the recipient of the 2007 Forrest M. Bird Lifetime Scientific Achievement Award. In 2017 he received the Jimmy A. Young medal for meritorious contributions to the American Association for Respiratory Care and the profession’s advancement (this is the AARC’s highest award). In 2021, Rob was inducted as a Legend of Respiratory Care in the AARC ‘s Virtual Museum. Over the last 15 years, Rob and Dr. Mireles-Cabodevila developed and implemented the Standardized Education for Ventilatory Assistance (SEVA™) course.

 

 

Eduardo Mireles-Cabodevila, MD

Dr. Mireles-Cabodevila is a Pulmonary and Critical Care Physician at the Cleveland Clinic in Ohio. He currently serves in several roles including Vice-Chair of the Department of Critical Care Medicine and Director of the Medical Intensive Care Unit at the Main Campus at the Cleveland Clinic. He is part of the Medical ECMO team and the Neuromuscular Pulmonary Clinic.

Dr. Mireles-Cabodevila has authored 1 book, 17 chapters, and over 70 articles in peer-reviewed medical journals. He is board-certified in Internal Medicine, Pulmonary, and Critical Care Medicine. He serves on the Editorial Board of Respiratory Care Journal. He has lectured locally, national and internationally on topics related to mechanical ventilation, critical care and neuromuscular diseases.

Dr. Mireles-Cabodevila is passionate about education. He is a former Program Director for the Critical Care fellowship and is currently the Medical Director of the Simulation and Advanced Skills Center at the Cleveland Clinic. He has developed, along with the Critical Care Simulation team, several courses and devices to enhance the training of healthcare providers. He specializes in critical care education and simulation to enhance and accelerate learning. Over the last 15 years, Dr. Mireles-Cabodevila and Professor Robert Chatburn developed and implemented the Standardized Education for Ventilatory Assistance (SEVA™) course.

SEVA™-basic

This course serves as an introduction to the SEVA learning program for mechanical ventilation. Topics are simplified to accommodate the beginning learner. It is comprised of 5 topics and is an online, self-directed course requiring a post-test.

Upon completingthe course, passing all course quizzes, and scoring 80% or higher on the final exam, learners will earn 2 hours of Continuing Respiratory Care Education (CRCE) credit by the American Association for Respiratory Care.

Course Outline:

  1. The equation of motion (simplified)
  2. Taxonomy (simplified)
  3. Choosing a mode of ventilation (based on clinical goals)
  4. Basic ventilator waveform interpretation
  5. Outline of patient ventilator interactions
  6. Post-Test

SEVA™-theory

SEVA-theory teaches 10 fundamental concepts, or maxims, for understanding the design and operation of mechanical ventilators. It also introduces the concepts needed for interpreting ventilator waveforms.

Upon completing Modules 1-12, passing all course quizzes, and scoring 80% or higher on the final exam, learners will earn 8 hours of Continuing Respiratory Care Education (CRCE) credit by the American Association for Respiratory Care.

Click on the “+” below to learn more about each course.

Introduction to Mechanical Ventilation

This module provides an overview of mechanical ventilation. It will describe and classify ventilators and introduce the concept of classifying modes of ventilation. Finally, it will outline a course of study for gaining the skills to appropriately match modes of ventilation to the assessed needs of the patient.

Objectives:

  1. Explain the A.I.M. rubric
  2. Define a ventilator and a mode of ventilation
  3. Give examples of how ventilators are classified in terms of operating principle or application
  4. Describe the skills required to use modes of ventilation appropriately
Maxim 1 - The Breath

This module will introduce the first of the 10 Maxims – The Breath. We will see how a breath is defined and the important mathematical relations related to ventilator settings.

Objectives:

  1. Define the following terms: maxim, mechanical ventilator, inspiratory time, inspiratory flow time, inspiratory pause time, expiratory time, expiratory flow time, expiratory pause time, influence diagram.
  2. Explain how a breath is defined.
  3. Explain in graphical terms how volume and flow are related.
  4. Draw the influence diagram for volume control ventilation along with all the associated equations.

 

Maxim 2 - The Assisted Breath

This module explains the concept of the assisted breath. When a patient cannot sustain the work of breathing, we use a ventilator to assist.

Objectives:

  1. Explain the difference between assisted, unassisted, and loaded breaths.
  2. Describe how work is calculated for an assisted breath.
  3. Show how we distinguish assisted, unassisted, and loaded breaths by looking at ventilator waveforms.
Maxim 3 - Volume or Pressure Control

In this module, we learn how breaths are assisted with either volume control or pressure control based on a mathematical model of the respiratory system called the equation of motion.

Objectives:

  1. Draw a single compartment model of the lungs and label the components and measurable variables
  2. Write the equations for resistance, compliance, and elastance
  3. Write and explain the equation of motion for a passive patient
  4. Use the equation of motion to define pressure control and volume control modes of ventilation
  5. Draw idealized waveforms for volume and pressure control
  6. Explain what the time constant is
  7. Explain what happens in volume control when elastance or resistance increases
  8. Explain what happens in pressure control when elastance or resistance increases
  9. Write the equation of motion showing the term representing patent inspiratory effort
  10. Explain what happens in volume control when Pmus increases
  11. Explain what happens in pressure control when Pmus increases
Maxim 4 - Trigger and Cycle Events

This module will  examine  the variables used to start (trigger) and end (cycle) inspiration.

Objectives:

  1. Define the terms trigger and cycle
  2. Describe 4 trigger variables
  3. Describe 4 cycle variables
  4. Calculate the inspiratory time based on the set frequency and I:E ratio
  5. Draw a diagram explaining how flow cycling works
  6. Describe what happens to inspiratory time if you increase the flow cycle threshold
  7. Distinguish between the terms sensitivity and trigger/cycle threshold
Maxim 5 - Machine vs. Patient Events

This module will take a look at the difference between machine initiated trigger and cycle events and those initiated by the patient. These are important concepts upon which some important definitions are based as the foundation of a mode classification system.

Objectives:

  1. Define the terms machine triggering and machine cycling
  2. Define the terms patient triggering and patient cycling
  3. List 2 machine trigger variables and 2 machine cycle variables
  4. List 3 patient trigger variables and 3 patient cycle variables
  5. Explain why pressure cycling is a form of patient cycling rather than machine cycling
  6. Explain why flow cycling is form of patient cycling rather than machine cycling
Maxim 6 - Spontaneous vs. Mandatory Breaths

This module will  explore the key concept of spontaneous versus mandatory breaths during mechanical ventilation.

Objectives:

  1. List examples of modes that illustrate every combination of patient and machine triggering and cycling
  2. Define a spontaneous breath
  3. Define a mandatory breath and give examples of trigger and cycle combinations
  4. Explain how the definition of a spontaneous breath relates to the definition of an assisted breath
  5. Explain how the definition of mandatory breath relates to the definition of an assisted breath
Maxim 7 - Breath Sequences

This module describes the possible sequences of mandatory and spontaneous breaths comprising a ventilation mode.

Objectives:

  1. List the 3 breathing sequences and give their definitions
  2. Describe the difference between CMV and IMV in term terms of trigger and synchronization windows
  3. Explain the 4 types of IMV
Maxim 8 - Ventilatory Patterns

This module  introduces the idea that modes can be distinguished by their ventilatory patterns, consisting of the control variable and the breath sequence.

Objectives:

  1. Name the 5 ventilatory patterns
  2. Describe the ventilatory patterns for the following mode names:
    • A/C Volume Control
    • A/C Volume Control Plus
    • BiLevel
    • NAVA
Maxim 9 - Targeting Schemes

In this module, we learn how to distinguish between ventilatory patterns based on their unique feedback control mechanisms, called targeting schemes.

Objectives:

  1. Draw a diagram illustrating the basic feedback control theory used in ventilators
  2. Define the terms target and targeting scheme
  3. Describe the 7 targeting schemes used in mechanical ventilators
  4. Describe the refined rubric for selecting the control variable, as modified by the existence of dual targeting
Maxim 10 - Mode Classification

This module will review the previous nine maxims and show how they form the basis of a system for classifying modes of mechanical ventilation.

Objectives:

  1. Describe the outline format for classifying modes of ventilation using the mode taxonomy
  2. Explain the difference between primary and secondary breaths for IMV modes
  3. Classify standard modes used in the ICU using the complete taxonomy
  4. Show how the concept of “variety” helps distinguish modes with the same tag
How to Read Graphic Displays

This final module will explain the concepts required to interpret ventilator displays showing pressure, volume, and flow waveforms.

Objectives:

  1. Describe the four-step procedure for routine inspection of ventilator graphics
  2. Draw the idealized pressure, volume, and flow waveforms for volume control and pressure control
  3. Explain how improper graphic scaling or leaks will distort waveforms
  4. Draw the pressure waveform for volume control showing work shifting due to the patient’s inspiratory effort
  5. Demonstrate how to identify the presence of autoPEEP
  6. Draw a pressure-volume loop for volume control showing evidence of over-distention
  7. Explain the effects of changes in lung mechanics on pressure, volume, and flow waveforms for both volume control and pressure control