What can we learn from high-frequency ventilation?
|
|
- Millicent Berry
- 5 years ago
- Views:
Transcription
1 What can we learn from high-frequency ventilation? Dipartimento di Medicina Perioperatoria, Terapia Intensiva ed Emergenza Azienda Sanitaria Universitaria Integrata di Trieste Università degli Studi di Trieste, Italy U. Lucangelo MD, PhD
2 Historical Overview of High Frequency Ventilation Oberg and Sjöstrand: first experimental application first clinical application High Frequency Positive Pressure Ventilation (HFPPV ) Lunkenheimer: High Frequency Oscillation (HFO) Klain and Smith 1977 High Frequency Jet Ventilation (HFJV)
3 The term High Frequency Ventilation is used to describe ventilation at higher than normal frequencies (above 60 cycles/min = 1 Hz) with reduced Tidal Volume (Vt) and Peak Airway Pressure (Ppeak)
4 Tidal Volume Tidal volume versus respiratory rate domain for different ventilatory strategies L F P P V + E C CO 2 R CV VD HFPPV HFJV HFOV Respiratory Rate (b/min)
5 High Frequency Ventilation Techniques Overwiew Heterogeneous group of Techniques Gas Delivery System Design Frequency ( cycles/min)
6 Gas Transport During HFV most popular theories Bulk gas flow Diffusion Taylor dispersion Asymmetric velocity profiles Pendelluft Collateral ventilation Cardiogenic oscillation
7 Gas Transport During HFV The relative importance of each of these mechanisms is not clear!! These mechanics are not mutually exclusive All may be operative simultaneously Effects of lung disease on regional mechanics
8 High-frequency ventilation was developed in an effort to avoid many of the complications and limitations of conventional mechanical ventilation Alveolar overdistension Use of large tidal volume Failure to exceed the minimum end-expiratory lung volume needed to prevent tidal closure of alveolar units
9 Froese CMM 1997;25:906
10 High Frequency Ventilation HFJV HFPV HFOV
11 H.F.O.V. is the form of high-frequency ventilation most widely used in adult critical care.
12 HFOV The oscillatory pressure swings and thus VT are provided by a piston O 2 INLET CO 2 WASH OUT Pressure Static Mean Airway Pressure P Unilevel Adjustable %I-time P MAP time
13 Pressure transmission in HFOV The oscillating pressures in the circuit are significantly damped in alveolar regions. Indeed, the impedance in the endotracheal tube alone significantly reduces the pressure swings in the trachea to 5-16% of that in the circuit.
14 Equation of motion during HFOV Paw( t) V t Ers V t Rrs V t Irs
15 Does High-Frequency Ventilation Offer Benefits Over Conventional Ventilation in Adult Patients With Acute Respiratory Distress Syndrome? Many of the available human data on delivered VT during HFOV are from studies of neonates. Neonates : small and uncuffed endotracheal tubes higher frequencies (10 15 Hz). Adults: cuffed endotracheal tubes lower frequency (3 6 Hz). Very different lung and chest wall mechanics. Therefore, the very small VT reported in neonates could well be irrelevant to adult medicine. Fessler H.E. and Hess D.R. Respiratory Care 2007
16 Tidal volume delivery during high frequency oscillatory ventilation in adults with acute respiratory distress syndrome. Decreasing endotracheal tube internal diameter from 8 mm to 7 mm and from 7 mm to 6 mm caused a 15.3% ± 1.7% and 18.9% ± 2.1% reduction in tidal volume, respectively. A 2 Hz increase in frequency (4, 6, 8, 10, 12 Hz) was associated with a 23.1% ± 6.3% decrease in tidal volume. A 10 cmh 2 O increase in pressure amplitude (20, 30, 40 cmh 2 O ) caused a 21.4% ±3.4% increase in tidal volume. Tidal volumes are not uniformly small during HFOV ( ml)!!! Hager DN et al. Crit Care Med 2007
17 Four methods of measuring tidal volume during high-frequency oscillatory ventilation. Measured VT varied with the pressure amplitude and varied strongly with the frequency. At a pressure amplitude of 90 cm H 2 O and a frequency of only 4 Hz, VT was 200 ml. At 10 Hz, the VT fell to about 80 ml, even at the pressure amplitude of 90 cm H 2 O. Hager DN, Fuld M, Kaczka DW, Fessler HE, et al. Crit Care Med 2006
18 Determinants of tidal volume during high-frequency oscillation. In an adult sheep model, was used HFVO management strategies that were identical to the ones used in early adult clinical trials by Fort and Mehta. These investigators found that quite large VT (ie, 6 ml/kg) were being delivered into the proximal airways. Sedeek KA et al. Crit Care Med 2003
19 VT is technically difficult to measure and is not monitored during HFOV. Reliable tidal volume estimates at the airway opening with an infant monitor during high-frequency oscillatory ventilation. Scalfaro P, Pillow JJ, Sly PD, Cotting J. Crit Care Med In the clinical practice, HFOV is not an intuitive ventilatory modality Four methods of measuring tidal volume during high-frequency oscillatory ventilation. Hager DN, Fuld M, Kaczka DW, Fessler HE, et al. Crit Care Med 2006 and the absence of real-time delivered volume monitoring Portable instrument for the volume measurement of high-frequency percussive produces disaffection among the physicians. ventilators. Riscica F, Lucangelo U, Accardo A. Biomed Sci Instrum 2010
20 Comparison of prone positioning and high-frequency oscillatory ventilation in patients with acute respiratory distress syndrome. Prospective randomized study that enrolled 39 ARDS patients with a PaO2/FIO 2 < 150 mm Hg at PEEP > 5 cm H 2 O. After 12 hours on conventional lung-protective mechanical ventilation (VT of 6 ml/kg, Pplat 35 cmh 2 O, with supine conventional ventilation). 12 patients received conventional lung protective mechanical ventilation in prone position. 13 patients received HFOV in supine position 12 patients received HFOV in prone position Papazian L, et al. Crit Care Med 2005
21 * * PaO 2 /FiO 2 Sup-CV Pro-CV Sup-CV Sup-CV Papazian L, et al. Crit Care Med 2005
22 Neutrophil counts in bronchoalveolar lavage fluid Papazian L, et al. Crit Care Med 2005
23 OSCAR/OSCILLATE, Both Imperfect Trials OSCILLATE (> 72 h excluded) OSCAR ( up to 7 days) CMV HFOV CMV HFOV PaO 2 /FiO 2 113±38 113±37 114±38 121±46 Hospital mortality 35% 47% 41.1% 41.7% Apache II 29±7-21±6.1 - VT (ml/kg) 7.1± ±3.5 - PREMATURELY STOPPED
24 Finally, the epiphenomena of HFOV include the potential for circulatory depression from high airway pressure and the need for heavy sedation or paralysis during HFOV.
25 Efficacy and adverse events of high-frequency oscillatory ventilation in adult patients with acute respiratory distress syndrome: a meta-analysis Huang et al. Critical Care 2014, 18:R102
26 Efficacy and adverse events of high-frequency oscillatory ventilation in adult patients with acute respiratory distress syndrome: a meta-analysis Huang et al. Critical Care 2014, 18:R102
27 The effect of HFOV on 30-day or hospital mortality Huang et al. Critical Care 2014, 18:R102
28 The application of HFOV was associated with a trend toward increased risk of barotrauma and unfavorable hemodynamics. Huang et al. Critical Care 2014, 18:R102
29 The application of HFOV was associated with a trend toward increased risk of barotrauma and unfavorable hemodynamics. Huang et al. Critical Care 2014, 18:R102
30 Current evidence did not support the routine use of HFOV for ARDS patients in the era of lung-protective ventilation because of its potential harm.
31 High Frequency PercussiveVentilation Delivers high frequency ventilation ( cycles/min) in combination with low frequency breath cycles. I E
32 Male, 58yrs old, BMI 27,7 Essential hypertension, paroxystic atrial flutter, mild mitral and aortic insuffciency Bilateral bronchopneumonia Nasal swab positive for influenza virus A (H1N1)
33 ph PaCO mmhg PaO mmhg HCO meq/l BE 4.5 and SaO % Oxygenation index = 39 Lung injury score = 3.25 FiO 2 = 1
34 PCV
35 HFPV
36 Electrical impedance tomography during VCV
37 Electrical impedance tomography during HFPV
38 The Evidence for New Ventilator Modes It s not the ventilator mode that makes a difference It s the skills of the clinician that makes the difference. Any ventilator mode has the potential to do harm! Dean Hess 2010
39 To ventilate, oscillate, or cannulate? Given the heterogeneity of acute respiratory distress syndrome, each of these modalities may play a role in an individual patient. Future studies comparing LPV, HFOV, and VV ECMO should not only focus on defining the patients who benefit most from each of these therapies but also consider long-term functional outcomes. Shekar K et al. Journal of Critical Care 2013
40 HFOV should be reserved for patients failing conventional ventilation and applied by clinicians with considerable experience with the device. Respir Care 2016
High Frequency Ventilation. Neil MacIntyre MD Duke University Medical Center Durham NC USA
High Frequency Ventilation Neil MacIntyre MD Duke University Medical Center Durham NC USA High frequency ventilation Concept of ventilator induced lung injury and lung protective ventilatory strategies
More informationhttp://www.priory.com/cmol/hfov.htm INTRODUCTION The vast majority of patients who are admitted to an Intensive Care Unit (ICU) will need artificial ventilation (Jones et al 1998). The usual means through
More informationVolume Diffusion Respiration (VDR)
Volume Diffusion Respiration (VDR) A therapy with many uses Jeffrey Pietz, MD April 15, 2016 VDR ventilation has been used to treat patients with: ARDS Meconium Aspiration Burn and Inhalation Injury RDS
More informationHow does HFOV work? John F Mills MBBS, FRACP, M Med Sc, PhD Neonatologist Royal Children s Hospital. Synopsis
How does HFOV work? John F Mills MBBS, FRACP, M Med Sc, PhD Neonatologist Royal Children s Hospital Synopsis Definition of an oscillator Historical perspective Differences between HFOV and CMV Determinants
More informationDriving Pressure. What is it, and why should you care?
Driving Pressure What is it, and why should you care? Jonathan Pak MD March 2, 2017 Lancet 1967; 290: 319-323 Traditional Ventilation in ARDS Tidal Volume (V T ) = 10-15 ml/kg PBW PEEP = 5-12 cm H 2 O
More information3100A Competency Exam
NAME DATE (Circle the appropriate answer) 3100A Competency Exam 1. Of the following, which best describes the mechanics of ventilation used by the 3100A? a. Active inspiration with passive exhalation b.
More informationMechanical Ventilation of the Patient with ARDS
1 Mechanical Ventilation of the Patient with ARDS Dean Hess, PhD, RRT, FAARC Assistant Professor of Anesthesia Harvard Medical School Assistant Director of Respiratory Care Massachusetts General Hospital
More informationWhat is an Optimal Paw Strategy?
What is an Optimal Paw Strategy? A Physiological Rationale Anastasia Pellicano Neonatologist Royal Children s Hospital, Melbourne Acute injury sequence Barotrauma Volutrauma Atelectotrauma Biotrauma Oxidative
More information5/9/2017. Definition & Description. HFOV Rationale, Physiology, & Applications. Definition & Description. Rationale. High Frequency Ventilation Types
High Frequency Oscillatory Ventilation Learning Objectives Explain the indications, rationale & monitoring for HFOV Explain the effects of adjusting HFOV ventilator controls Arthur Jones EdD, RRT This
More informationPART EIGHT HIGH FREQUENCY PERCUSSIVE OSCILLATION (HFPOV )
PART EIGHT HIGH FREQUENCY PERCUSSIVE OSCILLATION (HFPOV ) Note: For maximal comparative understanding, FIRST read PART SEVEN which defines the concept of High Frequency Oscillatory Ventilation (HFOV).
More informationVT PLUS HF performance verification of Bunnell Life-Pulse HFJV (High Frequency Jet Ventilator)
VT PLUS HF performance verification of Bunnell Life-Pulse HFJV (High Frequency Jet Ventilator) VT PLUS HF provides a special mode for evaluating the performance of high frequency ventilators while connected
More informationAccumulation of EEV Barotrauma Affect hemodynamic Hypoxemia Hypercapnia Increase WOB Unable to trigger MV
Complicated cases during mechanical ventilation Pongdhep Theerawit M.D. Pulmonary and Critical Care Division Ramathibodi Hospital Case I Presentation Male COPD 50 YO, respiratory failure, on mechanical
More informationVentilating the Sick Lung Mike Dougherty RRT-NPS
Ventilating the Sick Lung 2018 Mike Dougherty RRT-NPS Goals and Objectives Discuss some Core Principles of Ventilation relevant to mechanical ventilation moving forward. Compare and Contrast High MAP strategies
More informationMechanical ven3la3on. Neonatal Mechanical Ven3la3on. Mechanical ven3la3on. Mechanical ven3la3on. Mechanical ven3la3on 8/25/11. What we need to do"
8/25/11 Mechanical ven3la3on Neonatal Mechanical Ven3la3on Support oxygen delivery, CO2 elimination" Prevent added injury, decrease ongoing injury" Enhance normal development" Mark C Mammel, MD University
More informationONLINE DATA SUPPLEMENT. First 24 hours: All patients with ARDS criteria were ventilated during 24 hours with low V T (6-8 ml/kg
APPENDIX 1 Appendix 1. Complete respiratory protocol. First 24 hours: All patients with ARDS criteria were ventilated during 24 hours with low V T (6-8 ml/kg predicted body weight (PBW)) (NEJM 2000; 342
More informationProf. Javier García Fernández MD, Ph.D, MBA.
Prof. Javier García Fernández MD, Ph.D, MBA. Chairman of Anesthesia & Perioperative Medicine Department Puerta de Hierro Universitary Hospital Prof. of Anaesthesia and Perioperative Medicine. Autonoma
More informationWhy we should care (I)
What the $*!# is Lung Protective Ventilation and Why Should I be Using it in the OR? Disclosures KATHERINE PALMIERI, MD, MBA 64 TH ANNUAL POSTGRADUATE SYMPOSIUM UNIVERSITY OF KANSAS MEDICAL CENTER DEPARTMENT
More informationVENTILATORS PURPOSE OBJECTIVES
VENTILATORS PURPOSE To familiarize and acquaint the transfer Paramedic with the skills and knowledge necessary to adequately maintain a ventilator in the interfacility transfer environment. COGNITIVE OBJECTIVES
More informationBasics of Mechanical Ventilation. Dr Shrikanth Srinivasan MD,DNB,FNB,EDIC Consultant, Critical Care Medicine Medanta, The Medicity
Basics of Mechanical Ventilation Dr Shrikanth Srinivasan MD,DNB,FNB,EDIC Consultant, Critical Care Medicine Medanta, The Medicity Overview of topics 1. Goals 2. Settings 3. Modes 4. Advantages and disadvantages
More informationINTRODUCTION TO BI-VENT (APRV) INTRODUCTION TO BI-VENT (APRV) PROGRAM OBJECTIVES
INTRODUCTION TO BI-VENT (APRV) INTRODUCTION TO BI-VENT (APRV) PROGRAM OBJECTIVES PROVIDE THE DEFINITION FOR BI-VENT EXPLAIN THE BENEFITS OF BI-VENT EXPLAIN SET PARAMETERS IDENTIFY RECRUITMENT IN APRV USING
More informationHow Does Alteration of Airway Resistance Affect Delivered Tidal Volume in Adult Patients Receiving High-Frequency Oscillatory Ventilation?
Georgia State University ScholarWorks @ Georgia State University Respiratory Therapy Theses Department of Respiratory Therapy 1-21-2009 How Does Alteration of Airway Resistance Affect Delivered Tidal Volume
More informationOPEN LUNG APPROACH CONCEPT OF MECHANICAL VENTILATION
OPEN LUNG APPROACH CONCEPT OF MECHANICAL VENTILATION L. Rudo Mathivha Intensive Care Unit Chris Hani Baragwanath Aacademic Hospital & the University of the Witwatersrand OUTLINE Introduction Goals & Indications
More informationDisclosures. The Pediatric Challenge. Topics for Discussion. Traditional Anesthesia Machine. Tidal Volume = mls/kg 2/13/14
2/13/14 Disclosures Optimal Ventilation of the Pediatric Patient in the OR Consulting Draeger Medical Jeffrey M. Feldman, MD, MSE Division Chief, General Anesthesia Dept. of Anesthesiology and Critical
More informationPrinciples of mechanical ventilation. Anton van Kaam, MD, PhD Emma Children s Hospital AMC Amsterdam, The Netherlands
Principles of mechanical ventilation Anton van Kaam, MD, PhD Emma Children s Hospital AMC Amsterdam, The Netherlands Disclosure Research grant Chiesi Pharmaceuticals Research grant CareFusion GA: 27 weeks,
More informationexcellence in care Procedure Management of patients with difficult oxygenation. For Review Aug 2015
Difficult Oxygenation HELI.CLI.12 Purpose This procedure describes the processes and procedures for a lung protective strategy in the mechanical ventilation of patients that are difficult to oxygenate
More informationAdvanced Ventilator Modes. Shekhar T. Venkataraman M.D. Professor Critical Care Medicine and Pediatrics University of Pittsburgh School of Medicine
Advanced Ventilator Modes Shekhar T. Venkataraman M.D. Shekhar T. Venkataraman M.D. Professor Critical Care Medicine and Pediatrics University of Pittsburgh School of Medicine Advanced modes Pressure-Regulated
More informationThe ARDSnet and Lung Protective Ventilation: Where Are We Today
The ARDSnet and Lung Protective Ventilation: Where Are We Today 4-16-12 RCSW Bob Kacmarek PhD, RRT Harvard Medical School Massachusetts General Hospital Boston, Massachusetts Conflict of Interest Disclosure
More informationcarefusion.com CareFusion Yorba Linda, CA CareFusion
CareFusion 22745 Savi Ranch Parkway Yorba Linda, CA 92887 800.231.2466 toll-free 714.283.2228 tel 714.283.8493 fax CareFusion Germany 234 GmbH Leibnizstrasse 7 97204 Hoechberg Germany +49 931 4972-0 tel
More informationNeonatal tidal volume targeted ventilation
Neonatal tidal volume targeted ventilation Colin Morley Retired Professor of Neonatal Medicine, Royal Women s Hospital, Melbourne, Australia. Honorary Visiting Fellow, Dept Obstetrics and Gynaecology,
More informationMechanical Ventilation. Mechanical Ventilation is a Drug!!! is a drug. MV: Indications for use. MV as a Drug: Outline. MV: Indications for use
Mechanical Ventilation is a Drug!!! Mechanical Ventilation is a drug I am an employee of Philips Healthcare Hospital Respiratory Care Group and they help me pay for my kids education Jim Laging, RRT, RCP
More informationHFOV in the PICU and NICU setting
in the PICU and NICU setting Courtesy from G. Niemann Peter C. Rimensberger, MD Associate Professor Pediatric and Neonatal Intensive Care University Hospital of Geneva Allowable V t depends on pathology
More informationSUPPLEMENTARY APPENDIX. Ary Serpa Neto MD MSc, Fabienne D Simonis MD, Carmen SV Barbas MD PhD, Michelle Biehl MD, Rogier M Determann MD PhD, Jonathan
1 LUNG PROTECTIVE VENTILATION WITH LOW TIDAL VOLUMES AND THE OCCURRENCE OF PULMONARY COMPLICATIONS IN PATIENTS WITHOUT ARDS: a systematic review and individual patient data metaanalysis SUPPLEMENTARY APPENDIX
More informationKey words: intrahospital transport; manual ventilation; patient-triggered ventilation; respiratory failure
Intrahospital Transport of Critically Ill Patients Using Ventilator With Patient- Triggering Function* Toshiaki Nakamura, MD; Yuji Fujino, MD; Akinori Uchiyama, MD; Takashi Mashimo, MD; and Masaji Nishimura,
More informationUnderlying Principles of Mechanical Ventilation: An Evidence-Based Approach
Underlying Principles of Mechanical Ventilation: An Evidence-Based Approach Ira M. Cheifetz, MD, FCCM, FAARC Professor of Pediatrics and Anesthesiology Chief Medical Officer, Children s Services Associate
More informationDifficult Oxygenation Distribution: Sydney X Illawarra X Orange X
HELICOPTER OPERATING PROCEDURE HOP No: C/12 Issued: May 2011 Page: 1 of 5 Revision No: Original Difficult Oxygenation Distribution: Sydney X Illawarra X Orange X TRIM No: 09/300 Document No: D10/9973 X
More informationWhat is Lung Protective Ventilation? NBART 2016
What is Lung Protective Ventilation? NBART 2016 Disclosure Full time employee of Draeger Outline 1. Why talk about Lung Protective Ventilation? 2. What is Lung Protective Ventilation? 3. How to apply Lung
More informationBunnell LifePulse HFV Quick Reference Guide # Bunnell Incorporated
Bunnell Incorporated n www.bunl.com n 800-800-4358 (HFJV) n info@bunl.com 436 Lawndale Drive n Salt Lake City, Utah 84115 n intl 801-467-0800 n f 801-467-0867 Bunnell LifePulse HFV Quick Reference Guide
More informationAPRV: Moving beyond ARDSnet
APRV: Moving beyond ARDSnet Matthew Lissauer, MD Associate Professor of Surgery Medical Director, Surgical Critical Care Rutgers, The State University of New Jersey What is APRV? APRV is different from
More informationChapter 3: Invasive mechanical ventilation Stephen Lo
Chapter 3: Invasive mechanical ventilation Stephen Lo Introduction Conventional mechanical ventilation is the delivery of positive pressure to the airway to allow removal of CO2 and delivery of O2. In
More informationHumidification of Base Flow Gas during Adult High-Frequency Oscillatory Ventilation: An Experimental Study Using a Lung Model
Humidification of Base Flow Gas during Adult High-Frequency Oscillatory Ventilation: An Experimental Study Using a Lung Model a* b a a a a b ʼ 100 20 This schema shows the lung model and the ventilation
More informationMechanical Ventilation. Which of the following is true regarding ventilation? Basics of Ventilation
Mechanical Ventilation Jeffrey L. Wilt, MD, FACP, FCCP Associate Professor of Medicine Michigan State University Associate Program Director MSU-Grand Rapids Internal Medicine Residency Which of the following
More informationRESPIRATORY CARE POLICY AND PROCEDURE MANUAL. a) Persistent hypoxemia despite improved ventilatory pattern and elevated Fl02
The University of Mississippi AND PROCEDURE MANUAL Effective Date: June 30, 1990 Revised Date: December 2009 MANUAL CODE Page 1 of 5 PREPARED BY: Respiratory Care Policy and Procedure Review Committee
More informationMechanical Ventilation
Mechanical Ventilation Understanding Modes Rob Chatburn, RRT-NPS, FAARC Research Manager Respiratory Therapy Cleveland Clinic Associate Professor Case Western Reserve University 1 Overview Characteristics
More informationTest Bank for Pilbeams Mechanical Ventilation Physiological and Clinical Applications 6th Edition by Cairo
Test Bank for Pilbeams Mechanical Ventilation Physiological and Clinical Applications 6th Edition by Cairo Link full download: http://testbankair.com/download/test-bank-for-pilbeams-mechanicalventilation-physiological-and-clinical-applications-6th-edition-by-cairo/
More informationSumit Ray Senior Consultant & Vice-Chair Critical Care & Emergency Medicine Sir Ganga Ram Hospital
Sumit Ray Senior Consultant & Vice-Chair Critical Care & Emergency Medicine Sir Ganga Ram Hospital ARDS pathophysiology B Taylor Thompson et al. NEJM 2017;377:562-72. Outcome Australian Epidemiologic
More informationVENTILATION STRATEGIES FOR THE CRITICALLY UNWELL
VENTILATION STRATEGIES FOR THE CRITICALLY UNWELL Dr Nick Taylor Visiting Emergency Specialist Teaching Hospital Karapitiya Senior Specialist and Director ED Training Clinical Lecturer, Australian National
More informationLung recruitment maneuvers
White Paper Lung recruitment maneuvers Assessment of lung recruitability and performance of recruitment maneuvers using the P/V Tool Pro Munir A Karjaghli RRT, Clinical Application Specialist, Hamilton
More informationPressure -Volume curves in ARDS. G. Servillo
Pressure -Volume curves in ARDS G. Servillo Dipartimento di Scienze Chirurgiche, Anestesiologiche- Rianimatorie e dell Emergenza Facoltà di Medicina e Chirurgia Università degli Studi di Napoli Federico
More informationSupplementary Appendix
Supplementary Appendix This appendix has been provided by the authors to give readers additional information about their work. Supplement to: Talmor D, Sarge T, Malhotra A, et al. Mechanical ventilation
More informationThe Crossvent 2i+ 2. Ventilator Concept (brief theory of operation and features)
The Crossvent 2i+ 1. How is this ventilator classified 2. Ventilator Concept (brief theory of operation and features) -Your Two Choices with this Ventilator 3. An overview of the device (an in-service)
More informationImprovement of gas exchange during high frequency intermittent oscillation in rabbits
Original Contribution Kitasato Med J 2014; 44: 56-68 Improvement of gas exchange during high frequency intermittent oscillation in rabbits Shingo Kasahara, 1 Kagami Miyaji 2 1 Department of Cardiovascular
More informationHIGH FREQUENCY JET VENTILATION (HFJV): EQUIPMENT PREPRATION
POLICY The physician orders High Frequency Jet Ventilation (HFJV). The Respiratory Therapist in discussion with the physician will determine blood gas targets and ventilation settings for the treatment
More informationPART ONE CHAPTER ONE PRIMARY CONSIDERATIONS RELATING TO THE PHYSIOLOGICAL AND PHYSICAL ASPECTS OF THE MECHANICAL VENTILATION OF THE LUNG
PART ONE CHAPTER ONE PRIMARY CONSIDERATIONS RELATING TO THE PHYSIOLOGICAL AND PHYSICAL ASPECTS OF THE MECHANICAL VENTILATION OF THE LUNG POSSIBLE ORIGIN OF THE MECHANICAL VENTILATION OF THE LUNG- The first
More informationIndications for Mechanical Ventilation. Mechanical Ventilation. Indications for Mechanical Ventilation. Modes. Modes: Volume cycled
Mechanical Ventilation Eric A. Libré, MD VCU School of Medicine Inova Fairfax Hospital and VHC Indications for Mechanical Ventilation Inadequate ventilatory effort Rising pco2 with resp acidosis (7.25)
More informationFlight Medical presents the F60
Flight Medical presents the F60 Reliable Ventilation Across the Spectrum of Care Adult & Pediatric Pressure/Volume Control Basic/Advanced Modes Invasive/NIV High Pressure/Low Flow O2 Up to 12 hours batteries
More informationRESPIRATORY PHYSIOLOGY RELEVANT TO HFOV
RESPIRATORY PHYSIOLOGY RELEVANT TO Physiology of CMV 1 What is? Ventilation using a relatively high continuous distending pressure at the airway opening, around which an oscillatory wave is generated to
More informationUsing Common Ventilator Graphics to Provide Optimal Ventilation
Using Common Ventilator Graphics to Provide Optimal Ventilation David Vines, MHS, RRT, FAARC Associate Professor Chair / Program Director Department of Respiratory Care RUSH UNIVERSITY MEDICAL CENTER Disclosure
More information3. Mean airway pressure (MAWP) is characteristically lower in HFOV compared to conventional ventilation.
Sign up to receive ATOTW weekly - email worldanaesthesia@mac.com HIGH FREQUENCY OSCILLATORY VENTILATION ANAESTHESIA TUTORIAL OF THE WEEK 261 28 TH MAY 2012 Dr Sarah Jarvis, Mrs Karen Burt and Dr William
More informationPART SEVEN THE HISTORY AND APPLICATION OF HIGH FREQUENCY OSCILLATORY VENTILATION (HFOV)
PART SEVEN THE HISTORY AND APPLICATION OF HIGH FREQUENCY OSCILLATORY VENTILATION (HFOV) Reciprocating pistons with an eccentric travel speed, moving to and fro within a cylinder (with a common inlet/outlet),
More informationCarbon Dioxide Elimination and Gas Displacement Vary With Piston Position During High-Frequency Oscillatory Ventilation
Carbon Dioxide Elimination and Gas Displacement Vary With Piston Position During High-Frequency Oscillatory Ventilation Donna S Hamel RRT, Andrew L Katz MD PhD, Damian M Craig MSc, John D Davies RRT, Ira
More informationThe Puritan Bennett 980 Neonatal Ventilator System. Helping to Protect Our Most Vulnerable NEWBORNS
The Puritan Bennett 980 Neonatal Ventilator System Helping to Protect Our Most Vulnerable NEWBORNS 2 Helping Provide Comfortable Care When newborns first weeks or months of life are spent in the NICU,
More informationSafe and Intuitive Neonatal Ventilation
Safe and Intuitive Neonatal Ventilation www.hamilton-medical.com/g5 Clinical benefits for infants Improve patient outcome Use of protective tidal volumes, 4 6 ml/kg in preterm infants, has been shown
More informationPressure Controlled Modes of Mechanical Ventilation
Pressure Controlled Modes of Mechanical Ventilation Christopher Junker Department of Anesthesiology & Critical Care Medicine George Washington University Saturday, August 20, 2011 Assist Control Hypoxemic
More informationInitiation and Management of Airway Pressure Release Ventilation (APRV)
Initiation and Management of Airway Pressure Release Ventilation (APRV) Eric Kriner RRT Pulmonary Critical Care Clinical Specialist Pulmonary Services Department Medstar Washington Hospital Center Disclosures
More informationIntroduction to Conventional Ventilation
Introduction to Conventional Ventilation Dr Julian Eason Consultant Neonatologist Derriford Hospital Mechanics Inspiration diaphragm lowers and thorax expands Negative intrathoracic/intrapleural pressure
More informationTechnical Data and Specifications
Technical Data and Specifications INTENDED USE Ventilator designed to provide Invasive and Non-invasive ventilation for the critical care management of adult, pediatric and neonate-infant (including premature)
More informationDescription: Percentage of cases with median tidal volumes less than or equal to 8 ml/kg.
Measure Abbreviation: PUL 02 Description: Percentage of cases with median tidal volumes less than or equal to 8 ml/kg. NQS Domain: Patient Safety Measure Type: Process Scope: Calculated on a per case basis.
More informationSelecting the Ventilator and the Mode. Chapter 6
Selecting the Ventilator and the Mode Chapter 6 Criteria for Ventilator Selection Why does the patient need ventilatory support? Does the ventilation problem require a special mode? What therapeutic goals
More informationA Multi-centre RCT of An Open Lung Strategy including Permissive Hypercapnia, Alveolar Recruitment and Low Airway Pressure in
The PHARLAP Study A Multi-centre RCT of An Open Lung Strategy including Permissive Hypercapnia, Alveolar Recruitment and Low Airway Pressure in The PHARLAP Study Investigators for the ANZICS Clinical Trials
More informationMechanical Ventilation Guided by Esophageal Pressure in Acute Lung Injury *
A teaching hospital of Harvard Medical School Mechanical Ventilation Guided by Esophageal Pressure in Acute Lung Injury * Ray Ritz BA RRT FAARC Beth Israel Deaconess Medical Center Boston MA * n engl j
More informationThis is a pre-copyedited, author-produced PDF of an article accepted for publication in Neonatal Network following peer review. The version of record
This is a pre-copyedited, author-produced PDF of an article accepted for publication in Neonatal Network following peer review. The version of record [Neonatal Network (August 2013) Vol 32 (4): 246-261.
More informationMechanical Ventilation
PROCEDURE - Page 1 of 5 Purpose Scope Physician's Order Indications Procedure Mechanical Artificial Ventilation refers to any methods to deliver volumes of gas into a patient's lungs over an extended period
More informationPrinciples of Mechanical Ventilation: A Graphics-Based Approach
Principles of Mechanical Ventilation: A Graphics-Based Approach Steven M. Donn, MD, FAAP Professor of Pediatrics Neonatal-Perinatal Medicine C.S. Mott Children s Hospital University of Michigan Health
More informationPresentation Overview. Monitoring Strategies for the Mechanically Ventilated Patient. Early Monitoring Strategies. Early Attempts To Monitor WOB
Monitoring Strategies for the Mechanically entilated Patient Presentation Overview A look back into the future What works and what may work What s all the hype about the WOB? Are ventilator graphics really
More informationC - The Effects of Mechanical Ventilation on the Development of Acute Respiratory Distress Syndrome LIBRARIES ARCHIVES.
The Effects of Mechanical Ventilation on the Development of Acute Respiratory Distress Syndrome by Xiaoming Jia Submitted to the Department of Electrical Engineering and Computer Science in partial fulfillment
More informationAlveolar Recruiment for ARDS Trial
Alveolar Recruiment for ARDS Trial Alexandre Biasi Cavalcanti HCor Research Institute For the ART Investigators Trial Organization Coordination: HCor Research Institute (Sao Paulo, Brazil). Support: Brazilian
More informationJavier García Fernández. MD. Ph.D. MBA. Chairman of Anaesthesia and Critical Care Service Puerta de Hierro University Hospital Associate Professor.
Javier García Fernández. MD. Ph.D. MBA. Chairman of Anaesthesia and Critical Care Service Puerta de Hierro University Hospital Associate Professor. Medical School. UAM CV and Conflict of interest Chairman
More informationAutomatic Transport Ventilator
Automatic Transport Ventilator David M. Landsberg, MD, FACP, FCCP, EMT-P Luke J. Gasowski, RRT, NPS, ACCS, CCP-C, FP-C Christopher J. Fullagar, MD, FACEP, EMT-P Stan Goettel, MS, EMT-P Author credits /
More informationSLE5000 Infant Ventilator with HFO
SLE5000 Infant Ventilator with HFO When the smallest thing matters SLE5000 - The Total Solution for Infant Ventilation Shown on optional roll stand. Ventilator may be mounted either way round on stand.
More informationOperating Instructions for Microprocessor Controlled Ventilators
Page 1 of 5 Operating Instructions for Microprocessor Controlled Ventilators Purpose Audience Scope Physician's Order To provide guidelines for the procedure for the use of microprocessor controlled ventilators.
More informationPhysiological based management of hypoxaemic respiratory failure
Physiological based management of hypoxaemic respiratory failure David Tingay 1. Neonatal Research, Murdoch Children s Research Institute, Melbourne 2. Neonatology, Royal Children s Hospital 3. Dept of
More information4/2/2017. Sophisticated Modes of Mechanical Ventilation - When and How to Use Them. Case Study 1. Case Study 1. ph 7.17 PCO 2 55 PO 2 62 HCO 3
Sophisticated Modes of Mechanical entilation - When and How to Use Them Dr. Leanna R. Miller DNP, RN, CCRN-CMC, PCCN-CSC, CEN, CNRN, CMSRN, NP LRM Consulting Nashville, TN Case Study 1 A 55 year-old man
More informationEMS INTER-FACILITY TRANSPORT WITH MECHANICAL VENTILATOR COURSE OBJECTIVES
GENERAL PROVISIONS: EMS INTER-FACILITY TRANSPORT WITH MECHANICAL VENTILATOR COURSE OBJECTIVES Individuals providing Inter-facility transport with Mechanical Ventilator must have successfully completed
More informationNAVA Neurally Adjusted Ventilatory Assist In Neonates
NAVA Neurally Adjusted Ventilatory Assist In Neonates Howard Stein, M.D. Director Neonatology Toledo Children s Hospital Toledo, Ohio Disclaimers Dr Stein: Is on the speaker s bureau for Maquet Is discussing
More informationMechanical Ventilation
Mechanical Ventilation Chapter 4 Mechanical Ventilation Equipment When providing mechanical ventilation for pediatric casualties, it is important to select the appropriately sized bag-valve mask or endotracheal
More informationObjectives. Respiratory Failure : Challenging Cases in Mechanical Ventilation. EM Knows Respiratory Failure!
Respiratory Failure : Challenging Cases in Mechanical Ventilation Peter DeBlieux, MD, FAAEM, FACEP LSUHSC University Hospital Pulmonary and Critical Care Medicine Emergency Medicine pdebli@lsuhsc.edu Objectives
More informationRespiratory Failure & Mechanical Ventilation. Denver Health Medical Center Department of Surgery and the University Of Colorado Denver
Respiratory Failure & Mechanical Ventilation Denver Health Medical Center Department of Surgery and the University Of Colorado Denver + + Failure of the Respiratory Pump 1. Lack of patent airway 2. Bronchospasm
More informationCompleted downloadable Test Bank for Pilbeams Mechanical Ventilation Physiological and Clinical Applications 5th Edition by Cairo
Completed downloadable Test Bank for Pilbeams Mechanical Ventilation Physiological and Clinical Applications 5th Edition by Cairo Link full download: http://testbankcollection.com/download/pilbeams-mechanicalventilation-physiological-and-clinical-applications-5th-edition-test-bank-cairo
More informationNew Frontiers in Anesthesia Ventilation. Brent Dunworth, MSN, CRNA. Anesthesia Ventilation. New Frontiers in. The amount of gas delivered can be
New Frontiers in Anesthesia Ventilation Senior Director, Nurse Anesthesia Department of Anesthesiology University of Pittsburgh Medical Center Content Outline 1 2 Anesthesia Evolution Anesthesia Evolution
More information6 th Accredited Advanced Mechanical Ventilation Course for Anesthesiologists. Course Test Results for the accreditation of the acquired knowledge
6 th Accredited Advanced Mechanical Ventilation Course for Anesthesiologists Course Test Results for the accreditation of the acquired knowledge Q. Concerning the mechanics of the newborn s respiratory
More informationCorrective Measures for Compromised Oxygen Delivery During Endotracheal Tube Cuff Deflation With High-Frequency Percussive Ventilation
Corrective Measures for Compromised Oxygen Delivery During Endotracheal Tube Cuff Deflation With High-Frequency Percussive Ventilation Patrick F Allan MD and Gregory Naworol RRT OBJECTIVE: To determine
More informationCorporate Overview and Product Summary
2008 Corporate Overview and Product Summary Vapotherm Summary: Market leader and originator of High Flow Therapy Founded in 1999 Headquartered in Stevensville, MD Clinical and education leadership in High
More informationNOTE: If not used, provider must document reason(s) for deferring mechanical ventilation in a patient with an advanced airway
APPENDIX: TITLE: Mechanical Ventilator Use REVISED: November 1, 2017 I. Introduction: Mechanical Ventilation is the use of an automated device to deliver positive pressure ventilation to a patient. Proper
More informationThe Effect of Compliance Changes on Delivered Volumes in an Adult Patient Ventilated with High Frequency Oscillatory Ventilation: A Bench Model
Georgia State University ScholarWorks @ Georgia State University Respiratory Therapy Theses Department of Respiratory Therapy 9-15-2009 The Effect of Compliance Changes on Delivered Volumes in an Adult
More informationMechanical power and opening pressure. Fellowship training program Intensive Care Radboudumc, Nijmegen
Mechanical power and opening pressure Fellowship training program Intensive Care Radboudumc, Nijmegen Mechanical power Energy applied to the lung: Ptp * V (Joule) Power = Energy per minute (J/min) Power
More informationPERFORMANCE EVALUATION #34 NAME: 7200 Ventilator Set Up DATE: INSTRUCTOR:
PERFORMANCE EVALUATION #34 NAME: 7200 Ventilator Set Up DATE: 1. **Identify and name the filters on the 7200ae. 2. **Explain how each filter is sterilized. 3. **Trace the gas flow through the ventilator
More informationTitle: Maximization of oscillatory frequencies during arteriovenous extracorporeal lung assist: a large-animal model of respiratory distress
Author's response to reviews Title: Maximization of oscillatory frequencies during arteriovenous extracorporeal lung assist: a large-animal model of respiratory distress Authors: Ralf M Muellenbach (muellenbac_r@klinik.uni-wuerzburg.de)
More informationNeonatal Assisted Ventilation. Haresh Modi, M.D. Aspirus Wausau Hospital, Wausau, WI.
Neonatal Assisted Ventilation Haresh Modi, M.D. Aspirus Wausau Hospital, Wausau, WI. History of Assisted Ventilation Negative pressure : Spirophore developed in 1876 with manual device to create negative
More informationThe Basics of Ventilator Management. Overview. How we breath 3/23/2019
The Basics of Ventilator Management What are we really trying to do here Peter Lutz, MD Pulmonary and Critical Care Medicine Pulmonary Associates, Mobile, Al Overview Approach to the physiology of the
More informationPatrick F Allan MD, Jefferson R Thurlby MD, and Gregory A Naworol RRT
Measurement of Pulsatile Tidal Volume, Pressure Amplitude, and Gas Flow During High-Frequency Percussive Ventilation, With and Without Partial Cuff Deflation Patrick F Allan MD, Jefferson R Thurlby MD,
More information