? PSV. Lung Protective Ventilation Strategies
|
|
- Coral Carter
- 5 years ago
- Views:
Transcription
1 Lung Protective Ventilation Strategies Martin Keszler, MD, FAAP Professor of Pediatrics Brown University Women and Infants Hospital Providence, RI Alphabet Soup of Respiratory Support: State-of-the-Art 2014? BiPAP? PSV???? Unique Challenges in NB Ventilation Children Small Adults! Newborns Small Children! Transitional circulation Compliant chest wall, stiff lungs Unfavorable chest wall mechanics Limited muscle strength and endurance Immature respiratory control Rapid RR, short time constants Small trachea, high ETT resistance Uncuffed ETT Tidal volume measurement Awake, breathing patient Need to understand the pathophysiology
2 Matthay MA and Zimmerman GA Am J Respir Cell Mol Biol 33: The Pathogenesis of BPD Chorioamnionitis Initiation of airbreathing Preterm Labor Preterm Delivery Fetal Lung Development!!! Mechanical Ventilation Oxygen Infection Postnatal Lung Growth and Development PDA Fluid intake Pulmonary outcome Antenatal Steroids Cannalicular Stage Postnatal Steroids Saccular Stage Nutrition, antioxidants,?ino,??? Alveolar Stage Compliant chest wall Limited muscle strength C-section/ absence of labor Fluid filled lungs Respiratory depression Limited ability to establish FRC
3 Effect of PEEP on Rabbit Lung Aeration: Phase contrast radiographs after 20 breaths. Siew, et al, JAP 2009 SI in preterm rabbits te-pas, et al, Pediatr Res 2009 RCT of SI + PEEP vs PEEP te Pas, et al, Pediatrics 2007 SI + PEEP n=104 PEEP n=103 p value Intubated in DR 17% 36% Length of RS (d) 2.7 [0.5-10] 4.3 [0.5-20] 0.01 >1 dose of Surf 10% 21% 0.02 Survival 98% 96% 0.4 BPD 22% 34% 0.05 IVH 3-4/PVL 9% 8% 0.4
4 Sustained Lung Inflation in DR: 25 cm H 2 O for 15 s Lista, et al, Neonatology 2010 Volume or Pressure Ventilation? Bourns LS BP 200
5 Why Volume-Targeted Ventilation? Volutrauma not Barotrauma Inadvertent hyperventilation is common Hypocarbia is bad for the brain and the lungs Adult-type volume controlled ventilation poses challenges in NB Effect of Pressure v. Volume on Lung Injury Hernandez, et al, J Appl Physiol 1989 Capillary filtration coefficient: measure of acute lung injury E I PIP is Excessive Relative to Compliance!!! V T P! FRC
6 Ventilator-Induced Lung Injury: Volutrauma, not Barotrauma Rodents ventilated with 3 modes: - High pressure (45 cm H 2 O), high volume - Low (negative) pressure, high volume - High pressure (45 cm H 2 O), low volume (strapped chest & abdomen) Qwl/BW (ml/kg) * * DLW/BW (g/kg) *P< Albumin space (%) * Dreyfuss D et al. Am Rev Respir Dis. 1988;137: Limitations of Volume - Controlled Ventilation in Newborns Vent. V Flow Sensor Actual tidal volume is influenced by: 1) Ratio of circuit compliance to respiratory system compliance 1 V TLung = V T set * CT 1 + Tubing System and Humidifier Humid C RS C T C RS Leak 2) compressible volume of the circuit, including humidifier Respiratory System Both High and Low PCO 2 Increase Risk of IVH Fabres, et al, Pediatrics 2007
7 Modalities of Volume -Targeted Ventilation Controls Adjusts Based on Servo (PRVC) V T to circuit PIP VIP Bird (VAPS) Bear Cub 750 (Volume Limit) Avea (VAPS + VL) P. Bennett 840 (Volume Vent +) Babylog, Evita (VG, Neoflow) Minimum V T to patient Max. V T to patient Min/Max V T to circuit/pt V T to circuit V T to patient Inspiratory time ( ) Inspiratory time ( ) Inspiratory time ( ) Inspiratory time / flow PIP Inspiratory V T of last breath Inspiratory V T Inspiratory V T Inspiratory V T Inspiratory V T Exhaled V T of last breath VTV Control Algorithm Volume Limit PRESSURE FLOW Pressure limited breaths Decreased compliance or decreased patient effort Volume limited breath VOLUME Volume Limit Increased compliance or increased patient effort
8 Volume Limit Volume Guarantee Principles of operation The PIP ( working pressure ) is servoregulated within preset limits ( pressure limit ) to achieve V T that is set by the user. Regulation of PIP is in response to exhaled V T to minimize artifact due to ETT leak. Breath terminates if 130% of TV T reached. Separate algorithm for spontaneous and machine breaths. Pressure limit Working Pressure V T = V T set by user Pressure Limit Working Pressure PRESSURE Target tidal volume VOLUME
9 Extreme Periodic Breathing Owen, et al, ADC 2010 VG vs. NAVA / Proportional Assist (or PAV) Benefits of VG Maintenance of (relatively) constant tidal volumes Prevention of overdistention and volutrauma due to Surfactant administration Lung volume recruitment Clearance of lung fluid Automatic lowering of pressure support level during weaning Compensation for variable respiratory drive stabilization of tidal volume and minute ventilation due to changes of respiratory drive (periodic breathing)
10 PLV vs. VTV MAA: Mortality Peng, et al, ADC-FNN 2014 PLV vs. VTV MAA: BPD Peng, et al, ADC-FNN 2014 PLV vs. VTV MAA: Other outcomes Peng, et al, ADC-FNN 2014 Outcome No. of Studies No. of Subjects RR (95% CI) or Mean diff (95%CI) Any IVH ( ) Grade 3-4 IVH ( ) Cystic PVL ( ) Pneumothorax ( ) Any hypocapnia ( ) Failure of assigned mode ( ) Duration of suppl. O 2 (d) (-2.5to-0.88)
11 Barriers to acceptance Inertia / fear of the unknown Rationalization: need more evidence Lack of understanding of - Rationale - Functionality - Appropriate settings - Limitations The benefits of VTV can not be realized without ensuring that the tidal volume is evenly distributed throughout an open lung!!!
12 Non-Homogenous aeration in RDS Recruitment/ derecruitment injury Shear forces Atelectotrauma Expiration Ventilated Stable Ventilated Unstable Unventilated Inspiration Adequate PIP, Adequate PEEP V Good oxygenation, low FiO2, minimal lung injury V T CCP P COP FRC P CCP = critical closing pressure; COP = critical opening pressure Lung volume recruitment Alveolar Recruitment maneuvre Ventilation on the expiratory limb of the P-V loop, once recruitment occurs.
13 Berger, et al Neonatology 2013 Oxygenation guided lung recruitment De Jaegere, et al AJRCCM 2006 Alveolar instability in an injured lung
14 OLC Prevents Lung Injury vankaam, et al Pediatr Res 2003 VG reduces markers of lung inflammation Lista, et al 2005 & 2006 Two prospective randomized trials A/C vs. A/C + VG BAL on days 1,3,5 5 ml/kg reduced proinflammatory cytokine levels and decreased duration of ventilation 3 ml/kg increased proinflammatory cytokine levels Low PEEP (3-4 cm H 2 O) Proportion of values outside the target range A/C 60% A/C+VG 50% 40% 30% 20% 10% 0% VT>6/kg * p < * PaCO2<35 * Keszler, et al. Ped Pulmonol 04
15 VG-Clinical Caveats VG should be implemented immediately upon initiation of mechanical ventilation. The usual starting target V T is 4-5 ml/kg during the acute phase of the illness. Larger V T is needed in ELBW infants, those with MAS and older infants with chronic lung disease! PIP limit should be set 25% above the PIP currently needed to deliver the target V T and adjusted as needed. PIP will default to the limit if sensor is out or when giving a manual breath! If the low V T alarm sounds repeatedly, increase the pressure limit AND INVESTIGATE THE CAUSE V T in infants with MAS Sharma, et al in press Relationship of Birthweight and V T Montazami,et al, Ped Pulmonol 2009 VT (ml/kg) RLBW * *RLBW = Ridiculously LBW R= p<0.001 Weight (kg) ELBW
16 Conventional Physiology Anatomical dead-space = 2mL/kg. Instrumental dead-space is fixed. Anatomical + Instrumental dead-space = 3mL in a typical 1 kg infant Anatomical + Instrumental dead-space = 2.5mL in a typical 0.5 kg infant Alveolar ventilation = tidal volume dead-space volume) x RR Alveolar ventilation = X Alveolar ventilation = 0.5 X Alveolar ventilation = 0 VT = 5mL, DS=3mL VT = 4mL, DS=3mL VT = 3mL, DS=3mL Gas Flow Through Narrow ETT Fresh gas inflow spikes through DS gas Mixing when flow abruptly stops Exhaled gas spikes through mixed DS gas
17 Time to Eliminate CO 2 from Test Lung Seconds mm ETT, DS = 3.5 ml DS + 2 DS+ 1 DS DS -0.5 DS - 1 DS -1.5 Tidal Volume (ml) Keszler, et al. ADC FN in print Relationship of Post-Natal Age and V T (ml/kg) Day 1-2 n = 251 Day 5-7 n = 185 Day n = 216 Day n = 176 V T (ml/kg) PCO 2 (torr) Keszler et al, Arch Dis Child 09 Corrected V T Herber-Jonat, Ped Crit Care Med 2008
18 Lung Injury: Strategies for Prevention Optimal DR stabilization (?SI) Avoidance of mechanical ventilation Avoid excessive V T Optimize lung volume / avoid atelectasis Surfactant replacement PRN Volume-targeted ventilation High-frequency ventilation Permissive hypercapnia/lower SPO 2 (?) Thank You mkeszler@wihri.org VG Clinical Caveats: Weaning If target V T is set at low normal (usually 4 ml/kg in first few days, higher later on) and PaCO 2 is allowed to rise to the mid - high 40s (ph <7.35), weaning occurs automatically ( self-weaning ). If V T is set too high and/or the ph is too high, the baby will not have a respiratory drive and will not self-wean. If the V T is set too low, there will be excessive WOB! Most infants can be extubated when they consistently maintain V T at or above the target value with working PIP < cm H 2 O (< cm H 2 O in infants > 1 kg) with FiO 2 < 0.35 and good sustained respiratory effort.
19 Work of Different VT target Patel, et al Pediatrics 2009
? PSV. Lung Protective Ventilation Strategies
Lung Protective Ventilation Strategies Martin Keszler, MD, FAAP Professor of Pediatrics Brown University Women and Infants Hospital Providence, RI Respiratory Support in Neonatology: State-of-the-Art 2012?
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 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 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 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 informationVolume vs Pressure during Neonatal Ventilation
Volume vs Pressure during Neonatal Ventilation David Tingay 1. Neonatal Research, Murdoch Children s Research Institute, Melbourne 2. Neonatology, Royal Children s Hospital 3. Dept of Paediatrics, University
More informationTrust Guideline for Neonatal Volume Guarantee Ventilation (VGV)
A Clinical Guideline For Use in: By: For: Division responsible for document: Key words: Name of document author: Job title of document author: Name of document author s Line Manager: Job title of author
More informationVolume Targeted Ventilation on the Neonatal Unit
This guidance does not override the individual responsibility of health professionals to make appropriate decision according to the circumstances of the individual patient in consultation with the patient
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 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 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 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 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 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 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 informationVolume Targeted Ventilation in Newborns is their value? Michael Finelli RRT, NRCP Hospital for Sick Children Toronto C.S.R.T Newfoundland - May 2010
Volume Targeted Ventilation in Newborns is their value? Michael Finelli RRT, NRCP Hospital for Sick Children Toronto C.S.R.T Newfoundland - May 2010 Disclosure: I ve run a consulting business for over
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 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 informationMechanical Ventilation. Flow-Triggering. Flow-Triggering. Advanced Concepts. Advanced Concepts in Mechanical Ventilation
Mechanical Ventilation Advanced Concepts in Mechanical Ventilation Flow-Triggering Trigger = the variable that causes the vent to begin the inspiratory phase Common triggers 1-2- 3- Effort required to
More informationVolume Guarantee New Approaches in Volume Controlled Ventilation for Neonates
Volume Guarantee New Approaches in Volume Controlled Ventilation for Neonates Jag Ahluwalia Colin Morley Hans Georg Wahle Important Notice: Medical knowledge changes constantly as a result of new research
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 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 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 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 informationManaging Patient-Ventilator Interaction in Pediatrics
Managing Patient-Ventilator Interaction in Pediatrics Robert L. Chatburn, MHHS, RRT-NPS, FAARC Clinical Research Manager - Section of Respiratory Therapy Professor of Medicine Case Western Reserve University
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 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 informationPhysiological Basis of Mechanical Ventilation
Physiological Basis of Mechanical Ventilation Wally Carlo, M.D. University of Alabama at Birmingham Department of Pediatrics Division of Neonatology wcarlo@peds.uab.edu Fine Tuning Mechanical Ventilation
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 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 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 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 informationRESPIRATORY PHYSIOLOGY, PHYSICS AND PATHOLOGY IN RELATION TO ANAESTHESIA AND INTENSIVE CARE
Course n : Course 3 Title: RESPIRATORY PHYSIOLOGY, PHYSICS AND PATHOLOGY IN RELATION TO ANAESTHESIA AND INTENSIVE CARE Sub-category: Intensive Care for Respiratory Distress Topic: Pulmonary Function and
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 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 informationINTELLiVENT -ASV. The world s first Ventilation Autopilot
INTELLiVENT -ASV The world s first Ventilation Autopilot Intelligent Ventilation since 1983 We live for ventilation technology We live for ventilation technology that helps caregivers improve the lives
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 informationPotential Conflicts of Interest Received research grants from Hamilton, Covidien, Drager, General lel Electric, Newport, and Cardinal Medical Received
How Does a Mechanical Ventilator t 6-22-10 Spain Work? Bob Kacmarek PhD, RRT Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts Potential Conflicts of Interest Received research
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 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 informationQUICK REFERENCE GUIDE
cm H O 2 cm H O 2 cm HO 2 PSI cm H O 2 ON OFF UPPER LIMIT LOWER LIMIT UPPER LIMIT LOWER LIMIT LIFE PULSE HIGH-FREQUENCY VENTILATOR QUICK REFERENCE GUIDE 01388-08.11 MONITOR PIP JET VALVE ALARMS READY SILENCE
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 informationClassification of Mechanical Ventilators
Classification of Mechanical Ventilators Kacmarek s 12 Point Classification Positive/Negative Pressure Powering Mechanism Driving Mechanism Single or Double Circuited Modes of Ventilation Cycling Parameter
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 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 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 informationHigh 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 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 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 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 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 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 informationGuide to Understand Mechanical Ventilation Waveforms
Do No Harm Ventilate Gently Guide to Understand Mechanical Ventilation Waveforms Middle East Critical Care Assembly 1/30/2015 Mazen Kherallah, MD, FCCP http://www.mecriticalcare.net Email: info@mecriticalcare.net
More informationMEDICAL EQUIPMENT IV MECHANICAL VENTILATORS. Prof. Yasser Mostafa Kadah
MEDICAL EQUIPMENT IV - 2013 MECHANICAL VENTILATORS Prof. Yasser Mostafa Kadah Mechanical Ventilator A ventilator is a machine, a system of related elements designed to alter, transmit, and direct energy
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 informationNewer forms of conventional ventilation for preterm newborns
Acta Pædiatrica ISSN 0803 5253 REVIEW ARTICLE Newer forms of conventional ventilation for preterm newborns Sunil K Sinha (Sunil.sinha@stees.nhs.uk) 1, Steven M Donn 2 1.Professor of Paediatrics and Neonatal
More informationChapter 4: Ventilation Test Bank MULTIPLE CHOICE
Instant download and all chapters Test Bank Respiratory Care Anatomy and Physiology Foundations for Clinical Practice 3rd Edition Will Beachey https://testbanklab.com/download/test-bank-respiratory-care-anatomy-physiologyfoundations-clinical-practice-3rd-edition-will-beachey/
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 informationSLE4000. Infant Ventilator with touch-screen operation. When the smallest thing matters
SLE4000 Infant Ventilator with touch-screen operation When the smallest thing matters SLE4000 - The Total Solution for Conventional Infant Ventilation SLE is a world leader in the design and manufacture
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 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 informationV8600 Ventilator. Integrated Invasive & Noninvasive Ventilation
V8600 Ventilator Integrated Invasive & Noninvasive Ventilation 0123 V8600 Ventilator Invasive Ventilation With state-of-the-art turbine technology, V8600 helps achieve sequential ventilation in various
More informationASV. Adaptive Support Ventilation
ASV Adaptive Support Ventilation Intelligent Ventilation since 1983 We live for ventilation technology We live for ventilation technology that helps caregivers improve the lives of their critically ill
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 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 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 informationInspiration 7i Ventilator
Inspiration 7i Ventilator Clinician Focused Products is not just a tag line, rather a belief system. Low cost of ownership High performance PSOL and active exhalation Comprehensive graphics and trending
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 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 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 informationPeter Kremeier, Christian Woll. 2nd. Understanding and comparing modes of ventilation. The Kronberg List of Ventilation Modes
Extended Edition Revised and 2nd Peter Kremeier, Christian Woll Understanding and comparing modes of ventilation The Kronberg List of Ventilation Modes Contents Preface... 3 Comparison Table - Parameters...6
More informationAirox Supportair Ventilator
Airox Supportair Ventilator A versatile hospital ventilator with a titration platform that enables a smooth transition to the patient s home care ventilator Titration Platform The Supportair ventilator
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 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 informationInvasive mechanical ventilation:
Invasive mechanical ventilation definition mechanical ventilation: using an apparatus to facilitate transport of oxygen and CO2 between the atmosphere and the alveoli for the purpose of enhancing pulmonary
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 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 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 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 informationUnderstanding and comparing modes of ventilation
Understanding and comparing modes of ventilation Löwenstein Medical GmbH & Co. KG Content Volume-Controlled Ventilation Modes VCV PLV VC-SIMV Optional VCV Flexible VCV Pressure-Controlled Ventilation Modes
More informationThe physiological functions of respiration and circulation. Mechanics. exercise 7. Respiratory Volumes. Objectives
exercise 7 Respiratory System Mechanics Objectives 1. To explain how the respiratory and circulatory systems work together to enable gas exchange among the lungs, blood, and body tissues 2. To define respiration,
More informationUpdate to RS-232 commands. Changing patient from NIV to INVASIVE Vent Type. SNDF command
Changing patient from NIV to INVASIVE Vent Type Table 9 shows automatic settings changes that occur when changing the same patient from NIV to INVASIVE Vent Type. Table 9: Automatic settings changes NIV
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 informationWales Neonatal Network Guideline
Neonatal Ventilation: Ventilation Modes Please refer to the longer version of this guideline (available on the network website) for further detailed information. Commonly used ventilation modalities: Continuous
More informationQUICK GUIDE: VOLUME GUARANTEE VENTILATION Prematurely Born Infants < Weeks Gestation
Initial Set-up QUICK GUIDE: VOLUME GUARANTEE VENTILATION Prematurely Born Infants < 32 +0 Weeks Gestation Mode: SIPPV + VG Tidal volume: 4-5 ml/kg Pmax (PIP limit): 25 cmh 2 O PEEP: 5 cmh 2 O & Insp. time
More informationVentilators. Dr Simon Walton Consultant Anaesthetist Eastbourne DGH KSS Basic Science Course
Ventilators Dr Simon Walton Consultant Anaesthetist Eastbourne DGH KSS Basic Science Course Objectives Discuss Classification/ terminology Look at Modes of ventilation How some specific ventilators work
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 informationInspire rpap REVOLUTION FROM THE FIRST BREATH
Inspire rpap TM REVOLUTION FROM THE FIRST BREATH The Inspire rpap The Inspire rpap is a revolutionary, non-invasive system for the initial stabilisation and resuscitation of infants. TM Its innovative,
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 informationSafe ventilation at rest and on the move
Safe ventilation at rest and on the move The HAMILTON-C2 is designed to provide Intelligent Ventilation, delivering: Ease of use Improved patient outcome www.hamilton-medical.com/c2 Help protect 5 million
More informationVirginia Beach EMS. Oxylator EMX. Debra H. Brennaman, RN, MPA, NREMT-P
Virginia Beach EMS Oxylator EMX Debra H. Brennaman, RN, MPA, NREMT-P Oxylator EMX Overview Patient responsive oxygen powered resuscitation / ventilation device intended to provide emergency ventilatory
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 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 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 informationIntroduction. Respiration. Chapter 10. Objectives. Objectives. The Respiratory System
Introduction Respiration Chapter 10 The Respiratory System Provides a means of gas exchange between the environment and the body Plays a role in the regulation of acidbase balance during exercise Objectives
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 informationbirth: a transition better guidelines better outcomes the birth experience a challenging transition the fountains of life: 2/8/2018
better guidelines better outcomes neonatal resuscitation Anne G. Wlodaver, MD neonatology OU medical center the birth experience a challenging transition birth requires major and sudden transitions some
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 informationMedical Instruments in the Developing World
2.2 Ventilators 2.2.1 Clinical Use and Principles of Operation Many patients in an intensive care and the operating room require the mechanical ventilation of their lungs. All thoracic surgery patients,
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 information