Tissue is the Issue. PEEP CPAP FiO2 HFNC PSV HFNC. DO 2 = CO [(Hb x 1.34) SaO PaO 2 ] perfusione

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Tissue is the Issue. PEEP CPAP FiO2 HFNC PSV HFNC. DO 2 = CO [(Hb x 1.34) SaO PaO 2 ] perfusione"

Transcription

1 Tissue is the Issue perfusione PEEP CPAP FiO2 HFNC PSV HFNC DO 2 = CO [(Hb x 1.34) SaO PaO 2 ]

2 O2 HFNC PEEP CPAP PSV ARF

3 ACPE

4 HIGH FLOW NASAL CANNULA High and Exact FiO2, High Flow heating and humidification, well tolerated Remove CO2 from high respiratory tract Nasopharyngeal dead space washout has been proposed to reduce CO2 rebreathing, thus providing a fresh reservoir of oxygen from which to breathe PEEP? pharyngeal pressures of 2 8 cm H2O contributing to lung recruitment and upper airway splinting

5 FiO % Flow 10-60L/min FiO % Flow 15-45L/min

6 O2 20L/min Flow 50L/min

7

8 acute and chronic RF Settings: HFNC Pediatrics SDB COPD Hypoxaemic ARF postextubation preintubation oxygenation acute heart failure DNI

9

10

11

12

13 HFNC was initiated as a front line therapy in place of other oxygen therapy modalities, and used based on clinician discretion. 75% of HFNC interventions involved patients with hypoxemia and 25% of them involved elevated arterial carbon dioxide levels. Respondents indicated excellent respiratory responses as well as high ease of use and patient tolerance. Disposition decisions were to admit 41% of cases to the ICU, 54% to the medical floor and 5% to discharge. HFNC may be useful in the ED to rapidly stabilize patients in significant respiratory distress with an easily tolerated respiratory support modality. Clinical use guidelines were established that were effective and acceptable to clinical staff. The use of the therapy may have utility in reducing ICU admissions associated with the use of NIPPV as a primary respiratory modality.

14

15 In patients with acute hypoxemic respiratory failure, HFNC oxygen therapy was associated with a reduction in the proportion requiring endotracheal intubation and a decreased respiratory rate compared with conventional oxygen therapy In the comparison of HFNC oxygen therapy and noninvasive ventilation, no differences were observed in the intubation rate, Paco2 level or arterial ph, but the respiratory rate was significantly lower in the HFNC group. ICU mortality did not differ between groups.

16 PEEP CPAP shifts the lungs to a more compliant portion of P/V curve

17 PEEP 0 Shunt 50% PEEP keep the lung open PEEP 15 Shunt 15% FRC PEEP 10 Shunt 25%

18

19 EFFETTI EMODINAMICI EFFETTI VENTILATORI PEEP Migliorare gli scambi gassosi (reclutamento alveolare) Migliorare la meccanica polmonare (CFR) Aumento PIT Ritorno Venoso Resistenze Vascolari Polmonari Volumi Cardiaci P transmurale Ventricolare Pre/Post carico ventricolare Output Cardiaco

20 PEEP: Effetti Emodinamici PEEP = PIT riempimento ventricolare in diastole PRECARICO Facilita lo svuotamento ventricolare in sistole POST CARICO L effetto sulla Gittata Cardiaca ( o ) deriva dalla combinazione dei 2 effetti, dal prevalere di uno rispetto all altro, e dipende dal contesto clinico

21 ARDS Polmonite Shunt - V/Q - Ipox EPAc PEEP = PIT Precarico VDx-Sn Postcarico VDx-Sn Ritorno Venoso Volumi Cardiaci Resistenze Polmonari EFFETTO PREVALENTE MECCANISMI Postcarico VSn Precarico VDx P Transmurale Vsn Resistenze Polmonari Ritorno Venoso CO liquidi/amine + VM + CO diuretici/nitrati

22 Best PEEP? Hemodynamic Effects Respiratory Effects

23 PEEP in ACPE with preserved LVEF

24 The role of continuous positive airway pressure in acute cardiogenic edema with preserved left ventricular systolic function A.Bellone et al Compare the effect of continuous positive airway pressure (CPAP) in patients with acute cardiogenic pulmonary edema (ACPE) with preserved or impaired left ventricular systolic function with regard to resolution time Resolution time is not significantly different in patients with ACPE with preserved or impaired systolic function submitted to CPAP 2009 Oct;27(8):986-91

25 In restrictive AHRF lung volume is reduced, lung is poorly ventilated. PEEP may assist in lung recruitment, improve compliance and correct Hypoxaemia... Increasing PEEP for a given inspiratory pressure increases Vt, reduces pco2. In obstructive disease with flow limitation (COPD), PEEP improves expiratory airflow (reduces obstruction), limits dynamic hyperinflation improves compliance and may improve tidal volume ( improves alveolar ventilation). In NIV epeep improves triggering and patient comfort, reduces WOB (vs ipeep)

26 From Appendini L. et al. Am J Respir Crit Care Med 1996; 154: PTPdi= extimate of diaphragm O2 consumption 41% Pres Pel,L Pel,w PEEPi 37% PEEPi 15% 7%

27 Pressure Support Vt V E Obstructive Pts Raw Restrictive Pts Compliance

28 At high levels of inspiratory pressure-assist, NIV consistently increased dynamic lung compliance and tidal volume, improved arterial blood gases NIV reduces WOB and inspiratory effort in direct proportion to the level of inspiratory pressure-assist, and also by the ability of applied positive end-expiratory pressure (PEEP) to counter intrinsic PEEP. This occurs in in patients with diverse etiologies and severity of pulmonary disease. Consequently reduces dyspnea.

29 High PS and Rise Time Pts compliance Air Leaks Effort

30 L. Appendini et al. Am J Respir Crit care Med 1994; 149:

31 PSV PEEP

32 Airway recruitment in Pts with Flow Limitation (CV)

High Velocity Nasal Insufflation: Mechanisms of Action and Emergency Medicine Application

High Velocity Nasal Insufflation: Mechanisms of Action and Emergency Medicine Application High Velocity Nasal Insufflation: Mechanisms of Action and Emergency Medicine Application North Coast Pulmonary Seminar Fisher-Titus Medical Center September 27, 2017 Eric Smith, MS, RRT Area Clinical

More information

What is the next best step?

What is the next best step? Noninvasive Ventilation William Janssen, M.D. Assistant Professor of Medicine National Jewish Health University of Colorado Denver Health Sciences Center What is the next best step? 65 year old female

More information

RESPIRATORY FAILURE NON INVASIVE VENTILATION TREATMENT

RESPIRATORY FAILURE NON INVASIVE VENTILATION TREATMENT RESPIRATORY FAILURE NON INVASIVE VENTILATION TREATMENT Dr. Dhruva Chaudhry Senior Professor & Chair Pulmonary & Critical Care Medicine PGIMS,UHS Rohtak, Haryana General Secretary (Elect) Indian Society

More information

NIV in ARDS. New evidence

NIV in ARDS. New evidence F. Javier Belda MD, PhD, Professor of Anesthesiology NIV in ARDS. New evidence Head of Department of Anesthesia and Critical Care University of Valencia (Spain) fjbelda@uv.es ALI/ARDS Report of the American-European

More information

1. When a patient fails to ventilate or oxygenate adequately, the problem is caused by pathophysiological factors such as hyperventilation.

1. When a patient fails to ventilate or oxygenate adequately, the problem is caused by pathophysiological factors such as hyperventilation. Chapter 1: Principles of Mechanical Ventilation TRUE/FALSE 1. When a patient fails to ventilate or oxygenate adequately, the problem is caused by pathophysiological factors such as hyperventilation. F

More information

Prepared by : Bayan Kaddourah RN,MHM. GICU Clinical Instructor

Prepared by : Bayan Kaddourah RN,MHM. GICU Clinical Instructor Mechanical Ventilation Prepared by : Bayan Kaddourah RN,MHM. GICU Clinical Instructor 1 Definition Is a supportive therapy to facilitate gas exchange. Most ventilatory support requires an artificial airway.

More information

Potential Conflicts of Interest

Potential Conflicts of Interest Potential Conflicts of Interest Patient Ventilator Synchrony, PAV and NAVA! Bob Kacmarek PhD, RRT Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 4-27-09 WSRC Received research

More information

Noninvasive Ventilation: Non-COPD Applications

Noninvasive Ventilation: Non-COPD Applications Noninvasive Ventilation: Non-COPD Applications NONINVASIVE MECHANICAL VENTILATION Why Noninvasive Ventilation? Avoids upper A respiratory airway trauma system lacerations, protective hemorrhage strategy

More information

Acute Respiratory Failure. Presented by Omar AL-Rawajfah, RN, PhD

Acute Respiratory Failure. Presented by Omar AL-Rawajfah, RN, PhD Acute Respiratory Failure Presented by Omar AL-Rawajfah, RN, PhD Lecture Outlines Etiology and Pathophysiology Classification Assessment Collaborative Management ۲ Etiology and Pathophysiology Acute respiratory

More information

Patient-Ventilator Asynchrony: How to fix it

Patient-Ventilator Asynchrony: How to fix it Patient-Ventilator Asynchrony: How to fix it Younsuck Koh, MD, PhD, FCCM Dept. of Pulmonary & CCM Asan Medical Center, Univ. of Ulsan College of Medicine Seoul, Korea 2 Systems Patient-Ventilator Synchrony

More information

CPAP therapy in the Newborn. Thrathip Kolatat M.D. Neonatal Intensive Care Unit Department of Pediatrics Faculty of Medicine Siriraj Hospital

CPAP therapy in the Newborn. Thrathip Kolatat M.D. Neonatal Intensive Care Unit Department of Pediatrics Faculty of Medicine Siriraj Hospital CPAP therapy in the Newborn Thrathip Kolatat M.D. Neonatal Intensive Care Unit Department of Pediatrics Faculty of Medicine Siriraj Hospital Continuous Positive Airway Pressure (CPAP) CPAP the application

More information

High Flow Nasal Cannula Therapy: A Simple and Effective Modality

High Flow Nasal Cannula Therapy: A Simple and Effective Modality High Flow Nasal Cannula Therapy: A Simple and Effective Modality Presented by: Meagan N. Dubosky, MS, RRT-ACCS, NPS, AE-C Manager, Respiratory Care & Pulmonary Rehab Services Rush Oak Park Hospital, Chicago,

More information

ARF, Mechaical Ventilation and PFTs: ACOI Board Review 2018

ARF, Mechaical Ventilation and PFTs: ACOI Board Review 2018 ARF, Mechaical Ventilation and PFTs: ACOI Board Review 2018 Thomas F. Morley, DO, FACOI, FCCP, FAASM Professor of Medicine Chairman Department of Internal Medicine Director of the Division of Pulmonary,

More information

Oxygen & High flow nasal Oxygen therapy. Learning points. Why? 18/07/

Oxygen & High flow nasal Oxygen therapy. Learning points. Why? 18/07/ Oxygen & High flow nasal Oxygen therapy 13.07.2017 Learning points Update on BTS guidance May 2017 Help you understand the mechanism of action of high flow nasal oxygen therapy Help you think about the

More information

Dr. Yasser Fathi M.B.B.S, M.Sc, M.D. Anesthesia Consultant, Head of ICU King Saud Hospital, Unaizah

Dr. Yasser Fathi M.B.B.S, M.Sc, M.D. Anesthesia Consultant, Head of ICU King Saud Hospital, Unaizah BY Dr. Yasser Fathi M.B.B.S, M.Sc, M.D Anesthesia Consultant, Head of ICU King Saud Hospital, Unaizah Objectives For Discussion Respiratory Physiology Pulmonary Graphics BIPAP Graphics Trouble Shootings

More information

Lecture Notes. Chapter 9: Smoke Inhalation Injury and Burns

Lecture Notes. Chapter 9: Smoke Inhalation Injury and Burns Lecture Notes Chapter 9: Smoke Inhalation Injury and Burns Objectives List the factors that influence mortality rate Describe the nature of smoke inhalation and the fire environment Recognize the pulmonary

More information

INDICATIONS FOR RESPIRATORY ASSISTANCE A C U T E M E D I C I N E U N I T P - Y E A R M B B S 4

INDICATIONS FOR RESPIRATORY ASSISTANCE A C U T E M E D I C I N E U N I T P - Y E A R M B B S 4 INDICATIONS FOR RESPIRATORY ASSISTANCE A C U T E M E D I C I N E U N I T P - Y E A R M B B S 4 RESPIRATORY FAILURE Acute respiratory failure is defined by hypoxemia with or without hypercapnia. It is one

More information

INTRODUCTION The effect of CPAP works on lung mechanics to improve oxygenation (PaO 2

INTRODUCTION The effect of CPAP works on lung mechanics to improve oxygenation (PaO 2 2 Effects of CPAP INTRODUCTION The effect of CPAP works on lung mechanics to improve oxygenation (PaO 2 ). The effect on CO 2 is only secondary to the primary process of improvement in lung volume and

More information

Proportional Assist Ventilation (PAV) (NAVA) Younes ARRD 1992;145:114. Ventilator output :Triggering, Cycling Control of flow, rise time and pressure

Proportional Assist Ventilation (PAV) (NAVA) Younes ARRD 1992;145:114. Ventilator output :Triggering, Cycling Control of flow, rise time and pressure Conflict of Interest Disclosure Robert M Kacmarek Unconventional Techniques Using Your ICU Ventilator!" 5-5-17 FOCUS Bob Kacmarek PhD, RRT Massachusetts General Hospital, Harvard Medical School, Boston,

More information

The new ARDS definitions: what does it mean?

The new ARDS definitions: what does it mean? The new ARDS definitions: what does it mean? Richard Beale 7 th September 2012 METHODS ESICM convened an international panel of experts, with representation of ATS and SCCM The objectives were to update

More information

Lecture Notes. Chapter 2: Introduction to Respiratory Failure

Lecture Notes. Chapter 2: Introduction to Respiratory Failure Lecture Notes Chapter 2: Introduction to Respiratory Failure Objectives Define respiratory failure, ventilatory failure, and oxygenation failure List the causes of respiratory failure Describe the effects

More information

Noninvasive Mechanical Ventilation in Children ศ.พญ.อร ณวรรณ พฤทธ พ นธ หน วยโรคระบบหายใจเด ก ภาคว ชาก มารเวชศาสตร คณะแพทยศาสตร โรงพยาบาลรามาธ บด

Noninvasive Mechanical Ventilation in Children ศ.พญ.อร ณวรรณ พฤทธ พ นธ หน วยโรคระบบหายใจเด ก ภาคว ชาก มารเวชศาสตร คณะแพทยศาสตร โรงพยาบาลรามาธ บด Noninvasive Mechanical Ventilation in Children ศ.พญ.อร ณวรรณ พฤทธ พ นธ หน วยโรคระบบหายใจเด ก ภาคว ชาก มารเวชศาสตร คณะแพทยศาสตร โรงพยาบาลรามาธ บด Noninvasive Mechanical Ventilation Provide support without

More information

Recent Advances in Respiratory Medicine

Recent Advances in Respiratory Medicine Recent Advances in Respiratory Medicine Dr. R KUMAR Pulmonologist Non Invasive Ventilation (NIV) NIV Noninvasive ventilation (NIV) refers to the administration of ventilatory support without using an invasive

More information

RESPIRATORY FAILURE. Michael Kelly, MD Division of Pediatric Critical Care Dept. of Pediatrics

RESPIRATORY FAILURE. Michael Kelly, MD Division of Pediatric Critical Care Dept. of Pediatrics RESPIRATORY FAILURE Michael Kelly, MD Division of Pediatric Critical Care Dept. of Pediatrics What talk is he giving? DO2= CO * CaO2 CO = HR * SV CaO2 = (Hgb* SaO2 * 1.34) + (PaO2 * 0.003) Sound familiar??

More information

5. What is the cause of this patient s metabolic acidosis? LACTIC ACIDOSIS SECONDARY TO ANEMIC HYPOXIA (HIGH CO LEVEL)

5. What is the cause of this patient s metabolic acidosis? LACTIC ACIDOSIS SECONDARY TO ANEMIC HYPOXIA (HIGH CO LEVEL) Self-Assessment RSPT 2350: Module F - ABG Analysis 1. You are called to the ER to do an ABG on a 40 year old female who is C/O dyspnea but seems confused and disoriented. The ABG on an FiO 2 of.21 show:

More information

PAPER DE LA VNI EN LA RETIRADA DE LA VENTILACIÓ INVASIVA I FRACÀS D EXTUBACIÓ

PAPER DE LA VNI EN LA RETIRADA DE LA VENTILACIÓ INVASIVA I FRACÀS D EXTUBACIÓ PAPER DE LA VNI EN LA RETIRADA DE LA VENTILACIÓ INVASIVA I FRACÀS D EXTUBACIÓ Dr. Miquel Ferrer UVIIR, Servei de Pneumologia, Hospital Clínic, IDIBAPS, CibeRes, Barcelona. E- mail: miferrer@clinic.ub.es

More information

I. Subject: Pressure Support Ventilation (PSV) with BiPAP Device/Nasal CPAP

I. Subject: Pressure Support Ventilation (PSV) with BiPAP Device/Nasal CPAP I. Subject: Pressure Support Ventilation (PSV) with BiPAP Device/Nasal CPAP II. Policy: PSV with BiPAP device/nasal CPAP will be initiated upon a physician's order by Respiratory Therapy personnel trained

More information

Nasal High Flow Humidification with or without Oxygen for COPD Management. Shereen Bailey, RCP, RRT, NPS

Nasal High Flow Humidification with or without Oxygen for COPD Management. Shereen Bailey, RCP, RRT, NPS Nasal High Flow Humidification with or without Oxygen for COPD Management Shereen Bailey, RCP, RRT, NPS Objectives How it works COPD Management today The role of NHFC Evidence Research/Case Studies Types

More information

High-flow nasal oxygen therapy and noninvasive ventilation in the management of acute hypoxemic respiratory failure

High-flow nasal oxygen therapy and noninvasive ventilation in the management of acute hypoxemic respiratory failure Review Article Page 1 of 8 High-flow nasal oxygen therapy and noninvasive ventilation in the management of acute hypoxemic respiratory failure Jean-Pierre Frat 1,2,3, Rémi Coudroy 1,2,3, Nicolas Marjanovic

More information

High flow nasal Oxygen therapy. Learning points. Part 1: Oxygen 21/06/ Oxford Advanced Course: Newcastle

High flow nasal Oxygen therapy. Learning points. Part 1: Oxygen 21/06/ Oxford Advanced Course: Newcastle High flow nasal Oxygen therapy 15.06.2017 Oxford Advanced Course: Newcastle Learning points Update on BTS guidance May 2017 Help you understand the mechanism of action of high flow nasal oxygen therapy

More information

Respiratory Distress During RSV Season

Respiratory Distress During RSV Season Respiratory Distress During RSV Season Carroll King, MD, FAAP Disclosure : Carroll King, MD, FAAP has nothing to disclose. 1 Objectives At the end of this educational activity, participants should be able

More information

Non-invasive Ventilation

Non-invasive Ventilation Non-invasive Ventilation 163 29 Non-invasive Ventilation AM BHAGWATI Artificial ventilatory support has became an integral component in the management of critically ill patients in the intensive care units.

More information

APRV: An Update CHLOE STEINSHOUER, MD PULMONARY & SLEEP CONSULTANTS OF KANSAS 04/06/2017

APRV: An Update CHLOE STEINSHOUER, MD PULMONARY & SLEEP CONSULTANTS OF KANSAS 04/06/2017 APRV: An Update CHLOE STEINSHOUER, MD PULMONARY & SLEEP CONSULTANTS OF KANSAS 04/06/2017 Disclosures No conflicts of interest Objectives Attendees will be able to: Define the mechanism of APRV Describe

More information

Noninvasive ventilation: Selection of patient, interfaces, initiation and weaning

Noninvasive ventilation: Selection of patient, interfaces, initiation and weaning CME article Johnson S, et al: Noninvasive ventilation Noninvasive ventilation: Selection of patient, interfaces, initiation and weaning Saumy Johnson, Ramesh Unnikrishnan * Email: ramesh.unnikrishnan@manipal.edu

More information

A New Look at Managing Chronic Obstructive Pulmonary Disease (COPD): NIV Therapy

A New Look at Managing Chronic Obstructive Pulmonary Disease (COPD): NIV Therapy A New Look at Managing Chronic Obstructive Pulmonary Disease (COPD): NIV Therapy 1 ResMed 2013 Global leaders in sleep and respiratory medicine COPD Market Size Over 12M people in the US diagnosed with

More information

RESPIRATORY FAILURE - CAUSES, CLINICAL INFORMATION, TREATMENT AND CODING CONVENTIONS

RESPIRATORY FAILURE - CAUSES, CLINICAL INFORMATION, TREATMENT AND CODING CONVENTIONS RESPIRATORY FAILURE - CAUSES, CLINICAL INFORMATION, TREATMENT AND CODING CONVENTIONS QUIZ REVIEW The correct answer is in bold font. 1. Hypoxic respiratory failure involves: a. Low oxygen b. High oxygen

More information

NON-INVASIVE POSITIVE PRESSURE VENTILATION IN THE EMERGENCY DEPARTMENT

NON-INVASIVE POSITIVE PRESSURE VENTILATION IN THE EMERGENCY DEPARTMENT NON-INVASIVE POSITIVE PRESSURE VENTILATION IN THE EMERGENCY DEPARTMENT Developed by J. Osteraas and K. Fuzzard 2001. Reviewed and by K. Maddern 2010 Contents Introduction Assessment Learning Outcomes Background

More information

Noninvasive ventilation: modes of ventilation

Noninvasive ventilation: modes of ventilation CHAPTER 5 Noninvasive ventilation: modes of ventilation L. Brochard, S. Maggiore Medical Intensive Care Unit, Henri Mondor Hospital, AP-HP, Paris XII University and INSERM U 492, Créteil, France. Correspondence:

More information

Identification and Treatment of the Patient with Sleep Related Hypoventilation

Identification and Treatment of the Patient with Sleep Related Hypoventilation Identification and Treatment of the Patient with Sleep Related Hypoventilation Hillary Loomis-King, MD Pulmonary and Critical Care of NW MI Munson Sleep Disorders Center X Conflict of Interest Disclosures

More information

C h a p t e r 1 4 Ventilator Support

C h a p t e r 1 4 Ventilator Support C h a p t e r 1 4 Ventilator Support Shirish Prayag Ex. Hon. Asst. Prof of Medicine, BJ Medical College and Sassoon Hospital, Pune; Chief Consultant in Internal Medicine and Critical Care, Shree Medical

More information

Faculty Disclosure. Off-Label Product Use

Faculty Disclosure. Off-Label Product Use Faculty Disclosure X No, nothing to disclose Yes, please specify: Company Name Honoraria/ Expenses Consulting/ Advisory Board Funded Research Royalties/ Patent Stock Options Equity Position Ownership/

More information

Ventilator Dyssynchrony - Recognition, implications, and management

Ventilator Dyssynchrony - Recognition, implications, and management Ventilator Dyssynchrony - Recognition, implications, and management Gavin M Joynt Dept of Anaesthesia & Intensive Care The Chinese University of Hong Kong Dyssynchrony Uncoupling of mechanical delivered

More information

Quando la NIV non basta. Andrea Vianello Fisiopatologia e Terapia Intensiva Respiratoria Ospedale-Università di Padova

Quando la NIV non basta. Andrea Vianello Fisiopatologia e Terapia Intensiva Respiratoria Ospedale-Università di Padova Quando la NIV non basta Andrea Vianello Fisiopatologia e Terapia Intensiva Respiratoria Ospedale-Università di Padova Sixty-two RCTs including a total of 5870 patients Overall NIV failure: 16.3% NIV Real

More information

Keywords: Non-invasive mechanical ventilation, Respiratory Failure, Respiratory muscles, Hypercapnia, Breathing pattern.

Keywords: Non-invasive mechanical ventilation, Respiratory Failure, Respiratory muscles, Hypercapnia, Breathing pattern. Monaldi Arch Chest Dis 2004; 61: 2, 81-85 ORIGINAL ARTICLE Inspiratory muscle workload due to dynamic intrinsic PEEP in stable COPD patients: effects of two different settings of non-invasive pressure-support

More information

Mechanical Ventilation ศ.พ.ญ.ส ณ ร ตน คงเสร พงศ ภาคว ชาว ส ญญ ว ทยา คณะแพทยศาสตร ศ ร ราชพยาบาล

Mechanical Ventilation ศ.พ.ญ.ส ณ ร ตน คงเสร พงศ ภาคว ชาว ส ญญ ว ทยา คณะแพทยศาสตร ศ ร ราชพยาบาล Mechanical Ventilation ศ.พ.ญ.ส ณ ร ตน คงเสร พงศ ภาคว ชาว ส ญญ ว ทยา คณะแพทยศาสตร ศ ร ราชพยาบาล Goal of Mechanical Ventilation Mechanical ventilation is any means in which physical device or machines are

More information

Provide guidelines for the management of mechanical ventilation in infants <34 weeks gestation.

Provide guidelines for the management of mechanical ventilation in infants <34 weeks gestation. Page 1 of 5 PURPOSE: Provide guidelines for the management of mechanical ventilation in infants

More information

Ventilator Waveforms: Interpretation

Ventilator Waveforms: Interpretation Ventilator Waveforms: Interpretation Albert L. Rafanan, MD, FPCCP Pulmonary, Critical Care and Sleep Medicine Chong Hua Hospital, Cebu City Types of Waveforms Scalars are waveform representations of pressure,

More information

European Society of Intensive Care Medicine (ESICM) Acute Respiratory Failure Section WEAN SAFE. Data Collection Forms

European Society of Intensive Care Medicine (ESICM) Acute Respiratory Failure Section WEAN SAFE. Data Collection Forms European Society of Intensive Care Medicine (ESICM) Acute Respiratory Failure Section WEAN SAFE Data Collection Forms Study ID: Date of Data collection: FORM 0: - ORGANIZATIONAL DATA OF THE PARTICIPATING

More information

UPMC Critical Care

UPMC Critical Care UPMC Critical Care www.ccm.pitt.edu Cardiovascular insufficiency with Initiation and Withdrawal of Mechanical Ventilation Michael R. Pinsky, MD, Dr hc Department of Critical Care Medicine University of

More information

Supplementary appendix

Supplementary appendix Supplementary appendix This appendix formed part of the original submission and has been peer reviewed. We post it as supplied by the authors. This online publication has been corrected. The corrected

More information

11/20/2015. Beyond CPAP. No relevant financial conflicts of interest. Kristie R Ross, M.D. November 12, Describe advanced ventilation options

11/20/2015. Beyond CPAP. No relevant financial conflicts of interest. Kristie R Ross, M.D. November 12, Describe advanced ventilation options Beyond CPAP Kristie R Ross, M.D. November 12, 2015 No relevant financial conflicts of interest Sponsored by The Warren Alpert Medical School of Brown University Describe advanced ventilation options Compare

More information

Arterial Blood Gas Analysis

Arterial Blood Gas Analysis Arterial Blood Gas Analysis L Lester www.3bv.org Bones, Brains & Blood Vessels Drawn from radial or femoral arteries. Invasive procedure Caution must be taken with patient on anticoagulants ph: 7.35-7.45

More information

TNI 20: Breathe Easier without a Mask

TNI 20: Breathe Easier without a Mask TNI 20: Breathe Easier without a Mask TNI 20 is for many patients a much more comfortable alternative to positive pressure respiration (CPAP) and other methods to treat sleep-related breathing disorders

More information

Efficacy of High-Flow Nasal Cannula Therapy in Acute Hypoxemic Respiratory Failure: Decreased Use of Mechanical Ventilation

Efficacy of High-Flow Nasal Cannula Therapy in Acute Hypoxemic Respiratory Failure: Decreased Use of Mechanical Ventilation Efficacy of High-Flow Nasal Cannula Therapy in Acute Hypoxemic Respiratory Failure: Decreased Use of Mechanical Kazuma Nagata MD, Takeshi Morimoto MD PhD MPH, Daichi Fujimoto MD, Takehiro Otoshi MD, Atsushi

More information

a. Describe the physiological consequences of intermittent positive pressure ventilation and positive end-expiratory pressure.

a. Describe the physiological consequences of intermittent positive pressure ventilation and positive end-expiratory pressure. B. 10 Applied Respiratory Physiology a. Describe the physiological consequences of intermittent positive pressure ventilation and positive end-expiratory pressure. Intermittent positive pressure ventilation

More information

Acute respiratory failure

Acute respiratory failure Rita Williams, NP-C, PA PeaceHealth Medical Group Pulmonary & Critical Care Acute respiratory failure Ventilation/perfusion mismatching Most common cause of hypoxemia Normal is 1:1 ratio or 1 Ventilation

More information

Key words: COPD; gas exchange; inspiratory flow waveforms; mechanical ventilation; oxygen consumption; pulmonary mechanics; work of breathing

Key words: COPD; gas exchange; inspiratory flow waveforms; mechanical ventilation; oxygen consumption; pulmonary mechanics; work of breathing Effects of Inspiratory Flow Waveforms on Lung Mechanics, Gas Exchange, and Respiratory Metabolism in COPD Patients During Mechanical Ventilation* Shieh Ching Yang, MD, FCCP; and Sze Piao Yang, MD, FCCP

More information

Case Report High-Flow Nasal Cannula Therapy in a Patient with Reperfusion Pulmonary Edema following Percutaneous Transluminal Pulmonary Angioplasty

Case Report High-Flow Nasal Cannula Therapy in a Patient with Reperfusion Pulmonary Edema following Percutaneous Transluminal Pulmonary Angioplasty Hindawi Publishing Corporation Case Reports in Pulmonology Volume 2014, Article ID 837612, 5 pages http://dx.doi.org/10.1155/2014/837612 Case Report High-Flow Nasal Cannula Therapy in a Patient with Reperfusion

More information

Non-Invasive Assessment of Respiratory Function. Chapter 11

Non-Invasive Assessment of Respiratory Function. Chapter 11 Non-Invasive Assessment of Respiratory Function Chapter 11 Pulse Oximetry Laboratory measurements of ABG s are the gold standard for measuring levels of hypoxemia, however since these are performed intermittently

More information

176 Airway pressure release ventilation, biphasic positive airway pressure Continuous positive airway pressure Figure 3.23 Figure 7.

176 Airway pressure release ventilation, biphasic positive airway pressure Continuous positive airway pressure Figure 3.23 Figure 7. 176 INTENSIVE CARE Airway pressure release ventilation, biphasic positive airway pressure Alveolar ventilation is achieved by the time-cycled switching between two levels of CPAP. Inspiratory and expiratory

More information

3. Which of the following would be inconsistent with respiratory alkalosis? A. ph = 7.57 B. PaCO = 30 mm Hg C. ph = 7.63 D.

3. Which of the following would be inconsistent with respiratory alkalosis? A. ph = 7.57 B. PaCO = 30 mm Hg C. ph = 7.63 D. Pilbeam: Mechanical Ventilation, 4 th Edition Test Bank Chapter 1: Oxygenation and Acid-Base Evaluation MULTIPLE CHOICE 1. The diffusion of carbon dioxide across the alveolar capillary membrane is. A.

More information

DAILY SCREENING FORM

DAILY SCREENING FORM DAILY SCREENING FORM Patient s initials: Date of admission: Time of admission: Gender: M F Year of Birth: Type of admission: Medical/Surgical/Postoperative (elective) Days Date Mechanical ventilation Lung

More information

DAYTON CHILDREN S HOSPITAL CLINICAL PRACTICE GUIDELINES

DAYTON CHILDREN S HOSPITAL CLINICAL PRACTICE GUIDELINES DAYTON CHILDREN S HOSPITAL CLINICAL PRACTICE GUIDELINES DISCLAIMER: This Clinical Practice Guideline (CPG) generally describes a recommended course of treatment for patients with the identified health

More information

RESPIRATORY FAILURE IN CHILDREN: Stabilization & Management

RESPIRATORY FAILURE IN CHILDREN: Stabilization & Management RESPIRATORY FAILURE IN CHILDREN: Stabilization & Management J. Dani Bowman, MD, PhD Calle Gonzales, MD, MPH Mike Engel, MD ANMC Pediatric Critical Care Learning objectives Define and diagnose respiratory

More information

Mechanical Ventilation in COPD patients

Mechanical Ventilation in COPD patients Mechanical Ventilation in COPD patients Θεόδωρος Βασιλακόπουλος Καθηγητής Πνευμονολογίας-Εντατικής Θεραπείας Εθνικό & Καποδιστριακό Πανεπιστήμιο Αθηνών Νοσοκομείο «ο Ευαγγελισμός» Adjunct Professor, McGill

More information

Restrictive Pulmonary Diseases

Restrictive Pulmonary Diseases Restrictive Pulmonary Diseases Causes: Acute alveolo-capillary sysfunction Interstitial disease Pleural disorders Chest wall disorders Neuromuscular disease Resistance Pathophysiology Reduced compliance

More information

Basic mechanisms disturbing lung function and gas exchange

Basic mechanisms disturbing lung function and gas exchange Basic mechanisms disturbing lung function and gas exchange Blagoi Marinov, MD, PhD Pathophysiology Department, Medical University of Plovdiv Respiratory system 1 Control of breathing Structure of the lungs

More information

Negative Pressure Pulmonary Edema: Have you seen it? NPPE: Reported Cases. Pulmonary Physiology

Negative Pressure Pulmonary Edema: Have you seen it? NPPE: Reported Cases. Pulmonary Physiology Negative Pressure Pulmonary Edema: Have you seen it? Deborah A. Geisler, CRNA, MHSA Private Practitioner Ponte Vedra Beach, Florida NPPE: Reported Cases First described in 1927 Correlation of airway obstruction

More information

CLINICAL VIGNETTE 2016; 2:3

CLINICAL VIGNETTE 2016; 2:3 CLINICAL VIGNETTE 2016; 2:3 Editor-in-Chief: Olufemi E. Idowu. Neurological surgery Division, Department of Surgery, LASUCOM/LASUTH, Ikeja, Lagos, Nigeria. Copyright- Frontiers of Ikeja Surgery, 2016;

More information

Sample Case Study. The patient was a 77-year-old female who arrived to the emergency room on

Sample Case Study. The patient was a 77-year-old female who arrived to the emergency room on Sample Case Study The patient was a 77-year-old female who arrived to the emergency room on February 25 th with a chief complaint of shortness of breath and a deteriorating pulmonary status along with

More information

The Case for ECCO 2 R

The Case for ECCO 2 R The Case for ECCO 2 R Extracorporeal CO 2 Removal in Acute Respiratory Failure Disclaimer The information in this presentation is provided by ALung Technologies for the purpose of educating health care

More information

UNIVERSITY OF JORDAN DEPT. OF PHYSIOLOGY & BIOCHEMISTRY RESPIRATORY PHYSIOLOGY MEDICAL STUDENTS FALL 2014/2015 (lecture 1)

UNIVERSITY OF JORDAN DEPT. OF PHYSIOLOGY & BIOCHEMISTRY RESPIRATORY PHYSIOLOGY MEDICAL STUDENTS FALL 2014/2015 (lecture 1) UNIVERSITY OF JORDAN DEPT. OF PHYSIOLOGY & BIOCHEMISTRY RESPIRATORY PHYSIOLOGY MEDICAL STUDENTS FALL 2014/2015 (lecture 1) Textbook of medical physiology, by A.C. Guyton and John E, Hall, Twelfth Edition,

More information

Bilevel positive airway pressure nasal mask ventilation in patients with acute hypercapnic respiratory failure

Bilevel positive airway pressure nasal mask ventilation in patients with acute hypercapnic respiratory failure Bilevel positive airway pressure nasal mask ventilation in patients with acute hypercapnic respiratory failure CK Chan, KS Lau, HC Fan, CW Lam The efficacy and complications of bilevel positive airway

More information

Effectiveness and safety of a protocolized mechanical ventilation and weaning strategy of COPD patients by respiratory therapists

Effectiveness and safety of a protocolized mechanical ventilation and weaning strategy of COPD patients by respiratory therapists Original Article Effectiveness and safety of a protocolized mechanical ventilation and weaning strategy of COPD patients by respiratory therapists Cenk Kirakli, Ozlem Ediboglu, Ilknur Naz, Pinar Cimen,

More information

Mechanical Ventilation in COPD patients

Mechanical Ventilation in COPD patients Mechanical Ventilation in COPD patients Θεόδωρος Βασιλακόπουλος Καθηγητής Πνευμονολογίας-Εντατικής Θεραπείας Εθνικό & Καποδιστριακό Πανεπιστήμιο Αθηνών Νοσοκομείο «ο Ευαγγελισμός» Adjunct Professor, McGill

More information

OSA and COPD: What happens when the two OVERLAP?

OSA and COPD: What happens when the two OVERLAP? 2011 ISRC Seminar 1 COPD OSA OSA and COPD: What happens when the two OVERLAP? Overlap Syndrome 1 OSA and COPD: What happens when the two OVERLAP? ResMed 10 JAN Global leaders in sleep and respiratory medicine

More information

County of Santa Clara Emergency Medical Services System

County of Santa Clara Emergency Medical Services System County of Santa Clara Emergency Medical Services System Policy #700-M12: Continuous Positive Airway Pressure CONTINUOUS POSITIVE AIRWAY PRESSURE Effective: February 8, 2013TBD Replaces: NewFebruary 8,

More information

The use of proning in the management of Acute Respiratory Distress Syndrome

The use of proning in the management of Acute Respiratory Distress Syndrome Case 3 The use of proning in the management of Acute Respiratory Distress Syndrome Clinical Problem This expanded case summary has been chosen to explore the rationale and evidence behind the use of proning

More information

Nottingham Children s Hospital

Nottingham Children s Hospital High Flow Nasal Cannula Therapy Title of Guideline (must include the word Guideline (not protocol, policy, procedure etc) Guide line for the use of HFNCT (High Flow Nasal Cannula Therapy) Contact Name

More information

Capnography: The Most Vital of Vital Signs. Tom Ahrens, PhD, RN, FAAN Research Scientist, Barnes-Jewish Hospital, St. Louis, MO May, 2017

Capnography: The Most Vital of Vital Signs. Tom Ahrens, PhD, RN, FAAN Research Scientist, Barnes-Jewish Hospital, St. Louis, MO May, 2017 Capnography: The Most Vital of Vital Signs Tom Ahrens, PhD, RN, FAAN Research Scientist, Barnes-Jewish Hospital, St. Louis, MO May, 2017 Assessing Ventilation and Blood Flow with Capnography Capnography

More information

Articles. The Advantages of Nebulization in the Treatment of Mechanically Ventilated Neonates. Kristin Smith, RRT-NPS

Articles. The Advantages of Nebulization in the Treatment of Mechanically Ventilated Neonates. Kristin Smith, RRT-NPS Articles The Advantages of Nebulization in the Treatment of Mechanically Ventilated Neonates Kristin Smith, RRT-NPS A major goal in the care of premature babies is growth, and so all therapies are applied

More information

Effect of high-flow nasal cannula oxygen therapy in adults with acute hypoxemic respiratory failure: a meta-analysis of randomized controlled trials

Effect of high-flow nasal cannula oxygen therapy in adults with acute hypoxemic respiratory failure: a meta-analysis of randomized controlled trials RESEARCH Effect of high-flow nasal cannula oxygen therapy in adults with acute hypoxemic respiratory failure: a meta-analysis of randomized controlled trials Xiaofeng Ou MD PhD, Yusi Hua MD MSc, Jin Liu

More information

Respiratory failure CHAPTER 4. Basic pulmonary physiology. By the end of this chapter you will be able to:

Respiratory failure CHAPTER 4. Basic pulmonary physiology. By the end of this chapter you will be able to: Cooper-04.qxd 4/19/06 5:44 PM Page 50 CHAPTER 4 Respiratory failure By the end of this chapter you will be able to: Understand basic pulmonary physiology Understand the mechanisms of respiratory failure

More information

Physiological changes during low- and high-intensity noninvasive ventilation

Physiological changes during low- and high-intensity noninvasive ventilation Eur Respir J 2012; 39: 869 875 DOI: 10.1183/09031936.00056111 CopyrightßERS 2012 Physiological changes during low- and high-intensity noninvasive ventilation J. Lukácsovits*, A. Carlucci #, N. Hill ",

More information

Sub-category: Intensive Care for Respiratory Distress

Sub-category: Intensive Care for Respiratory Distress 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: Acute Respiratory Distress

More information

High-flow nasal cannula oxygen therapy: more than a higher amount of oxygen delivery

High-flow nasal cannula oxygen therapy: more than a higher amount of oxygen delivery Editorial High-flow nasal cannula oxygen therapy: more than a higher amount of oxygen delivery Eric Maury 1,2,3, Mikael Alves 4, Naike Bigé 1 1 Medical Intensive Care Unit, Saint-Antoine Hospital, Assistance-Publique

More information

Improving Non Invasive Ventilation in the Emergency Department

Improving Non Invasive Ventilation in the Emergency Department Improving Non Invasive Ventilation in the Emergency Department Presented by Michael Rodda, Application Specialist, Dräger Medical SSEM Conference, October 1 st, 2015 Welcome Michael Rodda - Application

More information