Mechanical Ventilation in COPD patients
|
|
- Brent Miller
- 6 years ago
- Views:
Transcription
1 Mechanical Ventilation in COPD patients Θεόδωρος Βασιλακόπουλος Καθηγητής Πνευμονολογίας-Εντατικής Θεραπείας Εθνικό & Καποδιστριακό Πανεπιστήμιο Αθηνών Νοσοκομείο «ο Ευαγγελισμός» Adjunct Professor, McGill University, Montreal, Canada Γενικός Γραμματέας Ελληνικής Πνευμονολογικής Εταιρείας
2 Outline Non invasive ventilation during exacerbations to avoid intubation Controlled mechanical ventilation Partial support ventilation Ventilator triggering Wasted efforts Weaning Non Invasive Ventilation after weaning Spontaneous breathing trial failure Post extubation
3 Non-invasive ventilation during exacerbations to avoid intubation
4 PTPdi/min (cmh20 x s/min) i-psv n-psv T-piece S.B. * *
5 % of patients Intubation rate in patients with acute exacerbation of COPD treated with and without NIPPV n=16 n=15 26 n=43 n=42 NIPPV Control 0 Kramer et al 1995 Brochard et al 1995
6 Hospital stay (days) of patients with acute exacerbation of COPD treated with and without NIPPV * NIPPV Control Brochard et al. NEJM 1995;333:817
7 % of patients In-hospital mortality (%) in patients with acute exacerbation of COPD treated with and without NIPPV n=30 n=30 n=43 n=42 Bott et al 1993 Brochard et al 1995 NIPPV Control
8 % of patients Early use of NIPPV for acute exacerbation of COPD on general wards NIPPV Control 5 n=118 n=118 n=118 n=118 0 Need for intubation In-hospital mortality Plant et al. Lancet 2000;355:1931
9 NIV in hypercapnic encephalopathy Scala et al, Intensive Care Med 2007;33:2101-8
10 Helmet worsens patient-ventilator interaction in COPD Navalesi P et al, Intensive Care Med 2007;33:74-81
11 Controlled mechanical ventilation
12 Mechanical Ventilation Volume Control Tidal Volume 520 ml Respiratory Rate = 16 breaths/min TI/TT = 0,25 PEEP = 0-5 cmh2o FiO2 = 50%
13 Pressure (cmh 2 O) Flow (l/sec) Dynamic hyperinflation Slope increase Over-distension End expiratory flow Time (sec)
14 Assessment of mechanics Ppeak Pplateau PEEPi End expiratory occlusion Rrs = (Ppeak-Pplateau)/V
15 When PEEPi is present during CMV Hemodynamic compromise Overdistension with risk of barotrauma Reduce f Reduce VT Increase inspiratory flow to prolong TE
16 Partial Support Modes
17 Ventilator triggering
18 Ptr
19 Aslanian P, AJRCCM 1998;157:135-43
20 Partitioning of pressure time product during flow and pressure triggering 9 Pressure Support 9 Assist control PTPes PTPtr PTPpost PTPpeepi PTPes PTPtr PTPpost PTPpeepi PT FT 0 PT FT Aslanian P, AJRCCM 1998;157:135-43
21 Paw (cmh 2 O) Flow (l/sec) Fr = 12 b/min Time (sec) 5 sec
22 Pes (cmh 2 O) Paw (cmh 2 O) Flow (l/sec) 0,8 0,6 0,4 0, , ,4-0,6-0, Fr = 33 b/min Time (sec) 5 sec Georgopoulos D
23 Ptr
24 Wasted effort PEEPi Ptr Dynamic Hyperinflation Vrel
25 Ineffective efforts increase as the level of ventilator support increases Leung P, AJRCCM 1997;155:
26 Ineffective efforts decrease as expiratory time increases ACV Tidal Volume constant Increased Flow Increased Expiratory time Kondili E, BJA 2003;91:106-19
27 Ptr
28 Factors predisposing to ineffective efforts The level of ventilator assistance Large tidal volume of the preceding breath Short expiratory time PEEPi
29 Pes (cmh 2 O) Paw (cmh 2 O) Flow (l/sec) Time (sec) 5 sec
30 Pes (cmh 2 O) Flow (l/sec) 0,8 0,6 0,4 0,2 0-0,2-0,4-0,6-0, Time (sec) 5 sec Georgopoulos D
31 Wasted efforts reduction during pressure support Cycling off criterion increased in steps of 10% Thille et al Intensive Care Med 2008;34: Gradual reduction of PS level-steps of 2 cmh 2 0
32 Addition of external PEEP Ptr PEEP external
33 Chao et al, Chest 1997;112: Asynchrony between patient ventilator Presence of Dynamic Hyperinflation and PEEPi. Apply external PEEP (~ 5 cmh 2 O)
34 Weaning
35 Pressure Support vs T-piece weaning in COPD COPD Screened 77 patients Excluded 2 Eligible T-tube trial 75 Trial Success 23 (31%) Trial Failure 52 (69%) T-tube 26 PS 26 Successful Weaning 20 (77%) Successful Weaning 19 (73%) Failed Weaning 6 (23%) Failed Weaning 7 (27%) Vitacca et al. Am J Respir Crit Care 2001; 164: 225
36 PSV T-piece AJRCCM 2001;164:
37 Non Invasive Ventilation as weaning technique in COPD patients who fail SBT after 2 days of MV Control NIV Nava et al. Ann Intern Med 1998;128:721
38 % of patients 60 days mortality (%) in patients with acute exacerbation of COPD using NIPPV as a weaning technique * NIPPV Control Nava et al. Ann Intern Med 1998;128:721
39 Non Invasive Ventilation during persistent (3 days) spontaneous breathing trial failure NIV NIV COPD 25/43 patients Ferrer et al. Am J Respir Crit Care Med 2003;168:70-76
40 Non-Invasive Ventilation (n.114) Conventional Therapy (n.107) Absolute Risk Difference Relative Risk (95% CI) p-value Mortality 25% 14% 11.4% ( ) 1.75 ( ) 0.05 Reintubation 49% 49% 0% 0.99 ( ) ns
41 Did this RCT killed NIV?
42 Mortality % / /14 General COPD /114 * 15/107 0 NIV Standard therapy Esteban, A. et al. N Engl J Med 2004;350:
43 TIME to REINTUBATION % patients deaths 0-12 hr hr hr hr Epstein and Ciubotaru AJRCCM 1998;158:489-93
44 Another way to see the problem: If timing is a key factor, why should we wait until post-extubation respiratory failure is overt?
45 NIV to prevent extubation failure in patients with successful SBT Αναπνευστική ανεπάρκεια 33% 16% Ferrer et al. Am J Respir Crit Care Med 2006;173:164-70
46 Survival of patients receiving NIV to prevent extubation failure in patients with successful SBT subgroup analysis Ferrer et al. Am J Respir Crit Care Med 2006;173:164-70
47 Ferrer et al, Lancet 2009;374:
48 NIV after extubation in patients who develop hypercapnia during a spontaneous breathing trial Ferrer et al, Lancet 2009;374:
49 Time elapsed from extubation to development of respiratory failure NIV immediately after extubation in patients who develop hypercapnia during a spontaneous breathing trial Ferrer et al, Lancet 2009;374:
50 NIV is beneficial Summary To avoid intubation When spontaneous breathing trial fails in COPD To prevent extubation failure in COPD patients During CMV check mechanics and PEEPi To avoid hemodynamic compromise To avoid overdistention Triggering: not really clinically important Wasted efforts Decrease support Apply external PEEP Weaning: No difference between different techniques PS vs T-piece The best technique is the one you know well
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 informationΠαθοφυσιολογια αποτυχίας αποδέσμευσης. Καρδιαγγειακό
Παθοφυσιολογια αποτυχίας αποδέσμευσης Καρδιαγγειακό Θεόδωρος Βασιλακόπουλος Καθηγητής Πνευμονολογίας-Εντατικής Θεραπείας Εθνικό & Καποδιστριακό Πανεπιστήμιο Αθηνών Νοσοκομείο «ο Ευαγγελισμός» Adjunct Professor,
More informationPAPER 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 informationThe Art and Science of Weaning from Mechanical Ventilation
The Art and Science of Weaning from Mechanical Ventilation Shekhar T. Venkataraman M.D. Professor Departments of Critical Care Medicine and Pediatrics University of Pittsburgh School of Medicine Some definitions
More informationLiberation from Mechanical Ventilation in Critically Ill Adults
Liberation from Mechanical Ventilation in Critically Ill Adults 2017 ACCP/ATS Clinical Practice Guidelines Timothy D. Girard, MD, MSCI Clinical Research, Investigation, and Systems Modeling of Acute Illness
More informationThe Impact of Patient-Ventilator. Karen J Bosma, MD, FRCPC Critical Care Medicine and Respirology
Achieving Restful Ventilation: The Impact of Patient-Ventilator Interaction on Sleep Karen J Bosma, MD, FRCPC Critical Care Medicine and Respirology Disclosure Statement I have received a research grant
More informationVentilator 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 informationVentilatory Management of ARDS. Alexei Ortiz Milan; MD, MSc
Ventilatory Management of ARDS Alexei Ortiz Milan; MD, MSc 2017 Outline Ventilatory management of ARDS Protected Ventilatory Strategy Use of NMB Selection of PEEP Driving pressure Lung Recruitment Prone
More informationPotential 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 informationConcerns and Controversial Issues in NPPV. Concerns and Controversial Issues in Noninvasive Positive Pressure Ventilation
: Common Therapy in Daily Practice Concerns and Controversial Issues in Noninvasive Positive Pressure Ventilation Rongchang Chen Guangzhou Institute of Respiratory Disease as the first choice of mechanical
More informationWeaning and extubation in PICU An evidence-based approach
Weaning and extubation in PICU An evidence-based approach Suchada Sritippayawan, MD. Div. Pulmonology & Crit Care Dept. Pediatrics Faculty of Medicine Chulalongkorn University Kanokporn Udomittipong, MD.
More informationRecognizing and Correcting Patient-Ventilator Dysynchrony
2019 KRCS Annual State Education Seminar Recognizing and Correcting Patient-Ventilator Dysynchrony Eric Kriner BS,RRT Pulmonary Critical Care Clinical Specialist MedStar Washington Hospital Center Washington,
More informationVentilator curves. Fellowonderwijs 2 feb 2012
Ventilator curves Fellowonderwijs 2 feb 2012 Mechanical ventilation Supported Ventilator affects patients respiratory drive Monitor interaction patient - ventilator Controlled Monitor interatcion patient
More informationNew Modes to Enhance Synchrony & Dietrich Henzler MD, PhD, FRCPC Division of Critical Care
New Modes to Enhance Synchrony & Dietrich Henzler MD, PhD, FRCPC Division of Critical Care Disclosure Conflicts of Interest 2001-2011 Research Grants & Payments (cost reimbursements, speaker fees) Draeger
More informationIMPLEMENTATION AT THE BEDSIDE
CLINICAL EVIDENCE GUIDE IMPLEMENTATION AT THE BEDSIDE Puritan Bennett PAV+ Software Utilization of the PAV+ software has been demonstrated to reduce asynchrony and improve respiratory mechanics. 2 Yet,
More informationNIV in hypoxemic patients
NIV in hypoxemic patients Massimo Antonelli, MD Dept. of Intensive Care & Anesthesiology Università Cattolica del Sacro Cuore Rome - Italy Conflict of interest (research grants and consultations): Maquet
More informationWeaning from Mechanical Ventilation. Dr Azmin Huda Abdul Rahim
Weaning from Mechanical Ventilation Dr Azmin Huda Abdul Rahim Content Definition Classification Weaning criteria Weaning methods Criteria for extubation Introduction Weaning comprises 40% of the duration
More informationRespiratory insufficiency in bariatric patients
Respiratory insufficiency in bariatric patients Special considerations or just more of the same? Weaning and rehabilation conference 6th November 2015 Definition of obesity Underweight BMI< 18 Normal weight
More informationNIV in COPD Acute and Chronic Use
NIV in COPD Acute and Chronic Use Dr C M Chu MD, MSc, FRCP, FCCP Consultant Physician Department of Medicine & Geriatrics United Christian Hospital, Hong Kong NIV in COPD I. AE-COPD/ARF II. III. Weaning
More informationDr. 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 informationPatient Ventilator Interactions. Patient-Ventilator Interactions. Assisted vs Controlled MV. Ventilatory Muscle Fatigue Recovery
Patient Ventilator Interactions Patient-Ventilator Interactions Neil MacIntyre MD Duke Uni versity Medi cal Center Durham NC, USA Newer a pproaches to improving intera ctions Assisted vs Controlled MV
More informationWeaning: Neuro Ventilatory Efficiency
Weaning: Neuro Ventilatory Efficiency Christer Sinderby Department of Critical Care Keenan Research Center at the Li Ka Shing Knowledge Institute of St. Michael's Hospital Faculty of Medicine, University
More information1. Screening to identify SBT candidates
Karen E. A. Burns MD, FRCPC, MSc (Epid) Associate Professor, Clinician Scientist St. Michael s Hospital, Toronto, Canada burnsk@smh.ca Review evidence supporting: 1. Screening to identify SBT candidates
More informationNoninvasive respiratory support:why is it working?
Noninvasive respiratory support:why is it working? Paolo Pelosi Department of Surgical Sciences and Integrated Diagnostics (DISC) IRCCS San Martino IST University of Genoa, Genoa, Italy ppelosi@hotmail.com
More informationNIV use in ED. Dr. Khalfan AL Amrani Emergency Resuscitation Symposium 2 nd May 2016 SQUH
NIV use in ED Dr. Khalfan AL Amrani Emergency Resuscitation Symposium 2 nd May 2016 SQUH Outline History & Introduction Overview of NIV application Review of proven uses of NIV History of Ventilation 1940
More informationSurgery Grand Rounds. Non-invasive Ventilation: A valuable tool. James Cromie, PGY 3 8/24/09
Surgery Grand Rounds Non-invasive Ventilation: A valuable tool James Cromie, PGY 3 8/24/09 History of mechanical ventilation 1930 s: use of iron lung 1940 s: First NIV system (Bellevue Hospital) 1950 s:
More informationNoninvasive 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 informationOutline. Basic principles of lung protective ventilation. The challenging areas. Small tidal volumes Recruitment
ARDS beyond 6/kg Gordon D. Rubenfeld, MD MSc Professor of Medicine, University of Toronto Chief, Program in Trauma, Emergency, and Critical Care Sunnybrook Health Sciences Centre Outline Basic principles
More informationTracking lung recruitment and regional tidal volume at the bedside. Antonio Pesenti
Tracking lung recruitment and regional tidal volume at the bedside Antonio Pesenti Conflicts of Interest Maquet: Received research support and consultation fees Drager: Received research support and consultation
More informationOptimize vent weaning and SBT outcomes. Identify underlying causes for SBT failures. Role SBT and weaning protocol have in respiratory care
Optimize vent weaning and SBT outcomes Identify underlying causes for SBT failures Role SBT and weaning protocol have in respiratory care Lower risk of developing complications Lower risk of VAP, other
More informationNon-invasive Positive Pressure Mechanical Ventilation: NIPPV: CPAP BPAP IPAP EPAP. My Real Goals. What s new in 2018? OMG PAP?
Non-invasive Positive Pressure Mechanical Ventilation: What s new in 2018? Geoffrey R. Connors, MD, FACP Associate Professor of Medicine University of Colorado School of Medicine Division of Pulmonary
More informationExtubation Failure & Delay in Brain-Injured Patients
Extubation Failure & Delay in Brain-Injured Patients Niall D. Ferguson, MD, FRCPC, MSc Director, Critical Care Medicine University Health Network & Mount Sinai Hospital Associate Professor of Medicine
More informationPressure-support ventilation
Intensive Care Med (2008) 34:1477 1486 DOI 10.1007/s00134-008-1121-9 ORIGINAL Arnaud W. Thille Belen Cabello Fabrice Galia Aissam Lyazidi Laurent Brochard Reduction of patient-ventilator asynchrony by
More informationARDS: an update 6 th March A. Hakeem Al Hashim, MD, FRCP SQUH
ARDS: an update 6 th March 2017 A. Hakeem Al Hashim, MD, FRCP SQUH 30M, previously healthy Hx: 1 week dry cough Gradually worsening SOB No travel Hx Case BP 130/70, HR 100/min ph 7.29 pco2 35 po2 50 HCO3
More informationVentilator ECMO Interactions
Ventilator ECMO Interactions Lorenzo Del Sorbo, MD CCCF Toronto, October 2 nd 2017 Disclosure Relevant relationships with commercial entities: none Potential for conflicts within this presentation: none
More informationARDS Assisted ventilation and prone position. ICU Fellowship Training Radboudumc
ARDS Assisted ventilation and prone position ICU Fellowship Training Radboudumc Fig. 1 Physiological mechanisms controlling respiratory drive and clinical consequences of inappropriate respiratory drive
More informationWhat 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 informationPatient-Ventilator Synchrony and Impact on Outcome
Variables Controlled during Mechanical Ventilation Patient-Ventilator Synchrony and Impact on Outcome 9-30-17 Cox Bob Kacmarek PhD, RRT Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
More informationCSIM annual meeting Acute respiratory failure. Dr. John Ronald, FRCPC Int Med, Resp, CCM. October 10, 2018
CSIM annual meeting - 2018 Acute respiratory failure Dr. John Ronald, FRCPC Int Med, Resp, CCM. October 10, 2018 NRGH affiliated with UBC medicine Disclosures None relevant to this presentation. Also no
More informationPatient Asynchrony and Its Impact on Patient Outcome
Patient Asynchrony and Its Impact on Patient Outcome 5-14-18 CSRC Bob Kacmarek PhD, RRT Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts Conflict of Interest Disclosure Robert
More informationProportional 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 informationCase Scenarios. Dr Shrikanth Srinivasan MD,DNB,FNB,EDIC. Consultant, Critical Care Medicine Medanta, The Medicity
Case Scenarios Dr Shrikanth Srinivasan MD,DNB,FNB,EDIC Consultant, Critical Care Medicine Medanta, The Medicity Case 1 A 36 year male with cirrhosis and active GI bleeding is intubated to protect his airway,
More informationWeaning: The key questions
Weaning from mechanical ventilation Weaning / Extubation failure: Is it a real problem in the PICU? Reported extubation failure rates in PICUs range from 4.1% to 19% Baisch SD, Wheeler WB, Kurachek SC,
More informationPrepared 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 informationKeeping Patients Off the Vent: Bilevel, HFNC, Neither?
Keeping Patients Off the Vent: Bilevel, HFNC, Neither? Robert Kempainen, MD Pulmonary and Critical Care Medicine Hennepin County Medical Center University of Minnesota School of Medicine Objectives Summarize
More informationCase discussion Acute severe asthma during pregnancy. J.G. van der Hoeven
Case discussion Acute severe asthma during pregnancy J.G. van der Hoeven Case (1) 32-year-old female - gravida 3 - para 2 Previous medical history - asthma Pregnant (33 w) Acute onset fever with wheezing
More information11 th Annual Congress Turkish Thoracic Society. Mechanical Ventilation in Acute Hypoxemic Respiratory Failure
11 th Annual Congress Turkish Thoracic Society Mechanical Ventilation in Acute Hypoxemic Respiratory Failure Lluis Blanch MD PhD Senior Critical Care Center Scientific Director Corporació Parc Taulí Universitat
More informationEffectiveness 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 informationRecent 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 informationHaut debit nasal ou BiPAP? Laurent Brochard Toronto
Haut debit nasal ou BiPAP? Laurent Brochard Toronto Conflicts of interest Our clinical research laboratory has received research grants for clinical trials from the following companies: General Electric
More informationBi-Level Therapy: Boosting Comfort & Compliance in Apnea Patients
Bi-Level Therapy: Boosting Comfort & Compliance in Apnea Patients Objectives Describe nocturnal ventilation characteristics that may indicate underlying conditions and benefits of bilevel therapy for specific
More informationPAOLO PELOSI, LAURA MARIA CHIERICHETTI, PAOLO SEVERGNINI
MANAGEMENT OF WEANING EUROANESTHESIA 2005 Vienna, Austria 28-31 May 2005 12RC11 PAOLO PELOSI, LAURA MARIA CHIERICHETTI, PAOLO SEVERGNINI Dipartimento Ambiente, Salute e Sicurezza, Universita degli Studi
More information17400 Medina Road, Suite 100 Phone: Minneapolis, MN Fax:
17400 Medina Road, Suite 100 Phone: 763-398-8300 Minneapolis, MN 55447-1341 Fax: 763-398-8400 www.pulmonetic.com Clinical Bulletin To: Cc: From: Domestic Sales Representatives and International Distributors
More informationMonitoring Respiratory Drive and Respiratory Muscle Unloading during Mechanical Ventilation
Monitoring Respiratory Drive and Respiratory Muscle Unloading during Mechanical Ventilation J. Beck and C. Sinderby z Introduction Since Galen's description 2000 years ago that the lungs could be inflated
More informationUCH WEANING FROM MECHANICAL VENTILATION PATHWAY
UCH WEANING FROM MECHANICAL VENTILATION PATHWAY WAKE WARM AND WEAN. POST OPERATIVE PATIENTS WHO HAVE BEEN VENTILATED < 24 HOURS DAILY EXTUBATION SCREEN A DAILY SCREEN TO BE CARRIED OUT ON ALL PATIENTS
More informationNAVA. In Neonates. Howard Stein, M.D. Director Neonatology. Neurally Adjusted Ventilatory Assist. Toledo Children s Hospital Toledo, Ohio
NAVA Neurally Adjusted Ventilatory Assist In Neonates Howard Stein, M.D. Director Neonatology Toledo Children s Hospital Toledo, Ohio Disclaimers Dr Stein: Is discussing products made by Maquet Has no
More informationEFFICACY OF BIPAP IN PATIENTS ADMITTED WITH HYPERCAPNIC RESPIRATORY FAILURE; AN EXPERIENCE AT A TERTIARY CARE HOSPITAL
ORIGINAL ARTICLE EFFICACY OF BIPAP IN PATIENTS ADMITTED WITH HYPERCAPNIC RESPIRATORY FAILURE; AN EXPERIENCE AT A TERTIARY CARE HOSPITAL Hussain Ahmad*, Saadia Ashraf*, Rukhsana Javed Farooqi*, Mukhtiar
More informationNoninvasive mechanical ventilation in acute respiratory failure
Eur Respir J, 1996, 9, 795 807 DOI: 10.1183/09031936.96.09040795 Printed in UK - all rights reserved Copyright ERS Journals Ltd 1996 European Respiratory Journal ISSN 0903-1936 SERIES: 'CLINICAL PHYSIOLOGY
More informationSpontaneous Breathing Trial and Mechanical Ventilation Weaning Process
Page 1 of 5 ASSESSMENT INTERVENTION Patient receiving mechanical ventilation Baseline ventilatory mode/ settings RT and RN to assess criteria 1 for SBT Does patient meet criteria? RT to initiate SBT Does
More informationTest Bank Pilbeam's Mechanical Ventilation Physiological and Clinical Applications 6th Edition Cairo
Instant dowload and all chapters Test Bank Pilbeam's Mechanical Ventilation Physiological and Clinical Applications 6th Edition Cairo https://testbanklab.com/download/test-bank-pilbeams-mechanical-ventilation-physiologicalclinical-applications-6th-edition-cairo/
More informationNew York Science Journal 2017;10(5)
Value of Automatic Tube Compensation during Weaning of Mechanically Ventilated Patient in Medical Intensive Care Unit Mohamed Abouzeid. 1, Ahmed E. Kabil. 2, Ahmed Al-Ashkar 1 and Hafez A. Abdel-Hafeez
More informationNoninvasive 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 informationHigh Flow Humidification Therapy, Updates.
High Flow Humidification Therapy, Updates. Bernardo Selim, M.D. I have no relevant financial relationships to disclose. Assistant Professor, Pulmonary, Critical Care and Sleep Medicine, Mayo Clinic What
More informationNew Modes and New Concepts In Mechanical Ventilation
New Modes and New Concepts In Mechanical Ventilation Prof Department of Anesthesia and Surgical Intensive Care Cairo University 1 2 New Ventilation Modes Dual Control Within-a-breath switches from PC to
More informationA simple case of.. Acute severe asthma. MasterclassIC Schiermonnikoog 2017
A simple case of.. Acute severe asthma MasterclassIC Schiermonnikoog 2017 Case (1) Female, 27 - G1P0 (26 weeks) PMH - several admissions for severe acute asthma (no MV) Progressive dyspnea for 1 week Admitted
More informationNon-invasive ventilation (NIV)
Non-invasive ventilation And the Lord God formed a man from the dust of the ground, and breathed into his nostrils the breath of life, and the man became a living being. B. Buyse (MD, PhD) Dept. of Pulmonology,
More informationYou are caring for a patient who is intubated and. pressure control ventilation. The ventilator. up to see these scalars
Test yourself Test yourself #1 You are caring for a patient who is intubated and ventilated on pressure control ventilation. The ventilator alarms and you look up to see these scalars What is the most
More informationThe Role of Noninvasive Ventilation in the Ventilator Discontinuation Process
The Role of Noninvasive Ventilation in the Ventilator Discontinuation Process Dean R Hess PhD RRT FAARC Introduction NIV to Shorten the Length of Invasive Ventilation NIV to Prevent Extubation Failure
More informationNoninvasive pressure support ventilation in COPD patients with postextubation hypercapnic respiratory insufficiency
Eur Respir J 1998; 11: 1349 1353 DOI: 10.1183/09031936.98.11061349 Printed in UK - all rights reserved Copyright ERS Journals Ltd 1998 European Respiratory Journal ISSN 0903-1936 Noninvasive pressure support
More informationAcute exacerbations are common in patients with
Predicting the Result of Noninvasive Ventilation in Severe Acute Exacerbations of Patients With Chronic Airflow Limitation* Antonio Antón, MD; Rosa Güell, MD; Juan Gómez, MD; José Serrano, MD; Abilio Castellano,
More informationAnalyzing Lung protective ventilation F Javier Belda MD, PhD Sº de Anestesiología y Reanimación. Hospital Clinico Universitario Valencia (Spain)
Analyzing Lung protective ventilation F Javier Belda MD, PhD Sº de Anestesiología y Reanimación Hospital Clinico Universitario Valencia (Spain) ALI/ARDS Report of the American-European consensus conference
More informationPATIENT-VENTILATOR ASYNCHRONY IN A TRAUMATICALLY INJURED POPULATION. 1. Bryce RH Robinson, MD FACS. 2. Thomas Blakeman, MSc RRT. 3.
PATIENT-VENTILATOR ASYNCHRONY IN A TRAUMATICALLY INJURED POPULATION. Bryce RH Robinson, MD FACS. Thomas Blakeman, MSc RRT. Peter Toth, MD. Dennis J Hanseman, PhD. Eric Mueller, PharmD FCCM. Richard Branson,
More informationEDUCATIONAL MATERIAL
ERS Annual Congress Amsterdam 26 30 September 2015 EDUCATIONAL MATERIAL Meet the expert 3 Mechanical ventilation: a friend and a foe Thank you for viewing this document. We would like to remind you that
More informationNon Invasive Ventilation (NIV) for Weaning/Extubation from Invasive Mechanical Ventilation (MV)
Interest of Non Invasive Ventilation in the Difficult Weaning Lyon - March 26-28, 2015 Non Invasive Ventilation (NIV) for Weaning/Extubation from Invasive Mechanical Ventilation (MV) Ch. GIRAULT Medical
More informationQuickLung Breather Patient Settings
The QuickLung Breather is capable of simulating a spontaneously breathing patient in a variety of modes and patterns. In response to customer requests, we have compiled five common respiratory cases below.
More informationMechanical Ventilation of the Patient with Neuromuscular Disease
Mechanical Ventilation of the Patient with Neuromuscular Disease Dean Hess PhD RRT Associate Professor of Anesthesia, Harvard Medical School Assistant Director of Respiratory Care, Massachusetts General
More informationLAS VEGAS Case Report Form 1 Intra-Operative
LAS VEGAS Case Report Form 1 Intra-Operative Patient Informed Consent 1. Informed consent applicable: yes no (choose no if waived by local EC) 1.1 If applicable; was consent obtained? yes no 1.2 If yes,
More informationKugelman A, Riskin A, Said W, Shoris I, Mor F, Bader D.
Heated, Humidified High-Flow Nasal Cannula (HHHFNC) vs. Nasal Intermittent Positive Pressure Ventilation (NIPPV) for the Primary Treatment of RDS, A Randomized, Controlled, Prospective, Pilot Study Kugelman
More informationCLINICAL 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 informationGE Healthcare. Non Invasive Ventilation (NIV) For the Engström Ventilator. Relief, Relax, Recovery
GE Healthcare Non Invasive Ventilation (NIV) For the Engström Ventilator Relief, Relax, Recovery COPD is currently the fourth leading cause of death in the world, and further increases in the prevalence
More informationMECHANICAL VENTILATION PROTOCOLS
GENERAL or SURGICAL Initial Ventilator Parameters Ventilator Management (see appendix I) Assess Patient Data (see appendix II) Data Collection Mode: Tidal Volume: FIO2: PEEP: Rate: I:E Ratio: ACUTE PHASE
More informationRespiratory Mechanics
Respiratory Mechanics Critical Care Medicine Specialty Board Tutorial Dr Arthur Chun-Wing LAU Associate Consultant Intensive Care Unit, Pamela Youde Nethersole Eastern Hospital, Hong Kong 17 th June 2014
More informationNoninvasive 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 informationProvide 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 informationAlma Mater University of Bologna. Respiratory and Critical Care Sant Orsola Hospital, Bologna, Italy
Alma Mater University of Bologna Respiratory and Critical Care Sant Orsola Hospital, Bologna, Italy Conflict of Interest I have affiliations with, special interests, or have conducted business with the
More informationInnovations in Neonatal Ventilation
Innovations in Neonatal Ventilation NAVA Neurally Adjusted Ventilatory Assist Howard Stein, M.D. Director Neonatology, Promedica Toledo Children s Hospital Clinical Professor of Pediatrics, University
More informationSurviving Sepsis Campaign. Guidelines for Management of Severe Sepsis/Septic Shock. An Overview
Surviving Sepsis Campaign Guidelines for Management of Severe Sepsis/Septic Shock An Overview Mechanical Ventilation of Sepsis-Induced ALI/ARDS ARDSnet Mechanical Ventilation Protocol Results: Mortality
More informationPatient-ventilator interaction and inspiratory effort during pressure support ventilation in patients with different pathologies
Eur Respir J, 1997; 1: 177 183 DOI: 1.1183/931936.97.11177 Printed in UK - all rights reserved Copyright ERS Journals Ltd 1997 European Respiratory Journal ISSN 93-1936 Patient-ventilator interaction and
More informationVentilation de l obèse: les 10 points clés
Ventilation de l obèse: les 10 points clés Samir JABER Department of Critical Care Medicine and Anesthesiology (DAR B) Saint Eloi University Hospital and Montpellier School of Medicine; INSERM U1046 University
More informationMonitor the patients disease pathology and response to therapy Estimate respiratory mechanics
Understanding Graphics during Mechanical Ventilation Why Understand Ventilator Graphics? Waveforms are the graphic representation of the data collected by the ventilator and reflect the interaction between
More informationThe Early Phase of the Minute Ventilation Recovery Curve Predicts Extubation Failure Better Than the Minute Ventilation Recovery Time
The Early Phase of the Minute Ventilation Recovery Curve Predicts Extubation Failure Better Than the Minute Ventilation Recovery Time Gonzalo Hernandez, Rafael Fernandez, Elena Luzon, Rafael Cuena and
More informationFAILURE OF NONINVASIVE VENTILATION FOR DE NOVO ACUTE HYPOXEMIC RESPIRATORY FAILURE: ROLE OF TIDAL VOLUME
FAILURE OF NONINVASIVE VENTILATION FOR DE NOVO ACUTE HYPOXEMIC RESPIRATORY FAILURE: ROLE OF TIDAL VOLUME Guillaume CARTEAUX, Teresa MILLÁN-GUILARTE, Nicolas DE PROST, Keyvan RAZAZI, Shariq ABID, Arnaud
More informationBasics of NIV. Dr Shrikanth Srinivasan MD,DNB,FNB,EDIC. Consultant, Critical Care Medicine Medanta, The Medicity
Basics of NIV Dr Shrikanth Srinivasan MD,DNB,FNB,EDIC Consultant, Critical Care Medicine Medanta, The Medicity Objectives: Definitions Advantages and Disadvantages Interfaces Indications Contraindications
More informationNIV in Acute Respiratory Failure: Where we fail? Dr Shrikanth Srinivasan MD,DNB,FNB,EDIC Consultant, Critical Care Medicine Medanta, The Medicity
NIV in Acute Respiratory Failure: Where we fail? Dr Shrikanth Srinivasan MD,DNB,FNB,EDIC Consultant, Critical Care Medicine Medanta, The Medicity Use of NIV 1998-2010 50 45 40 35 30 25 20 15 10 5 0 1998
More informationHow to optimize timing of extubation? Andrew JE Seely MD, PhD, FRCSC
How to optimize timing of extubation? Andrew JE Seely MD, PhD, FRCSC Disclosure Therapeutic Monitoring Systems (TMS) Founder and Chief Science Officer TMS Aim: improve patient care through innovative variability-derived
More informationAdaptive support ventilation for faster weaning in COPD: a randomised controlled trial
Eur Respir J 2011; 38: 774 780 DOI: 10.1183/09031936.00081510 CopyrightßERS 2011 Adaptive support ventilation for faster weaning in COPD: a randomised controlled trial C. Kirakli*, I. Ozdemir #, Z.Z. Ucar*,
More informationEISA I. AFIFY, M.D.; AHMED T. SHAARAWY, M.D.; AHMED E. KABIL, M.D. and MAGDY S. TAHA, M.Sc.
Med. J. Cairo Univ., Vol. 84, o. 2, December: 377-383, 2016 www.medicaljournalofcairouniversity.net Comparison between Pressure Regulated Volume Control Ventilation and Synchronized Intermittent Mandatory
More informationEmergency Department Protocol Initiative
Emergency Department Protocol Initiative ACUTE ASTHMA MANAGEMENT TOOLKIT March 2006 Provincial Emergency Services Project PHYSICIAN ORDER TEMPLATE FOR CTAS LEVEL 1 ASTHMA ADULT PEDIATRIC Date: Site: Arrival
More informationHigh Flow Oxygen Therapy in Acute Respiratory Failure. Laurent Brochard Toronto
High Flow Oxygen Therapy in Acute Respiratory Failure Laurent Brochard Toronto Conflicts of interest Our clinical research laboratory has received research grants for clinical research projects from the
More informationCardiorespiratory Interactions:
Cardiorespiratory Interactions: The Heart - Lung Connection Jon N. Meliones, MD, MS, FCCM Professor of Pediatrics Duke University Medical Director PCVICU Optimizing CRI Cardiorespiratory Economics O2:
More information