Innovations in Neonatal Ventilation
|
|
- Terence Eaton
- 6 years ago
- Views:
Transcription
1 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 of Toledo Health Science Campus Toledo, Ohio Dr Stein: Disclosures Is on the speaker s bureau for Maquet Is discussing products made by Maquet Has received no financial support or incentives from Maquet to use NAVA or collect this data Breathing Easy Respiratory Management in the Modern Era San Antonio, August 8, 16 NAVA Terminology EADi Electrical Activity of the Diaphragm Abbreviated as Edi Edi Peak - peak electrical activity tells you about the neural inspiratory effort Edi Min tonic electrical activity believed to play a role in preventing de-recruitment of the lung SIMV (pressure control) with EDI superimposed shows the lack of synchrony on the flow triggered breaths Pvent Flow Volume Edi Peak Edi Min Edi 1
2 Apnea - Failure to trigger Conventional Ventilation Patient Controls using Flow Trigger: Rate (in some modes) NAVA Ventilation Patient Controls using Neural Trigger: Inspiratory Time Rate Peak Pressure Ventilator Controls: Peak Pressure or Tidal Volume Inspiratory Time PEEP Minimum Rate FiO2 Synchrony: Only for Ventilator Controls: FiO2 PEEP Apnea time (minimum rate) Peak Inspiratory pressure alarm Synchrony: Size of Breath Conventional Ventilation Flow Trigger: Based on patient s effort NAVA Ventilation Neural Trigger: Based on patient's drive Clinical Guidelines When breathing: Ventilator synchronous for: Breath initiation only When apneic: Ventilates in pressure (or volume) control When breathing: Ventilator synchronous for: Breath initiation, size, and termination When apneic: Ventilates in pressure control Ventilator settings in NAVA: Apnea time Peak Inspiratory pressure alarm How to set the NAVA level Apnea Time Apnea Time Time the neonate is apneic before getting a backup breath Apnea time can now be lowered to minimum of 2 seconds After 2 seconds the neonate gets a pressure control breath This allows the user to deliver a minimum guaranteed back-up rate of 3 breaths/min Apnea alarm Minimum rate 1 sec breaths/min 1 sec 6 breaths/min sec 12 breaths/min sec 1 breaths/min 3 sec breaths/min 2 sec 3 breaths/min This is different from the backup rate: RR when the neonate is apneic and getting pressure control 2
3 Peak Inspiratory Pressure Alarm Peak Inspiratory Pressure Alarm Prevents High Pressures Peak Inspiratory pressure alarm Case presentation: ph 7. ph 7.1 ph 7.2 pco2 98 pco2 8 pco2 6 BE -8 BE - BE - ph 7.3 pco2 BE -3 Respiratory Rate 32 weeks gestation Primary C-section for maternal PIH 1.8 kg Apgars 7/8 8 minutes developed grunting and retractions placed on CPAP CXR showed mild to moderate RDS Edi Peak Peak Pressure 3:18 :18 :18 6:18 7:18 8:18 9:18 1:18 11: CPAP 2 - NIV PC 1/, 3 - NIV NAVA 2 - NIV NAVA 2 rate PEEP PEEP PIP Limit PIP Limit Stein H, Firestone K: Neonatology Today, 12, 7(), 1-8. How to set the NAVA level NAVA level is the proportionality factor that converts the Edi signal into a pressure The higher the NAVA level the more work of breathing the ventilator does The lower the NAVA level the more work of breathing the patient does Goal to unload the work of breathing from the patient to the ventilator without over assisting the patient The ventilator continues to respond to the patient s respiratory drive but supports the patient s respiratory effort Edi Titration Study to determine the optimal NAVA level Time (minutes)
4 Edi Titration Study to determine the optimal NAVA level 3 Change in Breakpoint from NAVA to NIV NAVA NAVA 1 1 Breakpoint Peak Inspiratory Pressure (cmh) Peak Pressure (cm H 2 O) Edi Peak (mcv) BrP-1 BrP-. BrP NAVA BrP+. BrP+1 BrP+1. BrP+2 LoVerde, Stein and Firestone, - in submission Change in Breakpoint from NAVA to NIV NAVA 3 NAVA NIV NAVA Pressure and Volume Distribution in Premature Neonates Peak Pressure (cm H 2 O) Variable (+ SD) NAVA NIV NAVA # Neonates 2 12 Birth weight grams 87 (362) 83 (179) Study weight grams 862 (361) 8 (16) Gestational age weeks 26. (2.3) 26.8 (1.) Study age - days 8 (9) 13 (12) Ave # Breaths /neonate 29,66,3 NAVA BrP-1 BrP-. BrP NAVA BrP+. BrP+1 BrP+1. BrP+2 NIV NAVABrP-1. BrP-1 BrP-. BrP NIV NAVA BrP+. BrP+1 BrP+1. Total breaths 711,98,361 Stein, Firestone 1 - in submission
5 Adult Infant NAVA Improves Synchrony (Courtesy of Dr. Beck, revised October 1) Asynchrony Index NAVA Asynchrony Index Conventional Number of Patients Type INV or NIV? (%) (%) AUTHOR/Year Mauri 12 1 Adult ARDS and ECMO INV 7 Piquilloud ICM Adult mixed INV. 12 Bertrand Adult mixed NIV 2 12 Spahija 1 9 Adult mixed INV 26 vaschetta 1 Adult mixed INV 22 Wu Zhonghua Jie He He Hu Xi Za Zhi 9 18 Adult ARDS INV 22 Terzi CCM 1 11 Adult ARDS INV 2 11 Colombo 8 1 mixed adult INV Delisle Sleep 11 1 mixed adult INV Piquilloud ICM Adult mixed NIV schmidt Dres ccm Adult mixed NIV Camarotta ICM 11 1 helmet adult NIV 2 Doorduin 1 12 Adult COPD niv 21 Moerer ICM 8 7 helmet healthy NIV 8 Beck Ped Res 9 7 NICU INV and NIV Clement PICU INV Bentsson 1 21 PICU INV zhu 1 1 PICU INV 22 Vignaux pccm PICU INV Bordessoule 12 1 PICU mixed INV 11 2 De la Oliva PICU mixed INV 2 12 Breatnach 1 16 PICU NICU INV Alander PICU NICU INV Chen 13 1 NICU INV Ducharme-Crevier 1 13 PICU NIV 8 27 Houtekie 1 1 PICU post cardiac NIV Longhini 1 12 NICU INV 22 Vignaux pccm 13 6 PICU NIV 2.3 Baudin 1 11 PICU NIV 3 38 Lee 1 1 NICU NIV TOTAL (ALL STUDIES) 2 TOTAL when AI reported Edi monitoring is essential for: quantifying the strength of spontaneous breathing, unloading of the diaphragm Detecting patient-ventilator asynchrony detecting central apnea and its therapy Detecting over-assist/sedation Accurate respiratory metrics AI = Asynchrony Index NAVA is synchronous for breath initiation, size and termination Neural trigger works independent of air leaks Synchronous non-invasive ventilation Neonates appear to have intact neuro-respiratory feedback mechanisms titration studies Herring Breuer Self regulate ventilatory needs NAVA often provides lower PIPs and may be lung protective NAVA provides equivalent or improved ABGs and FIO2 NAVA Appears safe PIP and TV are mostly below typical range for CV To date no adverse outcomes reported (23 peer reviewed publications, are in pediatric patients) NAVA improves comfort, incidence of central apnea (2 trials) NAVA reduces sedation requirements (1 trial) NAVA reduces length of stay in infants (2 trials) NAVA WORKS IN NEONATES! But does it make a difference? Large multi-center trials are needed to answer questions if: NAVA prevents intubation or decreases time on ventilators? NAVA decreases the incidence of chronic lung disease? NAVA improves outcomes? NAVA decreases costs
NAVA. 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 informationUsing NAVA titration to determine optimal ventilatory support in neonates
The University of Toledo The University of Toledo Digital Repository Master s and Doctoral Projects Using NAVA titration to determine optimal ventilatory support in neonates Stacey Leigh Fisher The University
More informationFaculty 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 informationNAVA-korzyści dla noworodka
DISCLOSURE No conflict of interest related to this topic NAVA-korzyści dla noworodka Jan Mazela Poznan University of Medical Sciences Poznan, Poland EUROPE POZNAŃ and WIELKOPOLSKA REGION POLAND WIELKOPOLSKA
More informationBreathing: Conventional. Matter?
Breathing: Conventional Ventilation Does the Mode Matter? Brian K. Walsh, RRT NPS, FAARC Director of Respiratory Care Children s Medical Center Dallas Disclosure Research relationships: Maquet NAVA GE
More informationCURRENT TRENDS IN NON-INVASIVE VENTILATION. Disclosures. Why not invasive ventilation? Objectives. Currently available modes
CURRENT TRENDS IN NON-INVASIVE VENTILATION ----------------------------------------------------------- Karen Drinkard, RRT-NPS Neonatal Respiratory Clinical Specialist University of Washington Medical
More informationNeurally Adjusted Ventilatory Assist Mode in Pediatric Intensive Care Unit and Pediatric Cardiac Care Unit
Review Article Neurally Adjusted Ventilatory Assist Mode in Pediatric Intensive Care Unit and Pediatric Cardiac Care Unit Monika Gupta 1,2,3*, Maria Bergel 1,3, Nicole Betancourt 1,3 and Vicki L. Mahan
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 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 informationServo-i Ventilator. One system, multiple options. This document is intended to provide information to an international audience outside of the US.
Servo-i Ventilator One system, multiple options This document is intended to provide information to an international audience outside of the US. One system, multiple options At Getinge we ve been developing
More informationSERVO-i ventilator One system, multiple options
SERVO-i ventilator One system, multiple options This document is intended to provide information to an international audience outside of the US. One system, multiple options At Maquet, part of Getinge
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 1. Shari McKeown, RRT Respiratory Services - VGH
Mechanical Ventilation 1 Shari McKeown, RRT Respiratory Services - VGH Objectives Describe indications for mcvent Describe types of breaths and modes of ventilation Describe compliance and resistance and
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 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 informationYear in Review. NAVA and Edi monitoring
NAVA and Edi monitoring Year in Review 2013 NAVA and Edi monitoring Year in Review is published on Critical Care News with permission from Jennifer Beck, PhD at www.ventquest.com Maquet Critical Care AB
More informationVolume Guarantee Initiation and ongoing clinical management of an infant supported by Volume Guarantee A Case Study
D-32084-2011 Volume Guarantee Initiation and ongoing clinical management of an infant supported by Volume Guarantee A Case Study Robert DiBlasi RRT-NPS, FAARC Respiratory Care Manager of Research & Quality
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 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 informationFeasibility Study on Neurally Adjusted Ventilatory Assist in Noninvasive Ventilation After Cardiac Surgery in Infants
Feasibility Study on Neurally Adjusted Ventilatory Assist in Noninvasive Ventilation After Cardiac Surgery in Infants Laurent Houtekie MD, Damien Moerman PT, Amaury Bourleau PT, Grégory Reychler PT PhD,
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 informationDaniel Hadfield Critical Care Nurse NIHR / HEE Clinical Doctoral Research Fellow King s College Hospital
Daniel Hadfield Critical Care Nurse NIHR / HEE Clinical Doctoral Research Fellow King s College Hospital Baby 2 Moving house Funding??????? Baby 1 NHS support Me My research Baby 2 Moving house Funding???????
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 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 informationHelp neonates breathe, sleep and grow. SERVO-n neonatal ventilator
Help neonates breathe, sleep and grow SERVO-n neonatal ventilator This document is intended to provide information to an international audience outside of the US. 2 SERVO-n They deserve our best from the
More informationNeurally Adjusted Ventilatory Assist After Pediatric Cardiac Surgery: Clinical Experience and Impact on Ventilation Pressures
Neurally Adjusted Ventilatory Assist After Pediatric Cardiac Surgery: Clinical Experience and Impact on Ventilation Pressures Benjamin Crulli MD, Mariam Khebir, Baruch Toledano MD MSc, Suzanne Vobecky
More informationFeasibility and physiological effects of noninvasive neurally adjusted ventilatory assist in preterm infants
Articles Clinical Investigation nature publishing group Feasibility and physiological effects of noninvasive neurally adjusted ventilatory assist in preterm infants Christopher K. Gibu 1,3, Phillip Y.
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 informationKing s Research Portal
King s Research Portal DOI: 10.1007/s00431-015-2595-4 Document Version Peer reviewed version Link to publication record in King's Research Portal Citation for published version (APA): Shetty, S., Bhat,
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 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 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 informationMechanical Ventilation Principles and Practices
Mechanical Ventilation Principles and Practices Dr LAU Chun Wing Arthur Department of Intensive Care Pamela Youde Nethersole Eastern Hospital 6 October 2009 In this lecture, you will learn Major concepts
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 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 informationNon Invasive Ventilation In Preterm Infants. Manuel Sanchez Luna Hospital General Universitario Gregorio Marañón Complutense University Madrid
Non Invasive Ventilation In Preterm Infants Manuel Sanchez Luna Hospital General Universitario Gregorio Marañón Complutense University Madrid Summary Noninvasive ventilation begings in the delivery room
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 informationKing s Research Portal
King s Research Portal DOI: 10.1007%2Fs00431-015-2595-4 Document Version Peer reviewed version Link to publication record in King's Research Portal Citation for published version (APA): Shetty, S., Bhat,
More informationSARASOTA MEMORIAL HOSPITAL DEPARTMENT POLICY
PS1006 SARASOTA MEMORIAL HOSPITAL DEPARTMENT POLICY TITLE: NON-INVASIVE VENTILATION FOR THE Job Title of Reviewer: EFFECTIVE DATE: REVISED DATE: Director, Respiratory Care Services 126.685 (neo) 3/26/15
More informationMinimizing Lung Damage During Respiratory Support
Minimizing Lung Damage During Respiratory Support University of Miami Jackson Memorial Medical Center Care of the Sick Newborn 15 Eduardo Bancalari MD University of Miami Miller School of Medicine Jackson
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 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 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 informationLung Wit and Wisdom. Understanding Oxygenation and Ventilation in the Neonate. Jennifer Habert, BHS-RT, RRT-NPS, C-NPT Willow Creek Women s Hospital
Lung Wit and Wisdom Understanding Oxygenation and Ventilation in the Neonate Jennifer Habert, BHS-RT, RRT-NPS, C-NPT Willow Creek Women s Hospital Objectives To review acid base balance and ABG interpretation
More informationObjectives. Apnea Definition and Pitfalls. Pathophysiology of Apnea. Apnea of Prematurity and hypoxemia episodes 5/18/2015
Apnea of Prematurity and hypoxemia episodes Deepak Jain MD Care of Sick Newborn Conference May 2015 Objectives Differentiating between apnea and hypoxemia episodes. Pathophysiology Diagnosis of apnea and
More informationCONVENTIONAL VENTILATION Part II
CONVENTIONAL VENTILATION Part II Conventional Ventilation Part II Objective of Presentation Review disease specific ventilator strategies Discuss non-invasive approaches to improving gas exchange Review
More informationSERVO EDUCATION NAVA in neonatal settings Study Guide
x SERVO EDUCATION Table of Contents TABLE OF CONTENTS 1 2 3 4 5 6 Introduction and background facts Invasive ventilation with NAVA Non invasive ventilation with NAVA NAVA and NIV NAVA features and management
More informationSTATE OF OKLAHOMA 2014 EMERGENCY MEDICAL SERVICES PROTOCOLS
3K NON-INVASIVE POSITIVE PRESSURE VENTILATION (NIPPV) ADULT EMT EMT-INTERMEDIATE 85 ADVANCED EMT PARAMEDIC Indications: 1. Dyspnea Uncertain Etiology Adult. 2. Dyspnea Asthma Adult. 3. Dyspnea Chronic
More informationComparison of Pressure-, Flow-, and NAVA-Triggering in Pediatric and Neonatal Ventilatory Care
47:76 83 (2012) Comparison of Pressure-, Flow-, and NAVA-Triggering in Pediatric and Neonatal Ventilatory Care Merja Ålander, MD, 1 * Outi Peltoniemi, MD, PhD, 1 Tytti Pokka, BSc, 1 and Tero Kontiokari,
More informationDr. AM MAALIM KPA 2018
Dr. AM MAALIM KPA 2018 Journey Towards Lung protection Goals of lung protection Strategies Summary Conclusion Before 1960: Oxygen; impact assessed clinically. The 1960s:President JFK, Ventilators mortality;
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 informationNON INVASIVE LIFE SAVERS. Non Invasive Ventilation (NIV)
Table 1. NIV: Mechanisms Of Action Decreases work of breathing Increases functional residual capacity Recruits collapsed alveoli Improves respiratory gas exchange Reverses hypoventilation Maintains upper
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 informationAssessment of patient-ventilator breath contribution during neurally adjusted ventilatory assist in patients with acute respiratory failure
Liu et al. Critical Care (2015) 19:43 DOI 10.1186/s13054-015-0775-2 RESEARCH Open Access Assessment of patient-ventilator breath contribution during neurally adjusted ventilatory assist in patients with
More informationTO THE OPERATOR AND PERSON IN CHARGE OF MAINTENANCE AND CARE OF THE UNIT:
fabian HFO Quick guide TO THE OPERATOR AND PERSON IN CHARGE OF MAINTENANCE AND CARE OF THE UNIT: This Quick Guide is not a substitute for the Operation Manual. Read the Operation Manual carefully before
More informationApplication of Lung Protective Ventilation MUST Begin Immediately After Intubation
Conflict of Interest Disclosure Robert M Kacmarek Managing Severe Hypoxemia!" 9-28-17 FOCUS Bob Kacmarek PhD, RRT Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts I disclose
More informationVENTILATING CHILDREN- a quick recap. Dr Despina Demopoulos Paediatric Intensivist
VENTILATING CHILDREN- a quick recap Dr Despina Demopoulos Paediatric Intensivist Introduction Six Tricks Case Scenarios Goals of ventilation Modes of ventilation Different diseases Conclusion OVERVIEW
More informationVon Reuss and CPAP, Disclosures CPAP. Noninvasive respiratory therapieswhy bother? Noninvasive respiratory therapies- types
Noninvasive respiratory therapiesby a nose? NEO- The Conference for Neonatology February 21, 2014 Disclosures I have no relevant financial relationships to disclose or conflicts of interest to release.
More informationUsefulness of DuoPAP in the treatment of very low birth weight preterm infants with neonatal respiratory distress syndrome
European Review for Medical and Pharmacological Sciences 2015; 19: 573-577 Usefulness of DuoPAP in the treatment of very low birth weight preterm infants with neonatal respiratory distress syndrome B.
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 informationVentilator 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 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 informationMechanical 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 informationWeb Appendix 1: Literature search strategy. BTS Acute Hypercapnic Respiratory Failure (AHRF) write-up. Sources to be searched for the guidelines;
Web Appendix 1: Literature search strategy BTS Acute Hypercapnic Respiratory Failure (AHRF) write-up Sources to be searched for the guidelines; Cochrane Database of Systematic Reviews (CDSR) Database of
More informationNon-Invasive Ventilation of the Restricted Thorax: Effects of Ventilator Modality on Quality of Life. The North Study
Non-Invasive Ventilation of the Restricted Thorax: Effects of Ventilator Modality on Quality of Life The North Study Lorna Cummins RRT, Pat Hanly MD, Andrea Loewen MD, Karen Rimmer MD Raymond Tye RRT,
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 informationSimulation 3: Post-term Baby in Labor and Delivery
Simulation 3: Post-term Baby in Labor and Delivery Opening Scenario (Links to Section 1) You are an evening-shift respiratory therapist in a large hospital with a level III neonatal unit. You are paged
More informationNoninvasive Respiratory Support in Infants and Children
Noninvasive Respiratory Support in Infants and Children Katherine L Fedor MBA RRT-NPS CPFT Introduction Indications Asthma Bronchiolitis Pediatric ARDS Cystic Fibrosis Obstructive Sleep Apnea Neuromuscular
More informationMechanical 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 informationAPRV Ventilation Mode
APRV Ventilation Mode Airway Pressure Release Ventilation A Type of CPAP Continuous Positive Airway Pressure (CPAP) with an intermittent release phase. Patient cycles between two levels of CPAP higher
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 informationLearning Objectives. 1. Indications versus contra-indications 2. CPAP versus NiVS 3. Clinical evidence
Learning Objectives 1. Indications versus contra-indications 2. CPAP versus NiVS 3. Clinical evidence Pre-hospital Non-invasive vventilatory support Marc Gillis, MD Imelda Bonheiden Our goal out there
More informationChallenging Cases in Pediatric Polysomnography. Fauziya Hassan, MBBS, MS Assistant Professor Pediatric Pulmonary and Sleep
Challenging Cases in Pediatric Polysomnography Fauziya Hassan, MBBS, MS Assistant Professor Pediatric Pulmonary and Sleep Conflict of Interest None pertaining to this topic Will be using some slides from
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 informationAirway pressure release ventilation (APRV) in PICU: Current evidence. Chor Yek Kee Sarawak General Hospital
Airway pressure release ventilation (APRV) in PICU: Current evidence Chor Yek Kee Sarawak General Hospital Outline Brief introduction of APRV History of APRV Common confusion in APRV Features of APRV and
More informationMonitoring Neural Output
Monitoring Neural Output Christer Sinderby Department of Critical Care & Keenan Research Center for Biomedical Science of St. Michael's Hospital Interdepartmental division of Critical Care Medicine, University
More informationAsynchrony and Dyspnea
Asynchrony and Dyspnea Richard D Branson MSc RRT FAARC, Thomas C Blakeman MSc RRT, and Bryce RH Robinson MD Introduction Defining Asynchrony Flow Asynchrony, Flow Mismatch, and Flow Starvation Missed Triggers
More informationMechanical 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 informationPap Settings. A review of fine tuning settings For patient comfort and compliance Wendy Cook BSRT Judy Salisbury RPGST
Pap Settings A review of fine tuning settings For patient comfort and compliance Wendy Cook BSRT Judy Salisbury RPGST Conflict of Interest Disclosure x 1. I do not have any relationships with any entities
More informationA Comparison of Leak Compensation in Acute Care Ventilators During Noninvasive and Invasive Ventilation: A Lung Model Study
A Comparison of Leak Compensation in Acute Care Ventilators During Noninvasive and Invasive Ventilation: A Lung Model Study Jun Oto MD PhD, Christopher T Chenelle, Andrew D Marchese, and Robert M Kacmarek
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 informationNI 60. Non-invasive ventilation without compromise. Homecare Pneumology Neonatology Anaesthesia. Sleep Diagnostics Service Patient Support
NI 60 Non-invasive ventilation without compromise Homecare Pneumology Neonatology Anaesthesia INTENSIVE CARE VENTILATION Sleep Diagnostics Service Patient Support NI 60 Non-invasive ventilation without
More informationOriginal Article. Effects of Pressure Support during an Acute Reduction of Synchronized Intermittent Mandatory Ventilation in Preterm Infants
Original Article Effects of Pressure Support during an Acute Reduction of Synchronized Intermittent Mandatory Ventilation in Preterm Infants Waldo Osorio, MD Nelson Claure, PhD Carmen D Ugard, RRT Kamlesh
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 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 informationSimulation 08: Cyanotic Preterm Infant in Respiratory Distress
Flow Chart Simulation 08: Cyanotic Preterm Infant in Respiratory Distress Opening Scenario Section 1 Type: DM As staff therapist assigned to a Level 2 NICU in a 250 bed rural medical center you are called
More informationInterfacility Protocol Protocol Title:
Interfacility Protocol Protocol Title: Mechanical Ventilator Monitoring & Management Original Adoption Date: 05/2009 Past Protocol Updates 05/2009, 12/2013 Date of Most Recent Update: March 23, 2015 Medical
More information1. Which of the following arterial blood gas results indicate metabolic acidosis?
B10 Baby s Breath: Ventilation Strategies and Blood Gas Interpretation Mary Beth Bodin, DNP, CRNP, NNP-BC Assistant Professor School of Nursing, University of Alabama at Birmingham Neonatal Nurse Practitioner
More informationFor invasive as well as non invasive ventilation Designed for cost-efficiency
DATA SHEET VENTILATION R HIGHLIGHTS For all patient categories - available in two editions NAVA - improved synchrony and unique monitoring capabilities Intuitive user interface For invasive as well as
More informationand Noninvasive Ventilatory Support
Chapter 2 Mechanical Ventilation and Noninvasive Ventilatory Support Megan L. Anderson and John G. Younger PERSPECTIVE Invasive and noninvasive ventilation are essential tools for treatment of critically
More informationPatient ventilator asynchrony during conventional mechanical ventilation in children
https://doi.org/10.1186/s13613-017-0344-8 RESEARCH Open Access Patient ventilator asynchrony during conventional mechanical ventilation in children Guillaume Mortamet 1,2,3, Alexandrine Larouche 1,3, Laurence
More informationProne ventilation revisited in H1N1 patients
International Journal of Advanced Multidisciplinary Research ISSN: 2393-8870 www.ijarm.com DOI: 10.22192/ijamr Volume 5, Issue 10-2018 Case Report DOI: http://dx.doi.org/10.22192/ijamr.2018.05.10.005 Prone
More informationAPRV: 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 informationCharisma High-flow CPAP solution
Charisma High-flow CPAP solution Homecare PNEUMOLOGY Neonatology Anaesthesia INTENSIVE CARE VENTILATION Sleep Diagnostics Service Patient Support charisma High-flow CPAP solution Evidence CPAP therapy
More informationEPNV-Montreux 2018: Preliminary Educational and Scientific Program
EPNV-Montreux 2018: Preliminary Educational and Scientific Program April 25-26, 2018: Pre-Conference Workshops Wednesday (April 25): 09 00 18 00 Thursday (April 26): 08 00 12 00 April 26-28, 2018: Main
More informationPatient-Ventilator Interaction. David J Pierson MD FAARC
Conference Summary Patient-Ventilator Interaction David J Pierson MD FAARC Introduction Why Is Patient-Ventilator Interaction Important? What We Have Learned About Respiratory Muscle Function and Critical
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 informationClinical review: Update on neurally adjusted ventilatory assist report of a round-table conference
REVIEW Clinical review: Update on neurally adjusted ventilatory assist report of a round-table conference Nicolas Terzi* 1,2,3, Lise Piquilloud 4, Hadrien Rozé 5, Alain Mercat 6,7, Frédéric Lofaso 8,9,
More informationFeasibility of neurally adjusted positive end-expiratory pressure in rabbits with early experimental lung injury
Liu et al. BMC Anesthesiology (2015) 15:124 DOI 10.1186/s12871-015-0103-z RESEARCH ARTICLE Open Access Feasibility of neurally adjusted positive end-expiratory pressure in rabbits with early experimental
More information