Case 1. Level of difficulty: 2/5
|
|
|
- Bernard Allison
- 6 years ago
- Views:
Transcription
1 Case 1 Level of difficulty: 2/5
2 Summary Settings in the ventilator BULBAR ALS Ventilation 24h/24, Good tolerance PaO2 82; PaCO2 : 42, ph=7,42 (under ventilation) Mode: S/T Main parameters : Pressure Support +12 Variable EPAP (4-14) Backup rate: 12 Secondary parameters: Trigger 3 Cycling 3 Ramp 200ms Ti min/max?.
3 Ventilator /interface Ventilator: PRISMA Lowenstein Circuit Bucconasal masjintentional leak Monitoring procedures Built in software NO Polygraph Pneumotach Belts
4
5
6 Possible answers 1 Obstructive event without effort 2 Obstructive event with effort 3 Massive Leaks 4 Technical dysfunction of the device
7 Case 2 Level of difficulty: 3/5
8 Summary Settings in the ventilator 72-year-old female TB sequelae: Right upper lobe lobectomy 1967, apical pleural thickening. BMI 30 kg.m -2 HMV was started 8 years ago Well tolerated, 8hr/night Morning headache, sleepiness (ESS 10) FVC 1.24 (48%), FEV (42%), FEV1/FVC 61% ABG (Room air): ph 7.43, PaO 2 74, PaCO 2 46, Bic 29, Sat 96% Mode: ST (VPAP IV,Resmed ) IPAP 16/EPAP 6 Backup rate: 15x Secondary parameters: Trigger, medium Cycling, medium Rise time, 200ms Ti min/max, 0.5/1.6 sec.
9 Ventilator: Ventilator /interface Single-limb circuit Facial mask with intentional leak Monitoring procedure Overnight polysomnography EEG /EOG / EMGchin / Video External pneumotach Mask pressure transducer Chest and abdominal belts Snoring, body position ECG, SpO2, TcCO2 Surface diaphragm EMG.
10 2 min tracing
11 1 min tracing
12 What is your diagnosis? 1. Leaks 2. Obstruction of the upper airway with effort 3. Decrease of the ventilatory command 4. None of the previous.
13 Case 3 Level of difficulty: 4/5
14 Summary Settings in the ventilator COPD + SAHS (overlap syndrome) Unconfortable with the ventilator during sleep. Mode: (VPAP IV,Resmed ) S9 Resmed, mode ST IPAP 20, EPAP 11, FR de backup 20 Secondary parameters: Trigger, medium Cycling, medium Rise time, 200ms Ti min/max, 0.5/1.6 sec.
15 Flujo Presion Bandas SaO2 Pagina 2
16 Flujo Presion Bandas SaO2 Pagina 1
17 What is your diagnosis? 1) Double triggering 2) Auto triggering 3) Reverse triggering 4) Uncoupling
18 Case 4 Level of difficulty: 5/5
19 Summary Settings in the ventilator Cystic Fibrosis in 28 yrs old man, waiting for transplantation ABG during the day time (O2=2 l/min): PaO2= 65 mmhg, PaCO2= 70 mmhg ph=7.34 Night time ventilation well tolerated Mode: APCV Main parameters (IPAP=26/EPAP=5) Backup rate: 12 Secondary parameters: Trigger= 1 Ti=1.0 Ramp=1 Respiratory Function Tests: FEV1/FVC=34%, FEV1= 24% pred, FVC= 46% pred; TLC= 60% pred.
20 Ventilator /interface Facial Mask/ Valve Ventilator: VIVO50 Breas Circuit Monitoring procedures Polygraph Pneumothac Belts Oxymeter
21 2 min tracing
22 1 min tracing
23 1 min tracing
24 Possible answers 1 Overassistance 2 Double Triggering 3 Short cycle 4 Underassisstance (intracycle effort)
25 Case 5 Level of difficulty: 5/5
26 Summary Settings in the ventilator 67 years old, male, Spastic paraparesia ALS OSAS, starts with CPAP in 2012 due to Severe restrictive (muscular) disease (FVC 42%) shifts to NIV in 2015 Routine built-in sw monitoring. Unspecific sleep complaints: sleep fragmentation, morning headache,.. ABG, early morning, under NIV: ph 7,45 pco2 45 po2 65 HCO3-: 26 Mode: Resmed VPAP S9 Main parameters: IPAP 16 EPAP 10 Backup RR: 14 bpm Secondary parameters: Trigger medium Cycling medium Ramp 250ms Ti min/max 0,3-1,5 Other. Oronasal mask
27 Ventilator: Ventilator /interface Circuit Mask / intentional leak Monitoring procedures Built in software: ResCan
28
29 Summary Settings in the ventilator As ventilation dependence incresases a life support, battery powered ventilator is prescribed Mode: Trilogy Main parameters:.
30
31 Polygraphy (embletta): Resmed S9 flow and pressure signals+mask pressure+pneumotach for raw flow signal, before intentional leak
32 Ventilator: Ventilator /interface Circuit Mask / intentional leak Monitoring procedures FULL PSG: OMNILAB (PHILIPS)+EXTERNAL PNEUMOTACH (channel failure, ommited)+mask pressure (ommited) Paraesternal EMG TcpCO2 Oronasal mask
33 EMG para 2, only respiratory channels
34 EMG para
35 1 respiratory channels
36 Multiple choice questions 1.Uncoupling: neural and mechanical times are completely independent 2.Double triggering, 3.Double triggering and premature cycling 4.Reverse triggering
37 Case 6 Level of difficulty: 3/5
38 Summary Settings in the ventilator 66 years old, male Advanced COPD with hypercapnia Poor NIV compliance. Tracings correponding to reassessment. Mode: VIVO 40 Main parameters: IPAP 18 EPAP 6 Backup RR: 14 Secondary parameters: Trigger. 3 (1-9) Cycling 4 (1-9) Presur. Time: 1 (1-9) Ti min/max / Other. Oronasal mask
39 Ventilator: Vivo 40 Ventilator /interface Circuit Bucconasal mask with intentional leak Monitoring procedures Polygraph Pneumotach Belts SpO2 Parasternal EMG.
40
41 What happens in the indicated cycles? 1. Underassistance 2. Overshooting (overassistance) 3. Delayed triggering 4. Upper airway obstruction
42 Case 7 Level of difficulty: 5/5
43 Summary Settings in the ventilator COPD GOLD 4-D Ventilation well tolerated, 11h/day ph=7,36; PaCO2=67; Pa02 65; HCO3-33mmol/l Mode: S/T Main parameters (IPAP=16/EPAP-6) Backup rate: 12 Secondary parameters: Trigger Medium Cycling Medium Ramp 150ms Ti min/max 0,8-1,6.
44 Ventilator: Ventilator /interface Circuit Oronasal mask with intentional leaks Monitoring procedures Built in software Rescan Polygraph Pneumotach Belts
45 2 min tracing Optional built in software
46 1 min tracing 5s
47 Possible answers 1 Autotrigger 2 Uncoupling 3 Double trigger 4 Premature cycling
48 Case 8 Level of difficulty: 4/5
49 Summary Settings in the ventilator Male, 70-years-old HMV started after acute respiratory falilure / CAP Kyphoscoliosis + Obesity (IMC 33 kg.m -2 ) FVC 1.63 (45%), FEV (45%) Good ventilation tolerance, objective adherence 8h/night ABG (Room Air): ph 7.42, PaO 2 74, PaCO 2 43, Bic 28, Sat 96% PSG performed 3 months after HMV starting Mode: PSV (VIVO 40, Breas) IPAP 20/EPAP 10 Backup rate: 15x Secondary parameters: Trigger 3 Cycling 3 Ramp 2 Ti min/max 0.3/1.4 sec Target Volume: Off
50 Ventilator: Ventilator /interface Single-limb Circuit Facial Mask with intentional leak Monitoring procedures Polysomnography EEG External Pneumotach Thorax and abdominal Belts SpO2, TcCO2.
51 2 min tracing
52 1 min tracing 1 2
53 Possible answers 1. Double triggering (1) in a obstructive event without effort (2) 2. Autotriggering (1) in a mixed obstructive event (2) 3. Autotriggering (1) in leaks (2) 4. Uncoupling (1) due to leaks (2)
54 Case 9 Level of difficulty: 1/5
55 Summary Settings in the ventilator COPD patient Main parameters IPAP 24, EPAP 9, FR backup 16, Secondary parameters: Ti min 0,7, Ti max 1,5, Rise time min (< 100 mseg), Trigger /cycling: medium
56 Ventilator /interface Ventilator: Lumis (ResMed) Circuit Bucconasal masjintentional leak Monitoring procedures Polygraph Pneumotach Belts
57 Presion Flujo Bandas SaO2 Pag 5
58 Presion Flujo Bandas SaO2 Pag 2
59 What is your diagnosis? 1) Intermitent leakage 2) Intermitent upper airway obstruction 3) Episodic patient s effort 4) Wrong parameters: The ventilator is in assured volume mode (IVAPS)
60 Case 10 Level of difficulty: 3/5
61 Summary Settings in the ventilator 34 years old, female Inmunosupressed due to renal transplantation CNS disease, JC virus, bulbar injurie ABG: Acute ventilatory failure with acidosis Hypoventilation symptoms, headache, somnolence, flapping Mode: Resmed Stellar 150 Main parameters: IPAP 14 EPAP 6 Backup RR: 14 Secondary parameters: Trigger high Cycling medium Presur. Time: 250ms Ti min/max / Other. Oronasal mask
62 Ventilator /interface Flow/Pres from vent leak Mask pressure Raw flow Monitoring procedures Built in software: ResCan Full PSG, raw (pneumotach and mask pressure) and ventilator signals Neural channels ommited_
63
64 Most of night time spent on BURR Mask pressure Presure from device Raw flow Flow from device
65 5 minutes PSG 1 2
66 2 minutes 1
67 2 minutes 2
68 Multiple choice question A. Both events are obstructions with effort B. 1.- Upper airway obstruction without effort and 2.- Upper airway obstruction with effort C. 1.- Upper airway obstruction without effort and 2.- decreased ventilatory command with passive movements of the bands. D. Both are decrease in ventilatory command.
69 Case 11 Level of difficulty: 5/5
70 Summary Settings in the ventilator 64 years old, male Obesity hypoventilation syndrome During adaptation s process, built in software was downloaded and upper airway obstructions were documented. Mode: Lumis 150 Main parameters: IPAP 15 EPAP 5 Backup RR: 14 Secondary parameters: Trigger. medium Cycling medium Presur. Time: 150 msec Ti min/max / Other. Oronasal mask
71 Ventilator: Vivo 40 Ventilator /interface Circuit Bucconasal mask with intentional leak Monitoring procedures Polygraph Pneumotach Belts SpO2 Parasternal EMG.
72
73 Obstruction without effort
74 What happens in the indicated cycles It is a delayed cycling, with active exhalation Underassistance. The support provided by the ventilator does not match the patient s needings Leaks after the obstruction It is a pressure support with assured volume mode (ivaps).
75 Case 12 Level of difficulty: 4/5
76 Summary Settings in the ventilator Diaphragm paralysis after surgery for timectomy ABG during the day time(fio2=21%): PaO2= 67.6 mmhg PaCO2=34.2 mmhg ph=7.44 HCO3-: 23 Mode: APCV Main parameters (IPAP=14/EPAP=4) Backup rate: 12 Secondary parameters: Trigger= 1 l/min Ti=1.2 Ramp=2 Night time ventilation uncorfortable with several arousals
77 Ventilator /interface Ventilator A40 (Philips): Circuit Nasal Mask / intentional leak Monitoring procedures Polygraph Belt (one belt) Oxymeter Pressure and Flow signals treated by the ventilator
78 2 min tracing
79 1 min tracing
80 1 min tracing
81 Possible answers 1 Uncoupling 2 Double Triggering 3 Auto-triggering 4 Underassistance
BiPAPS/TVAPSCPAPASV???? Lori Davis, B.Sc., R.C.P.T.(P), RPSGT
BiPAPS/TVAPSCPAPASV???? Lori Davis, B.Sc., R.C.P.T.(P), RPSGT Modes Continuous Positive Airway Pressure (CPAP): One set pressure which is the same on inspiration and expiration Auto-PAP (APAP) - Provides
(To be filled by the treating physician)
CERTIFICATE OF MEDICAL NECESSITY TO BE ISSUED TO CGHS BENEFICIAREIS BEING PRESCRIBED BILEVEL CONTINUOUS POSITIVE AIRWAY PRESSURE (BI-LEVEL CPAP) / BI-LEVEL VENTILATORY SUPPORT SYSTEM Certification Type
A 74-year-old man with severe ischemic cardiomyopathy and atrial fibrillation
1 A 74-year-old man with severe ischemic cardiomyopathy and atrial fibrillation The following 3 minute polysomnogram (PSG) tracing was recorded in a 74-year-old man with severe ischemic cardiomyopathy
Monitoring: gas exchange, poly(somno)graphy or device in-built software?
Monitoring: gas exchange, poly(somno)graphy or device in-built software? Alessandro Amaddeo Noninvasive ventilation and Sleep Unit & Inserm U 955 Necker Hospital, Paris, France Inserm Institut national
Bi-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
2/13/2018 OBESITY HYPOVENTILATION SYNDROME
OBESITY HYPOVENTILATION SYNDROME David Claman, MD UCSF Professor of Medicine Director, UCSF Sleep Disorders Center Disclosures: None. 1 COMPLICATIONS OF OSA Cardiovascular HTN, CHF, CVA, arrhythmia, Pulm
Average volume-assured pressure support
Focused review Average volume-assured pressure support Abdurahim Aloud MD Abstract Average volume-assured pressure support (AVAPS) is a relatively new mode of noninvasive positive pressure ventilation
Ron Hosp, MS-HSA, RRT Regional Respiratory Specialist. This program has been approved for 1 hour of continuing education credit.
Ron Hosp, MS-HSA, RRT Regional Respiratory Specialist This program has been approved for 1 hour of continuing education credit. Course Objectives Identify at least four goals of home NIV Identify candidates
Challenging 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
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
All About Positive Airway Pressure (PAP) Therapy
All About Positive Airway Pressure (PAP) Therapy Nitipatana Chierakul Division of Respiratory Disease and Tuberculosis, Department of Medicine, Siriraj Medical School Siriraj Sleep Center: Fiscal-year
High Flow Nasal Cannula in Children During Sleep. Brian McGinley M.D. Associate Professor of Pediatrics University of Utah
High Flow Nasal Cannula in Children During Sleep Brian McGinley M.D. Associate Professor of Pediatrics University of Utah Disclosures Conflicts of Interest: None Will discuss a product that is commercially
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
Reasons Providers Use Bilevel
Reasons Providers Use Bilevel More comfort, improve therapy compliance Noncompliant OSA (NCOSA) 1 Scripts from lab referrals Central/Complex Sleep Apnea 2 For ventilations needs Restrictive Thoracic Disorders/Neuromuscular
Policy Specific Section: October 1, 2010 January 21, 2013
Medical Policy Bi-level Positive Airway Pressure (BPAP/NPPV) Type: Medical Necessity/Not Medical Necessity Policy Specific Section: Durable Medical Equipment Original Policy Date: Effective Date: October
Titration protocol reference guide
PN 1079754_Cover:22037_Cov_Canada 11/22/10 Philips Healthcare is part of Royal Philips Electronics How to reach us www.philips.com/healthcare healthcare@philips.com Asia +49 7031 463 2254 Europe, Middle
Supplementary Online Content
Supplementary Online Content Murphy PB, Rehal S, Arbane G, et al. Effect of home noninvasive ventilation with oxygen therapy vs oxygen therapy alone on hospital readmission or death after an acute COPD
Index. sleep.theclinics.com. Note: Page numbers of article titles are in boldface type.
Index Note: Page numbers of article titles are in boldface type. A Acquired central hypoventilation syndrome, NPPV in children with, 475 Acute cardiogenic pulmonary edema, PAP therapy in, 394 395 Adaptive
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
How To Set Up A Ven.lator: Standard Versus High Pressure
How To Set Up A Ven.lator: Standard Versus High Pressure Dean R. Hess PhD RRT Assistant Director of Respiratory Care MassachuseBs General Hospital Associate Professor of Anesthesia Harvard Medical School
CAPNOGRAPHY in the SLEEP CENTER Julie DeWitte, RCP, RPSGT, RST Assistant Department Administrator Kaiser Permanente Fontana Sleep Center
FOCUS Fall 2018 CAPNOGRAPHY in the SLEEP CENTER Julie DeWitte, RCP, RPSGT, RST Assistant Department Administrator Kaiser Permanente Fontana Sleep Center 1 Learning Objectives The future of in laboratory
Patient ventilator asynchrony and sleep disruption during noninvasive
Review Article Patient ventilator asynchrony and sleep disruption during noninvasive ventilation Michelle Ramsay Lane Fox Unit, St Thomas Hospital, London, UK Correspondence to: Dr. Michelle Ramsay, MRCP
Auto Servo Ventilation Indications, Basics of Algorithm, and Titration
Auto Servo Ventilation Indications, Basics of Algorithm, and Titration 1 ASV Learning Objectives Understand the indications for Auto Servo Ventilation Differentiate obstructive versus central hypopneas
Questions: What tests are available to diagnose sleep disordered breathing? How do you calculate overall AHI vs obstructive AHI?
Pediatric Obstructive Sleep Apnea Case Study : Margaret-Ann Carno PhD, CPNP, D,ABSM for the Sleep Education for Pulmonary Fellows and Practitioners, SRN ATS Committee April 2014. Facilitator s guide Part
Chronic NIV in heart failure patients: ASV, NIV and CPAP
Chronic NIV in heart failure patients: ASV, NIV and CPAP João C. Winck, Marta Drummond, Miguel Gonçalves and Tiago Pinto Sleep disordered breathing (SDB), including OSA and central sleep apnoea (CSA),
Complex Sleep Apnea. Can we do better? David Weed D.O.,FCCP,FAASM. September 8, 2016
Complex Sleep Apnea Can we do better? David Weed D.O.,FCCP,FAASM September 8, 2016 If you don t know where you are going, you ll end up somewhere else. Yogi Berra Objectives Discuss what syndromes comprise
Causes and Consequences of Respiratory Centre Depression and Hypoventilation
Causes and Consequences of Respiratory Centre Depression and Hypoventilation Lou Irving Director Respiratory and Sleep Medicine, RMH louis.irving@mh.org.au Capacity of the Respiratory System At rest During
PAP Therapy Devices: Delivering the Right Therapy To The Right Patient. Ryan Schmidt, BS, RRT Clinical Specialist Philips Respironics
PAP Therapy Devices: Delivering the Right Therapy To The Right Patient Ryan Schmidt, BS, RRT Clinical Specialist Philips Respironics Conflict of Interest Disclosure(s) I do not have any potential conflicts
Rebecca Mason. Respiratory Consultant RUH Bath
NIV in motor neurone disease Rebecca Mason Respiratory Consultant RUH Bath NIV in motor neurone disease Why does MND affect the Respiratory System? Should NIV be offered to patients with MND? If so when?
NIV 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
Wolfram Windisch Lung Center Cologne University of Witten/Herdecke, Germany
Wolfram Windisch Lung Center Cologne University of Witten/Herdecke, Germany Non-invasive positive pressure ventilation (NPPV) used in patients with chronic hypercapnic respiratory failure that arises from
Name of Policy: Noninvasive Positive Pressure Ventilation
Name of Policy: Noninvasive Positive Pressure Ventilation Policy #: 203 Latest Review Date: April 2014 Category: Durable Medical Equipment Policy Grade: Effective July 31, 2013: Active Policy but no longer
KENNEDY DISEASE PULMONARY CONSIDERATIONS: SCIENCE & MANAGEMENT STRATEGIES
KENNEDY DISEASE PULMONARY CONSIDERATIONS: SCIENCE & MANAGEMENT STRATEGIES When you can t breathe nothing else matters American Lung Association Noah Lechtzin, MD; MHS Associate Professor of Medicine Johns
Mechanical 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
Non-invasive Ventilation protocol For COPD
NHS LANARKSHIRE MONKLANDS HOSPITAL Non-invasive Ventilation protocol For COPD April 2017 S Baird Review Date: Oct 2019 Approved by Medical Directorate Indications for Non-Invasive Ventilation (NIV) NIV
NIPPV FOR THE HYPERCAPNIC COPD AND OBSESITY HYPOVENTILATION PATIENT
NIPPV FOR THE HYPERCAPNIC COPD AND OBSESITY HYPOVENTILATION PATIENT Gaurav Singh, MD Stanford University Associate Professor Saturday, January 19, 2019 3:20 p.m. 4:00 p.m. Gaurav Singh, MD, completed all
Overlap Syndrome. José M. Marin Hospital Universitario Miguel Servet Zaragoza, Spain.
Overlap Syndrome José M. Marin Hospital Universitario Miguel Servet Zaragoza, Spain. I have nothing to disclose. Agenda Effects of sleep on breathing Sleep in COPD The Overlap Syndrome Treatment of the
Respiratory Failure how the respiratory physicians deal with airway emergencies
Respiratory Failure how the respiratory physicians deal with airway emergencies Dr Michael Davies MD FRCP Consultant Respiratory Physician Respiratory Support and Sleep Centre Papworth Hospital NHS Foundation
PEDIATRIC PAP TITRATION PROTOCOL
PURPOSE In order to provide the highest quality care for our patients, our sleep disorders facility adheres to the AASM Standards of Accreditation. The accompanying policy and procedure on pediatric titrations
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
Long-term non-invasive ventilation in cystic fibrosis Experience over two decades
Journal of Cystic Fibrosis 11 (2012) 187 192 www.elsevier.com/locate/jcf Original Article Long-term non-invasive ventilation in cystic fibrosis Experience over two decades William G. Flight a, b,, Jonathan
Monitoring and Troubleshooting Adherence to PAP Devices and Understanding Device Downloads
Monitoring and Troubleshooting Adherence to PAP Devices and Understanding Device Downloads Christine Won, MD MS Medical Director, Yale Sleep Center Associate Professor of Medicine Yale School of Medicine
Best Match. Non-Invasive Ventilation. WSS Fall Objectives. BiPAP AVAPS Patient Types 9/10/2018. Advanced Algorithms - Clinical Applications
WSS Fall 2018 Advanced Algorithms - Clinical Applications Average Volume Assured Ventilation (AVAPS) Auto Servo Ventilation (SV) Hank Hart BS, LPN Objectives Differentiate between BiPAP AVAPS and BiPAP
Domiciliary ventilation. Dr. K T Prasad
Domiciliary ventilation Dr. K T Prasad Make BJ et al. Chest. 1998 May;113(5 Suppl):289S-344S Cost per patient: 718.80 $ vs. 235.13 $ per day Bach JR et al. Chest. 1992 Jan;101(1):26-30 HMV: Patients perspective
Lumis Tx: the all-in-one hospital ventilation solution
Lumis Tx: the all-in-one hospital ventilation solution The Lumis Tx is a multi-purpose non-invasive ventilator that treats the full range of respiratory conditions and is suitable for a variety of hospital
Non-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,
Condensed version.
I m Stu 3 Condensed version smcvicar@uwhealth.org Listen 1. Snoring 2. Gurgling 3. Hoarseness 4. Stridor (inspiratory/expiratory) 5. Wheezing 6. Grunting Listen Crackles Wheezing Stridor Absent Crackles
Understanding Breathing Muscle Weakness
Understanding Breathing Muscle Weakness A N D R E A L. K L E I N P R E S I D E N T / F O U N D E R B R E A T H E W I T H M D w w w.facebook.com/ b r e a t h e w i t h m d h t t p : / / w w w. b r e a t
Oxygen and ABG. Dr Will Dooley
Oxygen and ABG G Dr Will Dooley Oxygen and ABGs Simply in 10 cases Recap of: ABG interpretation Oxygen management Some common concerns A-a gradient Base Excess Anion Gap COPD patients CPAP/BiPAP First
Hypoventilation? Obstructive Sleep Apnea? Different Tests, Different Treatment
Hypoventilation? Obstructive Sleep Apnea? Different Tests, Different Treatment Judith R. Fischer, MSLS, Editor, Ventilator-Assisted Living (fischer.judith@sbcglobal.net) Thanks to Josh Benditt, MD, University
Respiratory Medicine. Some pet peeves and other random topics. Kyle Perrin
Respiratory Medicine Some pet peeves and other random topics Kyle Perrin Overview 1. Acute asthma Severity assessment and management 2. Acute COPD NIV and other management 3. Respiratory problems in the
Basics 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
The International Palestinian Congress in Sleep Medicine
The International Palestinian Congress in Sleep Medicine Temporomandibular Disorders and Sleep Apnea 26 and 27 October, 2017 Notre Dame Hotel, Jerusalem Using PAP Downloads to Manage Sleep Apnea Patients
Mechanical 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
Transcutaneous Monitoring and Case Studies
Transcutaneous Monitoring and Case Studies Objectives General concept, applications and principles of operation Role of TCM in clinical settings Role of TCM in home care settings Need for continuous TCM
What is SDB? Obstructive sleep apnea-hypopnea syndrome (OSAHS)
Have a Good Sleep? Estimated 70 million Americans have clinically significant sleep problems Chronic insomnias report decreased quality of life, memory and attention problems, decreased physical health
AFCH NEUROMUSCULAR DISORDERS (NMD) PROTOCOL
AFCH NEUROMUSCULAR DISORDERS (NMD) PROTOCOL A. Definition of Therapy: 1. Cough machine: 4 sets of 5 breaths with a goal of I:E pressures approximately the same of 30-40. Inhale time = 1 second, exhale
Disclosures. Michael Gunnuscio RPSGT, Bob Chase RRT, Umakanth Khatwa MD
Disclosures Michael Gunnuscio and Umakanth Khatwa have no financial relationships to disclose. Robert Chase works full time with North Atlantic Medical. Copyright 2014 Boston Children s Hospital 1 CPAP
Non-Invasive Ventilation
Khusrav Bajan Head Emergency Medicine, Consultant Intensivist & Physician, P.D. Hinduja National Hospital & M.R.C. 112 And the Lord God formed man of the dust of the ground and breathed into his nostrils
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:
Home Mechanical Ventilation:
Home Mechanical Ventilation: A Global A Global View View Nicholas Hill MD Tufts Medical Center Boston MA Nicholas S Hill MD Tufts Medical Center Boston, MA Disclosures Research Grants MAB Breathe Technologies
Medicare C/D Medical Coverage Policy. Respiratory Assist Devices for Obstructive Sleep Apnea and Breathing Related Sleep Disorders
Medicare C/D Medical Coverage Policy Respiratory Assist Devices for Obstructive Sleep Apnea and Breathing Related Sleep Disorders Origination: June 26, 2000 Review Date: January 18, 2017 Next Review January,
BPAP 25A Training A.Giudice,RPSGT Clinical Education Manager
1 Solutions in Sleep Therapy BPAP 25A Training A.Giudice,RPSGT Clinical Education Manager 2 To access press and hold the On/Off Button and Ramp Button and at the same time connect the power cord into the
Home Mechanical Ventilation. Anthony Bateman
Home Mechanical Ventilation Anthony Bateman What is Long Term Ventilation? LTV is the provision of respiratory support to individuals with non-acute respiratory failure Progression of expected disease
How to choose the right mask under long term nocturnal NIV
How to choose the right mask under long term nocturnal NIV Jean Christian Borel j.borel@agiradom.com 1 AGIRàdom. Associa-on 38- Meylan 2 Univ Grenoble Alpes, HP2, 38000 Grenoble France 3 CRIUCPQ, Université
Titration and monitoring of CPAP in infants
Titration and monitoring of CPAP in infants Brigitte Fauroux, MD PhD Pediatric Noninvasive Ventilation and Sleep Unit Necker University Hospital & Inserm U 955 Paris, France Inserm Institut national de
Respiratory Management of Facioscapulohumeral Muscular Dystrophy. Nicholas S. Hill, MD Tufts Medical Center Boston, MA
Respiratory Management of Facioscapulohumeral Muscular Dystrophy Nicholas S. Hill, MD Tufts Medical Center Boston, MA Respiratory Involvement in FSHD Very variable time of onset rate of progression Muscles
Respiratory Disease. Dr Amal Damrah consultant Neonatologist and Paediatrician
Respiratory Disease Dr Amal Damrah consultant Neonatologist and Paediatrician Signs and Symptoms of Respiratory Diseases Cardinal Symptoms Cough Sputum Hemoptysis Dyspnea Wheezes Chest pain Signs and Symptoms
NIV 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
Helpful hints for filing
Helpful hints for filing Respiratory Assist Devices HCPCS Code E0470 E0471 Overview The following information describes the Durable Medical Equipment Medicare Administrative Contractors' (DME MACs) medical
NON-INVASIVE VENTILATION. Lijun Ding 23 Jan 2018
NON-INVASIVE VENTILATION Lijun Ding 23 Jan 2018 Learning objectives What is NIV The difference between CPAP and BiPAP The indication of the use of NIV Complication of NIV application Patient monitoring
Pain patient with sleep-disordered breathing
Pain patient with sleep-disordered breathing Clinical scenario: A 50-year old female with a history of acid reflux, fibromyalgia, spinal stenosis and degenerative disk disease s/p C3/C4 disk fusion, depression
Preventing Respiratory Complications of Muscular Dystrophy
Preventing Respiratory Complications of Muscular Dystrophy Jonathan D. Finder, MD Professor of Pediatrics University of Pittsburgh School of Medicine Children s Hospital of Pittsburgh Introduction Respiratory
Mechanical 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
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
Enclosed on Page 5 is an authorization form to release your health information.
Monitor Medical, Inc. "The CPAP Co." Ph: (877) 569-9436 Fax: (888) 773-2854 www.monitormedical.com Dear Medicare Beneficiary: Thank you for selecting Monitor Medical, Inc. to provide you with all of your
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.
POLICY. Number: Title: APPLICATION OF NON INVASIVE VENTILATION FOR ACUTE RESPIRATORY FAILURE. Authorization
POLICY Number: 7311-60-024 Title: APPLICATION OF NON INVASIVE VENTILATION FOR ACUTE RESPIRATORY FAILURE Authorization [ ] President and CEO [ x ] Vice President, Finance and Corporate Services Source:
CMS Reimbursement of CPAP, Oxygen, BPAP, HMV for Sleep Disordered Breathing Peter C Gay Professor of Medicine Mayo Clinic Rochester, MN
45th Annual New Mexico Thoracic Society Lung Disease Symposium CMS Reimbursement of CPAP, Oxygen, BPAP, HMV for Sleep Disordered Breathing Peter C Gay Professor of Medicine Mayo Clinic Rochester, MN Conflicts?
OXYGEN USE IN PHYSICAL THERAPY PRACTICE. Rebecca H. Crouch, PT,DPT,MS,CCS,FAACVPR
OXYGEN USE IN PHYSICAL THERAPY PRACTICE Rebecca H. Crouch, PT,DPT,MS,CCS,FAACVPR Supplemental Oxygen Advantages British Medical Research Council Clinical Trial Improved survival using oxygen 15 hrs/day
Non-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,
Dr. Karan Madan Senior Resident
SLEEP DISORDERED BREATHING DIAGNOSIS & MANAGEMENT Dr. Karan Madan Senior Resident Department of Pulmonary medicine Sleep disordered breathing (SDB) Definition- Sleep-disordered breathing (SDB) is present
TSANZ meeting 01 Apr Physiology of respiratory failure in COPD & OHS. Bhajan Singh MBBS FRACP PhD
TSANZ meeting 01 Apr 2015 Physiology of respiratory failure in & OHS Bhajan Singh MBBS FRACP PhD Head of Department, Pulmonary Physiology & Sleep Medicine, Sir Charles Gairdner Hospital Director, West
Choosing the Appropriate Mode of PAP Therapy in the Perioperative Setting
Choosing the Appropriate Mode of PAP Therapy in the Perioperative Setting Lisa F. Wolfe MD Northwestern University Chicago, Illinois Choosing the Appropriate Mode of PAP Therapy in the Perioperative Setting
3/13/2014. Home Sweet Home? New Trends in Testing for Obstructive Sleep Apnea. Disclosures. No relevant financial disclosures
2014 Big Sky Pulmonary Conference Home Sweet Home? New Trends in Testing for Obstructive Sleep Apnea Eric Olson, MD Associate Professor of Medicine Co-Director, Center for Sleep Medicine Mayo Clinic olson.eric@mayo.edu
NON-INVASIVE VENTILATION MADE RIDICULOUSLY SIMPLE
NON-INVASIVE VENTILATION MADE RIDICULOUSLY SIMPLE Jennifer Newitt, MD 3 rd year Pulmonary/Critical Care Fellow Mentor: Patrick Strollo Jr, MD Myth or Fact?!? Myth or Fact?!? Treatment for Obstructive
By Mark Bachand, RRT-NPS, RPFT. I have no actual or potential conflict of interest in relation to this presentation.
By Mark Bachand, RRT-NPS, RPFT I have no actual or potential conflict of interest in relation to this presentation. Objectives Review state protocols regarding CPAP use. Touch on the different modes that
Which device for your patient?
Which device for your patient? Which device for your patient? Description Page Sleep therapy 4-5 Home NIV 6-7 Airway clearance 8 Oxygen 8-9 Patient interface 10-11 SDB screening and diagnostic 12-13 EncorePro
Nasal versus full face mask for noninvasive ventilation in chronic respiratory failure.
Eur Respir J 2004; 23: 605 609 DOI: 10.1183/09031936.04.00051604 Printed in UK all rights reserved Copyright #ERS Journals Ltd 2004 European Respiratory Journal ISSN 0903-1936 Nasal versus full face mask
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
Pap 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
CPAP in the treatment of sleep apnea. Titration, fixed and intelligent systems. Marc Josep M Montserrat. Barcelona. Spain
CPAP in the treatment of sleep apnea. Titration, fixed and intelligent systems Marc 2015 Josep M Montserrat. Barcelona. Spain Faculty disclosure No 1. INTRODUCTION 2. TITRATION 3. AUTOMATIC CPAP 4. FOLLOW
Management of OSA in the Acute Care Environment. Robert S. Campbell, RRT FAARC HRC, Philips Healthcare May, 2018
Management of OSA in the Acute Care Environment Robert S. Campbell, RRT FAARC HRC, Philips Healthcare May, 2018 1 Learning Objectives Upon completion, the participant should be able to: Understand pathology
Web 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
Management of OSA. saurabh maji
Management of OSA saurabh maji INTRODUCTION Obstructive sleep apnea is a major public health problem Prevalence of OSAS in INDIA is 2.4% to 4.96% in men and 1% to 2 % in women In the rest of the world
NON 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
Approach to type 2 Respiratory Failure
Approach to type 2 Respiratory Failure Changing Nature of NIV Not longer just the traditional COPD patients Increasingly Obesity Neuromuscular Pneumonias 3 fold increase in patients with Ph 7.25 and below
SLEEP DISORDERED BREATHING AND CHRONIC LUNG DISEASE: UPDATE ON OVERLAP SYNDROMES
SLEEP DISORDERED BREATHING AND CHRONIC LUNG DISEASE: UPDATE ON OVERLAP SYNDROMES ROBERT OWENS, MD ASSISTANT CLINICAL PROFESSOR OF MEDICINE UNIVERSITY OF CALIFORNIA AT SAN DIEGO LA JOLLA, CA Robert L. Owens,
more than 50% of adults weigh more than 20% above optimum
In the US: more than 50% of adults weigh more than 20% above optimum >30 kg m -2 obesity >40 kg m -2 morbid obesity BMI = weight(kg) / height(m 2 ) Pounds X 2.2 Inches divided by 39, squared From 2000