Mechanical Ventilation for Dummies Keep It Simple Stupid
|
|
- Reginald Fisher
- 8 years ago
- Views:
Transcription
1 Mechanical Ventilation for Dummies Keep It Simple Stupid Indications Airway Ventilation failure (CO2) Hypoxia Combination Airway obstruction Inability to protect airway Hypoxia (PaO 2 < 50) Hypercapnia (PaCO 2 > 50) Respiratory distress (RR > 30, use of accessory muscles)
2 Ventilator Management Scalar CMV ACV IMV SIMV SIMV + PS PCV IRV PRVC APRV CPAP Control Mode- Scalars (Volume- Targeted Ventilation) Preset Peak Flow Dependent on C L & R aw Preset V tt Essentials of of Ventilator Graphics T im e (s e c ) F lo w (L/min) P r e s s u r e (cm H 2 O) V o olu m e e (ml) 2000 RespiMedu CLINICAL UTILITY OF VENTILATOR GRAPHICS Vijay Deshpande, MS, RRT, FAARC
3 Ventilator Management Loops Pressure-Volume Loops Flow-Volume Loop V T Inspiration Volume (ml ml) Expiration Expiration Expiration Expiration Inspiration Inspiration Inspiration Inspiration Flow (L/min) 4 FRC 1 3 Volume (ml) Essentials of of Ventilator Graphics P aw aw aw (cm aw H 2 O) O) PIP 2000 RespiMedu Essentials of of Ventilator Graphics Expiration RespiMedu CLINICAL UTILITY OF VENTILATOR GRAPHICS Vijay Deshpande, MS, RRT, FAARC
4 Ventilator Management This really is all there is to it Time (RR) Volume (Vt) Pressure (PIP, P plat ) Flow Volume vs Time Scalar Inspiratory Tidal Tidal Volume Volume (ml) Inspiration Expiration TI TI Time (sec)
5 Ventilator Management Control Mechanical Ventilation Time Set respiratory rate Volume Set Vt Flow Set to deliver the Vt } Independent Variables Airway Pressure Dependent on the interaction of the above and on the respiratory system compliance and airflow resistance
6 Ventilator Management Pressure Control Ventilation Time Set respiratory rate Pressure Set pressure Flow Set to deliver pressure } Independent Variables Volume Dependent on the interaction of the above and on the respiratory system compliance and airflow resistance
7 Ventilator Management Dual Control Modes - PRVC Time Set RR Volume Set V T Flow Set } Independent Variables Pressure increases or decreases to maintain the set V T (Dependent variable), but this is Limited (i.e. controlled)
8 Airway Pressure Release Ventilation APRV-BILEVEL SIMV CPAP is transiently decreased or released to a lower level during expiration. Advantages 1. Lower Paw for a given V T 2. Lower V E, i.e., less dead space 3. Limited adverse effects on cardiac function 4. Spontaneous breathing 5. Decreased sedation Potential Disadvantages 1. Volumes change with changes in compliance and resistance 2. New technology 3. Limited access to technology 4. Limited research and clinical experience
9 Ventilator Management Peak Insp Pressure (PIP) vs. Plateau airway pressure (P plat) Transairway pressure PIP-Pplat Obstruction Secretions RAD P aw aw (cm H 2 O) Components of Inflation Pressure A 1 2 B PIP P plat plat /Alveolar Pressure A. Airway Resistance B. B. Distending Pressure Time (sec) Begin Inspiration Begin Expiration CLINICAL UTILITY OF VENTILATOR GRAPHICS Vijay Deshpande, MS, RRT, FAARC
10 Ventilator Management Compliance Relationship of volume to pressure Dynamic vs static Lung Compliance Changes in the P-V Loop V T Volume Targeted Ventilation Volume (ml( ml) COMPLIANCE Normal Increased Decreased Essentials of of Ventilator Graphics P aw aw aw aw (cm H 2 O) O) PIP levels 2000 RespiMedu CLINICAL UTILITY OF VENTILATOR GRAPHICS Vijay Deshpande, MS, RRT, FAARC
11 History of Mechanical Ventilation Poliomyelitis Negative pressure (iron lung) WW II Positive pressure cycled (Bennett and Bird) Volume cycle (Emerson) V T 6-8 ml/kg, Sigh ml/kg V T 10-15ml/kg without sighs ARDS & PEEP Ashbaugh Bigelow and Petty UCHSC 1967
12 Ventilator Induced Lung Injury VILI is due to volume (Overdistension) Ventilation 45 cm H 2 O Baseline 5 min 20 min Dreyfuss Am. Rev. Respir. Dis. 1998; 137:
13 ARDS is Not Homogeneous Gattinoni L. Milan Italy
14 Inflection Points Paw increases with little change in the volume Lower Lung Compliance Changes in the P-V Loop Upper Overdistension V T Volume Targeted Ventilation P aw rises aw with little or or no change in in V T Volume (ml( ml) COMPLIANCE Normal Increased Decreased P aw aw (cm H 2 O) O) PIP levels Pressure (cm H 2 O) Essentials of of Ventilator Graphics P aw aw aw (cm aw (cm H 2 O) 2 O) RespiMedu Essentials of of Ventilator Graphics RespiMedu CLINICAL UTILITY OF VENTILATOR GRAPHICS Vijay Deshpande, MS, RRT, FAARC
15 ARDSnet NIH NHLBI ARDS Clinical Trials Network
16 ARDS Network: ARMA Respiratory Management in ARDS 6 vs. 12 ml/kg Tidal Volume Mode: Volume Assist / Control Rate: Set rate < 35; adjust for ph goal = Oxygenation PaO 2 = mmhg SaO 2 = 88-95% PEEP FiO I:E = 1: Weaning by Pressure Support when PEEP/FiO2 < 8/.40 New Eng J Med 2000; 342: 1301
17 ARDS Network: ARMA Respiratory Management in ARDS 6 vs. 12 ml/kg Tidal Volume 12 ml/kg Group Initial Vt = 12 ml/kg IBW If Pplat > 50 cmh20, reduce Vt by 1 ml/kg. Minimum Vt = 4 ml/kg If Pplat < 45 cmh20 and Vt < 11 ml/kg, increase Vt by 1 ml/kg. 6 ml/kg Group Initial Vt = 6 ml/kg IBW. If Pplat > 30 cmh20, reduce Vt by 1 ml/kg. Minimum Vt = 4 ml/kg. If Pplat < 25 cmh20 and Vt < 5 ml/kg, increase Vt by 1 ml/kg. New Eng J Med 2000; 342: 1301
18 ARDS Network: ARMA Respiratory Management in ARDS 6 vs. 12 ml/kg Tidal Volume cm water ml/kg 12 ml/kg Plateau Pressure * * * * Study Day New Eng J Med 2000; 342: 1301
19 ARDS Network: ARMA Respiratory Management in ARDS 6 vs. 12 ml/kg Tidal Volume P/F 160 * * * PEEP (cm water) * * 6 ml/kg 12 ml/kg ml/kg 12 ml/kg Study Day Study Day New Eng J Med 2000; 342: 1301
20 ARDS Network: ARMA Respiratory Management in ARDS 6 vs. 12 ml/kg Tidal Volume Vt 6 vs. 12 ml/kg Mortality 31.0 vs 39.8% New Eng J Med 2000; 342: 1301
21 ARDS Network: ALVEOLI High vs. Low PEEP Ventilator management the same as ARMA except PEEP Lower PEEP/ Higher FiO 2 Treatment Group FiO PEEP Higher - PEEP/Lower FiO 2 Treatment Group FiO PEEP N Engl J Med 351:327, July 22, 2004
22 ARDS Network: ALVEOLI High vs. Low PEEP Variable Day 1 Day 3 Day 7 Low High Low High Low High PEEP P/F N Engl J Med 351:327, July 22, 2004
23 ARDS Network: ALVEOLI High vs. Low PEEP Conclusions VT goal 6 ml/kg Pplat limit of 30 cm H2O, Outcomes are similar whether lower or higher PEEP levels are used. N Engl J Med 351:327, July 22, 2004
24 ARDS Network: FACTT Fluids and Catheter Treatment Trial PAC vs. CVP N Engl J Med 354:2213, May 25, 2006
25 ARDS Network: FACTT Conservative vs. Liberal Fluid N Engl J Med 354:2564, June 15, 2006
26 D ARDS Network: FACTT Conservative vs. Liberal Fluid Furosemide mg/d Intake ml/d Output ml/d Balance ml/d Liberal Conserve Liberal Conserve Liberal Conserve Liberal Conserve N Engl J Med 354:2564, June 15, day fluid balance
27 ARDS Network: FACTT Conservative vs. Liberal Fluid N Engl J Med 354:2564, June 15, 2006
28 ARDS Network: FACTT Conservative vs. Liberal Fluid Outcome Liberal Conserve P Death 28.4% 25.5% 0.30 (60d) VFD (28d) ICU-FD (28d) Dialysis (60d) N Engl J Med 354:2564, June 15, 2006
29 ARDS Network: LASRS Late ARDS Steroid Rescue Study Methylprednisolone 2 mg/kg load 0.5 mg / kg q 6 for 14d, 0.5 mg / kg q 12 for 7d, Taper over 4 days Taper over a 2 days if septic shock Intensive infection surveillance 28.6 v 29.2% New Eng J Med Volume 2006; 354:
30 ARDS Network: LASRS Late ARDS Steroid Rescue Study Placebo (91) MP (89) p Mortality (60d) 28.6% 29.2% 1.0 VFD (28d) ICU FD (28d) Myopathy (no.) Infections / pts 43/30 25/20.14 Amylase (D7) Glucose (D7) New Eng J Med Volume 2006; 354:
31 Institute for Healthcare Improvement (IHI) Ventilator Bundle HOB > 30 o DVT prophylaxis PUD Prophylaxis Daily sedative vacation and assessment of readiness to extubate
32 Mechanical Ventilation Weaning What was the reason for intubation? Has that reason been resolved? Can patient protect airway? Can patient handle secretions? Oxygenation? Ventilation? (CO2) Others: Cardiac function, acid base, abdomen, renal function 35% prediction You will never find a fever if you do not measure a temperature?
33 Nonphysicain Directed Weaning Protocol Ordered Ely AmJRCCM 1999; 159: 439 Kollef CCM 1997; 25: 567
34 Daily Sedative Vacation Control Vacation Kress New Eng J Med 2000
35 Mechanical Ventilation Weaning Pressure Support Gradual reduction in ventilator work is assumed by the patient SIMV + PS Some breaths are ventilator work and some are patient work T-piece Discontinuation of ventilator work is assumed by patient. PSV Brochard AJRCCM 1994; 150: 896 SBT q d Esteban NEJM 1995; 332: 345
36 Mechanical Ventilation Failure to Wean Increase in demands Abnormal respiratory mechanics RAD Decrease C Unresolved infection Fever = Me = work Decrease in patient capability Sedation Weakness Malnutrition Neuro- or Myo-pathy Chest wall mechanics Demands Total Support Deleterious work Capability Ventilator Independence Tolerable load
37 Weaning Guidelines Daily assessment of potential Spontaneous breathing trials ( min) Stable support between SBTs Ability to protect airway Reverse causes of failure Weaning protocols for nonphysician Prolonged ventilation=slow gradual lengthening of SBTs Chest 2001; 120: 375S
38 Mechanical Ventilation Weaning Withdrawl of the ventilator Test for successful extubation Vt 5-7 ml/kg RR < 30 Me < 15 L RR/Vt < 105 NIF < 20 FVC ml/kg 10% Failure
39 Questions? KISS
Year in review: mechanical ventilation
Year in review: mechanical ventilation Leo Heunks, MD, PhD Pulmonary and Critical Care Physician Dept of Critical Care Intensivisten dagen 2013 Disclosures Maquet (NAVA catheters, travel fee, speakers
More information3100B Clinical Training Program. 3100B HFOV VIASYS Healthcare
3100B Clinical Training Program 3100B HFOV VIASYS Healthcare HFOV at Alveolar Level Nieman,, G, SUNY 1999 Who DO We Treat? Only Pathology studied to date has been ARDS Questions about management of adults
More informationFrom AARC Protocol Committee; Subcommittee Adult Critical Care Version 1.0a (Sept., 2003), Subcommittee Chair, Susan P. Pilbeam
AARC - ADULT MECHANICAL VENTILATOR PROTOCOLS 1. Guidelines for Using Ventilator Protocols 2. Definition of Modes and Suggestions for Use of Modes 3. Adult Respiratory Ventilator Protocol - Guidelines for
More informationMECHINICAL VENTILATION S. Kache, MD
MECHINICAL VENTILATION S. Kache, MD Spontaneous respiration vs. Mechanical ventilation Natural spontaneous ventilation occurs when the respiratory muscles, diaphragm and intercostal muscles pull on the
More informationCommon Ventilator Management Issues
Common Ventilator Management Issues William Janssen, M.D. Assistant Professor of Medicine National Jewish Health University of Colorado Denver Health Sciences Center You have just admitted a 28 year-old
More informationAirway Pressure Release Ventilation
Page: 1 Policy #: 25.01.153 Issued: 4-1-2006 Reviewed/ Revised: Section: 10-11-2006 Respiratory Care Airway Pressure Release Ventilation Description/Definition Airway Pressure Release Ventilation (APRV)
More informationNurses and Respiratory Therapists Working Together for Safe Alarm Systems Management
Nurses and Respiratory Therapists Working Together for Safe Alarm Systems Management May 11, 2015 9/25/2013 1 AAMI Foundation Vision: To drive the safe adoption and use of healthcare technology Visit our
More informationMECHANICAL VENTILATION IN THE NEONATE
Supplemental Resources for the PICU/NICU MECHANICAL VENTILATION IN THE NEONATE I. GENERAL PRINCIPLES A. NEONATAL VENTILATORS We use three types of neonatal ventilators in the NICU: 1. SIMV (Synchronized
More informationNeurally Adjusted Ventilatory Assist: NAVA for Neonates
Neurally Adjusted Ventilatory Assist: NAVA for Neonates Robert L. Chatburn, MHHS, RRT-NPS, FAARC Research Manager Respiratory Institute Cleveland Clinic Professor Department of Medicine Lerner College
More informationProtocols for Early Extubation After Cardiothoracic Surgery
Protocols for Early Extubation After Cardiothoracic Surgery AATS / STS CT Critical Care Symposium April 27, 2014 Toronto, Ontario Nevin M. Katz, M.D. Johns Hopkins University Foundation for the Advancement
More informationAirway Pressure Release Ventilation (APRV) for the Treatment of Severe Life-Threatening ARDS in a Morbidly Obese Patient
Review Crit Care & Shock (2008) 11 : 132-136 Airway Pressure Release Ventilation (APRV) for the Treatment of Severe Life-Threatening ARDS in a Morbidly Obese Patient Amyn Hirani, Rodrigo Cavallazzi, Anastasia
More informationDe onderste steen boven. Regionale refereeravond IC 28 november 2012
De onderste steen boven Regionale refereeravond IC 28 november 2012 HISTORY Male 68 year Hypertension COPD gold IV Alcohol & nicotine abusus HISTORY - hospital admission: AE COPD with pneumonia (ph 7.32,
More informationDATA SHEET. Capnography option. www.airliquidemedicalsystems.com. November 2013 V2.2
November 2013 V2.2 DATA SHEET www.airliquidemedicalsystems.com [1] Monnal T75 (CO 2 )/ Air Liquide Medical Systems APPLICATION AREA OPERATING CONDITIONS Application: Patient categories: Weight: Intensive
More informationACUTE RESPIRATORY DISTRESS SYNDROME (ARDS) S. Agarwal, MD, S. Kache MD
ACUTE RESPIRATORY DISTRESS SYNDROME (ARDS) S. Agarwal, MD, S. Kache MD Definition ARDS is a clinical syndrome of lung injury with hypoxic respiratory failure caused by intense pulmonary inflammation that
More informationPrinciples of Mechanical Ventilation
Principles of Mechanical Ventilation The Basics Presented by WANG, Tzong-Luen Professor, Medical School, FJU Director, ED, SKH President, SECCM, Taiwan Origins of mechanical ventilation The era of intensive
More informationNeonatal Reference Guide
Operated by REACH Air Medical Services Assessment Heart Rate (beats/min.) Age Rate
More informationRecommendations: Other Supportive Therapy of Severe Sepsis*
Recommendations: Other Supportive Therapy of Severe Sepsis* K. Blood Product Administration 1. Once tissue hypoperfusion has resolved and in the absence of extenuating circumstances, such as myocardial
More informationImportance of Protocols in the Decision to Use Noninvasive Ventilation
Importance of Protocols in the Decision to Use Noninvasive Ventilation Janice L. Zimmerman, M.D. Weill Cornell Medical College The Methodist Hospital Houston, Texas Objectives Review application of protocols
More informationHigh-Frequency Oscillatory Ventilation
High-Frequency Oscillatory Ventilation Arthur Jones EdD, RRT Learning Objectives Describe the indications and rationale and monitoring for HFOV. Identify HFOV settings and describe the effects of their
More informationWEANING PROTOCOL IMPORTANT NOTICE: THIS DOCUMENT IS PROVIDED BY FAIRVIEW SOUTHDALE HOSPITAL SOLELY FOR INSTRUCTIONAL PURPOSES.
WEAIG PROTOCOL Contact: Ted Wawrzyniak, BS, RRT, CPS, tedwawrzyn@aol.com Fairview Southdale Hospital, Cardiopulmonary and eurology Services Department 6401 France Avenue South, Edina, M 55435-2199 Tel:
More informationOxygenation. Chapter 21. Anatomy and Physiology of Breathing. Anatomy and Physiology of Breathing*
Oxygenation Chapter 21 Anatomy and Physiology of Breathing Inspiration ~ breathing in Expiration ~ breathing out Ventilation ~ Movement of air in & out of the lungs Respiration ~ exchange of O2 & carbon
More informationPULMONARY PHYSIOLOGY
I. Lung volumes PULMONARY PHYSIOLOGY American College of Surgeons SCC Review Course Christopher P. Michetti, MD, FACS and Forrest O. Moore, MD, FACS A. Tidal volume (TV) is the volume of air entering and
More informationMechanical Ventilation
Mechanical Ventilation 127 Mechanical Ventilation William Benitz, M.D. Caring for a mechanically ventilated neonate continues to unnecessarily strike fear in the heart of many a resident. This fear is
More informationAuto Flow 20 Questions 20 Answers. Joseph Fitzgerald
Auto Flow 20 Questions 20 Answers Joseph Fitzgerald Important Notice: Medical knowledge changes constantly as a result of new research and clinical experience. The author of this introductory guide has
More informationThe Berlin definition of Severe ARDS includes assessment of which of the following?
2013 ACS Critical Care Update ARDS, Ventilators MCQs August, 2013 (Berlin Definition of ARDS Question 1) The Berlin definition of Severe ARDS includes assessment of which of the following? A. Oxygenation:
More informationHospital of the University of Pennsylvania Physician Practice Guideline
Page 1 of 5 KEY WORDS: Ventilator Respirator Weaning Extubation Liberation PURPOSE: To facilitate the liberation of patients from mechanical ventilation and provide a consistent approach to the ventilator
More informationOxygenation and Oxygen Therapy Michael Billow, D.O.
Oxygenation and Oxygen Therapy Michael Billow, D.O. The delivery of oxygen to all body tissues is the essence of critical care. Patients in respiratory distress/failure come easily to mind as the ones
More informationYear in Review 2012 Intensive Care. J.G. van der Hoeven j.vanderhoeven@ic.umcn.nl or hahoe@mac.com www.intensivistenopleiding.nl
Year in Review 2012 Intensive Care J.G. van der Hoeven j.vanderhoeven@ic.umcn.nl or hahoe@mac.com www.intensivistenopleiding.nl ARDS Difficult weaning Fluid therapy Sepsis Subjects Berlin definition Bilateral
More informationWeaning the Unweanable
Weaning the Unweanable Gerald W. Staton, Jr, MD Professor of Medicine Pulmonary & Critical Care Medicine Emory University School of Medicine Atlanta, GA gerald.staton@emory.edu Disclosures Pulmonary Program
More informationVolume Guarantee New Approaches in Volume Controlled Ventilation for Neonates. Jag Ahluwalia, Colin Morley, Hans Georg Wahle
Volume Guarantee New Approaches in Volume Controlled Ventilation for Neonates Jag Ahluwalia, Colin Morley, Hans Georg Wahle Important Notice: Medical knowledge changes constantly as a result of new research
More informationMECHANICAL VENTILATION
MECHANICAL VENTILATION INDICATIONS: Respiratory Failure Cardiopulmonary arrest Trauma (especially head, neck, and chest) Cardiovascular impairment (strokes, tumors, infection, emboli, trauma) Neurological
More informationTests. Pulmonary Functions
Pulmonary Functions Tests Static lung functions volumes Dynamic lung functions volume and velocity Dynamic Tests Velocity dependent on Airway resistance Resistance of lung tissue to change in shape Dynamic
More informationOPTIMAL PEEP DETERMINATION
by Kevin T. Martin BVE, RRT, RCP RC Educational Consulting Services, Inc. 16781 Van Buren Blvd, Suite B, Riverside, CA 92504-5798 (800) 441-LUNG / (877) 367-NURS www.rcecs.com BEHAVIORAL OBJECTIVES UPON
More informationImproving Weaning Automation (WEAN Study)
, 2013 Improving Weaning Automation (WEAN Study) François LELLOUCHE, MD, PhD Centre de recherche de l Institut Universitaire de Cardiologie et de Pneumologie de Québec CONFLICTS OF INTEREST - Research
More informationThe Sepsis Puzzle: Identification, Monitoring and Early Goal Directed Therapy
The Sepsis Puzzle: Identification, Monitoring and Early Goal Directed Therapy Cindy Goodrich RN, MS, CCRN Content Description Sepsis is caused by widespread tissue injury and systemic inflammation resulting
More informationComparison of the Rate of Improvement in Gas Exchange between Two High Frequency Ventilators in a Newborn Piglet Lung Injury Model
Comparison of the Rate of Improvement in Gas Exchange between Two High Frequency Ventilators in a Newborn Piglet Lung Injury Model Kurt Gillette, MD, San Antonio Military Medical Center Background: High
More informationNeonatal Reference Guide
Operated by REACH Air Medical Services Assessment Heart Rate (beats/min.) Rate
More informationMECHANICAL VENTILATION: AN OVERVIEW
MECHANICAL VENTILATION: AN OVERVIEW by Kevin T. Martin BVE, RRT, RCP V7117 HC 04 RC Educational Consulting Services, Inc. P.O. Box 1930, Brockton, MA 02303-1930 (800) 441-LUNG / (877) 367-NURS www.rcecs.com
More informationMechanical Ventilators
University of Washington Academic Medical Center Copyright 2000 Disclaimer Children's Hospital and Regional Medical Center Copyright 2002 Disclaimer Mechanical Ventilators Authors Created 07/31/95 Reviewed
More informationPlease answer the following questions before reading the tutorial. The answers are contained in the article.
ACUTE RESPIRATORY DISTRESS SYNDROME (ARDS) Author Dr D. Lacquiere Correspondence: david_lacquiere@hotmail.com Please answer the following questions before reading the tutorial. The answers are contained
More informationCurves and Loops in Mechanical Ventilation. Frank Rittner Martin Döring
Curves and Loops in Mechanical Ventilation Frank Rittner Martin Döring Curves and Loops in Mechanical Ventilation Frank Rittner Martin Döring 5 Contents Ventilation curve pattern Pressure-time diagram
More informationArtificial Ventilation Theory into practice
Artificial Ventilation Theory into practice Keith Simpson BVSc MRCVS MIET(Electronics) www.vetronic.co.uk ksimpson@vetronic.co.uk June 13 th 2014 Today we will discuss the administration of IPPV to anaesthetised
More informationD-36-2011. Curves and Loops in Mechanical Ventilation Frank Rittner Martin Döring
D-36-2011 Curves and Loops in Mechanical Ventilation Frank Rittner Martin Döring Curves and Loops in Mechanical Ventilation Frank Rittner Martin Döring 5 Contents Ventilation curve patterns 6 n Pressure-time
More informationBoaray 700 Anesthesia Machine
Boaray 700 Anesthesia Machine Features CE certification. 15 inch colored LCD, touch screen setting, big font display, free changeable angles of views. Various ventilation modes - VCV, PCV, SIMV+VCV, SIMV+PCV.
More informationLEVEL OF NURSES COMPETENCE IN MECHANICAL VENTILATION IN INTENSIVE CARE UNITS OF TWO TERTIARY HEALTH CARE INSTITUTIONS IN GAUTENG
LEVEL OF NURSES COMPETENCE IN MECHANICAL VENTILATION IN INTENSIVE CARE UNITS OF TWO TERTIARY HEALTH CARE INSTITUTIONS IN GAUTENG Lynn Botha Thesis submitted in fulfillment of the requirements for the degree
More informationRESPIRATORY VENTILATION Page 1
Page 1 VENTILATION PARAMETERS A. Lung Volumes 1. Basic volumes: elements a. Tidal Volume (V T, TV): volume of gas exchanged each breath; can change as ventilation pattern changes b. Inspiratory Reserve
More information5/30/2014 OBJECTIVES THE ROLE OF A RESPIRATORY THERAPIST IN THE DELIVERY ROOM. Disclosure
THE ROLE OF A RESPIRATORY THERAPIST IN THE DELIVERY ROOM Ona Fofah, MD FAAP Assistant Professor of Pediatrics Director, Division of Neonatology Department of Pediatrics Rutgers- NJMS, Newark OBJECTIVES
More informationVENTILATION SERVO-s EASY AND RELIABLE PATIENT CARE
VENTILATION SERVO-s EASY AND RELIABLE PATIENT CARE Critical Care SERVO-s 3 SERVO-s SIMPLY MAKES SENSE MAQUET THE GOLD STANDARD Leading the way: MAQUET is a premier international provider of medical products
More informationEdwards FloTrac Sensor & Edwards Vigileo Monitor. Understanding Stroke Volume Variation and Its Clinical Application
Edwards FloTrac Sensor & Edwards Vigileo Monitor Understanding Stroke Volume Variation and Its Clinical Application 1 Topics System Configuration Pulsus Paradoxes Reversed Pulsus Paradoxus What is Stroke
More informationTwo Steps forward in Ventilation. Ernst Bahns. Because you care
Two Steps forward in Ventilation Ernst Bahns Because you care Important Note: Medical knowledge changes constantly as a result of new research and clinical experience. The author of this introductory guide
More informationManagement of airway burns and inhalation injury PAEDIATRIC
Management of airway burns and inhalation injury PAEDIATRIC A multidisciplinary team should provide the management of the child with inhalation injury. Childhood inhalation injury mandates transfer to
More informationFisiología Respiratoria, Hipercapnia Permisiva e Injuria Pulmonar. Wally A. Carlo, M.D. University of Alabama at Birmingham
Fisiología Respiratoria, Hipercapnia Permisiva e Injuria Pulmonar Wally A. Carlo, M.D. University of Alabama at Birmingham Randomized Trial of Oxygen Saturation Targets in Premature Infants - the SUPPORT
More informationSaint Thomas Hospital Protocol. Protocol Title: Terminal Weaning from Ventilator Protocol No.: V-09. Medical Staff departments
Saint Thomas Hospital Protocol Protocol No.: V-09 Operating Unit(s) Medical Staff departments Important s: Affected: affected:! Hospital! Medicine of Origin: 2/00 " Regional Network! Surgery Reviewed:
More informationPulmonary Diseases. Lung Disease: Pathophysiology, Medical and Exercise Programming. Overview of Pathophysiology
Lung Disease: Pathophysiology, Medical and Exercise Programming Overview of Pathophysiology Ventilatory Impairments Increased airway resistance Reduced compliance Increased work of breathing Ventilatory
More informationBergen Community College Division of Health Professions Department of Respiratory Care RSP-231, Respiratory Care Clinical Externship IV
Date of Most Recent Syllabus Revision: August 2014 Semester and Year: Fall 2014 Bergen Community College Division of Health Professions Department of Respiratory Care RSP-231, Respiratory Care Clinical
More informationVentilator Application of the Passy-Muir Valve David A. Muir Course Outline Benefits Review of the Biased Closed Position No Leak Passy-Muir Valves
Ventilator Application of the Passy-Muir Valve Michael S. Harrell, B.S., RRT Director of Clinical Education-Respiratory mharell@passy-muir.com (949) 833-8255 David A. Muir 23 year-old ventilator dependent
More informationThe Respiratory Therapist s Role in Organ Donation. Laure Kendall, LBSW
The Respiratory Therapist s Role in Organ Donation Laure Kendall, LBSW Midwest Transplant Network Organ & Tissue Procurement Professional Education Donor Family Aftercare Community Education 24 hour Call
More informationThe centrepiece of a complete anaesthesia workstation
The centrepiece of a complete anaesthesia workstation IntelliSave AX700 anaesthesia machine A slim design with rich functionality To develop the first Philips-branded anaesthesia machine, we listened to
More informationColorado Cardiac Conference: 2 nd teaching workshop. Proactive Respiratory Therapy in postoperative Cardiac Patients
Colorado Cardiac Conference: 2 nd teaching workshop Proactive Respiratory Therapy in postoperative Financial Disclosures Donald Fritz, RT Jerrold Judd, RT No relevant financial relationships with any commercial
More informationPhysiology of Ventilation
Physiology of Ventilation Lecturer: Sally Osborne, Ph.D. Department of Cellular & Physiological Sciences Email: sosborne@interchange.ubc.ca Useful link: www.sallyosborne.com Required Reading: Respiratory
More informationPediatric Airway Management
Pediatric Airway Management Dec 2003 Dr. Shapiro I., PICU Adult Chain of Survival EMS CPR ALS Early Defibrillation Pediatric Chain of Survival Prevention CPR EMS ALS Out-of-Hospital Cardiac Arrest SIDS
More informationINTRODUCING RESMED S. Home NIV Solutions. S9 VPAP ST-A with ivaps S9 VPAP ST. Why choose average when you can choose intelligent?
INTRODUCING RESMED S Home NIV Solutions S9 VPAP ST-A with ivaps S9 VPAP ST Why choose average when you can choose intelligent? Now you can provide intelligent air through ResMed s intelligent Volume-Assured
More informationVentilation Perfusion Relationships
Ventilation Perfusion Relationships VENTILATION PERFUSION RATIO Ideally, each alveolus in the lungs would receive the same amount of ventilation and pulmonary capillary blood flow (perfusion). In reality,
More informationSafe Zone: CV PIP < 26; HFOV: MAP < 16; HFJV: MAP < 16 Dopamine infusion up to 20 mcg/kg/min Epinephrine infusion up to 0.1 mcg /kg/min.
Congenital Diaphragmatic Hernia: Management Guidelines 5-2006 Issued By: Division of Neonatology Reviewed: Effective Date: Categories: Chronicity Document Congenital Diaphragmatic Hernia: Management Guidelines
More informationNEWBORN (birth to 24 hours)
NEWBORN (birth to 24 hours) 3kg ETT size: 3mm ETT length: 14cm AIRTRAQ: GREY LMA size: 1 or 1.5 IGT size: 5 FG SHOCK: 15 joules CPR: one third of chest depth rate 100/min 3:1 The emphases in resuscitation
More informationDräger Ventilation Mini Manual Brief explanation of ventilation modes and functions
Dräger Ventilation Mini Manual Brief explanation of ventilation modes and functions 1 TABLE OF CONTENTS 3 Table of contents PC-BIPAP vs. PC-AC Pressure Control Biphasic Positive Airway Pressure vs. Pressure
More informationVentilation: Theory and Practice
AACN Clinical Issues Volume 12, Number 2, pp. 234 246 2001, AACN Airway Pressure Release Ventilation: Theory and Practice P. Milo Frawley, RN, MS,* and Nader M. Habashi, MD Airway pressure release ventilation
More informationKING FAISAL SPECIALIST HOSPITAL AND RESEARCH CENTRE (GEN. ORG.) NURSING AFFAIRS. Scope of Service PEDIATRIC INTENSIVE CARE UNIT (PICU)
PICU-Jan.2012 Page 1 of 7 Number of Beds: 18 Nurse Patient Ratio: 1:1-2 : The Pediatric Intensive Care Unit (PICU) provides 24 hour intensive nursing care for patients aged neonate through adolescence.
More informationBIPAP Synchrony TM AVAPS
BIPAP Synchrony TM AVAPS Product Presentation V1.6 Contents Home NIV Solution introduction BiPAP Technology and Auto-Trak algorithm Consensus conference, Chest 1999 The AVAPS algorithm The AVAPS settings
More informationSeptic Shock: Pharmacologic Agents for Hemodynamic Support. Nathan E Cope, PharmD PGY2 Critical Care Pharmacy Resident
Septic Shock: Pharmacologic Agents for Hemodynamic Support Nathan E Cope, PharmD PGY2 Critical Care Pharmacy Resident Objectives Define septic shock and briefly review pathophysiology Outline receptor
More informationVentilation modes in intensive care
Ventilation modes in intensive care Karin Deden Important note This brochure does not replace the instructions for use. Prior to using a ventilator the corresponding instructions for use must always be
More informationHow To Use High Frequency Oscillatory Ventilation
HIGH FREQUENCY OSCILLATORY VENTILATION ANAESTHESIA TUTORIAL OF THE WEEK 261 28 TH MAY 2012 Dr Sarah Jarvis, Mrs Karen Burt and Dr William English Royal Cornwall Hospitals NHS Trust, Cornwall, UK QUESTIONS
More informationHigh Frequency Ventilation Introductory Information
High-Frequency Oscillatory Ventilation Learning Objectives: Explain the indications, rationale and monitoring for HFOV. Explain the effects of adjusting HFOV ventilator controls. Arthur Jones EdD, RRT
More informationNon-Invasive Positive Pressure Ventilation in Heart Failure Patients: For Who, Wy & When?
REUNIÃO CONJUNTA DOS GRUPOS DE ESTUDO DE CUIDADOS INTENSIVOS CARDÍACOS E DE FISIOPATOLOGIA DO ESFORÇO E REABILITAÇÃO CARDÍACA O L H Ã O 2 7 e 2 8 d e J a n e i r o 2 0 1 2 Non-Invasive Positive Pressure
More informationNURSING SERVICES DEPARTMENT
NURSING SERVICES DEPARTMENT TITLE: Mechanical Ventilation PATIENT CARE PLAN DIAGNOSIS: DISCHARGE CRITERIA: 1 The patient will: Maintain adequate mechanics of PERTINENT INFORMATION:. ventilation as demonstrated
More informationNursing Education and Research
Melissa Meloche Meloche, RN RN, MSN MSN, CCRN Nursing Education and Research Describe the purpose p of common clinical equipment found in the Intensive Care Unit and how this equipment could impact a patient
More informationImpact Uni-Vent 754 Portable Ventilator
Impact Uni-Vent 754 Portable Ventilator Description - Indications- Contraindications- Side Effects- Special Considerations- The Uni-Vent 754 Portable Ventilator is a portable electronically controlled,
More informationRES Non-Invasive Positive Pressure Ventilation Guideline Page 1 of 9
Page 1 of 9 Scope: Respiratory Care Department, Physicians, Advanced Nurse Practitioners (APRN), Physician Assistants (PA) Population: Patients receiving rescue or non-rescue non-invasive positive pressure
More informationRehabilitation within critical care. By David McWilliams Senior Specialist Physiotherapist Critical Care Manchester Royal Infirmary
Rehabilitation within critical care By David McWilliams Senior Specialist Physiotherapist Critical Care Manchester Royal Infirmary Contents Negative effects of Critical illness/ prolonged ventilation Evidence
More informationObjectives COPD. Chronic Obstructive Pulmonary Disease (COPD) 4/19/2011
Objectives Discuss assessment findings and treatment for: Chronic Obstructive Pulmonary Disease Bronchitis Emphysema Asthma Anaphylaxis Other respiratory issues Provide some definitions Chronic Obstructive
More informationLab #11: Respiratory Physiology
Lab #11: Respiratory Physiology Background The respiratory system enables the exchange of O 2 and CO 2 between the cells and the atmosphere, thus enabling the intake of O 2 into the body for aerobic respiration
More informationPediatric Respiratory System: Basic Anatomy & Physiology. Jihad Zahraa Pediatric Intensivist Head of PICU, King Fahad Medical City
Pediatric Respiratory System: Basic Anatomy & Physiology Jihad Zahraa Pediatric Intensivist Head of PICU, King Fahad Medical City Outline Introduction Developmental Anatomy Developmental Mechanics of Breathing
More informationRespiratory failure. (Respiratory insuficiency) MUDr Radim Kukla KAR FN Motol
Respiratory failure (Respiratory insuficiency) MUDr Radim Kukla KAR FN Motol Respiratory failure definition Failure of ability to secure the metabolic needs of organism i.e. proper oxygenation and excretion
More informationVELA. ventilator user guide. Critical care ventilation
VELA ventilator user guide Critical care ventilation Table of contents VELA ventilator model matrix...1-2 Panels...3-8 Circuit assembly...9-12 Primary controls...13-16 Extended Functions...17-19 Operational
More informationNIV in non CPE, non-copd, non-neuromuscular patients
NIV in non CPE, non-copd, non-neuromuscular patients Giorgio Iotti Anestesia e Rianimazione 2 Pavia Italia Missioni ECMOteam Pavia 2009/2011 18 4 2 Trasporto con ECMO senza ECMO ALI/ARDS Immunocompetent
More informationD-37-2011. Pressure Support Ventilation A New Triggered Ventilation Mode for Neonates. Jean Christophe Rozé Thomas Krüger
D-37-2011 Pressure Support Ventilation A New Triggered Ventilation Mode for Neonates Jean Christophe Rozé Thomas Krüger Important Notice: Medical knowledge changes constantly as a result of new research
More informationPAP 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
More informationLong Term Acute Care Hospital: Criteria for Admission
Easy Choice Health Plan, Inc. Harmony Health Plan of Illinois, Inc. M issouri Care, Inc. Ohana Health Plan, a plan offered by WellCare Health Insurance of Arizona, Inc. WellCare Health Insurance of Illinois,
More informationOxylog 3000 plus Emergency & Transport Ventilation
Oxylog 3000 plus Emergency & Transport Ventilation Offering high ventilation performance with features such as AutoFlow integrated capnography and non-invasive Ventilation, the compact and robust Oxylog
More informationRESISTANCE AND COMPLIANCE
by Kevin T. Martin BVE, RRT, RCP RC Educational Consulting Services, Inc. 16781 Van Buren Blvd, Suite B, Riverside, CA 92504-5798 (800) 441-LUNG / (877) 367-NURS www.rcecs.com BEHAVIORAL OBJECTIVES UPON
More informationHow To Determine The Difference Between Long Versus Short Inspiratory Times In Neonates
Long versus short inspiratory times in neonates receiving mechanical ventilation (Review) Kamlin COF, Davis PG This is a reprint of a Cochrane review, prepared and maintained by The Cochrane Collaboration
More informationEvidence-Based Ventilator Weaning and Discontinuation
Evidence-Based Ventilator Weaning and Discontinuation Neil R MacIntyre MD FAARC Introduction Assessing Ventilator-Discontinuation Potential Extubation Managing the Patient Who Fails SBT Protocols Implemented
More informationDräger Evita Infinity V500 ventilator ICU Ventilation and Respiratory Monitoring
Dräger Evita Infinity V500 ventilator ICU Ventilation and Respiratory Monitoring Combine fully-featured, high-performance ventilation with Infinity Acute Care System integration to meet the challenges
More informationASSISTED VENTILATION IN NEONATES
ASSISTED VENTILATION IN NEONATES CONTINUOUS POSITIVE AIRWAY PRESSURE (CPAP) DEFINITION Continuous Positive Airway Pressure or CPAP is a modality of respiratory support in which increased pulmonary pressure
More informationSE5h, Sepsis Education.pdf. Surviving Sepsis
Surviving Sepsis 1 Scope and Impact of the Problem: Severe sepsis is a major healthcare problem that affects millions of people around the world each year with an extremely high mortality rate of 30 to
More informationFor every breath he takes. Trilogy200 ventilator s added sensitivity lets you breathe easier knowing your patients are where they belong home.
For every breath he takes Trilogy200 ventilator s added sensitivity lets you breathe easier knowing your patients are where they belong home. Sensitive to your patients needs Trilogy200, a portable life-support
More informationChronic Critical Illness: Can it be prevented? Carmen C Polito, MD Pulmonary & Critical Care Medicine Emory University Atlanta, GA cpolito@emory.
Chronic Critical Illness: Can it be prevented? Carmen C Polito, MD Pulmonary & Critical Care Medicine Emory University Atlanta, GA cpolito@emory.edu Data free zone Disclosures A (Very) Old Case 65 year-old
More informationWeaning of the Patient with ARDS
Weaning of the Patient with ARDS William E. Hurford, MD Associate Professor of Anesthesia Harvard Medical School Director, Critical Care Department of Anesthesia and Critical Care Massachusetts General
More informationEvidence-Based Guidelines for Weaning and Discontinuing Ventilatory Support
Special Articles Evidence-Based Guidelines for Weaning and Discontinuing Ventilatory Support A Collective Task Force Facilitated by the American College of Chest Physicians, the American Association for
More information240- PROBLEM SET INSERTION OF SWAN-GANZ SYSTEMIC VASCULAR RESISTANCE. Blood pressure = f(cardiac output and peripheral resistance)
240- PROBLEM SET INSERTION OF SWAN-GANZ 50 kg Pig Rt Jugular 0 cm Rt Atrium 10 cm Rt ventricle 15 cm Wedge 20-25 cm SYSTEMIC VASCULAR RESISTANCE Blood pressure = f(cardiac output and peripheral resistance)
More information