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Pressure Support Ventilation Pressure rise time Cycling off criteria

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Apresentação em tema: "Pressure Support Ventilation Pressure rise time Cycling off criteria"— Transcrição da apresentação:

1 Pressure Support Ventilation Pressure rise time Cycling off criteria

2 Modos Ventilatórios (Chatburn RL, 1992)
CICLOS MANDATÓRIOS CICLOS ESPONTÂNEOS Controle Disparo Limite Ciclagem Ventilação Mandatória Contínua Volume Tempo Pressão Fluxo - Pressão Ventilação Mandatória Intermitente Ventilação Espontânea Contínua

3 Figure 1. Flow, Airway Pressure, and Inspiratory and Expiratory Muscle Activity in a Patient with Chronic Obstructive Pulmonary Disease Who Received Pressure-Support Ventilation at an Airway Pressure of 20 cm of Water. The electromyograms in the lower portion of the figure show inspiratory muscle activity in the patient's diaphragm and expiratory muscle activity in the transversus abdominis. The patient's increased inspiratory effort caused the airway pressure to fall below the set sensitivity (-2 cm of water), and inadequate delivery of flow by the ventilator resulted in a scooped contour on the airway-pressure curve during inspiration. While the ventilator was still pumping gas into the patient, his expiratory muscles were recruited, causing a bump in the airway-pressure curve. That the flow never returned to zero throughout expiration reflected the presence of auto-positive end-expiratory pressure. The broken red line shows airway pressure in another patient, who generated just enough effort to trigger the ventilator and in whom there was adequate delivery of gas by the ventilator. Data are from Jubran et al.6 and Parthasarathy et al.11 Tobin M. N Engl J Med 2001;344:

4 Figure 1. Flow, Airway Pressure, and Inspiratory and Expiratory Muscle Activity in a Patient with Chronic Obstructive Pulmonary Disease Who Received Pressure-Support Ventilation at an Airway Pressure of 20 cm of Water. The electromyograms in the lower portion of the figure show inspiratory muscle activity in the patient's diaphragm and expiratory muscle activity in the transversus abdominis. The patient's increased inspiratory effort caused the airway pressure to fall below the set sensitivity (-2 cm of water), and inadequate delivery of flow by the ventilator resulted in a scooped contour on the airway-pressure curve during inspiration. While the ventilator was still pumping gas into the patient, his expiratory muscles were recruited, causing a bump in the airway-pressure curve. That the flow never returned to zero throughout expiration reflected the presence of auto-positive end-expiratory pressure. The broken red line shows airway pressure in another patient, who generated just enough effort to trigger the ventilator and in whom there was adequate delivery of gas by the ventilator. Data are from Jubran et al.6 and Parthasarathy et al.11 Tobin M. N Engl J Med 2001;344:

5 Figure 1. Flow, Airway Pressure, and Inspiratory and Expiratory Muscle Activity in a Patient with Chronic Obstructive Pulmonary Disease Who Received Pressure-Support Ventilation at an Airway Pressure of 20 cm of Water. The electromyograms in the lower portion of the figure show inspiratory muscle activity in the patient's diaphragm and expiratory muscle activity in the transversus abdominis. The patient's increased inspiratory effort caused the airway pressure to fall below the set sensitivity (-2 cm of water), and inadequate delivery of flow by the ventilator resulted in a scooped contour on the airway-pressure curve during inspiration. While the ventilator was still pumping gas into the patient, his expiratory muscles were recruited, causing a bump in the airway-pressure curve. That the flow never returned to zero throughout expiration reflected the presence of auto-positive end-expiratory pressure. The broken red line shows airway pressure in another patient, who generated just enough effort to trigger the ventilator and in whom there was adequate delivery of gas by the ventilator. Data are from Jubran et al.6 and Parthasarathy et al.11 Tobin M. N Engl J Med 2001;344:

6 Figure 1. Flow, Airway Pressure, and Inspiratory and Expiratory Muscle Activity in a Patient with Chronic Obstructive Pulmonary Disease Who Received Pressure-Support Ventilation at an Airway Pressure of 20 cm of Water. The electromyograms in the lower portion of the figure show inspiratory muscle activity in the patient's diaphragm and expiratory muscle activity in the transversus abdominis. The patient's increased inspiratory effort caused the airway pressure to fall below the set sensitivity (-2 cm of water), and inadequate delivery of flow by the ventilator resulted in a scooped contour on the airway-pressure curve during inspiration. While the ventilator was still pumping gas into the patient, his expiratory muscles were recruited, causing a bump in the airway-pressure curve. That the flow never returned to zero throughout expiration reflected the presence of auto-positive end-expiratory pressure. The broken red line shows airway pressure in another patient, who generated just enough effort to trigger the ventilator and in whom there was adequate delivery of gas by the ventilator. Data are from Jubran et al.6 and Parthasarathy et al.11 Tobin M. N Engl J Med 2001;344:

7 PSV: Inspiratory rise time / Cycling-off criteria
Pressurização Ciclagem PB 760 5 – 100% 1 – 45% PF T-Bird 5 – 30% PF PB 84 1 – 80% Vela Evita 2dura 0 – 2s 25% PF Avea 1 - 9 5 – 45% PF Evita 4 Bipap Vision 0.05 – 0.4 s Auto-trak Evita XL Esprit 0.1 – 0.9 s 10 – 45% PF Servo-i 0 – 0.4 s 1 – 80% PF LTV1000 10 – 40% PF Servo-s Elisee Galileo 25 – 200 ms e500 1 - 19 5 – 50% PF

8 Des-sincronia durante a fase de pressurização (pressure delivery phase)
Pressure rise time

9 Pressure overshoot

10 Effect of different inspiratory rise time in ALI (Chiumello, 2003)
Coc TI VT VE PEEPi PSV 5 IRT 0% 40% - 5% IRT 40% PSV 15

11

12 WOB vs. P0.1

13 Des-sincronia durante a fase de ciclagem (cycling off phase)
Abertura prematura da válvula expiratória (premature cycling) Abertura retardada da válvula expiratória (delayed cycling)

14 Abertura prematura da válvula expiratória

15 Abertura retardada da válvula expiratória

16 Effect of different cycling-off criteria in COPD (Chiumello, 2007)
PEEP TI VT VE PEEPi PSV 5 Coc 5% Coc 40% 6 PSV 15

17


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