carmen silvia valente barbas assincronias: como abordar. interpretação das curvas

CARMEN SILVIA VALENTE BARBAS

Assincronias: Como abordar. Interpretação das curvas

Marini JJ, Smith TC, Lambi VJ. External work output and force generation during syncronized intermitent mechanical ventilation. Effect of machine assistance on breathing effort . Am Rev Respir Dis 1988; 138: 1169-1179.

Sassoon CSH. Intermitent Mandatory Ventilation.in Principles and Practice of Mechanical Ventilation,Mc Graw Hill, 1994: 221-238.

Improved efficacy of spontaneous breathing with inspiratorypressure support.Brochard L, Pluskwa F, Lemaire F. Am Rev Respir Dis 1987, 136: 411-5.

Barbas CSV, Amato MBP, Rodrigues Jr M. Técnicas de Assistência Ventilatória emCONDUTAS NO PACIENTE GRAVE, 1998:321-352.

Inspiratory Pressure Support prevents diaphragmatic fatigueduring weaning from mechanical ventilationBrochard L, Harf A, Lorino H, Lemaire F.

Am Rev Respir Dis 1989, 139: 513-21.

Inspiratory Pressure Support Compensates for the Additional Work of breathing Caused by Endotracheal Tube.Brochard L, Rua F, Lorino H, Lorino H, Lemaire F, Harf A.

Anesthesiology, 1991: 739-74.

PERSPECTIVAS

Palv

Controle : Pressão Inclinação Ciclagem

Ciclagem (Fluxo)

PRESSÃO SUPORTE:

Palv

Controle : Pressão

Ciclagem (Fluxo)

UTI-RESPIRATÓRIA HC- FMUSP, 1991.

Amato MBP, Barbas CSV, Bonassa J; Saldiva PHN; Zin WA; Carvalho CRR Volume-assured pressure support ventilation (VAPSV). A new approach for reducing muscle workload during acute respiratory failure. Chest - 01-Oct-1992; 102(4): 1225-34

VAPSV: ventilação com pressão

de suporte e volume garantido: ventilação que

combina a pressão de

suporte e ventilação

ciclada a volume num

mesmo ciclo respiratório.

Amato MBP, Barbas CSV, Bonassa J; Saldiva PHN; Zin WA; Carvalho CRR Volume-assured pressure support ventilation (VAPSV). A new approach for reducing muscle workload during acute respiratory failure. Chest - 01-Oct-1992; 102(4): 1225-34

Amato MBP, Barbas CSV, Bonassa J; Saldiva PHN; Zin WA; Carvalho CRR Volume-assured pressure support ventilation (VAPSV). A new approach for reducing muscle workload during acute respiratory failure. Chest - 01-Oct-1992; 102(4): 1225-34

Amato MBP, Barbas CSV, Bonassa J; Saldiva PHN; Zin WA; Carvalho CRR . Volume-assured pressure support ventilation (VAPSV). A new approach for reducing muscle workload during acute respiratory failure. Chest - 01-Oct-1992; 102(4): 1225-34

CLOSED-LOOP CONTROL MECHANICAL VENTILATIONDUAL CONTROL MODESCOMBINING VOLUME AND PRESSURE BREATHS

Respir Care Clin N Am - 01-Sep-2001; 7(3): 397-408.

Branson RD, Davis Jr K.

Controle de pressão e volume em alça fechada durante o Mesmo ciclo respiratório:VAPSV: BIRD 8400 T-BIRDPA: Bear 1000.

VAPS: BIRD 8400 e T-BIRD

Controle de pressão e volume em alça fechada durante o mesmo ciclo respiratório:

PRESSURE

AUGMENTATION: BEAR 1000

PATIENT-VENTILATOR ASYNCHRONY:

1. INEFFECTIVE TRIGGERING (90%)2. AUTOTRIGGERING3. DOUBLE TRIGGERING4. PREMATURE CYCLE5. DELAYED CYCLING

NAVA: É UM

NOVO MODO

VENTILATÓRIO

AJUSTADO

ATRAVÉS

DO DRIVE NEURAL.

NAVA:

NAVA VENTILATION-REVIEW Minerva Anesthesiol, 2010, 346-52.

Caso 2: Paciente de 76 anos, tabagista grave ,DPOC grave , obstrução grave, Auto-PEEP de 15 cmH20 Dessincronização na PSV

Proportional assist ventilation is a mode of partial ventilatory support in which the ventilator applies pressure in proportion to the patient’s inspiratory effort

% PAV-PLUS 5 to 95%

And in proportion to the patients respiratory mechanics (compliance and resistance)

PAV-PLUS

0

10

20

30

40

50

0 10 20 30 40 50

0

10

20

30

40

50

0 10 20 30 40 50

Patients breathing frequency (breaths/min)

Ven

tilat

or r

ate

(cyc

les/

min

)

PS (696 measurements) PAV (744measurements)

Xirouchaki et al. Intensive Care Med 2008

In the PS group, from a total of 696 measurements, 95 (13.6%) revealed a difference between patients’ breathing frequency and ventilator rate. In the PAV+ group, from a total of 744 measurements, 21 (2.8%) revealed a difference between patients’ breathing frequency and ventilator rate .

CARMEN SILVIA VALENTE BARBAS

Assincronias: Como abordar. Interpretação das curvas