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