carmen silvia valente barbas
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Assincronias: Como abordar. Interpretação das curvas. CARMEN SILVIA VALENTE BARBAS. Marini JJ, Smith TC, Lambi VJ. External work output and force generation during syncronized intermitent mechanical ventilation. Effect of machine assistance on breathing effort . - PowerPoint PPT PresentationTRANSCRIPT
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