Next up is respiratory therapist Benevides Netto on 'Optimising Patient Ventilatory Interactions'
#CCSSA2022 #critcare #FOAMcc
#CCSSA2022 #critcare #FOAMcc
First speaks to how patient-ventilator dyssynchrony is common, and has been found in all modes of ventilation! It has significant consequences, via a variety of mechanisms - see P-SILI (but not only P-SILI!)
How to monitor asynchrony
- Graphic analysis
- Oesophageal pressure
- Diaphragmatic ultrasound
- Electrical impedence tomography
#CCSSA2022
- Graphic analysis
- Oesophageal pressure
- Diaphragmatic ultrasound
- Electrical impedence tomography
#CCSSA2022
How to improve P-V interactions:
--> Match patient trigger to patient
--> PS level setting
--> Appropriate inspiratory flow
--> Proper setting of inspiratory time
--> Adjust proper rise time
--> Appropriate level of PEEP
doi.org/10.1186/s40635….
#CCSSA2022
--> Match patient trigger to patient
--> PS level setting
--> Appropriate inspiratory flow
--> Proper setting of inspiratory time
--> Adjust proper rise time
--> Appropriate level of PEEP
doi.org/10.1186/s40635….
#CCSSA2022
If these do not work, there are other forms of ventilation that may help
- Proportional Assisted Ventilation
- Neurally Adjusted Ventilation
- Noisy / Variable PSV
There are also pharmacological interventions
- Adequate sedation
- Partial NMB
#CCSSA2022
- Proportional Assisted Ventilation
- Neurally Adjusted Ventilation
- Noisy / Variable PSV
There are also pharmacological interventions
- Adequate sedation
- Partial NMB
#CCSSA2022
A subtle form of dyssynchrony is called Pendulluft Asynchrony, first described by Yoshida in 2013, which is characterised by a mismatch of air distribution in different lung regions. I knew nothing about this - its fascinating!
doi.org/10.1164/rccm.2…
#CCSSA2022
doi.org/10.1164/rccm.2…
#CCSSA2022
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