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Ventilatory support in special situations balamugesh

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Dang Thanh Tuan
Dang Thanh Tuan
Gesundheit & Medizin
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Ventilatory support in special situations Dr.Balamugesh.T, MD, DM Dept. of Pulmonary Medicine, CMC, Vellore.
And the Lord God formed man of the dust of the ground, and breathed into his nostrils and breath of life, and man become a living soul. Genesis 2:7
[object Object],[object Object],[object Object],[object Object]
ARDS ,[object Object],[object Object],[object Object],[object Object],Mortality - 26% to 74%
Eddy Fan, JAMA. 2005;294
“ baby lung” Eddy Fan, JAMA. 2005;294
Ventilation Induced Lung Injury ,[object Object],[object Object],[object Object],[object Object],[object Object]
Ventilation in ARDS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Which mode? ,[object Object],[object Object],ARDS Clinical Trials Network
How much FiO2? ,[object Object],[object Object],[object Object],[object Object]
How much Tidal volume? ARDS Network ,[object Object],[object Object],[object Object],[object Object],Mortality
PEEP ,[object Object],[object Object],[object Object],[object Object]
Open Lung Ventilation (OLV) ,[object Object],[object Object]
PEEP…. ,[object Object],[object Object],[object Object]
optimal PEEP J J Cordingley, Thorax 2002;57
How much PEEP? ,[object Object],[object Object],[object Object],N Engl J Med 2004;351
Permissive hypercapia – ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Protective lung ventilation protocol from the ARDSNet study ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Refractory hypoxia ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Prone position ventilation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],No differences in clinical outcome
Recruitment manoeuvres ,[object Object],[object Object],[object Object]
Inverse ratio ventilation ,[object Object],[object Object],[object Object]
Obstructive lung disease ,[object Object],[object Object]
Indications for NIV for AE-COPD GOLD 2005
Exclusion criteria GOLD 2005
Indications for Invasive Mechanical Ventilation GOLD 2005
Think twice ,[object Object],[object Object],[object Object],[object Object],Mortality among COPD patients with respiratory failure is no greater than mortality among patients ventilated for non-COPD causes GOLD 2005
Post-Intubation hypotension ,[object Object],[object Object]
Mechanical ventilation ,[object Object],[object Object],[object Object],[object Object]
PEEP ,[object Object],[object Object],[object Object],[object Object]
Post extubation NIV ,[object Object],[object Object]
Asthma
NIV in asthma ,[object Object],[object Object]
NIV in acute bronchial asthma ,[object Object],[object Object],Chest. 2003;123
NIV in asthma…. ,[object Object],[object Object],[object Object]
Endotracheal intubation ,[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object]
• FiO 2 = 1.0 (initially) • Long expiratory time (I:E ratio >1:2) • Low tidal volume 5–7 ml/kg • Low ventilator rate (8–10 breaths/min) • Set inspiratory pressure 30–35 cm H2O on pressure control ventilation or limit peak inspiratory pressure to <40 cm H2O • Minimal PEEP <5 cm H2O
Aerosol delivery ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Ventilator strategies in Bronchopleural fistula
[object Object],[object Object],[object Object]
Measures to reduce air-leak ,[object Object],[object Object],[object Object],[object Object],[object Object]
Chest tube ,[object Object],[object Object]
High-frequency ventilation (HFV) ,[object Object],[object Object]

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17 capnography part4 non-intubated
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16 capnography part3 intubated
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15 capnography part2 introduction
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14 capnography part1 overview
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13 icu monitoring standards and capnography
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12 mainstream sidestream capnpgraphy
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Ventilatory support in special situations balamugesh

  • 1. Ventilatory support in special situations Dr.Balamugesh.T, MD, DM Dept. of Pulmonary Medicine, CMC, Vellore.
  • 2. And the Lord God formed man of the dust of the ground, and breathed into his nostrils and breath of life, and man become a living soul. Genesis 2:7
  • 3.
  • 4.
  • 5. Eddy Fan, JAMA. 2005;294
  • 6. “ baby lung” Eddy Fan, JAMA. 2005;294
  • 7.
  • 8.
  • 9.
  • 10.
  • 11.
  • 12.
  • 13.
  • 14.
  • 15. optimal PEEP J J Cordingley, Thorax 2002;57
  • 16.
  • 17.
  • 18.
  • 19.
  • 20.
  • 21.
  • 22.
  • 23.
  • 24. Indications for NIV for AE-COPD GOLD 2005
  • 26. Indications for Invasive Mechanical Ventilation GOLD 2005
  • 27.
  • 28.
  • 29.
  • 30.
  • 31.
  • 33.
  • 34.
  • 35.
  • 36.
  • 37.
  • 38. • FiO 2 = 1.0 (initially) • Long expiratory time (I:E ratio >1:2) • Low tidal volume 5–7 ml/kg • Low ventilator rate (8–10 breaths/min) • Set inspiratory pressure 30–35 cm H2O on pressure control ventilation or limit peak inspiratory pressure to <40 cm H2O • Minimal PEEP <5 cm H2O
  • 39.
  • 40.
  • 41. Ventilator strategies in Bronchopleural fistula
  • 42.
  • 43.
  • 44.
  • 45.

Hinweis der Redaktion

  1. volume versus pressure controlled ventilation in ARDS have been reported but have been too small to detect any important outcome differences. Whatever mode of ventilation is used, it is now clear that