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Ventilator Graphics (Japanese edition)

人工呼吸器グラフィック 患者の人工呼吸器外れを識別すると、設定を最適化します。

Flow Patterns and Flow Rates

One corrective action in correcting flow mismatch is switching from a constant flow pattern to a decelerating flow pattern this provides a high initial peak flow. The above video overviews how different flow patterns effect inspiratory flow rates. 


RELATED POST/LINKS

Correcting flow mismatch by increasing ventilator flow rate

Creating Flow Mismatch with a Simulator

Oxylog 3000 Simulator

Why I do not use Draeger ventilator simulators

Flow mismatch: patient ventilator asynchrony associated with volume ventilation

Waveform of the week: Flow Mis-match

Decreasing Dyspnea During Mechanical Ventilation

Correcting flow mismatch by increasing ventilator flow rate

Flow mismatch is a common patient ventilatory asynchrony associated with volume ventilation, which may lead to cardiovascular instability, increased oxygen consumption, increased carbon dioxide production, increased patient discomfort and prolonged mechanical ventilation[iv]. Fortunately, flow mismatch can be simply identified with the proper assessment of the pressure waveform.

To correct flow mismatch titrate the flow rate to match the patient’s inspiratory demands. Another corrective action is switching from a constant flow pattern to a decelerating flow pattern this provides a high initial peak flow. One must consider that changes in ventilatory demand may result in unnecessary higher than average assist resulting in ventilator induced diaphragm dysfunction[ii], a lower PaCO2 set-point, and delay in liberation.


RELATED POST/LINKS

Creating Flow Mismatch with a Simulator

Oxylog 3000 Simulator

Why I do not use Draeger ventilator simulators

Flow mismatch: patient ventilator asynchrony associated with volume ventilation

Waveform of the week: Flow Mis-match

Decreasing Dyspnea During Mechanical Ventilation

Creating Flow Mismatch with a simulator

I know in the past I stated I did not use Draeger simulators. However this Oxylog simulator is responsive and I will be using it in a few videos. This video demonstrates that with this simulator, one can create "Flow Mismatch" a patient-ventilator asynchrony common in VC-CMV.

RELATED POST/LINKS

Oxylog 3000 Simulator

Why I do not use Draeger ventilator simulators

Flow mismatch: patient ventilator asynchrony associated with volume ventilation

Waveform of the week: Flow Mis-match

Decreasing Dyspnea During Mechanical Ventilation

A Synopsis of Strategies in Difficult Intra-Operative Ventilation

Image from: http://www.esicm.org

“Strategies in Difficult Intra-Operative Ventilation” was a continuing education course originally presented at the 2012 American Academy of Anesthesiologist convention. 

Now the course is available online through the ASA website for continuing education units. I would not recommend this course for the ICU practitioner because it overviews strategies that we practice daily or weekly, however for the anesthesia provider that is not familiar with lung protective strategies the course may be beneficial. 

Below is a synopsis of the course and a hyperlink to the website. 

Whats in your pockets? Are you a Prepper or Macgyver?

In a previous post (The RT Hoarder) I mention that I carry very little on me when I'm at work. 

Yes, I believe in being prepared, however I try to practice the "Macgyver" philosophy [1], versus the "Dooms Day Prepper" mentality [2].

This post presents my Everyday Carry (EDC) [3] from when I first started in the field of respiratory therapy to what I carry now. I will describe "what is in my pockets" and why, also notice the progression throughout the years.

What items do I get rid of & what do I always need to practice the profession?

EDC as a RT student & new graduate.

Waveform of the Week

Waveform of the week 

I posted a patient ventilator asynchrony case on the GMEP Media Gallery.

Here is the link for viewing:

https://gmep.org/media/14733

Os Gráficos do Ventilador

Os Gráficos do Ventilador

Identificando a Assincronia Paciente-Ventilador e Otimizando as Definições 

AMAZON KINDLE

http://www.amazon.com/Ventilador-Identificando-Assincronia-Paciente-Ventilador-ebook/dp/B00CPBHZUU/ref=sr_1_1?s=books&ie=UTF8&qid=1368070803&sr=1-1

Dead Falls, Trip Wires, and Ventilator Settings

As many may not know I grew up in the Midwest and was raised on the principles of self-reliance and the respect for nature. I was taught how to hunt, fish, trap, forge, and grow one’s own vegetables. Our family even attempted to save enough food for a year, preparation for hard times or a catastrophic event (most likely a tornado).

Volume-Control to Pressure Control

Image 1: The Settings of VC-CMV. The settings highlighted in yellow are associated with patient-ventilator asynchrony. 

VC-CMV is likely the most utilized mode of mechanical ventilation. This is due to a few a reasons:

     1. VC-CMV is a standard mode on almost every intensive care ventilator (table 1).

     2. VC-CMV is one of the first modes of mechanical ventilation.

     3. VC-CMV is easy to understand in both theory and operation.

     4. VC-CMV is the standard of care when ventilating patients with Acute Respiratory Distress

          Syndrome (ARDS) and Acute Lung Injury (ALI).

Vent Graphics Contest WINNERS

First, I would like to thank all my readers who entered the "Vent Graphics Contest" , I appreciate all of the efforts.

First Prize

John Priest

Equipment Used: Epiphan 

Image 1 & 2: Preventing auto-triggering.

Capture the Flag: Vent Graphics Contest

http://www.youtube.com/user/devinsupertramp

I have many people ask how I create and capture videos of ventilator waveforms. In this post I will describe  my techniques and introduce a ventilator screen capture contest for my new book Ventilator Graphics: Identifying Patient Ventilator Asynchrony & Optimizing Settings (2nd Ed).

Here are the contest prizes:

1. iTunes gift card ($50), free copy of the new book ($9.99), your screen shot will be used in the new book.
2. iTunes gift card ($25) free copy of the new book ($9.99), your screen shot will be used in the new book.
3. iTunes gift card ($10) free copy of the new book ($9.99), your screen shot will be used in the new book.

The Importance of Identifying Patient Ventilator Asynchrony

There are many factors that increase the risks for prolonged mechanical ventilation (PMV). So It is imperative that the practitioner is able to identify factors that they can proactively emend.

One factor associated with PMV is inappropriate ventilator settings. The below abstract reinforces how ventilator asynchrony increases the likelihood of  PMV. 

Quantifying Patient Ventilator Asynchrony

SERVO-i Ventilator screen. Using NAVA monitoring & captured screen shots to quantify patient ventilator asynchrony.

Patient ventilator asynchrony is present in the majority of ventilated patients [1].

One of the most difficult components of patient ventilator assessment is actually recognizing asynchrony. Authors of the following study “Efficacy of ventilator waveforms observation in detecting patient–ventilator asynchrony” ‘[2] demonstrate how challenging identifying asynchrony is, even for the seasoned physician.

"It's a Nail"



“Spoils of War” by Andy Ihnatko 2009.

 A colleague of mine described a presentation she attended today in which the speaker was describing the usefulness of the “Dynamic Lung” and how there was no use for those squiggly little lines (referring to ventilators waveforms).

Is this guy serious?

Waveform of the Week: “Golden Moment”

Image 1: Screen of the FLOWi anesthesia delivery system, showing the "Golden Moment" highlighted with blue circle.

It has been over a year since writing a waveform of the week post; however I have incorporated ventilator waveform pictures in recent posts. The waveform for this week is termed the “Golden Moment”

Decreasing Dyspnea during Mechanical Ventilation

Flow Mismatch Associated with VC-CMV

Utilizing Volume Control-Continuous Mandatory Ventilation (VC-CMV) may lead to patient ventilator asynchrony [1] and dyspnea. The main reason for these issues is the fixed (constant) flow rate associated with VC-CMV.

Ventilator Graphics: Identifying Patient Ventilator Asynchrony and Optimizing Settings

NOW AVAILABLE on Kindle

The Intrinsic Diaphragmatic Frequency

Image 1: Missed trigger attempts, notice the flow distortions (purple flow waveform) without associated breaths. Ventilator measured rate 12 bpm, however true intrinsic rate 30 bpm. 

Many patients receiving mechanical have high intrinsic diaphragmatic rates (≥30 breaths per minute) even when very well assisted [1]. This is usually unnoticed because the ventilator only measures machine or patient triggered breaths; however the patient’s true respiratory rate may be higher. This can be problematic when performing a spontaneous breathing trial (SBT) for a couple of reasons.