Mechanical Ventilation in COPD patients - PowerPoint PPT Presentation

mechanical ventilation in copd patients n.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
Mechanical Ventilation in COPD patients PowerPoint Presentation
Download Presentation
Mechanical Ventilation in COPD patients

play fullscreen
1 / 86
Mechanical Ventilation in COPD patients
605 Views
Download Presentation
sol
Download Presentation

Mechanical Ventilation in COPD patients

- - - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript

  1. Mechanical Ventilation in COPD patients Theodoros Vassilakopoulos Critical Care Department University of Athens Medical School Athens, Greece

  2. Outline • Pathophysiology • Non invasive ventilation during exacerbations to avoid intubation • Controlled mechanical ventilation • Partial support ventilation • Ventilator triggering • Wasted efforts • Weaning • Non Invasive Ventilation after weaning • Spontaneous breathing trial failure • Post extubation

  3. Pathophysiology Barnes, P. J. N Engl J Med 2000;343:269-280

  4. Flow Limitation Hyperinflation

  5. Trapped gas Tidal breathing in COPD IRV IRV VT VT Normal COPD ERV ERV

  6. Static Hyperinflation Dynamic Hyperinflation Gas Trapping in resting conditions Hyperinflation Normal IRV IC TLC VT ERV FRC RV Gas Trapping due to exercise

  7. Φυσιολογική αναπνοή

  8. Αναπνοή στη ΧΑΠ

  9. 600 ml 600 ml PEEPi

  10. Flow Pes W elastic P-V curve W resistive reduction bronchial caliber W PEEPi

  11. Decreased zoneApposition Lower rib retraction

  12. Length Tension Relationship: Diaphragmatic Weakness

  13. Imbalance Load / Neuromuscular Capacity Vassilakopoulos T et al Eur Respir J 1996;9:2383-2400

  14. Non-invasive ventilation during exacerbations to avoid intubation

  15. Intubation rate in patients with acute exacerbation of COPD treated with and without NIPPV % of patients n=16 n=15 n=43 n=42

  16. NIV in acute hypercapnic respiratory failure Celikel T et al, Chest 1998;114:1636-42

  17. Hospital stay (days) of patients with acute exacerbation of COPD treated with and without NIPPV * Brochard et al. NEJM 1995;333:817

  18. In-hospital mortality (%) in patients with acute exacerbation of COPD treated with and without NIPPV % of patients n=30 n=30 n=43 n=42

  19. Early use of NIPPV for acute exacerbation of COPD on general wards % of patients n=118 n=118 n=118 n=118 Plant et al. Lancet 2000;355:1931

  20. When is NIV successful? Nava et al Intensive Care Med 2006;32:361-70

  21. Controlled mechanical ventilation

  22. Low frequency diaphragmatic fatigue takes time to recover Laghi F et al J Appl Physiol 1995; 500:193-204

  23. End expiratory flow Slope increase Dynamic hyperinflation Flow (l/sec) Over-distension Pressure (cmH2O) Time (sec)

  24. Assessment of mechanics V’ Ppeak Pplateau PEEPi End expiratory occlusion Rrs = (Ppeak-Pplateau)/V’

  25. Reduce f Reduce VT Increaseinspiratory flow to prolong TE Hemodynamic compromise Overdistension with risk of barotrauma When PEEPi is present during CMV

  26. Partial Support Modes

  27. Ventilator triggering

  28. Ptr

  29. Parthasarathy S, AJRCCM 2000;160:546-552

  30. Aslanian P, AJRCCM 1998;157:135-43

  31. Pressure vs Flow triggering during ACV Aslanian P, AJRCCM 1998;157:135-43

  32. Partitioning of pressure time product during flow and pressure triggering Assist control Pressure Support Aslanian P, AJRCCM 1998;157:135-43

  33. Pressure vs Flow triggering with different ventilators Aslanian P, AJRCCM 1998;157:135-43

  34. Pressure versus Flow Triggering • The effort required varies with the Ventilator • Flow triggering may require slightly less effort than pressure triggering • Any difference recorded is of minor clinical significance Tutuncu A, CCM 1997;25:756-60 Aslanian P, AJRCCM 1998;157:135-43 Goulet R, Chest 1997;111:1649-53 Giuliani R, AJRCCM 1995;151:1-9

  35. Effect of change in PS level Yamada Y, J Appl Physiol 1999;160:1766-70

  36. Patient effort during triggering Tobin M, AJRCCM 2001;163:1059-1063

  37. Ineffective efforts

  38. Flow (l/sec) Paw (cmH2O) 5 sec Time (sec) Fr = 12 b/min

  39. Flow (l/sec) Paw (cmH2O) Pes (cmH2O) 5 sec Time (sec) Fr = 33 b/min Georgopoulos D

  40. Characteristics of preceding breaths PEEPi VT TE Leung P, AJRCCM 1997;155:1940-8