1 / 31

VIASYS HEALTHCARE INTERNATIONAL

VIASYS HEALTHCARE INTERNATIONAL. Oslo, November 2006 High Frequency Oscillation. SensorMedics 3100. High Frequency Ventilation Modes:. HFPPV : High Frequency Positive Pressure Ventilation HFFI : High Frequency Flow Interruption HFJV : High Frequency Jet Ventilation

fuller
Télécharger la présentation

VIASYS HEALTHCARE INTERNATIONAL

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. VIASYS HEALTHCARE INTERNATIONAL

  2. Oslo, November 2006High Frequency Oscillation SensorMedics 3100

  3. High Frequency Ventilation Modes: • HFPPV : High Frequency Positive Pressure Ventilation • HFFI : High Frequency Flow Interruption • HFJV : High Frequency Jet Ventilation • HFOV : High Frequency Oscillating Ventilation

  4. Pig model 3 kg with RDS PCV PEEP : 7 cm H2O MAP : 15 cm H2O PIP : 24 cm H2O Zoneof Overdistention Injury “Safe” Window Volume Zone of Derecruitment and Atelectasis Injury Pressure Pulmonary Injury Sequence • There are two injury zones during mechanical ventilation • Low Lung Volume Ventilation tears adhesive surfaces • High Lung Volume Ventilation over-distends, resulting in “Volutrauma” • The difficulty is finding the “Sweet Spot” Froese AB, Crit Care Med 1997; 25:906

  5. Sensormedics 3100A HFO Ventilator 2 Principles: 1) Oxygenation (O2) CPAP 2) Ventilation (CO2) Oscillation

  6. Principle 1: CDP Adjust Valve ET Tube Oscillator Patient BIAS Flow Increase Lungvolume with a “super CPAP system”

  7. Optimized Lung Volume Strategy: CT Scan : RDS pig model 3 kg Continuous Distending Pressure 5 cm H2O

  8. Optimized Lung Volume Strategy: CT Scan : RDS pig model 3 kg Continuous Distending Pressure 12 cm H2O

  9. Optimized Lung Volume Strategy: CT Scan : RDS pig model 3 kg Continuous Distending Pressure 20 cm H2O

  10. CT 2 CT 1 CT 3 • CDP = • Lung Volume Paw = CDP Continuous Distending Pressure

  11. Oxygenation-Pressure Curve

  12. Expiration = ACTIVE No Airtrapping Disconnection Oxygenation from Ventilation Principle 2: CDP Adjust Valve ET Tube Oscillator Patient BIAS Flow Decrease TV’s to physiological dead space and increase frequency (0.1 – 2ml/Kg)

  13. + + - - + + Amplitude CDP/Lung volume CDP/Lung volume - -

  14. Optimized Lung Volume Strategy: • 2.) Decrease Tidal Volumes to less or equal then dead space • and increase frequency ! Benefits: - enhanced gas exchange doe to combined gas transport mechanisms - no excessive volume swings - reduced regional overinflation and stretching - reduced Volutrauma

  15. GAS EXCHANGE IN HFOV: 1.)Convection (Bulk Flow) Ventilation 2.) Asymetrical Velocity Profile 3.) Taylor Dispersion 4.) Molecular Diffusion 5.) Pendelluft 6.) Cardiogenic Mixing

  16. SUGGESTED READING : • Chang HK. Mechanisms of gas transport during ventilation by HFOV, Brief Review, J Appl Physiol, 1994 • Schindler M, et al. Effect of Lung Mechanics on Gas Transport During HFO. Pediatric Pulmonology, 1991

  17. Pressure transmission CMV / HFOV : • Distal amplitude measurements with alveolar capsules in animals, demonstrate it to be greatly reduced or “attenuated” as the pressure traverses through the airways. • Due to the attenuation of the pressure wave, by the time it reaches the alveolar region, it is reduced down to .1 - 5 cmH2O. Gerstman et al

  18. I + + + Amlitude Delta P = TV = Ventilation + + + CDP = Lungvolume = Oxygenation + + + + _ _ _ _ _ _ _ _ _ E Airway Pressure Transmission HFOV : Pressure ET Tube Trachea Alveolus Transmission

  19. HFOV Principle:Pressure curves CMV / HFOV Injury Injury

  20. CMV Stable Aveoli

  21. CMV Instable Aveoli versus HFOV Carney et al. Crit Care Med 2005;33:S122-S128

  22. CMV Instable Aveoli versus HFOV - 2

  23. Dynamic Multiscan CT: Method airway pressure CT-acquisition time

  24. After lavage, Step up

  25. After lavage, Step down

  26. Dynamic Multiscan CT: Results

  27. D Pressure (Amplitude) controls CO2 CDP controls O2

  28. CLINICAL APPLICATIONS • Neonatal • Prematurity / RDS • Surfactant Distribution • PPHN • Pneumonia's • Meconium Aspirations • Blood Aspirations • Hypoplasias • CDH • Pulmonary Hypoplasia • > 24 hrs. > 40 % FiO2 • Neonatal Airleaks • PIE • Pneumothoraces • Pneumomediastinum • Pneumoperitoneum

  29. Pulmonary Injury Sequence: • If we cannot prevent the injury sequence , then the • target goal is to interrupt the sequence of events ! • High Frequency Oscillation does not reverse injury, • but will interrupt the progression of injury

  30. HFOV effectively decouples:Oxygenation & Ventilation

  31. 3100 A HFOV Resume: • Less Oxygen exposure: • Stable lung inflation • Recruitment of alveolar space • Improved matching V/Q • Reduction of Volutrauma: • No conventional breaths • Less Volume swings • No high peak pressures • Active Exhalation • Reduces Airtrapping • Reduces Airway stretch • Sufficient Humidification • less risk NTB HFOV effectively decouples Oxygenation and Ventilation

More Related