Assincronias: Como abordar.
Interpretação das curvas
CARMEN SILVIA VALENTE BARBAS
Marini JJ, Smith TC, Lambi VJ. External work output and force generation during syncronized
intermitent mechanical ventilation. Effect of machine assistance on breathing effort .
Am Rev Respir Dis 1988; 138: 1169-1179.
Sassoon CSH. Intermitent Mandatory Ventilation.in Principles and Practice
of Mechanical Ventilation,Mc Graw Hill, 1994: 221-238.
Improved efficacy of spontaneous breathing with inspiratory
pressure support.
Brochard L, Pluskwa F, Lemaire F.
Am Rev Respir Dis 1987, 136: 411-5.
Barbas CSV, Amato MBP, Rodrigues Jr M. Técnicas de Assistência Ventilatória em
CONDUTAS NO PACIENTE GRAVE, 1998:321-352.
Inspiratory Pressure Support prevents diaphragmatic fatigue
during weaning from mechanical ventilation
Brochard L, Harf A, Lorino H, Lemaire F.
Am Rev Respir Dis 1989, 139: 513-21.
Inspiratory Pressure Support Compensates for the Additional
Work of breathing Caused by Endotracheal Tube.
Brochard L, Rua F, Lorino H, Lorino H, Lemaire F, Harf A.
Anesthesiology, 1991: 739-74.
PRESSÃO SUPORTE:
Palv
PERSPECTIVAS
Palv
Ciclagem
(Fluxo)
Controle : Pressão
Ciclagem
(Fluxo)
Controle : Pressão
Inclinação
Ciclagem
UTI-RESPIRATÓRIA HC- FMUSP, 1991.
Amato MBP, Barbas CSV, Bonassa J; Saldiva PHN; Zin WA; Carvalho CRR Volume-assured pressure
support ventilation (VAPSV). A new approach for reducing muscle workload during acute respiratory
failure. Chest - 01-Oct-1992; 102(4): 1225-34
VAPSV:
ventilação
de
com
suporte
garantido:
combina
ciclada
e
a
volume
ventilação que
a
suporte
e
pressão
pressão
de
ventilação
volume
num
mesmo ciclo respiratório.
Amato MBP, Barbas CSV, Bonassa J; Saldiva PHN; Zin WA; Carvalho CRR Volume-assured
pressure support ventilation (VAPSV). A new approach for reducing muscle workload
during
acute
respiratory
failure.
Chest
01-Oct-1992;
102(4):
1225-34
Amato MBP, Barbas CSV, Bonassa J; Saldiva PHN; Zin WA; Carvalho CRR
Volume-assured pressure support ventilation (VAPSV). A new approach for reducing muscle workload
during acute respiratory failure. Chest - 01-Oct-1992; 102(4): 1225-34
Amato MBP, Barbas CSV, Bonassa J; Saldiva PHN; Zin WA; Carvalho CRR . Volume-assured pressure
support ventilation (VAPSV). A new approach for reducing muscle workload during acute respiratory
failure. Chest - 01-Oct-1992; 102(4): 1225-34
CLOSED-LOOP CONTROL MECHANICAL VENTILATION
DUAL CONTROL MODES
COMBINING VOLUME AND PRESSURE BREATHS
Branson RD, Davis Jr K.
Respir Care Clin N Am - 01-Sep-2001; 7(3): 397-408.
Controle de pressão e volume
em alça fechada durante o
Mesmo ciclo respiratório:
VAPSV: BIRD 8400
T-BIRD
PA: Bear 1000.
Controle de pressão e volume em alça fechada
durante o mesmo ciclo respiratório:
VAPS:
BIRD 8400 e T-BIRD
PRESSURE
AUGMENTATION:
BEAR 1000
PATIENT-VENTILATOR ASYNCHRONY:
1. INEFFECTIVE TRIGGERING (90%)
2. AUTOTRIGGERING
3. DOUBLE TRIGGERING
4. PREMATURE CYCLE
5. DELAYED CYCLING
NAVA:
É UM
NOVO MODO
VENTILATÓRIO
AJUSTADO
ATRAVÉS
DO DRIVE
NEURAL.
NAVA:
NAVA VENTILATION-REVIEW
Minerva Anesthesiol, 2010, 346-52.
Caso 2: Paciente de 76 anos, tabagista grave ,
DPOC grave , obstrução grave, Auto-PEEP
de 15 cmH20 Dessincronização na PSV
Proportional assist ventilation is a mode of partial
ventilatory support in which the ventilator applies
pressure in proportion to the patient’s
inspiratory effort
% PAV-PLUS
5 to 95%
And in proportion to the patients respiratory
mechanics (compliance and resistance)
PAV-PLUS
In the PS group, from a total of 696 measurements, 95 (13.6%) revealed a
difference between patients’ breathing frequency and ventilator rate.
In the PAV+ group, from a total of 744 measurements, 21 (2.8%) revealed
a difference between patients’ breathing frequency and ventilator rate .
Ventilator rate (cycles/min)
PS (696 measurements)
PAV (744measurements)
50
50
40
40
30
30
20
20
10
10
0
0
0
10
20
30
40
50
0
10
20
30
40
50
Patients breathing frequency (breaths/min)
Xirouchaki et al. Intensive Care Med 2008
Assincronias: Como abordar.
Interpretação das curvas
CARMEN SILVIA VALENTE BARBAS