Lung Mechanics Beyond Basics

Lluís Blanch M.D., Ph.D. Consultant Critical Care Scientific Director Corporació Parc Taulí Universitat Autónoma de Barcelona Sabadell, Spain. Cairo 3 - 4 February 2010 Lung Mechanics Beyond Basics 10th Pulmonary Medicine Update Course

Equation of motion

Time VCV. Effects of an End-Inspiratory Occlusion

Effect of Increasing Elastance during CF.VCV Change in the Slope of P ao (t) Curve

Lucangelo U, Bernabè F, and Blanch L. Resp Care 2005; 50 : 55-65 Time course of Airway Pressure During Constant-Flow Inflation

Albaiceta GM, Blanch L, Lucangelo U. Current Opinion in Crtical Care 2008 (in press) Human ARDS

VT PEEP Obese patient Stroke + Moderate ALI

Static P-V Curves at Different PEEP FRC  V inducedby PEEP Recruited lung volume Nil recruitment at PEEP 20 Closing pressure

Maggiore S et al. AJRCCM 2001; 164: 795-801

Galileo Ventilator's Built-in PV Tool-2 Piacentini E, Wysocki M, Blanch L. Intensive Care Med 2009. Paw (cmH 2 O) Vol (ml)  2  1  3  4 Pressure/Time Ramp 3 cmH2O/s Pressure/Time Ramp 5 cmH2O/s

Nahum A. Yearbook in Intensive Care Medicine. 1995. Dynamic P-V Curves at Different Flows & Equal Tidal Volume

Inspiratory P-V Curves in ARDS Patients with Different CT Patterns Rouby et al. Intensive Care Med 2000;26:1046 Lobar Diffuse Patchy

Effect of Increasing Resistance during CF.VCV Upward Shift in the P ao (t) Curve

Airway Pressure Tracheal Pressure

Blanch L et al. Am J Respir Crit Care Med 1995;151:A328 Partitioning of Rrs in Patients (CF.VCV)

Alveolar Heterogeneity during Histamine Challenge AutoPEEP: Pendelluft Effect Romero P, Lopez J, Blanch L. Pulmonary mechanics beyond peripheral airways. In: Milic_Emili J, ed. Applied Physiology in Respiratory Mechanics. Springer 1997; p.190-210.

Air Trapping Inspiration Expiration Time (sec) Flow (L/min) } Normal Patient Air Trapping Auto-PEEP

Before Time (sec) Flow (L/min) PEFR After Long T E Higher PEFR Shorter T E Response to Bronchodilator Rajiv Dhand. Respiratory Care 2005 (February). Vol 50. Nº 2.

AutoPEEP Generation: Lengthen Ti at equal Ttot (Airflow decreased for a similar VT) Blanch L, Bernabe F, Lucangelo U. Respir Care 2005;50:110-123 AutoPEEP Time (s) Airflow (L/s)

Lucangelo U, Bernabè F, and Blanch L. Resp Care 2005; 50 : 55-65 Progressive increase of inspiratory pause during VCV

INTRINSIC PEEP (PEEP i ) in static and dynamic conditions Flow (l/s) 0 Dynamic PEEPi (4cm H20) Tracheal Pressure (cmH 2 O) 0 1 10 2 0 30 Static PEEPi (8 cmH20) END EXPIRATORY OCCLUSION

Respir Care 2005;50(1):110-123

Leatherman JW et al. Crit Care Med 1996; 24:541-546 Expiratory Airway Occlusion in Asthma Measured AutoPEEP = 5 cmH 2 O 5

Mechanisms of Auto PEEP Generation

Vieillard-Baron A et al. Crit Care Med 2002; 30:1407-12 Increasing Respiratory Rate in ARDS

AJRCCM 2000;161:1590-6

PEEP & AutoPEEP in COPD Patients Blanch L, Fernandez R. In: Mancebo J, Brochard L, eds. Arnette 1996; 329-345.

Ventilator Waveforms at the Bedside
Displays of pressure, flow and volume, and derived loops are available in the majority of modern ventilators.
Ventilator waveforms are important to understand basic respiratory pathophysiology, and play a role in treatment decisions in patients receiving mechanical ventilation.

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Lung Mechanics Beyond Basics

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