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MECHANICAL VENTILATION
AND LOW FLOW ECCO2R
Jonckheer Joop
I
INTRODUCTION
11-10-2019
Mechanical ventilation and ECCO2R
2
Goals of mechanical “ventilation”
Ventilation:
CO2
MV = TV x...
I
INTRODUCTION
11-10-2019
Mechanical ventilation and ECCO2R
3
Mechanical power & Toxicity O2
Atelectotrauma
Volumotrauma
B...
I
MECHANICAL VENTILATION
Pplat < 30
TV 6ml/kg
VS
Pplat <50
TV 12 ml/kg
11-10-2019
Mechanical ventilation and ECCO2R
4
Baro...
I
MECHANICAL VENTILATION
11-10-2019
Mechanical ventilation and ECCO2R
5
Respiratory rate ???
I
MECHANICAL VENTILATION
11-10-2019
Mechanical ventilation and ECCO2R
6
Volumotrauma
I
MECHANICAL VENTILATION
11-10-2019
Mechanical ventilation and ECCO2R
7
oxygenation
I
MECHANICAL VENTILATION
11-10-2019
Mechanical ventilation and ECCO2R
8
oxygenation
I
VOLUME VS PRESSURE CONTROL VENTILATION?
11-10-2019
Mechanical ventilation and ECCO2R
9
Volume Pressure
I
VOLUME VS PRESSURE CONTROL VENTILATION?
11-10-2019
Mechanical ventilation and ECCO2R
10
Volume Pressure
I
PRONING
11-10-2019
Mechanical ventilation and ECCO2R
11
I
MECHANICAL VENTILATION
11-10-2019
Mechanical ventilation and ECCO2R
12
Conclusion on limits
Δ P< 15
TV 0.6 ml/kg
Pplat< ...
I
ECCO2R SYSTEMS
11-10-2019
Mechanical ventilation and ECCO2R
13
I11-10-2019
Mechanical ventilation and ECCO2R
14
I
N=
11-10-2019
Mechanical ventilation and ECCO2R
15
N=95
SAE: 6
ECCO2R-SAE: 2
ECCO2R-AE: 39%
AIM:
I11-10-2019
Mechanical ventilation and ECCO2R
16
I11-10-2019
Mechanical ventilation and ECCO2R
17
I
INDICATION ECCO2R
11-10-2019
Mechanical ventilation and ECCO2R
18
Case series and case reports…
Further evidence is need...
I
ECCO2R SYSTEMS
11-10-2019
Mechanical ventilation and ECCO2R
19
I
ECCO2R
Does it really give less complications than vv-ECMO ???
Pro:
- Smaller cannulas ? => smaller holes
- Low flow => ...
I11-10-2019
Mechanical ventilation and ECCO2R
21
flow
I
CITRATE ANTICOAGULATION
11-10-2019 22
41 32
CO2 in effluent
( ml/min)
24 ± 5 38 ± 12 23 ± 5 NA
True REE (Kcal /day) 1935...
I
ANALOGY EVOLUTION CRRT
11-10-2019
Mechanical ventilation and ECCO2R
23
Veno-venous
I
CO2 REMOVAL ?
11-10-2019
Mechanical ventilation and ECCO2R
24
THANK YOU
Tel: 0032498638164
E-mail: Joop.jonckheer@uzbrussel.be
@joopjonckheer
www.ricula.be
I
PRESSURE RELEASE VENTILATION VS
PRESSURE ASSISTED VENTILATION DURING ARDS
11-10-2019
Mechanical ventilation and ECCO2R
26
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9. mechanical ventilation during ecmo and eccor techniques #beach2019 (jonckheer) Slide 1 9. mechanical ventilation during ecmo and eccor techniques #beach2019 (jonckheer) Slide 2 9. mechanical ventilation during ecmo and eccor techniques #beach2019 (jonckheer) Slide 3 9. mechanical ventilation during ecmo and eccor techniques #beach2019 (jonckheer) Slide 4 9. mechanical ventilation during ecmo and eccor techniques #beach2019 (jonckheer) Slide 5 9. mechanical ventilation during ecmo and eccor techniques #beach2019 (jonckheer) Slide 6 9. mechanical ventilation during ecmo and eccor techniques #beach2019 (jonckheer) Slide 7 9. mechanical ventilation during ecmo and eccor techniques #beach2019 (jonckheer) Slide 8 9. mechanical ventilation during ecmo and eccor techniques #beach2019 (jonckheer) Slide 9 9. mechanical ventilation during ecmo and eccor techniques #beach2019 (jonckheer) Slide 10 9. mechanical ventilation during ecmo and eccor techniques #beach2019 (jonckheer) Slide 11 9. mechanical ventilation during ecmo and eccor techniques #beach2019 (jonckheer) Slide 12 9. mechanical ventilation during ecmo and eccor techniques #beach2019 (jonckheer) Slide 13 9. mechanical ventilation during ecmo and eccor techniques #beach2019 (jonckheer) Slide 14 9. mechanical ventilation during ecmo and eccor techniques #beach2019 (jonckheer) Slide 15 9. mechanical ventilation during ecmo and eccor techniques #beach2019 (jonckheer) Slide 16 9. mechanical ventilation during ecmo and eccor techniques #beach2019 (jonckheer) Slide 17 9. mechanical ventilation during ecmo and eccor techniques #beach2019 (jonckheer) Slide 18 9. mechanical ventilation during ecmo and eccor techniques #beach2019 (jonckheer) Slide 19 9. mechanical ventilation during ecmo and eccor techniques #beach2019 (jonckheer) Slide 20 9. mechanical ventilation during ecmo and eccor techniques #beach2019 (jonckheer) Slide 21 9. mechanical ventilation during ecmo and eccor techniques #beach2019 (jonckheer) Slide 22 9. mechanical ventilation during ecmo and eccor techniques #beach2019 (jonckheer) Slide 23 9. mechanical ventilation during ecmo and eccor techniques #beach2019 (jonckheer) Slide 24 9. mechanical ventilation during ecmo and eccor techniques #beach2019 (jonckheer) Slide 25 9. mechanical ventilation during ecmo and eccor techniques #beach2019 (jonckheer) Slide 26
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This workshop will outline the basic principles of extracorporeal life support made easy by key-experts in the field. During the course delegates will gain a good understanding of ECMO in the following areas: Theoretical concepts, basic physiology and pathophysiology, cardiac and respiratory support and monitoring, alarm settings and monitoring, role of cardiac ultrasound during ECMO, newest technologies, circuits and devices, practical hands-on sessions and simulations.

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9. mechanical ventilation during ecmo and eccor techniques #beach2019 (jonckheer)

  1. 1. MECHANICAL VENTILATION AND LOW FLOW ECCO2R Jonckheer Joop
  2. 2. I INTRODUCTION 11-10-2019 Mechanical ventilation and ECCO2R 2 Goals of mechanical “ventilation” Ventilation: CO2 MV = TV x f Oxygenation O2 PEEP & FiO2 I/E
  3. 3. I INTRODUCTION 11-10-2019 Mechanical ventilation and ECCO2R 3 Mechanical power & Toxicity O2 Atelectotrauma Volumotrauma Barotrauma CO2 O2
  4. 4. I MECHANICAL VENTILATION Pplat < 30 TV 6ml/kg VS Pplat <50 TV 12 ml/kg 11-10-2019 Mechanical ventilation and ECCO2R 4 Barotrauma & Volumotrauma
  5. 5. I MECHANICAL VENTILATION 11-10-2019 Mechanical ventilation and ECCO2R 5 Respiratory rate ???
  6. 6. I MECHANICAL VENTILATION 11-10-2019 Mechanical ventilation and ECCO2R 6 Volumotrauma
  7. 7. I MECHANICAL VENTILATION 11-10-2019 Mechanical ventilation and ECCO2R 7 oxygenation
  8. 8. I MECHANICAL VENTILATION 11-10-2019 Mechanical ventilation and ECCO2R 8 oxygenation
  9. 9. I VOLUME VS PRESSURE CONTROL VENTILATION? 11-10-2019 Mechanical ventilation and ECCO2R 9 Volume Pressure
  10. 10. I VOLUME VS PRESSURE CONTROL VENTILATION? 11-10-2019 Mechanical ventilation and ECCO2R 10 Volume Pressure
  11. 11. I PRONING 11-10-2019 Mechanical ventilation and ECCO2R 11
  12. 12. I MECHANICAL VENTILATION 11-10-2019 Mechanical ventilation and ECCO2R 12 Conclusion on limits Δ P< 15 TV 0.6 ml/kg Pplat< 30 cmH2O RR ??? FiO2 < 60% PEEP ↑ CO2
  13. 13. I ECCO2R SYSTEMS 11-10-2019 Mechanical ventilation and ECCO2R 13
  14. 14. I11-10-2019 Mechanical ventilation and ECCO2R 14
  15. 15. I N= 11-10-2019 Mechanical ventilation and ECCO2R 15 N=95 SAE: 6 ECCO2R-SAE: 2 ECCO2R-AE: 39% AIM:
  16. 16. I11-10-2019 Mechanical ventilation and ECCO2R 16
  17. 17. I11-10-2019 Mechanical ventilation and ECCO2R 17
  18. 18. I INDICATION ECCO2R 11-10-2019 Mechanical ventilation and ECCO2R 18 Case series and case reports… Further evidence is needed
  19. 19. I ECCO2R SYSTEMS 11-10-2019 Mechanical ventilation and ECCO2R 19
  20. 20. I ECCO2R Does it really give less complications than vv-ECMO ??? Pro: - Smaller cannulas ? => smaller holes - Low flow => lesser “tear” trauma on RBC ? ( theoretical) Con: - Smaller cannulas => lower flow? More thrombosis - Low flow => needs anticoagulation. 11-10-2019 Mechanical ventilation and ECCO2R 20
  21. 21. I11-10-2019 Mechanical ventilation and ECCO2R 21 flow
  22. 22. I CITRATE ANTICOAGULATION 11-10-2019 22 41 32 CO2 in effluent ( ml/min) 24 ± 5 38 ± 12 23 ± 5 NA True REE (Kcal /day) 1935 ± 921 1723 ± 752 1604 ± 633 1713 ± 704 * 0,65 * 0,014 * 0,193 + Mechanical ventilation and ECCO2R
  23. 23. I ANALOGY EVOLUTION CRRT 11-10-2019 Mechanical ventilation and ECCO2R 23 Veno-venous
  24. 24. I CO2 REMOVAL ? 11-10-2019 Mechanical ventilation and ECCO2R 24
  25. 25. THANK YOU Tel: 0032498638164 E-mail: Joop.jonckheer@uzbrussel.be @joopjonckheer www.ricula.be
  26. 26. I PRESSURE RELEASE VENTILATION VS PRESSURE ASSISTED VENTILATION DURING ARDS 11-10-2019 Mechanical ventilation and ECCO2R 26
  • hungbeoicu

    Apr. 19, 2020
  • anwaryusr3

    Oct. 13, 2019
  • DwightDumay

    Oct. 13, 2019

This workshop will outline the basic principles of extracorporeal life support made easy by key-experts in the field. During the course delegates will gain a good understanding of ECMO in the following areas: Theoretical concepts, basic physiology and pathophysiology, cardiac and respiratory support and monitoring, alarm settings and monitoring, role of cardiac ultrasound during ECMO, newest technologies, circuits and devices, practical hands-on sessions and simulations.

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