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Lung Mechanics Beyond Basics

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Presentation of Dr. Lluis Blanch at 10th Pulmonary Medicine Update Course, Cairo, Egypt. Pulmonary Medicine Update Course is organized by Scribe : www.scribeofegypt.com

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Lung Mechanics Beyond Basics

  1. 1. 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
  2. 2. Equation of motion
  3. 3. Time VCV. Effects of an End-Inspiratory Occlusion
  4. 4. Effect of Increasing Elastance during CF.VCV Change in the Slope of P ao (t) Curve
  5. 5. Lucangelo U, Bernabè F, and Blanch L. Resp Care 2005; 50 : 55-65 Time course of Airway Pressure During Constant-Flow Inflation
  6. 6. Albaiceta GM, Blanch L, Lucangelo U. Current Opinion in Crtical Care 2008 (in press) Human ARDS
  7. 7. VT PEEP Obese patient Stroke + Moderate ALI
  8. 8. Static P-V Curves at Different PEEP FRC  V inducedby PEEP Recruited lung volume Nil recruitment at PEEP 20 Closing pressure
  9. 9. Maggiore S et al. AJRCCM 2001; 164: 795-801
  10. 10. 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
  11. 11. Nahum A. Yearbook in Intensive Care Medicine. 1995. Dynamic P-V Curves at Different Flows & Equal Tidal Volume
  12. 12. Inspiratory P-V Curves in ARDS Patients with Different CT Patterns Rouby et al. Intensive Care Med 2000;26:1046 Lobar Diffuse Patchy
  13. 13. Effect of Increasing Resistance during CF.VCV Upward Shift in the P ao (t) Curve
  14. 14. Airway Pressure Tracheal Pressure
  15. 15. Blanch L et al. Am J Respir Crit Care Med 1995;151:A328 Partitioning of Rrs in Patients (CF.VCV)
  16. 16. 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.
  17. 17. Air Trapping Inspiration Expiration Time (sec) Flow (L/min) } Normal Patient Air Trapping Auto-PEEP
  18. 18. 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.
  19. 19. 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)
  20. 20. Lucangelo U, Bernabè F, and Blanch L. Resp Care 2005; 50 : 55-65 Progressive increase of inspiratory pause during VCV
  21. 21. 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
  22. 22. Respir Care 2005;50(1):110-123
  23. 23. Leatherman JW et al. Crit Care Med 1996; 24:541-546 Expiratory Airway Occlusion in Asthma Measured AutoPEEP = 5 cmH 2 O 5
  24. 24. Mechanisms of Auto PEEP Generation
  25. 25. Vieillard-Baron A et al. Crit Care Med 2002; 30:1407-12 Increasing Respiratory Rate in ARDS
  26. 26. AJRCCM 2000;161:1590-6
  27. 27. PEEP & AutoPEEP in COPD Patients Blanch L, Fernandez R. In: Mancebo J, Brochard L, eds. Arnette 1996; 329-345.
  28. 28. Ventilator Waveforms at the Bedside <ul><li>Displays of pressure, flow and volume, and derived loops are available in the majority of modern ventilators. </li></ul><ul><li>Ventilator waveforms are important to understand basic respiratory pathophysiology, and play a role in treatment decisions in patients receiving mechanical ventilation. </li></ul>

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