У нас вы можете посмотреть бесплатно Why Spontaneous Breathing and Synchrony Matters by L. Brochard | OPENPediatrics или скачать в максимальном доступном качестве, видео которое было загружено на ютуб. Для загрузки выберите вариант из формы ниже:
Если кнопки скачивания не
загрузились
НАЖМИТЕ ЗДЕСЬ или обновите страницу
Если возникают проблемы со скачиванием видео, пожалуйста напишите в поддержку по адресу внизу
страницы.
Спасибо за использование сервиса ClipSaver.ru
Please visit: www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open access-and thus at no expense to the user. For further information on how to enroll, please email: [email protected] Please note: OPENPediatrics does not support nor control any related videos in the sidebar, these are placed by Youtube. We apologize for any inconvenience this may cause. I think that the title is good. Because I'm going to discuss a situation where synchrony-- and I think by synchrony, we mean synchrony between the patient and the ventilator-- so a situation where synchrony is good. But it's also a situation where synchrony may be bad or harmful. So these are my conflicts of interest. We all want ventilated patients to start as early as possible having some spontaneous breathing activity. I'm not going to go into details. But we have very strong-- not only experimental but now clinical-- data showing that the diaphragm especially can very rapidly go to atrophy if it's not used. And therefore to preserve respiratory muscle function, which will be important for weaning but also for long term consequences, trying to promote spontaneous breathing as early as possible is really something which looks very important. And there are also a number of mostly experimental studies which suggest that having spontaneous breathing activity-- diaphragm activity, probably during acute lung injury or ARDS, improve VA/Q relationship. So it may improve regional ventilation by reopening some part of the lung close to the diaphragm or the respiratory muscles. And in this regard, we think that having a good vent synchrony between the patient and the ventilator is probably something important. I listed some of the clinical issues where we think that a good synchrony and poor synchrony makes a difference. I will show very briefly one example about sleep in the ICU. Synchrony may be important for respiratory muscle function. Because otherwise, the respiratory muscle may work in situations where the shortening of the muscles will not be at the same time as an increase in volume. And that may not be good for the muscle. We have a question mark about the importance of synchrony in terms of comfort and need for sedation. But it may be something. It may be playing a role there. And we have also examples where asynchrony makes more complicated the weaning assessment. Which may explain the relationship between the number of asynchrony and the duration of ventilation. And also, another important aspect is that for a lot of asynchrony, we have tools to minimize this asynchrony. So it may matter. It's associated with duration of ventilation. And it's possible to minimize. But there also other possible situations-- which I put on the other part-- where a good synchrony between the patient and the ventilator may not be desirable. Because it may simply amplify the transpulmonary pressure swings, which way harm the lung. And it may also facilitate over-assist, which is a very frequent event in the ICU. One example about sleep-- a very nice study performed by Sairam Parthasarathy and Martin Tobin. They compared, during the night, the same patient ventilated with assist-control for a few hours, versus pressure support ventilation. You have all the typical recordings of polysomnography, with EEG, the eye motion, some EMG recordings, ventilation, SpO2, and EKG. If you just look at the pressure support part, you see that when you look at the line indicating VT, that there are frequent interruptions in ventilation. And this is intermittent apnea-- episodes of apnea.