Upload
akasma
View
157
Download
0
Embed Size (px)
DESCRIPTION
APRV, DuoPAP, BiPAP: Pro & Con… M Wysocki – March 2009. Plan. Definitions… Spontaneous ventilation is important… No evidences… Increasing complexity…. Definitions. L Rose, Intensive Care Med 2008. Definitions. L Rose, Intensive Care Med 2008. APRV: How it looks…. - PowerPoint PPT Presentation
Citation preview
0.
45
APRV, DuoPAP, BiPAP: Pro & Con…M Wysocki – March 2009
0.
45
Plan
• Definitions…
• Spontaneous ventilation is important…
• No evidences…
• Increasing complexity…
0.
45
Definitions
L Rose, Intensive Care Med 2008
0.
45
Definitions
L Rose, Intensive Care Med 2008
0.
45
APRV: How it looks…
0.
45
APRV… with versus without SB in pigs
Wrigge H, Anesthesiology 2003
0.
45
APRV w/o SB reduced Pigs Intestinal Blood Flow?
Hering R, Anesthesiology 2003
0
10
20
30
40
50
60
70
80
90
100
Stom
ach
Duoden
um
Jeju
num
Ileon
Colon
Inte
stin
al B
lood
Flo
w (
mL/
gr/m
in) APRV w SB
APRV w/o SB and high VT
APRV w/o SB and low VT
0.
45
APRV with SB better than PCV in polytrauma…
Putensen C, Am J Respir Crit Care Med 2001
0.
45
ASV with SB vs VC preserves diaphragmatic Funct°
Dia
ph
rag
mat
ic f
un
ctio
n
ASVVC
Duration of Mechanical Ventilation
Jung B, SRLF 2009
0.
45
APRV: Where are the clinical evidences?
• Valentine – Am Respir Resp Dis 1991: Cross Over study
• Räsänen – Crit Care Med 1991: Cross Over study
• Davis – Arch Surg 1993: Short term physiologic study
• Sydow – Am J Respir Crit Care Med 1994: Short term physiologic study
• Putensen - Am J Respir Crit Care Med 1999: Cross Over study
• Putensen - Am J Respir Crit Care Med 2001: n = 30 APRV vs PCV (cf slide before)
• Hering – Intensive Care Med 2002: Cross Over study
• Varpula – Acta Anesthesiol Scand 2003: Short term w/wo prone
• Varpula - Acta Anesthesiol Scand 2004: n = 58; SIMV vs APRV – equivalent
• Uyar – Anaesth Intensive Care 2005: n = 20: PSV vs APRV - equivalent
0.
45
APRV: how to make your life complex…
9 settings!!!
0.
45
…while it can be easier!!!
0.
45
…while it can be easier!!!
0.
45
…while it can be easier!!!
0.
45
…while it can be easier!!!
0.
45
APRV: CONCLUSIONS
• Spontaneous breathing is important…
• APRV – DuoPAP – BIPAP are:
1. Complex
2. Dangerous
3. No evidence showing the opposite…
« What’s difficult is to make things easier »