By Antonio M. Esquinas
This ebook establishes the indicators for using NIV within the context of weaning from invasive mechanical air flow. It offers a entire evaluate of key issues suitable for proper useful program, together with NIV and weaning ideas, very important points of sufferer care sooner than and after weaning, and pediatric and neonatology weaning. ultimately, the booklet summarizes foreign directions and new views of NIV in the course of weaning. With contributions via foreign specialists within the box on noninvasive mechanical air flow, the ebook will function a worthy advisor for serious care physicians, respiration physiotherapists, and pulmonologists.
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Additional info for Noninvasive Mechanical Ventilation and Difficult Weaning in Critical Care: Key Topics and Practical Approaches
Sample text
Although the Bispectral Index (BIS©, Aspect Medical Systems, Norwood, MA, USA) represents a novel method of measuring depth of sedation through the use of electroencephalography, more research is likely needed at this time before it sees routine use for this application. In addition to sedation scales, there are also various pain scales that may be employed to guide the administration of adequate analgesia, such as the Numeric Rating Scale, the Behavioral Pain Scale, the Critical Care Pain Observation Tool, and the Nonverbal Pain Scale [6].
Critical illness neuromyopathy (CINM) can manifest itself as ICU-acquired weakness and subsequent PMV, usually associated with multiple organ failure, muscle inactivity, hyperglycemia, or use of corticosteroids and neuromuscular blockers. As a result, early mobilization, minimizing the use of deep sedation and steroids, and avoidance of hyperglycemia have been advocated as effective preventive strategies during the acute phase of critical illness [7, 10]. Ventilator-induced diaphragm dysfunction constitutes a rapid form of skeletal muscle injury that may occur within only 18 h of MV [7, 11].
Repusseau and H. 1 Characteristics of studies comparing NAVA to PSV in NIV No. of Year, author patients 2008, 10 Camarota 2012, Piquilloud 13 2012, Schmidt 17 2013, Bertrand 13 Patients PSV settings Leaks ARF post extubation Helmet®, NIV algorithm, all patients: PS 12 cmH2O, PEEP 10 cmH2O, expiratory trig 50 % Oro-nasal mask, No NIV algorithm Optimized settings for each patients Oro-nasal mask, with and without NIV algorithm, All patients PEEP 4cmH2O, expiratory trig 30 % Oro-nasal mask, NIV algorithm, PEEP 5-10 cmH2O, expiratory trig 30 % NAVA 43 % PSV 5 % 5 ARF 8 prophylactic post extubation 6 COPD Prophylactic post extubation 4 COPD ARF (5 post extubation, 7 pneumonia) No COPD NAVA 15 % PSV 14 % With NIV algorithm : NAVA 26 % PSV 13 % NAVA 13 % PSV 14 % NAVA benefits Decrease Inspiratory and expiratory trig delay, AI Increase time of synchrony Decrease inspiratory trig delay, AI, ineffective effort, delayed cycling, premature cycling Decrease inspiratory trig delay, AI, delayed cycling, premature cycling Decrease inspiratory trig delay, Ti excess, ineffective effort, delayed cycling, AI ARF acute respiratory failure, COPD chronic obstructive pulmonary disease, NIV noninvasive ventilation, PSV pressure support ventilation, PEEP positive end-expiratory pressure, cmH2O centimeters of water, Trig trigger, NAVA neurally adjusted ventilatory assist, AI asynchrony index automatically adjust the flow and the inspiratory trigger.
