Why Isn't The Patient Breathing Up? (Triggering)

Описание: Is there anything more frustrating in the ICU when you decide to start weaning a patient - they look like they're assisting the ventilator. You switch them over to a "spontaneous" mode and then......nothing.....no breaths....eventually the backup starts. This tutorial is about triggering of mechanical ventilation. I will revisit how patients trigger the ventilator, the different systems used and introduce I-Sync - a new method of triggering. Finally I will discuss the problem of Auto-PEEP and explain why, in the setting of Auto-PEEP, there is no point fiddling with the flow by or negative pressure. I guarantee you will learn something. @ccmtutorials www.ccmtutorials.org
Contents:
00:10 Introduction
00:45 Clinical Scenario
01:40 The Patient Seems to Be Assisting, But Won’t Trigger on Pressure Support
02:50 Asynchrony vs Dysynchrony
04:00 Undertriggering (on flow-by)
04:40 Flow Triggering Explained
07:10 How Much Gas Needs To Be Moved in Flow-By
09:20 Flow triggering (Vsens) in Puritan Bennett Ventilators
10:50 Flow Triggering in Patients With Rapid Shallow Breathing
12:30 Undertriggering
13:25 Negative Pressure Triggering
16:15 IE Sync Triggering
19:30 Auto-PEEP and Failure to Trigger
24:18 Review of Tutorial