A method of evaluating the effectiveness of assisted ventilation

 

(57) Abstract:

The invention relates to medicine, resuscitation, and can be used to assess the effectiveness of assisted ventilation (WL). Without the cooperation of the patient record and estimate the average speed of spontaneous inspiratory flow (Fenvironments) and the instantaneous speed of spontaneous inspiratory flow (Fmgnew); depression in the respiratory tract during inhalation (NIP) and, if Ra 0.10-1,5 cm water.art., FenvironmentsFmgnewequal 0-0,5 l/min/kg (NIP equal to (-5) - 0 cm of water.art., then evaluate WL as effective, and if Ra 0.1more than 1.5 cm of water.St, Fenvironmentsand Fmgnewmore than 0.5 l/min/kg, NIP below (-5) cm water.article, appreciate WL as inefficient and conduct activities to improve its effectiveness, and 10 minutes after the execution of these activities again register the same performance (Fenvironmentsand Fmgnew, NIP, Ra 0.1) assess the effectiveness WL; these activities continue to obtaining the parameters of the Fenvironmentsand Fmgnew, NIP, Pa 0.1corresponding effective WL. This invention is a highly sensitive test for detection of respiratory failure during WWL that, in turn, sposobstvuya lungs, and the prompt restoration of spontaneous breathing at last. 1 PL.

The method relates to medicine, in particular to resuscitation, and can be used for long-term artificial lung ventilation (ALV) on transition to assisted ventilation (WL).

During prolonged mechanical ventilation before physician-intensivist is achieving the most effective for patient ventilation of the lungs.

The main criteria for the effectiveness of mechanical ventilation are:

1) compliance of metabolic gas exchange needs of a patient (lack of oxygen debt, normeinrete);

2) the stability of the system and organ hemodynamics (no negative influence of mechanical ventilation on heart, brain);

3) compliance with ventilation mechanical properties of the lung - thorax (no Baro-, volutrauma, auto-peep; the presence of a full exhalation);

4) respiratory patient comfort (no dyspnea, tachypnea, synchronization of the patient from the respirator) (Zilber, A. P., Artificial ventilation in acute respiratory failure. - M., 1978. - S. 94).

In the process of weaning patient - increases. This is because breathing comfort during WWL reflects the absence of respiratory failure (CF) patients and, conversely, the absence of respiratory comfort during WWL reflects the presence of DN. In turn, the close relationship of the NAM breathing comfort during WWL due to the fact that the auxiliary ventilation can be effectively applied only in patients with intact or recovered by the regulation of breathing.

In connection with the foregoing values characterizing NAM when vvl, can serve as performance criteria WL (Kassil C. L., Lesquin airport, S., Virigina M. A. Respiratory support. - M., 1997. - S. 198).

There is a method of detection of nephropathy in a patient during WWL under which the NAM is judged by the stability of the frequency of breathing, tidal volume, the ratio of inspiration and expiration, the maximum pressure on the breath, the heartbeat, the absence of the sensation of breathlessness in a patient (frost centuries, Vlasenko, A. C., Sachs, Acting, Mitrokhin, A. A., Galushka, S. C., Ostapchenko D. A. Monitoring of patients under conditions of mechanical ventilation //Bulletin of the int. Ter. 2002. No. 2. - C. 3-8). Based on a comprehensive analysis of the listed symptoms it is possible to judge NAM, synchronization of a patient with a respirator, the stomach is icestone standards deviations of the values of tidal volume, relations of inspiration and expiration, the maximum pressure on the breath, the heartbeat, the corresponding DN. Therefore, the conclusion of DN is given on the basis of the subjective views of the doctor about the norms of the tidal volume, the relationship of inspiration and expiration, the maximum pressure on the breath, the heart rate corresponding to the synchronization of the patient with the respirator.

2) the Presence of shortness of breath can only be determined at an adequate contact patients. To identify shortness of breath in patients with disorders of consciousness is impossible. Often the symptom of dyspnea in the ventilated patient is associated with insufficient analgo-sedation.

Shortness of breath and desynchronization of the patient with breathing during mechanical ventilation compound catabolism, promote lung (barotrauma, holding, atelectasis, pneumonia, spontaneous pneumothorax and pulmonary complications (disorders of the Central and cerebral hemodynamics) and thereby complicate the course of the critical state.

There is a method of identifying NAM during WWL based on the detection of violations of the adaptation of the patient from the respirator - identifying “non-synchronous” breathing. According to the method of analysis of the nature of the change curves of pressure and flow in the Airways Posa support. - M., 1997. - S. 190-191).

The method has the following disadvantages:

1. Not provided accurate quantitative characteristic curves of pressure and flow in the respiratory tract, the appropriate NAM during WWL. Therefore, the conclusion of the synchronization of the patient with the respirator during WWL and the absence of DN is given based on a qualitative comparison of the curves of pressure and flow in the respiratory tract of a patient with an ideal (synchronous) for WL curves or, in the absence of the curves of pressure and flow of the patient signs rasinhronizatsiey described for ventilation (Kassil C. L., Lesquin airport, S., Virigina M. A. Respiratory support. - M., 1997. - S. 190-191).

2. For implementing the method, you must have a respirator or respiratory monitor, a graphics monitor. However, the portion of serverserial able to measure spontaneous respiratory activity of the patient (vital capacity, negative pressure during inhalation, peak spontaneous inspiratory flow), for example Puritan Bennett 7200, does not allow graphical monitoring. The most intensive therapy in Russia does not currently include respiratory monitors.

Closest to the claimed AVL pressure in the first 100 MS (0.1 s) inhalation (P100, Ra 0.1) (1. Silber, A. P. Respiratory medicine. - Petrozavodsk, 1996. - S. 89-116.; 2. Silber, A. P. Shamirzaev E. K., Karakozov M. R. Influence of dormicum and anexate on the mechanics of breathing, neurosecretory drive and respiratory muscle //Bulletin of intensive therapy, 1998. The collection “Actual issues of General anesthesia and sedation”. - S. 23-25.; 3. A brief description of modern methods of artificial ventilation of the lungs. The user manual. Drager. - N-2). Occlusive pressure P100is the criterion of Central regulation of breathing with respiratory failure, characterized by neurosecretory drive. Method of measurement Pa 0.1(Ra 0.1), in turn, allows us to judge the presence or absence of respiratory failure in a patient based on the assessment of neurorestoratology drive. According to the method of respiratory failure in spontaneous ventilation is diagnosed at Pa 0.1more than 6 cm of water. Art.

The method is suitable for use in very heavy patients, including patients with disorders of consciousness, because it does not require any cooperation with the patient - only the presence of spontaneous breathing, even extremely weak.

However, the method has drawbacks.

2) If for the detection of respiratory failure during mechanical ventilation to use the limit of Pa 0.1(more than 6 cm of water.cent.), the corresponding DN in spontaneous breathing, the method is low-sensitivity. Therefore, to evaluate the effectiveness WL the absence of respiratory failure in a patient the method is discomposition.

The present invention is to improve the quality of treatment patients under prolonged mechanical ventilation, by assessing the effectiveness of assisted ventilation on the basis of quantitative estimates of the parameters of spontaneous respiratory activity of the patient characterizing respiratory failure.

The task is solved in that define the monitor data: occlusive airway pressure during inhalation (Pa 0.1and additionally the average rate of spontaneous inspiratory flow (Fsrad), the instantaneous rate of spontaneous inspiratory flow (Fmgnew), the negative pressure in the airway during inhalation (NIP). Monitor data register without the cooperation of the patient and, if occlusive airway pressure during inhalation (Pa 0.1) 0-1,5 cm water.art., the average rate of spontaneous flow in the SAR the respiratory tracts on the breath (NIP) (-5)-0 cm water.art., then evaluate WL as effective. Pa 0.1more than 1.5 cm of water.art., Fenvironmentsand Fmgnewmore than 0.5 l/min/kg, NIP below (-5) cm water.article appreciate WL as inefficient and conduct activities to improve the effectiveness of assisted ventilation, and 10 minutes after the implementation of measures to improve the efficiency WL newly register the same results (Pa 0.1FenvironmentsFmgnew, NIP), assessing the effectiveness WL. Measures to increase efficiency WL continue to obtaining the parameters of the Pa 0.1FenvironmentsFmgnew, NIP, appropriate and effective vvl.

The novelty of the method

1. To quantify the effectiveness WL proposed to take into account monitoring data: the average rate of spontaneous inspiratory flow (Fenvironments) and the instantaneous speed of spontaneous inspiratory flow (Fmgnew), the negative pressure in the airway during inhalation (NIP).

2. These figures (FenvironmentsFmgnew, NIP) proposed to register without the cooperation of the patient.

3. The proposed quantitative standards, the average rate of spontaneous inspiratory flow (Fenvironments), the instantaneous velocity of spontaneous inspiratory flow (Fmgnew), once eastwoodiae effective vvl.

Justification of the method

While effective vvl with respiratory comfort and synchronization of the patient with the respirator no signs of respiratory distress. The rate of spontaneous inspiratory flow (average and instantaneous), the negative pressure in the airway inspiratory occlusion pressure in the Airways during inhalation with effective WL correspond to the normal values of these quantities at a calm shallow breathing in a healthy person:

the rate of spontaneous inspiratory flow at the rate of 0.5 l/min/kg, and a high value indicates NAM; lower respiratory comfort.

- depression in the respiratory tract during inhalation in normal (-5) cm water.art., lower values recorded during days; higher respiratory comfort.

- occlusive airway pressure during inhalation in the rate of 1.1-1.5 cm of water.art., the growth of this indicator is observed at NAM, lower respiratory comfort.

The above implies that the task of resuscitation in the process of respiratory support of a patient with DN - set ventilation mode, approaching the values for these indicators to zero. Zero values denote maximum breathing to the lungs. However, during WWL, when there is a gradual weaning of the patient from the respirator, indicators of spontaneous respiratory activity, it is desirable to maintain the interval between zero and values when diagnosed respiratory failure, asynchronous with the respirator. In this case, respiratory failure is not, and spontaneous respiratory activity without load for the patient and the respiratory comfort features.

It is important that the measurement of these indicators is spontaneous respiration was carried out unnoticed by the patient. In this case excluded arbitrary emotional reaction of the patient on the study. Therefore, maintenance of sedation of the patient for 2-4 levels on a scale of Ramsey during the implementation of the method is required.

Traditionally, the definition of indicators of spontaneous respiratory activity of the patient (vacuum inspiratory vital capacity of the lungs) during artificial ventilation of the lungs was performed to determine the functional readiness of the patient to the translation of spontaneous breathing. To do this, the doctor asked the patient to make the maximum inhalation. In this case, was diagnosed functionality of the respiratory system of the patient.

The lack of cooperation is">The method is applicable during mechanical ventilation modern servies-piratorov III-IV generation.

The method is as follows

The method allows to evaluate the effectiveness of vvl by identifying signs of respiratory distress.

The method used in WL held mode normogastria and normoxemia. Duration normogastria and normoxemia before making way shall be not less than 30 minutes.

To eliminate the subjective factor that affects the measurement result, the patient must cooperate with the doctor during the complete method. Therefore, the method is carried out on the background standard for intensive care and resuscitation moderate analgo-sedation the patient (the depth of sedation 2-4 on a scale of Ramsey).

Record the weight of the patient.

During assisted ventilation (WL) register without the cooperation of the patient monitor data: occlusive pressure in the Airways during inhalation, the rate of spontaneous inspiratory flow (average and instantaneous), the negative pressure in the respiratory tract during inhalation.

If occlusion of the airway pressure during inhalation (Pa 0.1) 0-1,5 cm water.art., THE (Fmgnew) 0-0,5 l/min/kg, the negative pressure in the airway during inhalation (NIP) (-5)-0 cm water.art., then evaluate WL as effective.

When Ra 0.1more than 1.5 cm of water.art., Fenvironmentsand Fmgnewmore than 0.5 l/min/kg, NIP below (-5) cm water.article appreciate auxiliary ventilation as inefficient and conduct activities to improve the effectiveness of assisted ventilation (changing characteristics of ventilation, analgo-sedation no deeper than 5 degrees on the scale of Ramsey) (Kassil C. L., Lesquin airport, S., Virigina M. A. Respiratory support. - M., 1997. - S. 191-195).

10 minutes after the implementation of measures to improve the efficiency WL assess the same parameters (Pa 0.1FenvironmentsFmgnew, NIP), assessing the adequacy of WL.

Measures to increase efficiency WL continue to obtaining the parameters of the Pa 0.1FenvironmentsFmgnew, NIP, appropriate and effective vvl.

Example 1

Patient W., 57 years old, weight 76 kg, with a diagnosis of severe closed traumatic brain injury, brain contusion severe, with the formation of acute subdural hematoma in the right fronto-parieto-temporal region, the dislocation of the brain in the rough stage clinical demotional craniotomies, remove a subdural hematoma. In the postoperative period developed acute lung injury. Within 3 days was forced ventilation mode IPPV (CMV) respirator Drager Evita 4. To cerebroprotective was conducted intravenous infusion of thiopental sodium. On the fourth day after surgery, the infusion of thiopental sodium discontinued, the patient was transferred to the auxiliary ventilation mode with ASB pressure support (Pressure Support).

Sedation was performed with phenobarbital 0.1 mg 2 times a day.

Made setting ventilation for standard ventilation (normocapnia). After 30 minutes appreciated the depth of analgo-sedation the patient (the depth of sedation 4 points on a scale of Ramsey). Recorded the average speed of spontaneous inspiratory flow (Fenvironments) 48 l/min (0,63 l/min/kg) and the instantaneous speed of spontaneous inspiratory flow (Fmgnew) 50 l/min (0,66 l/min/kg), the negative pressure in the airway during inhalation (NIP) (-8) cm water.cent.), occlusion of the airway pressure during inhalation (Pa 0.1) 3.5 cm of water.article Estimated WL as ineffective. In the analysis of respiratory curves revealed desynchronization with the respirator.

Changed features ventilation: increased peep and glicee (Fenvironments) 32 l/min (0,42 l/min/kg) and the instantaneous speed of spontaneous inspiratory flow (Fmgnew) 33 l/min (0,43 l/min/kg), the negative pressure in the airway during inhalation (NIP) (-4) cm water.art., occlusion of the airway pressure during inhalation (Pa 0.1) 1.2 cm water.article Estimated WL as effective. In timing with the respirator was not recorded.

Example 2

Patient K., 35 years old, weight 66 kg, with a diagnosis of concomitant injury, blunt abdominal trauma, rupture of retroperitoneal portion of the duodenum, retroperitoneal abscess, diffuse purulent peritonitis, closed fracture of vertebra 2 was admitted to the intensive care unit after laparotomy, the suturing gap duodenum, laparotomy, drainage of the retroperitoneal space. In the postoperative period developed acute lung injury. Within 1 day were forced ventilation mode IPPV respirator Drager Evita 4. On the second day after surgery the patient was transferred to the auxiliary ventilation mode with ASB pressure support (Pressure Support).

Sedation was achieved by Relanium 10 mg 4 times a day.

Made the installation of ventilation parameters, providing normogastria (normocapnia). After 30 minutes appreciated globingo flow inspiratory (Fenvironments) 39 l/min (0,59 l/min/kg) and the instantaneous speed of spontaneous inspiratory flow (Fmgnew) 37 l/min (0,56 l/min/kg), the negative pressure in the airway during inhalation (NIP) (-9) cm water.art., occlusion of the airway pressure during inhalation (Pa 0.1) 4.5 cm water.article Estimated WL as ineffective. It was noted shortness of breath and desynchronization with the respirator.

Changed features ventilation: increased trigger sensitivity, increased frequency of breaths and the duration of the inspiratory pause.

After 10 minutes has determined the average rate of spontaneous inspiratory flow (Fenvironments) 0 l/min/kg and the instantaneous speed of spontaneous inspiratory flow (Fmgnew) 0 l/min/kg, the negative pressure in the airway during inhalation (NIP) (-4) cm water.cent.), occlusion of the airway pressure during inhalation (Pa 0.1) 1.4 cm water.article Estimated WL as effective. Shortness of breath and desynchronization with the respirator has not been detected.

By the present method study of 22 patients with surgical, trauma and neurosurgical profiles in long-term artificial lung ventilation (ALV). Indications for long-term mechanical ventilation was respiratory failure, evolved as a result of concomitant injury, traumatic brain what erionite, pancreatitis, pneumonia, pulmonary embolism, hemorrhagic, anaphylactic shocks. All patients were diagnosed with acute lung injury.

The original patients were ventilated by a respirator Puritan Bennett AE, Drager Evita 4 in enforcing mode. In the process of weaning from the respirator used auxiliary ventilation (WL).

In 1 and 2 days since WL registered rate of spontaneous inspiratory flow (average and instantaneous), the negative pressure in the airway inspiratory occlusion pressure in the Airways during inhalation, analysis evaluating WL. Fixed the feeling of shortness of breath and desynchronization with the respirator on the analysis of the respiratory curves. At the same time these same patients were identified efficiency WL (absence of respiratory failure) by evaluating Fa 0.1the traditional method silber A. P. Respiratory medicine. - Petrozavodsk, 1996. - S. 89-116; silber, A. P. Shamirzaev E. K., Karakozov M. R. Influence of dormicum and anexate on the mechanics of breathing, neurosecretory drive and respiratory muscle //Bulletin of intensive therapy, 1998. The collection “Actual issues of General anesthesia and sedation”. - S. 23-25.; A brief description of the current methodology is made, when occlusive pressure Fa 0.1it was less than 6 cm of water. Art.

The results show that the definition of efficiency WL based on the analysis of the rate of spontaneous inspiratory flow, dilution airway inspiratory occlusion of airway pressure during inhalation is highly specific test to determine the effectiveness of vvl, since there are no false positive results in diagnostic efficiency WL (table). Low sensitivity of the method, probably related to the fact that as a comparison we used nitroparaffins traditional way of ascertaining the effectiveness of WL.

Because effective vvl taken ventilation without respiratory failure, the proposed method is also highly sensitive test for detection of respiratory failure during WWL. The results confirm that in 6 out of 8 cases in which traditional way WL assessed as effective, and offer as ineffective, the patients had signs of respiratory distress (feelings of shortness of breath or signs of desynchronization of the patient with a respirator). In contrast, in all cases (31), when the th is the operator.

In our opinion, the proposed method can be most successfully used to assess the effectiveness of assisted ventilation during prolonged mechanical ventilation.

The inventive method of assessing the effectiveness of assisted ventilation is used in intensive care clinical hospital №29, Novokuznetsk and GB No. 1, Myski.

A method of evaluating the effectiveness of assisted ventilation (WL), including the registration of occlusal airway pressure during inhalation (Pa 0.1), characterized in that it further without the cooperation of the patient record and estimate the average speed of spontaneous inspiratory flow (Fenvironments) and the instantaneous speed of spontaneous inspiratory flow (Fmgnew), the negative pressure in the airway during inhalation (NIP) and, if occlusive airway pressure during inhalation (Pa 0.1) 0-1 .5 cm tbsp. water, the average rate of spontaneous inspiratory flow (Fenvironments) and the instantaneous speed of spontaneous inspiratory flow (Fmgnew) 0-0,5 l/min/kg, the negative pressure in the airway during inhalation (NIP) (-5)-0 cm tbsp. water, then evaluate WL as effective, and if Ra 0.1more than 1.5 cm tbsp. water, Fenvironmentsand Fmgnewmore than 0.5 l/min/kg, NIP below (-5) cm tbsp. water, estimated as the Chairman of ventilation, and after 10 min of implementation of measures to improve the efficiency of assisted ventilation newly register the same performance (Fenvironmentsand Fmgnew, NIP, Pa 0.1), assessing the effectiveness of assisted ventilation; measures to increase the efficiency WL continue to obtaining the parameters of the Fenvironmentsand F mgnew, NIP, Ra 0.1corresponding effective vvl.



 

Same patents:

The ventilator // 2240767
The invention relates to medical equipment, namely, devices for artificial ventilation of the lungs, and is intended for use in the departments of surgery, anesthesiology and intensive care

The invention relates to medicine, namely to resuscitation, and can be used to assess the adequacy of assisted ventilation

The invention relates to medicine, in particular to methods and means for restoring proper breathing patients after artificial ventilation of the lungs
The invention relates to medicine, namely anesthesiology, and can be used to provide intraoperative monitoring of the spinal cord through the implementation of planned urgent Wake-up the patient on the stage surgical correction of scoliosis or other spinal deformities
The invention relates to medicine, pediatric anesthesiology and can be used for anesthetic management video thoracoscopic surgery in children

The ventilator // 2219892
The invention relates to medical equipment, namely, devices for artificial lung ventilation (ALV), and will find application in the departments of surgery, anesthesiology and intensive care

The invention relates to medical equipment, namely to methods of artificial controlled or assisted ventilation (ALV), and can be used in the process of intensive care clinical hospitals and medical research institutions, can also be used in neonatology for respiratory support

The invention relates to medicine, namely to devices active compression-decompression of the chest during resuscitation

The invention relates to medicine and is intended to improve the functions of circulation and respiration in patients with a decrease in these functions in the various branches of the profile, and can also be used for the resuscitation of

The invention relates to medicine and is designed to regulate the flow of gas to the patient, and the flow is adjusted to maintain a physiological process, such as an effective respiratory function and/or lack of revivals

The ventilator // 2240767
The invention relates to medical equipment, namely, devices for artificial ventilation of the lungs, and is intended for use in the departments of surgery, anesthesiology and intensive care

The invention relates to medicine, namely to resuscitation, and can be used to assess the adequacy of assisted ventilation

The invention relates to medicine, namely to resuscitation, and can be used to assess the adequacy of assisted ventilation

The invention relates to medicine, in particular to methods and means for restoring proper breathing patients after artificial ventilation of the lungs

The invention relates to medicine, in particular to methods and means for restoring proper breathing patients after artificial ventilation of the lungs

The invention relates to medicine, resuscitation and can be used for artificial respiration to restore circulation
The invention relates to medicine, namely anesthesiology, and can be used to provide intraoperative monitoring of the spinal cord through the implementation of planned urgent Wake-up the patient on the stage surgical correction of scoliosis or other spinal deformities
The invention relates to medicine, pediatric anesthesiology and can be used for anesthetic management video thoracoscopic surgery in children

The ventilator // 2219892
The invention relates to medical equipment, namely, devices for artificial lung ventilation (ALV), and will find application in the departments of surgery, anesthesiology and intensive care

The invention relates to medical equipment, namely to methods of artificial controlled or assisted ventilation (ALV), and can be used in the process of intensive care clinical hospitals and medical research institutions, can also be used in neonatology for respiratory support

FIELD: medical engineering.

SUBSTANCE: device has belt manufactured from inextensible flexible material having clamps mounted on one side along its length, with rollers enveloped by cords. Closed chambers built from flexible material, filled with liquid and having pressure gages, are attached to its other side in camp projections. Electromotor is mounted in the middle part of the belt on the same side with the clamps. The electromotor has control system. Drum enveloped with cords is rigidly fixed on the electromotor end part. The middle portion of each cord is rigidly connected to cylindrical drum surface. Free ends of the cords are connected to end clamps.

EFFECT: retained ability of unrestrained patient movements.

2 dwg

Up!