Name: mechanical ventilation boot camp curriculum
Uploaded: 2018-03-12T15:00:00.000+00:00
Duration: 7 min 36 s
Description: Watch this Scientific Journal Video about Mechanical Ventilation Boot Camp Curriculum at JoVE.com

著者は、カリキュラムの開発と実行の彼女の援助のためのアンナ Ciullo、MD を感謝したいです。このレポートの外部資金はありませんでした。

ここで説明したすべてのメソッドは、レビューから除外されるよう Summa 制度審査会によって見つけられました。
1 日 1 – 事前テストの評価
<ol><li>重要なアクション チェックリスト、プリテスト景況感調査結果、プリテスト認知多肢選択試験を印刷します。</li>
	<li>以下の名称を ICU ベッド 3 つ人間患者シミュレータを配置: 急性呼吸窮迫症候群 (ARDS)、無気肺粘液を差し込むと気胸にセカンダリ。別々 の部屋でシミュレータを設定またはまで十分離れて、学習者が、同時に他を簡単に聞くことができる場合もなりますがセッションを実行します。専用の学習スペースにシミュレータを配置します。</li>
	<li>人間患者シミュレータを挿管します。シミュレータがシミュレータの首の後ろにつながるシミュレータの内側の頬の穴からではなく気管に気管内チューブを置かないでください。<ol>
<li>今シミュレータの首の後ろに隠されている気管内チューブを肺シミュレータから段ボールの気管チューブを接続します。一度接続すると、肺シミュレータは機能的な今です。この接続を隠すために枕を使用します。</li>
	</ol>
</li>
	<li>肺シミュレータを入れます。患者のライブラリ フォルダーのメニューから選択した病理学的状態を選択します。肺シミュレータの選択した病理を開始します。<ol>
<li>シミュレータの口から出てくる気管内チューブに人工呼吸器を接続します。人工呼吸器は、肺の病理学のソフトウェア プログラムを開始する前に気管内チューブに接続されて、人工呼吸器は正しく機能しません。</li>
		<li>シミュレータを呼吸人間患者シミュレータに接続します。挿管の人間患者シミュレータを機械的人工呼吸器に接続します。</li>
	</ol>
</li>
	<li>各人間患者シミュレータによる模擬患者モニターを配置します。肺シミュレータ プログラム内でバイタル サイン ソフトウェアを選択します。模擬患者のプレゼンテーションの発症のための適切な初期バイタル サインを選択します。バイタル サイン モニターを有効にします。</li>
	<li>事前に選択された患者のバイタル サイン、ポータブル胸部 x 線像、心電図検査は、各症例のため動脈血ガス測定を各それぞれ患者モニター (例えば、autoPEEP 人間患者シミュレータに画像をアップロードにアップロードします。autoPEEP 患者として指定)。</li>
	<li>どこに教員を観察ケースを各学習者の各駅で重要なアクション チェックリストを設定します。これは、一方向のガラスの後ろにまたはベッドサイド テーブルの上があります十分な距離で、学習者はチェックリストを読むできません。各ステーションに一つの教員を割り当てます。</li>
	<li>景況感調査結果、認知の試験、および重要なアクション チェックリストに使用する 4 桁の識別コードを選ぶ各学習者があります。コードは、匿名で収集したデータを確認する使用ことがあります。学習者は、彼らは一貫してカリキュラムを通して覚えて任意の 4 桁コードを選択できます。</li>
	<li>別の部屋で学習する 5 分事前景況感調査を管理します。その終了時に学習者に 25 分プリテスト認知多肢選択試験を管理します。</li>
	<li>駅は、各駅で現在ある学習者に学習のレポートを持っています。残りの学生は別の部屋で待つ可能性があります。ある学習者を彼らの重要なアクションのチェックリストの教員に、4 桁の識別コードを提供します。</li>
	<li>学習ケースの幹を読み取り部があります。シナリオを介して動作するように駅あたりの学習者 10 分の最大を許可します。ケースの中にフィードバックを管理しないでください。シナリオの最後では、自分の部屋に戻って学習を却下します。</li>
	<li>各ケースの完了時に各学習者の重要なアクション チェックリスト記入部があります。すべての学習者は、すべてのステーションが完了するまで、すべての局による学習者を個別に回転します。紙や電子メールを介して学習する補足的な測定値を配布します。</li>
</ol>2 日 2-カリキュラムと教育的介入
<ol><li>上記のようにモニター、人工呼吸器、呼吸シミュレータ人間患者シミュレータと 5 つの局を設定します。</li>
	<li>次のトピックのいずれかの各ステーションに割り当てる: ARDS 無気肺粘液プラグ、気胸、続発変更薬物の過剰摂取と動的超インフレに二次的精神状態。2 つまたは 3 人のグループで学習者を配置します。各ステーションに一つの教員を割り当てます。</li>
	<li>できるように各チームのケースのシナリオで作業する 10 分。教員のフィードバック、ベッドサイドの命令を提供するために 35 分。残りの 4 つのステーションを介して学習を回転させます。</li>
</ol>3 日 3-ポスト試験の評価
<ol><li>重要なアクション チェックリスト、ポストテスト景況感調査結果、事後テスト認知多肢選択試験を印刷します。上記のようにモニター、人工呼吸器、呼吸シミュレータ人間患者シミュレータと 3 つの駅を設定します。次のトピックのいずれかの各ステーションに割り当てる: ARDS 無気肺気胸に接続する、粘液にセカンダリ。</li>
	<li>各症例のため動脈血ガス測定、心電図、ポータブル胸部 x 線像のバイタル サインを各それぞれ患者モニター (例えば、autoPEEP、autoPEEP として指定人間患者シミュレータに画像をアップロードにアップロードします。患者)。</li>
	<li>各学習者の各ステーションの重要なアクション チェックリストを設定します。各ステーションに一つの教員を割り当てます。5 分後テスト景況感調査および 25 分ポストテスト認知の多肢選択式試験を管理します。</li>
	<li>駅は、各駅で現在ある学習者に学習のレポートを持っています。残りの学生は別の部屋で待つ可能性があります。ある学習者を彼らの重要なアクションのチェックリストの教員に、4 桁の識別コードを提供します。</li>
	<li>学習ケースの幹を読み取り部があります。シナリオを介して動作するように駅あたりの学習者 10 分の最大を許可します。ケースの中にフィードバックを管理しないでください。シナリオの最後では、自分の部屋に戻って学習を却下します。</li>
	<li>各ケースの完了時に各学習者の重要なアクション チェックリスト記入部があります。すべての学習者は、すべてのステーションが完了するまで、すべての局による学習者を個別に回転します。すべての学習者に 10 分後教育カリキュラムを管理します。</li>
</ol>

<ol>
	<li>Slutsky, A. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=History+of+mechanical+ventilation.+From+vesalius+to+ventilator-induced+lung+injury.">History of mechanical ventilation. From vesalius to ventilator-induced lung injury.</a> Am J Respir Crit Care Med. 191 (10), 1106-1115 (2015).</li><li>Ahmed, N., Devitt, K. S., Keshet, I., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+Systematic+Review+of+the+Effects+of+Resident+Duty+Hour+Restrictions+in+Surgery.">A Systematic Review of the Effects of Resident Duty Hour Restrictions in Surgery.</a> Ann Surg. 259 (6), 1041-1053 (2014).</li><li>Ziv, A., Wolpe, P. R., Small, S. D., Glick, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Simulation-Based+Medical+Education:+An+Ethical+Imperative.">Simulation-Based Medical Education: An Ethical Imperative.</a> Acad Med. 78 (8), 783-788 (2003).</li><li>Duwat, A., Hubert, V., Deransy, R., Dupont, H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Difficult+airway+management:+assessment+of+knowledge+and+experience+in+anaesthesiology+residents.">Difficult airway management: assessment of knowledge and experience in anaesthesiology residents.</a> Ann Fr Anesth Reanim. 32 (40), 231-234 (2013).</li><li>Lee, M. O., Brown, L. L., Bender, J., Machan, J. T., Overly, F. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+medical+simulation-based+educational+intervention+for+emergency+medicine+residents+in+neonatal+resuscitation.">A medical simulation-based educational intervention for emergency medicine residents in neonatal resuscitation.</a> Acad Emerg Med. 19 (5), 577-585 (2012).</li><li>Barsuk, J. H., Cohen, E. R., Caprio, T., McGaghie, W. C., Simuni, T., Wayne, D. B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Simulation-based+education+with+mastery+learning+improves+residents'+lumbar+puncture+skills.">Simulation-based education with mastery learning improves residents' lumbar puncture skills.</a> Neurology. 79 (2), 132-137 (2012).</li><li>Barsuk, J. H., Cohen, E. R., Vozenilek, J. A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Simulation-based+education+with+mastery+learning+improves+paracentesis+skills.">Simulation-based education with mastery learning improves paracentesis skills.</a> J Grad Med Educ. 4 (1), 23-27 (2012).</li><li>Sohmer, B., Hudson, C., Hudson, J., Posner, G. D., Naik, V. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Transesophageal+echocardiography+simulation+is+an+effective+tool+in+teaching+psychomotor+skills+to+novice+echocardiographers.">Transesophageal echocardiography simulation is an effective tool in teaching psychomotor skills to novice echocardiographers.</a> Can J Anaesth. 61 (3), 235-241 (2014).</li><li>Sigounas, V. J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Evaluation+of+simulation-based+training+model+on+vascular+anastomotic+skills+for+surgical+residents.">Evaluation of simulation-based training model on vascular anastomotic skills for surgical residents.</a> Simul Healthc. 7 (6), 334-338 (2012).</li><li>Dawe, S. R., Windsor, J. A., Broeders, J. A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+systematic+review+of+surgical+skills+transfer+after+simulation-based+training:+laparoscopic+cholecystectomy+and+endoscopy.">A systematic review of surgical skills transfer after simulation-based training: laparoscopic cholecystectomy and endoscopy.</a> Ann Surg. 259 (2), 236-248 (2014).</li><li>Spadaro, S., Karbing, D. S., Fogagnolo, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Simulation+Training+for+Residents+Focused+on+Mechanical+Ventilation.">Simulation Training for Residents Focused on Mechanical Ventilation.</a> Simul Healthc. , (2017).</li><li>Yee, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Mechanical+Ventilation+Boot+Camp:+A+Simulation-Based+Pilot+Study.">Mechanical Ventilation Boot Camp: A Simulation-Based Pilot Study.</a> Crit Care Res Pract. 2016, (2016).</li><li>Ryoo, E. N., Ha, E. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+Importance+of+Debriefing+in+Simulation-Based+Learning:+Comparison+Between+Debriefing+and+No+Debriefing.">The Importance of Debriefing in Simulation-Based Learning: Comparison Between Debriefing and No Debriefing.</a> Comput Inform Nurs. 33 (12), 538-545 (2015).</li><li>Shinnick, M. A., Woo, M., Horwich, T. B., Steadman, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Debriefing:+The+Most+Important+Component+in+Simulation?.">Debriefing: The Most Important Component in Simulation?.</a> Clin Simul Nurs. 7 (3), e105-e111 (2011).</li></ol>

著者が明らかに何もありません。

ブート キャンプは、3 つの別々 のセッションで構成されています。最初の日中に学習の事前テスト完了 5 分シナリオを受ける前に景況感調査と医療の知識をテストします。教員は、あらかじめ決められた重要なアクションを使用して学習者を評価します。学習者は、2 日前に完了する非同期読み取りを与えられています。2 日目は、2-3 学習者のグループが異なる 5 つのシナリオを介して動作?...

このブート キャンプは、住民の人工呼吸器のアラームのトラブルシューティングし同様に機械的に換気の患者を管理する方法を教えるために開発されました。この患者集団の管理は批判的に病気の患者の経験を制限している初心者の医師に威圧的な可能性があります。ベッドサイドで重要な介護の原則を教えるは国立作業時間制限1,2、および米国の法医学的懸念3によってより困難行われます。シミュレーションが開発し、侵襲的処置6,7,8,9,10 と同様に、救命スキル4,5を改良する効果的なモダリティ.シミュレーションを通じて学習者は、その医学的意思決定の結果が患者を危険にさらすことがなく、経験があります。このカリキュラムは、異なる学習モダリティ、intensivist、人工呼吸器の実践練習からベッドサイド教育補足の非同期読み取りなどの様々 なことができます。
以前の研究では、機械換気11,12のマネキン ベースの教育と知識の増加を示しています。Spadaroら11は、機械換気のシミュレーション教材を受けて麻酔住民のマネキン ベースのトレーニングとコンピューター ベースのトレーニングを比較しました。マネキン ベースのトレーニングを受けた住民より高いキー アクションとグローバル評価スコアを持っていた。私たちの以前の研究12で述べたように、最初の年の住民は知識の向上、信頼、そして能力を示したこのブート キャンプ ・ カリキュラムの結論の後。
書き込まれると、この 3 日間のカリキュラムは最初 1 日目の学習者の基本知識の評価し同様に 3 日目のカリキュラム完了時に自信を持って、知識、能力の変更を評価教育のためことができます。1 と 3 の日は、2 日目はコンテンツの専門家によるベッドサイド教育に焦点を当てながら評価に向けて専念しています。精神状態の変調駅が指導中に追加されたときに初期評価とテストの最後の日の使用された病態 (急性呼吸窮迫症候群 [ARDS] 無気肺粘液を差し込むと気胸にセカンダリ)人工呼吸器の基本を確認する日。動的なハイパー インフレは、人工呼吸器診断と高原圧力患者の考察を含む管理を強化する教育の日にも追加されました。彼らは教育ニーズに適切な感じとして、教育者は病態を代えることができます。
準備、シミュレーション部開催、最初リハーサル日すべて参加している教育者は彼らの役割を知っていたことを確認し、装置が適切に働いていた。評価、クリティカルケア医師教育のためのシミュレーション教員を採用しました、教育者は、リソースをディクテーションする教員の役割を調整できます。このブート キャンプの実行準備物流計画が必要です。最初の年の住民は、カリキュラムの 3 日間すべてを完了することができます保護された時間をする必要があります。集中治療は、ベッドサイド教育のセッションに出席するため、事前にオフ時間をスケジュールする必要があります。シミュレータ、機械的人工呼吸器と人間患者シミュレータ呼吸などのシミュレーション機器を購入、レンタル、または借りて必要があります。

<table><tbody><tr><td>Puritan Bennett 840 Ventilator</td><td>Medtronic</td><td>4-840120EMC-01</td><td>http://www.medtronic.com/covidien/en-us/products/acute-care-ventilation/puritan-bennett-pb840-ventilator.html</td></tr><tr><td>ASL 5000 Breathing Simulator</td><td>IngMar</td><td>31 00 117</td><td>https://www.ingmarmed.com/</td></tr><tr><td>Smart Stat Basic</td><td>Simulaids</td><td>101-8002</td><td>https://www.simulaids.com/product/101-8002</td></tr></tbody></table>

mechanical ventilation boot camp curriculum

機械的に換気された患者の医学的管理が初心者プロバイダーへの挑戦です。この人口の不適切な管理は、増加罹患率と死亡率につながる可能性があります。3 日間シミュレーション ベースのブート キャンプは救命救急プロバイダーと一対一の命令を提供するために提供しています。これらの集中治療リアル人工呼吸器の実践的な練習で従事する学習パーソナライズされた即時フィードバックを分配することがあります。複数の異なる病態を確認できることは臨床設定でいない発生可能性があります。学習者は彼らの行動の即時の結果を可視化はできます、トラブルシューティングおよび質問すべてが、安全な学習環境と可能性があります。人間患者シミュレータ呼吸シミュレータと機械的人工呼吸器に接続しての利用について述べる。機器と専用ブート キャンプの実行に必要な時間のコストの潜在的なカリキュラム執行必要があります。ただし、この集中的な対話型トレーニングは、プロバイダーの能力、知識、および人工呼吸管理に自信を増加する示されています。このカリキュラムの概要では、機械的に換気された患者の管理上のプロバイダーを訓練するシミュレーション ベースのブート キャンプを実行する方法について説明します。

イーらで書きとめたので、このブート キャンプを受けた初年度住民は大幅に改善されたパフォーマンス、知識、自信の12を示した。前と後の介入によって認知的知識の評価平均スコアの 40.3% から 67.1%、+26.8 のスコアの平均変化から増加した複数の選択テスト % (図 1)。
重要な...

Watch this Scientific Journal Video about Mechanical Ventilation Boot Camp Curriculum at JoVE.com

Mechanical Ventilation Boot Camp Curriculum

このカリキュラムでは、シミュレーション ベースのブート キャンプをプロバイダーに機械的に換気された患者を管理する方法を教えることを実行する方法について説明します。

換気ブート キャンプ ・ カリキュラム

Medical management of mechanically ventilated patients is challenging to novice providers. Incorrect management of this population may lead to increased ...

mechanical-ventilation-boot-camp-curriculum

Universidad de Cartagena UDEC

Research

Education

JoVE Core

JoVE Journal

Medical-Surgical Nursing

Medicine

Unit 1

Fundamentals of Respiratory Care: Techniques and Management

SCIENTISTS IN ACTION

10.1K ビュー.  The Ohio State University. このカリキュラムでは、シミュレーション ベースのブート キャンプをプロバイダーに機械的に換気された患者を管理する方法を教えることを実行する方法について説明します。

ビデオ: Mechanical Ventilation Boot Camp Curriculum

Evaluation of Respiratory System Mechanics in Mice using the Forced Oscillation Technique

The forced oscillation technique (FOT) is a powerful, integrative and translational tool permitting the experimental assessment of lung function in mice in a comprehensive, detailed, precise and reproducible manner. It provides measurements of respiratory system mechanics through the analysis of pressure and volume signals acquired in reaction to predefined, small amplitude, oscillatory airflow waveforms, which are typically applied at the subject's airway opening. The present protocol details the steps required to adequately execute forced oscillation measurements in mice using a computer-controlled piston ventilator (flexiVent; SCIREQ Inc, Montreal, Qc, Canada). The description is divided into four parts: preparatory steps, mechanical ventilation, lung function measurements, and data analysis. It also includes details of how to assess airway responsiveness to inhaled methacholine in anesthetized mice, a common application of this technique which also extends to other outcomes and various lung pathologies. Measurements obtained in na&iuml;ve mice as well as from an oxidative-stress driven model of airway damage are presented to illustrate how this tool can contribute to a better characterization and understanding of studied physiological changes or disease models as well as to applications in new research areas.

The present protocol provides a detailed step-by-step description of the procedures required to execute measurements of respiratory system mechanics as well as the assessment of airway responsiveness to inhaled methacholine in mice using the forced oscillation technique (flexiVent; SCIREQ Inc, Montreal, Qc, Canada).

強制振動法を用いたマウスにおける呼吸器系の力学の評価

The  forced oscillation technique (FOT) is a powerful, integrative and translational  tool permitting the experimental assessment of lung function in mice ...

生物学

Setup and Execution Of the Blindfolded Code Training Exercise

Miscommunication is the most common cause of preventable patient harm in medicine. Currently, there is limited knowledge of innovative techniques to improve resident physician communication and leadership strategies in high-acuity situations. The blindfolded code training exercise removes visual stimuli from the team leader, forcing the team leader to effectively utilize closed-loop communication. The simple act of blindfolding the team leader creates a learning environment where the leader must utilize a conceptual framework and critical thinking strategies to organize the team and manage the resuscitation. An advantage to this teaching technique is that it does not require any special simulation equipment, making it a low-cost approach. The blindfolded code training exercise can be applied to the management of any critically ill patient where the primary objective is to focus on developing communication skills in acute resuscitations. The purpose of the description of the blindfolded code training exercise is to provide guidance on how to perform this innovative teaching technique to force effective closed-loop communication.

The blindfolded code training exercise, which blindfolds the team leader in a code resuscitation simulation, is an advanced teaching technique to improve closed-loop communication, organizational skills, and critical thinking.&#160;

セットアップと目隠しコード訓練の実行

Miscommunication is the most common cause of preventable patient harm in medicine. Currently, there is limited knowledge of innovative techniques to ...

医学

Use of an Integrated Low-Flow Anesthetic Vaporizer, Ventilator, and Physiological Monitoring System for Rodents

Low-flow digital vaporizers commonly utilize a syringe pump to directly administer volatile anesthetics into a stream of carrier gas. Per animal welfare recommendations, animals are warmed and monitored during procedures requiring anesthesia. Common anesthesia and physiological monitoring equipment include gas tanks, anesthetic vaporizers and stands, warming controllers and pads, mechanical ventilators, and pulse oximeters. A computer is also necessary for data collection and to run equipment software. In smaller spaces or when performing field work, it can be challenging to configure all this equipment in limited space.
The goal of this protocol is to demonstrate best practices for use of a low-flow digital vaporizer using both compressed oxygen and room air, along with an integrated mechanical ventilator, pulse oximeter, and far infrared warming as an all-inclusive anesthesia and physiological monitoring suite ideal for rodents.

Here, we present a protocol to safely and effectively administer anesthetic gas to mice using a digital, low flow anesthesia system with integrated ventilator and physiological monitoring modules.

げっ歯類のための統合された低流量麻酔気化器、換気装置および生理学的モニタリングシステムの使用

Low-flow digital vaporizers commonly utilize a syringe pump to directly administer volatile anesthetics into a stream of carrier gas. Per animal welfare ...

Normothermic Negative Pressure Ventilation Ex Situ Lung Perfusion: Evaluation of Lung Function and Metabolism

Lung transplantation (LTx) remains the standard of care for end-stage lung disease. A shortage of suitable donor organs and concerns over donor organ quality exacerbated by excessive geographic transportation distance and stringent donor organ acceptance criteria pose limitations to current LTx efforts. Ex situ lung perfusion (ESLP) is an innovative technology that has shown promise in attenuating these limitations. The physiologic ventilation and perfusion of the lungs outside of the inflammatory milieu of the donor body affords ESLP several advantages over traditional cold static preservation (CSP). There is evidence that negative pressure ventilation (NPV) ESLP is superior to positive pressure ventilation (PPV) ESLP, with PPV inducing more significant ventilator-induced lung injury, pro-inflammatory cytokine production, pulmonary edema, and bullae formation. The NPV advantage is perhaps due to the homogenous distribution of intrathoracic pressure across the entire lung surface. The clinical safety and feasibility of a custom NPV-ESLP device have been demonstrated in a recent clinical trial involving extender criteria donor (ECD) human lungs. Herein, the use of this custom device is described in a juvenile porcine model of normothermic NPV-ESLP over a 12 h duration, paying particular attention to management techniques. Pre-surgical preparation, including ESLP software initialization, priming, and de-airing of the ESLP circuit, and the addition of anti-thrombotic, anti-microbial, and anti-inflammatory agents, is specified. The intraoperative techniques of central line insertion, lung biopsy, exsanguination, blood collection, cardiectomy, and pneumonectomy are described. Furthermore, particular focus is paid to anesthetic considerations, with anesthesia induction, maintenance, and dynamic modifications outlined. The protocol also specifies the custom device's initialization, maintenance, and termination of perfusion and ventilation. Dynamic organ management techniques, including alterations in ventilation and metabolic parameters to optimize organ function, are thoroughly described. Finally, the physiological and metabolic assessment of lung function is characterized and depicted in the representative results.

Normothermic Negative Pressure Ventilation Ex Situ Lung Perfusion: Evaluation of Lung Function and Metabolism

This paper describes a porcine model of negative pressure ventilation ex situ lung perfusion, including procurement, attachment, and management on the custom-made platform. Focus is made on anesthetic and surgical techniques, as well as troubleshooting.

正常母性陰圧換気 ex situ 肺灌流:肺機能と代謝の評価

Lung transplantation (LTx) remains the standard of care for end-stage lung disease. A shortage of suitable donor organs and concerns over donor organ ...

Employing the Forced Oscillation Technique for the Assessment of Respiratory Mechanics in Adults

There is increasing interest in the use of the forced oscillation technique (FOT) or oscillometry to characterize respiratory mechanics in healthy and diseased individuals. FOT, a complementary method to traditional pulmonary function testing, utilizes a range of oscillatory frequencies superimposed on tidal breathing to measure the functional relationship between airway pressure and flow. This passive assessment provides an estimate of respiratory system resistance (Rrs) and reactance (Xrs) that reflect airway caliber and energy storage and dissipation, respectively. Despite the recent increase in popularity and updated Technical Standards, clinical adoption has been slow which relates, in part, to the lack of standardization regarding the acquisition and reporting of FOT data. The goal of this article is to address the lack of standardization across laboratories by providing a comprehensive written protocol for FOT and an accompanying video. To illustrate that this protocol can be utilized irrespective of a particular device, three separate FOT devices have been employed in the case examples and video demonstration. This effort is intended to standardize the use and interpretation of FOT, provide practical suggestions, as well as highlight future questions that need to be addressed.

As the use of forced oscillation technique (FOT) is increasingly utilized to characterize respiratory mechanics, there is a need to standardize methods with respect to nascent technical guidelines and various manufacturer's recommendations. A detailed protocol is provided including FOT assessment and interpretation for two cases to facilitate the standardization of methods.

成人の呼吸力学の評価のための強制振動技術の採用

There is increasing interest in the use of the forced oscillation technique (FOT) or oscillometry to characterize respiratory mechanics in healthy and ...

Ex Vivo Porcine Experimental Model for Studying and Teaching Lung Mechanics

Mechanical ventilation is widely used and requires specific knowledge for understanding and management. Health professionals in this field may feel insecure and lack knowledge because of inadequate training and teaching methods. Therefore, the objective of this article is to outline the steps involved in generating an ex vivo porcine lung model to be used in the future, to study and teach lung mechanics. To generate the model, five porcine lungs were carefully removed from the thorax following the guidelines of the Animal Research Ethics Committee with adequate care and were connected to the mechanical ventilator through a tracheal cannula. These lungs were then subjected to the alveolar recruitment maneuver. Respiratory mechanics parameters were recorded, and video cameras were used to obtain videos of the lungs during this process. This process was repeated for five consecutive days. When not used, the lungs were kept refrigerated. The model showed different lung mechanics after the alveolar recruitment maneuver every day; not being influenced by the days, only by the maneuver. Therefore, we conclude that the ex vivo lung model can provide a better understanding of lung mechanics and its effects, and even of the alveolar recruitment maneuver through visual feedback during all stages of the process.

Ex Vivo Porcine Experimental Model for Studying and Teaching Lung Mechanics

We present an ex vivo pig lung model for the demonstration of pulmonary mechanics and alveolar recruitment maneuvers for teaching purposes. The lungs can be used for more than one day (up to five days) with minimal changes in pulmonary mechanics variables.

Ex Vivo(エクス・ビボ )肺力学の研究と教育のためのブタ実験モデル

Mechanical ventilation is widely used and requires specific knowledge for understanding and management. Health professionals in this field may feel ...

Basic Life Support Part II:  Airway/Breathing and Continued Cardiopulmonary Resuscitation

Source: <a href="https://jove.unicartagenaproxy.elogim.com/author/Julianna_Jung">Julianna Jung</a>, MD, FACEP, Associate Professor of Emergency Medicine, The Johns Hopkins University School of Medicine, Maryland, USA
High-quality cardiopulmonary resuscitation (CPR) and defibrillation are the most important interventions for patients with cardiac arrest, and should be the first steps that rescuers perform. This is reflected in the American Heart Association's new "CAB" mnemonic. While rescuers were once taught the "ABCs" of cardiac arrest, they now learn "CAB" - circulation first, followed by airway and breathing. Only once CPR is underway (and defibrillation has been performed, if a defibrillator is available) do we consider providing respiratory support. This video will describe the correct technique for providing respiratory support to a patient in cardiac arrest, and how to continue basic life support over the period of time until help arrives.
This video assumes that all the steps described in "Basic Life Support Part I: Cardiopulmonary Resuscitation and Defibrillation" have already been completed. This video does NOT depict the initial steps taken when arriving at the scene of a cardiac arrest.

Basic Life Support II: Airway/Breathing &amp; Cardiopulmonary Resuscitation

基本的な生活支援 Ii: 気道・呼吸と継続的な心肺蘇生法

Source: Julianna Jung, MD, FACEP, Associate Professor of Emergency Medicine, The Johns Hopkins University School of Medicine, Maryland, USA
High-quality ...

JoVE Science Education

臨床技術科学

救急医療と救命救急診療

Mechanical Ventilation I: Indication and Settings

Mechanical ventilation is a life-saving technique for managing acute respiratory failure and other respiratory complications. The process involves using a machine known as a ventilator to supply oxygen to the lungs and assist in removing carbon dioxide. It serves as a bridge to long-term mechanical ventilation or a temporary measure until ventilatory support is discontinued. The ventilator can maintain this function for a prolonged period, providing critical support for patients until they can breathe independently.
Indications
Mechanical ventilation may be necessary for a variety of reasons. These include managing acute respiratory failure, controlling the patient&#39;s breathing during surgery or treatment, providing adequate oxygenation when the patient&#39;s own ventilatory efforts are insufficient, and allowing the respiratory muscles to rest. Several factors, including thoracic or abdominal surgery, drug overdose, neuromuscular disorders, inhalation injury, Chronic Obstructive Pulmonary Disease (COPD), multiple trauma, circulatory shock, multisystem failure, and coma, can result in respiratory failure and the need for mechanical ventilation. It allows patients on a ventilator to breathe spontaneously, alleviating the exhausting effort it would otherwise require.
Settings of Mechanical Ventilator
The settings of a mechanical ventilator are adjusted based on the patient&#39;s condition, level of consciousness, respiratory muscle strength, chest x-ray, and arterial blood gases (ABGs). These settings include:
<ol style="list-style-type: circle;">
	<li>Respiratory rate: It refers to the number of breaths the ventilator delivers per minute.</li>
	<li>Tidal volume (VT): It is the volume of gas delivered to the patient during each ventilator breath.</li>
	<li>O2 concentration (FIO2): This fraction of inspired O2 delivered to the patient can be set between 30% and 100%.</li>
	<li>Positive-end-expiratory pressure (PEEP): Positive pressure is applied at the end of the expiration of ventilator breaths.</li>
	<li>Pressure support: This is used to augment a patient&#39;s inspiratory pressure during spontaneous breathing.</li>
	<li>I/E ratio: This is the duration of inspiration (I) to the duration of expiration (E).</li>
	<li>Inspiratory flow rate and time: This is the speed with which the VT is delivered.</li>
	<li>Sensitivity: This determines the patient&#39;s effort to initiate a breath from the ventilator.</li>
	<li>Peak inspiratory pressure (PIP): This is the maximal pressure the ventilator can generate to deliver the VT.</li>
</ol>
Manipulating these settings can help correct hypoxemia and hypercarbia. As the patient&#39;s condition improves, the settings can be adjusted to allow them to take more control over their work of breathing.
Types of Mechanical Ventilation
Mechanical ventilators can be classified into two general categories: Negative pressure ventilators and positive-pressure ventilators.
Negative-pressure ventilators, also known as &#34;iron lungs,&#34; are older modes of ventilatory support that are rarely used today.
Positive-pressure ventilators inflate the lungs by exerting positive pressure on the airway, pushing air in, similar to a bellows mechanism, and forcing the alveoli to expand during inspiration. Expiration occurs passively. These ventilators are widely used in hospital settings and include:
<ol style="list-style-type: circle;">
	<li>Volume-Cycled Ventilators</li>
	<li>Pressure-Cycled Ventilators</li>
	<li>High-Frequency Oscillatory Support Ventilators</li>
	<li>Noninvasive Positive-Pressure Ventilation (NIPPV)</li>
	<li>Continuous positive airway pressure (CPAP)</li>
	<li>Bilevel positive airway pressure (BiPAP)</li>
</ol>
Each ventilator has distinctive features and is employed based on the patient&#39;s needs. The selection of the ventilator type is a critical decision made by healthcare professionals, made by considering the patient&#39;s current health status and the potential benefits and risks associated with each ventilator type.

機械換気I:表示と設定

Mechanical ventilation is a method of using a ventilator machine to deliver oxygen and remove carbon dioxide from the lungs when spontaneous breathing is ...

KEY TERMS AND CONCEPTS

Mechanical Ventilation II: Invasive Ventilation

Ventilators are essential medical equipment used to aid patients with respiratory difficulties. Their primary function is to assist or replace spontaneous breathing by providing mechanical ventilation. There are two general classes of mechanical ventilators: negative-pressure and positive-pressure ventilators.
Negative-Pressure Ventilators
Negative-pressure ventilators create a vacuum around the chest or body to draw air into the lungs, simulating breathing. This method does not require an artificial invasive airway; as a result, it is categorized as a form of non-invasive ventilation (NIV).
The &#34;iron lung,&#34; developed in the 1950s during the polio epidemic, was the first form of negative pressure ventilation. It intermittently reduces intrathoracic pressure, causing air to rush into the upper airway, followed by passive expiration when the machine cycles off. Portable negative-pressure ventilators are available for home use, primarily for patients with chronic neuromuscular diseases and central nervous system problems.
Positive-Pressure Ventilators
Positive-pressure ventilators differ from negative-pressure ventilators in their mechanism of lung inflation. Instead of exerting negative pressure to draw air into the lungs, positive-pressure ventilators apply positive pressure to the airway, expanding the alveoli and facilitating inspiration. Expiration occurs passively. These ventilators require ET intubation or tracheostomy and are widely used in hospitals and homes.
Volume-Cycled Ventilators
Volume-cycled ventilators deliver a preset volume of air with each inspiration. The ventilator cycles off after this volume is delivered, allowing passive exhalation. Volume-cycled ventilators ensure consistent breaths but may cause barotrauma due to the potentially excessive pressures needed to deliver breaths.
Pressure-Cycled Ventilators
Pressure-cycled ventilators deliver airflow until a preset pressure is reached, and then they cycle off for passive expiration. The air volume can vary with changes in the patient&#39;s airway resistance or compliance, possibly leading to inconsistent tidal volumes and compromised ventilation.
High-Frequency Oscillatory Support Ventilators
These ventilators deliver high respiratory rates, low tidal volumes, and high airway pressures. They are used to open alveoli in situations characterized by closed small airways, such as atelectasis and ARDS, and are believed to protect the lungs from pressure injury.

機械換気II:侵襲的換気

Invasive ventilation uses a mechanical ventilator connected to an endotracheal tube or tracheostomy to support breathing.
One common type is ...

Mechanical Ventilation III: Noninvasive Ventilation

Noninvasive positive-pressure ventilation (NIPPV), continuous positive airway pressure (CPAP), and bilevel positive airway pressure (BiPAP) are essential methods in respiratory care. These ventilation techniques offer unique benefits for patients with various respiratory conditions, providing adequate support without requiring intubation. Let&#39;s explore how each method is crucial in improving patient outcomes and enhancing respiratory therapy.
Noninvasive Positive-Pressure Ventilation (NIPPV)
NIPPV is a method of positive pressure ventilation that does not require intubation. It involves using facemasks or nasal devices to maintain prescribed pressure, reducing the risk of nosocomial infections. This method is suitable for patients with acute or chronic respiratory failure, acute pulmonary edema, COPD, chronic heart failure, or sleep-related breathing disorders.
Continuous Positive Airway Pressure (CPAP)
CPAP maintains a constant positive pressure in the airways throughout the breathing cycle, helping to keep alveoli open and prevent respiratory failure. This method is especially beneficial in treating obstructive sleep apnea, ensuring the airways remain open during sleep.
Bilevel Positive Airway Pressure (BiPAP)
BiPAP offers independent control of inspiratory and expiratory pressures while providing pressure support ventilation. It delivers two levels of positive airway pressure via a nasal or oral mask, nasal pillow, or mouthpiece with a tight seal and a portable ventilator. BiPAP is often used for patients who require ventilatory assistance at night.
Each type has advantages and disadvantages, and the choice depends on the patient&#39;s clinical condition, comfort, and the healthcare provider&#39;s expertise.

機械換気III.:非侵襲的換気

Noninvasive ventilation, or NIV, provides ventilatory support without inserting an artificial airway.
This type of ventilation is used in patients with ...

換気ブートキャンプ・カリキュラム

要約

さらに動画を探す

この動画の章

強制振動法を用いたマウスにおける呼吸器系の力学の評価

セットアップと目隠しコード訓練の実行

げっ歯類のための統合された低流量麻酔気化器、換気装置および生理学的モニタリングシステムの使用

正常母性陰圧換気 ex situ 肺灌流:肺機能と代謝の評価

成人の呼吸力学の評価のための強制振動技術の採用

Ex Vivo(エクス・ビボ )肺力学の研究と教育のためのブタ実験モデル

基本的な生活支援 Ii: 気道・呼吸と継続的な心肺蘇生法

機械換気I:表示と設定

機械換気II:侵襲的換気

機械換気III.:非侵襲的換気

換気ブート キャンプ ・ カリキュラム

要約

さらに動画を探す

この動画の章

強制振動法を用いたマウスにおける呼吸器系の力学の評価

セットアップと目隠しコード訓練の実行

げっ歯類のための統合された低流量麻酔気化器、換気装置および生理学的モニタリングシステムの使用

正常母性陰圧換気 ex situ 肺灌流:肺機能と代謝の評価

成人の呼吸力学の評価のための強制振動技術の採用

Ex Vivo(エクス・ビボ )肺力学の研究と教育のためのブタ実験モデル

基本的な生活支援 Ii: 気道・呼吸と継続的な心肺蘇生法

機械換気I:表示と設定

機械換気II:侵襲的換気

機械換気III.:非侵襲的換気

換気ブートキャンプ・カリキュラム