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

Os autores que gostaria de agradecer a Anna Ciullo, M.D. pela sua assistência com desenvolvimento curricular e execução. Não havia nenhum financiamento externo para este relatório.

Todos os métodos descritos aqui foram encontrados para ser isentos de revisão pelo Conselho de revisão institucional de Summa.
1. dia 1 – avaliação pré-teste
<ol><li>Imprima listas de ação crítica, inquéritos à confiança de pré-teste, exames de múltipla escolha cognitiva de pré-teste.</li>
	<li>Coloque três simuladores humanos-paciente em leitos de UTI, com as seguintes denominações: síndrome respiratória aguda (Sara), atelectasia completa do pulmão secundário para muco obstruindo e pneumotórax. Conjunto de simuladores em quartos separados ou muito distante o suficiente que os alunos não será capazes de facilmente ouvir o outro simultaneamente executado sessões. Coloque simuladores em um espaço de aprendizagem dedicado.</li>
	<li>Entube os simuladores humanos-paciente. Não coloque o tubo endotraqueal na traqueia do simulador, mas sim através de um buraco na bochecha de interior do simulador que leva na parte de trás do pescoço do simulador.<ol>
<li>Conecte o tubo de papelão ondulado das vias respiratórias partir o simulador de pulmão para o tubo endotraqueal que agora está escondido por trás do pescoço do simulador. Uma vez conectado, o simulador de pulmão agora está funcional. Use um travesseiro para esconder esta conexão.</li>
	</ol>
</li>
	<li>Liga o simulador de pulmão. Escolha o estado patológico selecionado do menu na pasta Biblioteca do paciente. Inicie a patologia selecionada no simulador de pulmão.<ol>
<li>Conecte o ventilador mecânico para o tubo endotraqueal saindo da boca do simulador. Se o ventilador está ligado ao tubo endotraqueal antes de iniciar o programa de software de patologia pulmonar, o ventilador não funcionará corretamente.</li>
		<li>Conecte a respiração simuladores simuladores humanos-paciente. Conecte os simuladores humanos-paciente intubados ventiladores mecânicos.</li>
	</ol>
</li>
	<li>Coloque um monitor paciente simulado por cada simulador de paciente humano. Selecione o software sinal vital dentro do programa de simulador de pulmão. Escolha os sinais vitais iniciais apropriados para o início da apresentação de paciente simulado. Habilite o monitor de sinais vitais.</li>
	<li>Carregar os sinais vitais do paciente pré-selecionado, imagens de raio-x do tórax, eletrocardiogramas e medições de gás de sangue arterial para cada caso de paciente para cada respectivo monitor paciente (por exemplo, autoPEEP imagens são enviadas para o simulador de paciente-humanos designado como o paciente autoPEEP).</li>
	<li>Estabelecidos em cada estação, listas de verificação críticas ações para cada aluno onde quer que os membros do corpo docente observarão o caso. Isto pode ser por trás de um vidro unidirecional ou em uma mesa de cabeceira, mas a suficiente distância afastado que os aprendentes não será capazes de ler as listas de verificação. Atribua a um membro do corpo docente para cada estação.</li>
	<li>Tem cada aluno escolher um código de quatro dígitos de identificação para usar para inquéritos à confiança, exames cognitivos e listas de ação crítica. Os códigos podem ser utilizados para analisar os dados coletados de forma anônima. Os alunos podem escolher qualquer código de quatro dígitos que eles lembrarão consistentemente ao longo do currículo.</li>
	<li>Em um quarto separado, administre pesquisa de confiança do pré-teste de 5 minutos para os alunos. Após a sua conclusão, administre exames de múltipla escolha cognitiva de pré-teste de 25 minutos para os alunos.</li>
	<li>Tem relatório de alunos para uma estação, com um aluno presente em cada estação. Restantes alunos podem esperar em uma sala separada. Tenho alunos fornecer seu código de identificação de quatro dígitos para faculdade para sua lista de ação crítica.</li>
	<li>Tem faculdade ler a haste caso para aluno. Permitir que os alunos um máximo de dez minutos por estação de trabalho através de um cenário. Não administre feedback durante o caso. Na conclusão do cenário, demita os aprendentes para voltar ao seu quarto separado.</li>
	<li>Tem faculdade preencher listas de ação crítica para cada aluno após a conclusão de cada caso. Gire os alunos através de todas as estações individualmente até que todos os estudantes completaram todas as estações. Distribua leituras complementares para os alunos via papel ou e-mail.</li>
</ol>2. dia 2 – currículo e intervenção educativa
<ol><li>Configurar cinco estações com humanos-paciente simuladores, simuladores de respiração, ventiladores e monitores como descrito acima.</li>
	<li>Atribuir a cada estação, um dos seguintes tópicos: SDRA, atelectasias secundárias de muco, obstruindo, pneumotórax, alterou o estado mental secundário a overdose de drogas e hiperinflação dinâmica. Organize os alunos em grupos de duas ou três pessoas. Atribua a um membro do corpo docente para cada estação.</li>
	<li>Permitir que cada equipe 10 min para trabalhar através de um cenário. Faculdade de dar 35 min para fornecer feedback e cabeceira de instrução. Gire os aprendentes através das restantes quatro estações.</li>
</ol>3. dia 3 – pós-teste de avaliação
<ol><li>Imprima listas de ação crítica, inquéritos à confiança depois do teste, pós-testes cognitivos exames de múltipla escolha. Configurar três estações com humanos-paciente simuladores, simuladores de respiração, ventiladores e monitores como descrito acima. Atribuir a cada estação, um dos seguintes tópicos: SDRA, atelectasias secundárias de muco, obstruindo, pneumotórax.</li>
	<li>Carregar os sinais vitais, imagens de raio-x do tórax, eletrocardiogramas e medições de gás de sangue arterial para cada caso de paciente para cada respectivo monitor paciente (por exemplo, autoPEEP imagens são enviadas para o simulador de paciente humano designado como o autoPEEP paciente).</li>
	<li>Estabelecidos em cada estação, listas de verificação críticas ações para cada aluno. Atribua a um membro do corpo docente para cada estação. Administre a pesquisa de confiança do pós-teste de 5 minutos e 25 minutos depois do teste cognitivo exame de múltipla escolha.</li>
	<li>Tem relatório de alunos para uma estação, com um aluno presente em cada estação. Restantes alunos podem esperar em uma sala separada. Tenho alunos fornecer seu código de identificação de quatro dígitos para faculdade para sua lista de ação crítica.</li>
	<li>Tem faculdade ler a haste caso para aluno. Permitir que os alunos um máximo de dez minutos por estação de trabalho através de um cenário. Não administre feedback durante o caso. Na conclusão do cenário, demita os aprendentes para voltar ao seu quarto separado.</li>
	<li>Tem faculdade preencher listas de ação crítica para cada aluno após a conclusão de cada caso. Gire os alunos através de todas as estações individualmente até que todos os estudantes completaram todas as estações. Administre 10 minutos pós-currículo pesquisa para todos os estudantes.</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>

Os autores não têm nada para divulgar.

O boot camp é composto por três sessões separadas. Durante o primeiro dia, os alunos completar um pre-teste pesquisa de confiança e conhecimento médico testar antes de se submeter a um cenário de cinco minutos. Corpo docente avaliar os alunos usando ações críticas pré-determinada. Leaners são dadas leitura assíncrona para concluir antes do dia 2. O segundo dia é composto por fase de intervenção, onde grupos de 2-3 alunos trabalham através de cinco cenários diferentes. Faculdade são ao lado do cama para ...

Este acampamento foi desenvolvido para ensinar os moradores a gerenciar um paciente ventilado mecanicamente, bem como solucionar problemas de alarmes do ventilador. Gestão de nesta população de pacientes pode ser intimidante para o praticante iniciante que pode ter limitada experiência com pacientes criticamente enfermos. Ensinar princípios de cuidados críticos, ao lado do cama é dificultada por restrições de trabalho-hora nacional1,2e preocupações médico-legal3 nos Estados Unidos. Simulação é uma modalidade eficaz para desenvolver e aperfeiçoar as habilidades de cuidados críticos4,5, bem como procedimentos invasivos6,7,8,9,10 . Através da simulação, os alunos podem experimentar o que as consequências da sua tomada de decisão médica é sem colocar os pacientes em risco. Este currículo permite uma variedade de modalidades de aprendizagem diferentes, incluindo o ensino de cabeceira de um intensivista, exercícios de prática com um ventilador e leitura assíncrona suplementar.
Estudos anteriores mostraram aumento do conhecimento com a educação baseada em manequim de ventilação mecânica11,12. Spadaro et al 11 em comparação treinamento baseado em computador, com treinamento em manequim para residentes de Anestesiologia, passando por ensino baseado em simulação de ventilação mecânica. Os moradores que foram submetidos a treinamento em manequim tinham maior acção-chave e pontuações de avaliação global. Conforme observado na nossa anterior estudo12, os residentes de primeiro ano demonstraram melhoria do conhecimento, confiança e competência após a conclusão deste currículo de treinamento.
Como está escrito, este currículo três dias permite que educadores inicialmente avaliar o conhecimento de linha de base dos seus alunos no primeiro dia, bem como avaliar as alterações na competência, conhecimento e confiança após a conclusão do currículo no terceiro dia. Dias 1 e 3 são dedicados para a avaliação, enquanto o segundo dia é focado na cabeceira ensino por especialistas de conteúdo. Condições patológicas (síndrome respiratória aguda [Sara], atelectasia secundária a muco obstruindo e pneumotórax) foram utilizadas para a avaliação inicial e finais dias de testes, enquanto uma estação de alteração do estado mental foi adicionada durante o ensino dia de rever conceitos básicos de ventilador. Hiperinflação dinâmica também foi adicionada para o dia de ensino como para reforçar o ventilador diagnóstico e gestão, incluindo a sua consideração em pacientes com pressão alta do planalto. Educadores podem substituir as patologias como sentem-se adequada para suas necessidades de ensino.
Em preparação, faculdade de simulação realizada um dia do ensaio inicial para garantir que todos os educadores participantes estavam cientes de seus papéis e para garantir o equipamento estava funcionando adequadamente. Enquanto fazíamos faculdade de simulação para avaliação e crítica cuidados médicos para o ensino, educadores podem ajustar os papéis dos professores como recursos ditam. Execução deste acampamento requer um planejamento de logística preparatória. Os residentes de primeiro ano devem ser agendada protegido para garantir podem terminar todos os três dias do currículo. Intensivists será necessário agendar tempo fora com antecedência para participar em sessões de ensino de cabeceira. Equipamento de simulação tais como respiratórios, simuladores, ventiladores mecânicos e simuladores de humanos-paciente pode ter que ser comprado, alugado ou emprestado.

<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

Gestão médica dos pacientes ventilados mecanicamente é um desafio para provedores de principiante. Gestão incorrecta desta população pode levar a aumento da morbidade e mortalidade. Um campo de treinamento de três dias com base em simulação serve para fornecer instrução individual com um provedor de cuidados críticos. Estas intensivists podem dispensar personalizado feedback imediato como aprendentes se envolver na prática hands-on com um ventilador muito mecânico. Várias patologias podem ser revistas que não podem ser encontradas na prática clínica. Aprendentes podem visualizar as consequências imediatas de suas ações e pode solucionar problemas e fazer perguntas, tudo em um ambiente de aprendizagem seguro. Nós descrevemos o uso de simuladores de paciente humano ligado à respiração simuladores e ventiladores mecânicos. Executores de currículo potencial devem estar cientes do custo do equipamento e o tempo necessário para dedicar-se à execução de acampamento; no entanto, este treinamento interativo intensivo foi mostrado para aumentar a competência do provedor, conhecimento e confiança na gestão do ventilador. Este resumo de currículo fornece orientação sobre como executar um campo de treinamento baseado em simulação para treinar fornecedores sobre a gestão dos pacientes mecanicamente ventilados.

Conforme observado na Yee et al, residentes de primeiro ano que passou por este acampamento demonstraram de confiança, conhecimento e desempenho significativamente melhorado12. Conhecimento cognitivo, avaliados pelo pré e pós-intervenção testes de escolha múltipla, aumentados de uma pontuação média de 40,3% para 67,1%, com uma mudança média de Pontuação de +26.8% (Figura 1).
<p class="jove_content" fo:keep-tog...

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

Mechanical Ventilation Boot Camp Curriculum

Este currículo descreve como executar um campo de treinamento baseado em simulação para ensinar os provedores gerenciar pacientes mecanicamente ventilados.

Ventilação mecânica Boot Camp currículo

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 visualizações.  The Ohio State University. Este currículo descreve como executar um campo de treinamento baseado em simulação para ensinar os provedores gerenciar pacientes mecanicamente ventilados.

Vídeo: 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).

Avaliação da mecânica respiratória em ratos usando a técnica de oscilações forçadas

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

Biologia

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;

Instalação e execução do exercício de treino código com os olhos vendados

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

Medicina

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.

Uso de um vaporizador anestésico integrado de baixo fluxo, ventilador e sistema de monitoramento fisiológico para roedores

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.

Perfusão pulmonar ex situ com pressão negativa normotérmica: avaliação da função e metabolismo pulmonar

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.

Empregando a Técnica de Oscilação Forçada para a Avaliação da Mecânica Respiratória em Adultos

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 Modelo Experimental Porcino para Estudo e Ensino de Mecânica Pulmonar

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

Suporte Básico de Vida Parte II: Via Aérea/Respiração e Ressuscitação Cardiopulmonar Continuada

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

JoVE Science Education

Habilidades Clínicas

Medicina de Emergência e Cuidados Intensivos

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.

Ventilação Mecânica I: Indicação e Configurações

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.

Ventilação Mecânica II: Ventilação Invasiva

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.

Ventilação Mecânica III: Ventilação Não Invasiva

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