Interferenze della ventilazione meccanica sull'emodinamica
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(2) Effects of different ventilatory mode on cardiopulmonary performance. SPONT. SPONT.. ASSIST. ASSIST.. CMV. CMV.. Mofied Mofiedfrom from Synder 1984 Synder 1984.
(3) ITP ,Blood Pressure and Cardiac Output.
(4) Attenzione alla PEEPi !.
(5) MV & venous return: effect of filling the Chest. Low TV High TV. Psf = Mean Systemic Filling Pressure (9mmHg).
(6) Effect of MV on CO depends from. Ï PVC. Ï Lung Volume. Ð Chest Wall Cpl. (PEEP, TV) Clinical consequence: Be carefull when ventilating with high Pressure/Volume patients with stiff chest wall (obese, scoliosis,ÏIntraAbdominalPressure etc.).
(7) MV & venous return: effect of filling status. Psf = 12 Psf = 7. Psf = Mean Systemic Filling Pressure (9mmHg).
(8) Effect of MV on CO depends from. Filling Status. Volemia. Vascular Tone. Clinical consequence: Be careful when ventilating Hypovolemic patients with reduced vascular tone (Hemorrhage, spinal trauma, CNS depression,sedation etc.).
(9) dUP and dDOWN to estimate cardiac filling.
(10) dDown è meglio di EchoCardio e WP.
(11) Physical Exam and Hypovolemia Signs. Sensitivity. Specificity. 1. Skin, mucous membranes. 85. 58. 2. Mental status. 57. 73. 3. Capillary refill. 34. 95. (McGee, JAMA, 1999). LSUHSC Critical Care Medicine.
(12) CVP as guide to Volume 24 20. N = 46. CVP (mm Hg). 16. La PVC NON è un buon indicatore 8 di VOLEMIA nel pz. Ventilato! 4 12. 0 -4 -8 35. 45. 55. 65. 75. 85. 95 105 115. Blood Volume (mL/kg) (Cohn JN: Ann Int Med, 1967;66:1283). LSUHSC Critical Care Medicine.
(13) Come valutare l’interferenza della MV sulle pressioni di riempimento.
(14) PEEP AND LV AFTERLOAD. Rasanen et al: Chest 1985; 87: 158-162.
(15) IntraThoracicPressure and LV function AO. ITP. Ptm = 100-(-20) = 120 effort effort==Ð ÐITP ITP==ÏPtm ÏPtm. Ð Ð LV 100 -20. Ï ÏLV LVafterload afterload.
(16) PEEP AND LV AFTERLOAD. Rasen et al: Chest 1985; 87: 158-162.
(17) IntraThoracicPressure and LV function AO. ITP. Ptm = 100-(-5) = 105 Ï Ïeffort effort==Ð ÐITP ITP==ÏPtm ÏPtm. Ð Ð LV 100 -5. Ï ÏLV LVafterload afterload.
(18) Razionale dell’uso della CPAP nell’EPA CPAP Ï ITP Ð Rit. Ven.. Ð LVafterload. Ï FRC Ï PaO2. Ï Cardiac performance Ð pulmonary congestion. Ð WOB.
(19) CPAP IN CARDIOGENIC PULMONARY EDEMA. Rasen et al: Am J Cardiol 1985; 55: 296-300.
(20) CPAP IN CARDIOGENIC PULMONARY EDEMA. Lenique F et al: Am J Respir Crit Care Med 1997; 155: 500-505.
(21) Out of hospital treatment of Acute Pulmonary Edema by non invasive CPAP G. Foti, M. Cazzaniga, E. Valle, M. Sabato, F. Apicella, V. Casartelli, G. Fontana, GP Rossi, S. Vesconi, A. Pesenti. • Istituto di Anestesia e Rianimazione, Università degli Studi, H. S. Gerardo - Monza - Italy • Servizio di Emergenza Territoriale, presidi di Carate e Desio • SSUEm 118 Brianza.
(22) Entry criteria: •ALS team availability •Pulmonary Edema diagnosis based on history and clinical findings •SpO2 < 95% in O2 by reservoire mask 63. 62. pts eligible. entered the study. 1 hypotension.
(23) 110 100. *. 90 SpO2 80 % 70. O2 reservoire CPAP. 60 50 40. * < 0.01. Modo.
(24) Pressione Arteriosa durante CPAP 300 Pressione Sistolica (mmHg). 250 200 150 100 50 0. PAS pre. O2 reservoire. PAS post. CPAP.
(25) Results: O2 Reservoire CPAP HR. 111±24. 103±15. < .01. MAP. 115±30. 101±18. < .01. Wet rales score. 3.6±0.7. 1.7±0.8. <.01.
(26) Outcome of ACPE pts: • Intubation rate • during transport 0% • hospital 2.2%. • Admission • ICU 0% • CCU 15.6% • General ward 84.4%. • Hospital stay • 10 ± 8 days.
(27) CPAP should be utilized as FIRST-LINE INTERVENTION in the treatment of Acute Pulmonary Edema.
(28)
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