Mechanical Ventilation PV Curves
description
Transcript of Mechanical Ventilation PV Curves
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Mechanical Ventilation PV
Curves
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Techniques for Measurement
1. Supersyringe
2. Constant Flow
3. Multiple Occlusion
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Low Constant Flow
• Simple• Can be performed on ventilator (some types)• Avoids disconnect• Hysteresis • Heavy sedation or paralysis required• Flow 9 L/min for “quasi-static” conditions1
1Qin Lu, AJRCCM 1999;159:275-282Servillo, AJRCCM 1997;155:1629-1636
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Radford, Tissue Elasticity, 1957
Surface forces due to air-liquidinterface
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Gattinoni, ARRD 1987;136:730-736
Pflex
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P
"safe"window
zone of overdistension
V
Pressure-Volume Curve
LIP
UIPzone of derecruitment and atelectasis
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PV CurveNormal ARDS COPD
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PV Curve
Normal
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PV Curve
ARDS
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P
"safe"window
zone of overdistension
V
atelectrauma
volutrauma
Lung Protective Ventilator Strategies
LIP
UIPzone of derecruitment and atelectasis
DON’T EVEN
THINKOF PARKING
HERE
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Pressure
Vo
lum
e
Safe
zon
e
Overdistention
Derecruited
Lower Pflex, LIP
Upper Pflex, UIP
PV Curve in ARDS
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Preventing Overdistention and Under-Recruitment
Injury“Lung Protective” Ventilation“Lung Protective” Ventilation
VOLUME
VOLUME
PressurePressure
Limit Distending PressureLimit Distending Pressure
Add PEEPAdd PEEP
Limit VT
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PV Curve
COPD