control of breathing under mechanical ventilation...control of breathing under mechanical...
TRANSCRIPT
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Control of Breathing Under Mechanical Ventilation
Ewan C. Goligher MD PhDInterdepartmental Division of Critical Care MedicineUniversity of Toronto
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Disclosures
• Conflicts of Interest• Equipment and personal fees from Getinge• Equipment from Timpel
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Outline
• Why we care: targeting respiratory effort• Control of ventilation• In non-ventilated subjects• On the ventilator
• Determinants of respiratory effort
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Challenge: Managing Respiratory Drive
Respiratory drive & effort
P-SILI
Myotrauma
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Respiratory drive and effort
Bertoni et al Crit Care 2019
Volutrauma
Myotrauma
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Control of Ventilation
Vaporidi et al AJRCCM 2019
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Control of Ventilation
Ve
PaCO2
PaCO2 =k ⋅V
.CO2
Ve.⋅ 1−Vd Vt( )
⇒Ve.=
1PaCO2
⋅k ⋅V
.CO2
1−Vd Vt( )
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Control of Ventilation
Ve
PaCO2
PaCO2 =k ⋅V
.CO2
Ve.⋅ 1−Vd Vt( )
⇒Ve.=
1PaCO2
⋅k ⋅V
.CO2
1−Vd Vt( )
![Page 10: Control of Breathing Under Mechanical Ventilation...Control of Breathing Under Mechanical Ventilation Ewan C. Goligher MD PhD Interdepartmental Division of Critical Care Medicine University](https://reader034.vdocuments.us/reader034/viewer/2022051806/5ffb2b1aecafa87a0542d542/html5/thumbnails/10.jpg)
Control of Ventilation
Vaporidi et al AJRCCM 2019
PaCO2 =k ⋅V
.CO2
Ve.⋅ 1−Vd Vt( )
⇒Ve.=
1PaCO2
⋅k ⋅V
.CO2
1−Vd Vt( )
![Page 11: Control of Breathing Under Mechanical Ventilation...Control of Breathing Under Mechanical Ventilation Ewan C. Goligher MD PhD Interdepartmental Division of Critical Care Medicine University](https://reader034.vdocuments.us/reader034/viewer/2022051806/5ffb2b1aecafa87a0542d542/html5/thumbnails/11.jpg)
Control of Ventilation: Pattern
Ve
Vt
RR
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Control of Ventilation: Respiratory Failure
Vaporidi et al AJRCCM 2019
Diaphragm dysfunction
Impaired mechanics
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Control of Ventilation in Respiratory Failure
Vaporidi et al AJRCCM 2019
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Ve
PaCO2
Control of Ventilation: Modes
Apneathreshold
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Respiratory drive and effort
Bertoni et al Crit Care 2019
Volutrauma
Myotrauma
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Determinants of Respiratory Muscle Pressure
Desired tidal volumeDesired inspiratory flow
Respiratory mechanics
Diaphragm function
Determinants of respiratory drive: sleep-wake status, acid-base, sedation, hypoxia, central demands
Ventilator pressure, flow, PEEP
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Patient-Ventilator Interaction
Vaporidi et al AJRCCM 2019
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Patient-Ventilator Interaction
Vaporidi et al AJRCCM 2019
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Patient-Ventilator Interaction
Vaporidi et al AJRCCM 2019
![Page 20: Control of Breathing Under Mechanical Ventilation...Control of Breathing Under Mechanical Ventilation Ewan C. Goligher MD PhD Interdepartmental Division of Critical Care Medicine University](https://reader034.vdocuments.us/reader034/viewer/2022051806/5ffb2b1aecafa87a0542d542/html5/thumbnails/20.jpg)
Patient-Ventilator Interaction
Vaporidi et al AJRCCM 2019
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Summary
• Why we care: targeting respiratory effort• Control of ventilation• In non-ventilated subjects• On the ventilator
• Determinants of respiratory effort