Mechanical Ventilation PV Curves. Techniques for Measurement 1. Supersyringe 2. Constant Flow 3. Multiple Occlusion.

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Presentation transcript:

Mechanical Ventilation PV Curves

Techniques for Measurement 1. Supersyringe 2. Constant Flow 3. Multiple Occlusion

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” conditions 1 1 Qin Lu, AJRCCM 1999;159: Servillo, AJRCCM 1997;155:

Radford, Tissue Elasticity, 1957 Surface forces due to air-liquid interface

Gattinoni, ARRD 1987;136: Pflex

P "safe" window zone of overdistension V Pressure-Volume Curve LIP UIP zone of derecruitment and atelectasis

PV Curve Normal ARDS COPD

Normal

ARDS

P "safe" window zone of overdistension V atelectrauma volutrauma Lung Protective Ventilator Strategies LIP UIP zone of derecruitment and atelectasis DON’T EVEN THINK OF PARKING HERE

Pressure Volume Safe zone Overdistention Derecruited Lower P flex, LIP Upper P flex, UIP PV Curve in ARDS

Preventing Overdistention and Under-Recruitment Injury “Lung Protective” Ventilation VOLUMEVOLUME VOLUMEVOLUME Pressure Limit Distending Pressure Add PEEP Limit VT

PV Curve COPD

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