EuAsia 2017 – Day 1: Respiratory failure and organ interaction

Respiratory failure and organ interaction

Lung failure (S Jabar)

Classical mechanism of damage – volutrauma, barotrauma, biotrauma, atelectatrauma

Low pressure and low volume ventilation but… –> reduces alveolar ventilation

You need to recruit before increasing PEEP

Low TV and high PEEP has a preventative role in the development of ARDS

All ICU patients are at risk of developing ARDS

2017-04-06 08.19.22 2017-04-06 08.18.23

 

References:

Happy 50th birthday ARDS

What’s new in ARDS: can we prevent it?

8 year trends on ARDS

Berlin definition ARDS

 

Pump failure (A Pesenti)

Sick muscle and/or too much work for muscle (they need to work less or to rest)

Measuring auto PEEP – measure pressure at end expiration

2017-04-06 08.25.03

References:

Respiratory Muscle Contribution to Lactic Acidosis in Low Cardiac Output

The role of PEEP in patients with chronic obstructive pulmonary disease during assisted ventilation 

Changes of Respiratory Mechanics in COPD Patients from Stable State to Acute Exacerbations with Respiratory Failure.

 

Diaphragmatic dysfunction (CY Lim)

2017-04-06 09.03.09 2017-04-06 09.07.20

References:

Diaphragm dysfunction assessed by ultrasonography: influence on weaning from mechanical ventilation.

Ultrasonography evaluation during the weaning process: the heart, the diaphragm, the pleura and the lung

Diaphragm dysfunction on admission to the intensive care unit. Prevalence, risk factors, and prognostic impact-a prospective study.

Patterns of diaphragm function in critically ill patients receiving prolonged mechanical ventilation: a prospective longitudinal study

Diaphragmatic dysfunction and respiratory illness (Review)

Evolution of Diaphragm Thickness during Mechanical Ventilation. Impact of Inspiratory Effort.

Mechanical Ventilation and Diaphragmatic Atrophy in Critically Ill Patients: An Ultrasound Study. 

Effect of theophylline on ventilator-induced diaphragmatic dysfunction

 

Heart Lung Interaction (M Cecconi)

Fluid responsiveness doesn’t mean the pt needs fluids

2017-04-06 09.14.39 2017-04-06 09.26.49

 

The Changes in Pulse Pressure Variation or Stroke Volume Variation After a Tidal Volume Challenge Reliably Predict Fluid Responsiveness During Low Tidal Volume Ventilation* 

Respiratory variation in inferior vena cava diameter: surrogate of central venous pressure or parameter of fluid responsiveness? Let the physiology reply

Predicting volume responsiveness by using the end-expiratory occlusion in mechanically ventilated intensive care unit patients. 

What role does the right heart play?

 

Lungs don’t interact just with the heart (K Zirpe)

Lung open to environment

2017-04-06 09.40.03

References:

Mechanical Ventilation as a Mediator of Multisystem Organ Failure in ARDS

Cardio-pulmonary-renal interaction

Brain-lung crosstalk: Implications for neurocritical care patients

Pulmonary-intestinal cross-talk in mucosal inflammatory disease