Some problems relate to mechanical ventilation physiotherapy

BỆNH VIỆN ĐẠI HỌC Y DƯỢC TP HCM KHOA PHỤC HỒI CHỨC NĂNG Some Problems Relate To Mechanical Ventilation - Physiotherapy BS Nguyễn Võ Hoàng Phúc BS Nguyễn Đức Thành Khoa Phục Hồi Chức Năng Bệnh Viện Đại Học Y Dược TPHCM CONTENTS Introduction MV Basic physiology of MV Complications of MV Yếu tố nguy Sedation vs MV Mobilization in patient with MV SAFEMOBE in patient with MV Introduction  “Mechanical ventilation (MV) is the most used short-term life support technique worldwide”  Over the last 50 years, MV has been an important tool:  Maintaining a patient’s breathing  Improving patient survival and recovery from lifethreatening diseases The mortality rate in intensive care units has notably decreased Tài Pham, Brochard L.J (2017), “Mechanical Ventilation: State of the Art”, Mayo Clinic Proc, vol 92(9), pp 1382-1400 Wang T.H (2020), “EEarly mobilization of mechanically ventilated patients in the intensive care unit”, pp 1-20 Introduction • Beginning: In the 16th century  Andreas Vesalius • Four centuries later, “the iron lung: the first negativepressure ventilator successfully used in clinical practice” Tài Pham, Brochard L.J (2017), “Mechanical Ventilation: State of the Art”, Mayo Clinic Proc, vol 92(9), pp 1382-1400 Introduction • 1952, Bjorn Iben (Blegdams Hospital )-> tracheostomy and positive-pressure ventilation to treat patients with paralytic poliomyelitis  mortality decreased from 87% to 40% • 1954, Claus Bang & Carl-Gunnar Engstrưm developed the first efficient mechanical ventilator • The first arterial blood gas analyzers were built shortly thereafter • 1967, Ashbaugh -> the use of positive end-expiratory pressure (PEEP) : ARDS • 1972, Servo 900A (Siemens-Eléma): the first mechanical ventilator with PEEP • In the United States: 310 persons/100,000 adult population undergo invasive ventilation for nonsurgical indications Tài Pham, Brochard L.J (2017), “Mechanical Ventilation: State of the Art”, Mayo Clinic Proc, vol 92(9), pp 1382-1400 Indications of MV • (1) airway protection for a patient with a decreased level of consciousness (eg, head trauma, stroke, drug overdose, anesthesia) • (2) hypercapnic respiratory failure due to airway, chest wall, or respiratory muscle diseases • (3) hypoxemic respiratory failure • (4) circulatory failure • (5) Cardiac or respiratory arrest Tài Pham, Brochard L.J (2017), “Mechanical Ventilation: State of the Art”, Mayo Clinic Proc, vol 92(9), pp 1382-1400 Basic physiology of MV Understanding of the basic physiology of MV -> necessary to optimally apply MV 4 elements determining the phases of the respiratory cycle Time Pressure Flow Volume Tài Pham, Brochard L.J (2017), “Mechanical Ventilation: State of the Art”, Mayo Clinic Proc, vol 92(9), pp 1382-1400 Basic physiology of MV The modes of MV are commonly defined by elements Phases of a breath: 1) The trigger phase initiates a breath • The ventilation is fully controlled  the trigger variable is time • The ventilator synchronizes the breath to the patient’s effort  the trigger variable: flow or pressure decrease Tài Pham, Brochard L.J (2017), “Mechanical Ventilation: State of the Art”, Mayo Clinic Proc, vol 92(9), pp 1382-1400 Basic physiology of MV 2) The target (or controlled) phase: pressure or flow will be maintained until the inspiration ends 3) The cycling phase determines the end of the inspiratory phase 4) The passive expiratory phase: - A pressure, flow, or a preset time reaches the preset value - The expiratory control variable: a pressure (PEEP) Tài Pham, Brochard L.J (2017), “Mechanical Ventilation: State of the Art”, Mayo Clinic Proc, vol 92(9), pp 1382-1400 Basic physiology of MV Therefore, Breaths can be:  Fully controlled-trigger: the patient does not actively contribute to the breath Partially supported: a combination of ventilator assistance and patient effort occurs in the same cycle Unassisted: The breath is generated entirely by the patient’s respiratory muscles Tài Pham, Brochard L.J (2017), “Mechanical Ventilation: State of the Art”, Mayo Clinic Proc, vol 92(9), pp 1382-1400 Out-of-bed mobilization: That is any activity where the patient sits over the edge of the bed (dangling), stands, walks, marches on the spot or sits out of bed) In-bed mobilization: that is any activity undertaken whilst the patient is sitting or lying in bed such as rolling, bridging, upper-limb weight training NOTES: No guidances for passive mobilization CONDITION - CONSIDERATIONS IN-BED EXERCISES OUT-BED EXERCISES Hodgson C., et al (2014), “Expert consensus and recommendations on safety criteria for active mobilization ofnmechanically ventilated critically ill adults”, Critical Care , 18:658 CONDITION - CONSIDERATIONS IN-BED EXERCISES OUT-BED EXERCISES Hodgson C., et al (2014), “Expert consensus and recommendations on safety criteria for active mobilization ofnmechanically ventilated critically ill adults”, Critical Care , 18:658 Hodgson C., et al (2014), “Expert consensus and recommendations on safety criteria for active mobilization ofnmechanically ventilated critically ill adults”, Critical Care , 18:658 Hodgson C., et al (2014), “Expert consensus and recommendations on safety criteria for active mobilization ofnmechanically ventilated critically ill adults”, Critical Care , 18:658 Thomas L.,et al, 2017 ,Physical activity and movement: A guideline for critically ill adults , Intensive care NSW, pp 1-33 Mobilization: Blood test Ghazinouri R., Gorman H., et al (2013), “ Lab values interpretion rerources”, The acute care section – APTA, 1-54 Let ‘s right now! Let ‘s right now! Câu hỏi lượng giá • • • • • • Chu kỳ hô hấp bao gồm giai đoạn A B C D E Câu hỏi lượng giá 2) Thông số sau tránh tập luyện chủ động? A Huyết áp tâm trương < 120 mmHg B Huyết áp tâm thu > 200 mmHg C Hemogloin < 80 g/L tiểu cầu < 20 x 10^9 G/L D Dùng lọai vận mạch liều thấp E Nhịp thở > 35 lần/phút Tài liệu tham khảo • • • • • • • • • Adler J., Malone D (2012), “Early Mobilization in the Intensive Care Unit: A Systematic Review”, Cardiopulmonary physical therapy journal, 23 (1), 1-13 Balley B., Thomsen G.E., et al, ″Early activity is feasible and safe in respiratory failure patients″, Crit Care Med, 2007, 35(1), pp 139 – 145 Clarissa, C., Salisbury, L., Rodgers, S et al (2019), Early mobilisation in mechanically ventilated patients: a systematic integrative review of definitions and activities j intensive care, vol (3) Dang S.L (2013), ″ABCDEs ICU: Early Mobility″, Crit Care Nurs Q, vol 36 (2), pp 163 -168 Dubb R, Nydahl P, Hermes C, Schwabbauer N, Toonstra A, Parker AM, Kaltwasser A, Needham DM, (2016), Barriers and Strategies for Early Mobilization of Patients in Intensive Care Units Ann Am Thorac Soc, vol 13 (5), pp 724-30 Hashem M.D., Nelliot A., Needham D.M (2016), ″Early Mobilization and Rehabilitation in the ICU: Moving Back to the Future ″, Respir Care, pp 971 – 979 Jonghe B.D., CooK D et al (2000), “Using and understanding sedation scoring systems: a systematic review”, Intensive Care Med, Vol 26, pp 275 - 285 Hodgson C., et al (2014), “Expert consensus and recommendations on safety criteria for active mobilization ofnmechanically ventilated critically ill adults”, Critical Care , 18:658 Perme C., Nawa R.K., Winkelman C., Masud F (2014), ″A tool to assess mobility status in critically ill patients: the Perme Intensive Care Unit Mobility Score″, Methodist Debakey Cardiovasc J, vol 10(1), pp 41-49 • • • • • • Tài liệu tham khảo Moreira F.C, Teixeira C (2020), “Changes in respiratory mechanics during respiratory physiotherapy in mechanically ventilated patients”, Original Article”, pp 1-6 Moris P.E (2007), ″Moving Our Critically Ill Patients: Mobility Barriers and Benefits″, Crit Care Clin, pp -20 Sessler CN, Gosnell MS, Grap MJ, Brophy GM, O'Neal PV, Keane KA, Tesoro EP, Elswick RK The Richmond AgitationSedation Scale: validity and reliability in adult intensive care unit patients Am J Respir Crit Care Med 2002 Nov 15;166(10):1338-44 Sommer J., et al (2015) , ″Physiotherapy in the intensive care unit: an evidence-based, expert driven, practical statement and rehabilitation recommendations″, Clinical Rehabilitation, Vol 29(11), pp 1051–1063 Stiller K., et al (2007), “Safety issues that should be considered when mobilizing critically ill patients”, Crit Care Clin 23, 35– 53 Sricharoenchai T, Parker A.M., et al (2013), ″Safety of physical therapy interventions in critically ill patients: A single center prospective evaluation of 1,110 ICU admissions″, Journal of critical care, 1-18 • • • • Tài Pham, Brochard L.J (2017), “Mechanical Ventilation: State of the Art”, Mayo Clinic Proc, vol 92(9), pp 1382-1400 Taito, S., Shime, N., Ota, K et al, (2016), “Early mobilization of mechanically ventilated patients in the intensive care unit”, j intensive care, vol (50) Wang T.H (2020), “EEarly mobilization of mechanically ventilated patients in the intensive care unit”, pp 1-20 Yang R, Zheng Q, Zuo D, Zhang C, Gan X (2020), “Safety Assessment Criteria for Early Active Mobilization in Mechanically Ventilated ICU Subjects” Respir Care