Multiprofessional Critical Care Review: Pediatric 2024 (MCCRCP24ON)-Pulm Waveform

Pulm Waveform

Pdf Summary

The document, "Pulmonary Waveform Analysis" by Dr. Ira M. Cheifetz, explores the intricacies of airway scalars and loops, various types of patient-ventilator dyssynchrony, and the impact of these issues on patient outcomes, particularly in cases involving pediatric critical care. <br /><br />Key topics covered include:<br />1. **Types of Dyssynchrony**: Issues like trigger, flow, and cycle dyssynchrony are discussed, noting problems like double-triggering, premature cycling, and delayed cycling. Dyssynchrony can result from insufficient or excessive ventilator sensitivity and mismatches between patient effort and ventilator support.<br />  <br />2. **Clinical Cases and Questions**: Two specific cases of infants with chronic lung disease (CLD) highlight practical aspects of managing dyssynchronies. Each case includes related questions regarding the patient's condition and the best ventilator settings to optimize oxygen consumption and alleviate clinical symptoms.<br /><br />3. **Impact and Adverse Outcomes**: Dyssynchrony can exacerbate respiratory conditions, lead to structural injury of respiratory muscles, worsen mechanics like PEEPi (intrinsic PEEP), and negatively impact gas exchange. Long-term complications include increased work of breathing (WOB), compromised cardiac output and patient comfort, and difficulties in weaning from ventilation.<br /><br />4. **Technical Concepts**:<br />   - **Flow and Cycle Dyssynchrony**: These occur when there's a mismatch between the ventilator’s inspiratory flow and the patient’s demand or when exhalation is prematurely cut off, leading to issues like ‘gas trapping’.<br />   - **Overdistention**: Defined by specific criteria such as 'beaking' of the pressure-volume curve, this condition can increase risks of volutrauma and barotrauma if not managed correctly.<br /><br />5. **Management Strategies**: Emphasis is placed on a vigilant, hands-on approach to adjusting ventilator settings based on careful assessment of airway graphics. Strategies include adjusting trigger sensitivity, inspiratory flow rates, and considering changes to modes allowing variable inspiratory flow to manage PEEPi and other issues.<br /><br />The document underscores the importance of understanding and promptly addressing ventilator-patient asynchrony to improve clinical outcomes and patient comfort in critical care settings.

Keywords

Pulmonary Waveform Analysis

airway scalars

loops

patient-ventilator dyssynchrony

pediatric critical care

trigger dyssynchrony

flow dyssynchrony

cycle dyssynchrony

ventilator settings

PEEPi

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