Name: mechanical ventilation boot camp curriculum
Uploaded: 2018-03-12T15:00:00.000+00:00
Duration: 7 min 36 s
Description: Watch this Scientific Journal Video about Mechanical Ventilation Boot Camp Curriculum at JoVE.com

Los autores desean agradecer a Anna Ciullo, M.D. por su asistencia con el desarrollo curricular y la ejecución. No hubo ningún financiamiento exterior para este informe.

Todos los métodos aquí descritos fueron encontrados para ser exentos de revisión por la Junta de revisión institucional de Summa.
1. día 1 – evaluación de la prueba
<ol><li>Imprimir listas de acción crítico, encuestas de confianza antes de la prueba, exámenes de opción múltiple cognitiva antes de la prueba.</li>
	<li>Coloque tres simuladores de pacientes humanos en camas de UCI con las siguientes designaciones: agudo Síndrome de dificultad respiratoria (SDRA), atelectasia completa del pulmón secundario a taponamiento de moco y neumotórax. Se simuladores en cuartos separados o lejos bastante aparte que los estudiantes no podrá fácilmente escuchar otra vez ejecutado sesiones. Lugar de simuladores en un espacio de aprendizaje dedicado.</li>
	<li>Intubar a los simuladores de paciente humano. No coloque el tubo endotraqueal en la tráquea del simulador, sino a través de un agujero en la mejilla interna del simulador que conduce a la parte posterior del cuello del simulador.<ol>
<li>Conecte el tubo corrugado vía aérea desde el simulador de pulmón al tubo endotraqueal que se esconde ahora detrás de cuello del simulador. Una vez conectado, el simulador de pulmón ahora es funcional. Use una almohada para ocultar esta conexión.</li>
	</ol>
</li>
	<li>Activar el simulador de pulmón. Seleccione estado patológico seleccionado en el menú carpeta paciente. Iniciar la patología seleccionada en el simulador de pulmón.<ol>
<li>Conecte el ventilador mecánico al tubo endotraqueal que sale de la boca del simulador. Si el ventilador está conectado al tubo endotraqueal antes de iniciar el programa de la patología del pulmón, el ventilador no funcionará correctamente.</li>
		<li>Conectar simuladores de pacientes humanos con simuladores de respiración. Conectar los simuladores de paciente humano intubados con ventiladores mecánicos.</li>
	</ol>
</li>
	<li>Coloque a un monitor paciente simulado por cada simulador de paciente humano. Seleccione el software de signo vital dentro del programa de simulador de pulmón. Elegir el apropiado signos vitales iniciales para el inicio de la presentación paciente simulado. Habilitar el monitor de signos vitales.</li>
	<li>Carga de pre-seleccion del paciente signos vitales, imágenes de rayos x de tórax portátil, electrocardiogramas y las mediciones de gas de sangre arterial para cada caso paciente a cada monitor paciente respectivo (por ejemplo, autoPEEP imágenes se suben al simulador de paciente humano señalado como el paciente autoPEEP).</li>
	<li>Establecidas listas de acciones en cada estación para cada alumno donde profesores observando el caso. Esto puede ser detrás de un cristal unidireccional o en una mesa de noche, pero a suficiente distancia que los alumnos no serán capaces de leer las listas de comprobación. Asignar a un miembro de la Facultad a cada estación.</li>
	<li>Tiene cada alumno elija un código de identificación de cuatro dígitos para encuestas de confianza, exámenes cognitivos y listas de acción crítica. Los códigos pueden utilizarse para revisar los datos recogidos de una manera anónima. Los estudiantes pueden elegir cualquier código de cuatro dígitos que recuerdan constantemente a lo largo del currículo.</li>
	<li>En una sala separada, administrar encuesta de confianza de 5 minutos antes de la prueba a los estudiantes. A su finalización, administrar exámenes de opción múltiple cognitiva 25 minutos antes de la prueba a los estudiantes.</li>
	<li>Tener informe de los alumnos a una estación, con un alumno presente en cada estación. Restantes los estudiantes pueden esperar en una sala separada. Tienen estudiantes proporcionar su código de identificación de cuatro dígitos a la Facultad para su lista de acción crítica.</li>
	<li>Tienen la Facultad de leer el caso tallo al alumno. Permiten a los estudiantes un máximo de diez minutos por estación de trabajo a través de un escenario. No administrar comentarios durante el caso. En la conclusión de la situación, despedir a estudiantes para volver a su cuarto.</li>
	<li>Tienen facultad llenar listas de acción crítica para cada alumno al finalizar cada caso. Gire el aprendizaje a través de todas las estaciones individualmente hasta que todos los estudiantes hayan completado todas las estaciones. Distribución de lecturas suplementarias a los estudiantes vía papel o correo electrónico.</li>
</ol>2. día 2 – plan de estudios y la intervención educativa
<ol><li>Establecer cinco estaciones con simuladores de pacientes humanos, simuladores de respiración, ventiladores y monitores como se describió anteriormente.</li>
	<li>Asignar a cada estación de uno de los siguientes temas: SDRA, atelectasia secundaria a taponamiento, neumotórax, moco alterado estado mental secundario a sobredosis de droga y la hiperinflación dinámica. Organizar los estudiantes en grupos de dos o tres personas. Asignar a un miembro de la Facultad a cada estación.</li>
	<li>Permitir a cada equipo 10 minutos para trabajar a través de un escenario. Facultad de dar 35 min para proporcionar instrucción retroalimentación y mesitas de noche. Gire el aprendizaje a través de las cuatro estaciones restantes.</li>
</ol>3. día 3 – evaluación post prueba
<ol><li>Imprimir listas de acción crítico, encuestas de confianza de postest, exámenes de opción múltiples cognitivos post-test. Establecer tres estaciones con simuladores de pacientes humanos, simuladores de respiración, ventiladores y monitores como se describió anteriormente. Asignar a cada estación de uno de los siguientes temas: SDRA, atelectasia secundaria a moco taponamiento, neumotórax.</li>
	<li>Subir los signos vitales, imágenes de rayos x de tórax portátil, electrocardiogramas y las mediciones de gas de sangre arterial para cada caso paciente a cada monitor paciente respectivo (por ejemplo, autoPEEP imágenes se suben al simulador de paciente humano designado como la autoPEEP paciente).</li>
	<li>Establecidas listas de acciones en cada estación para cada alumno. Asignar a un miembro de la Facultad a cada estación. Administrar la encuesta de confianza del post-test de 5 minutos y examen de selección múltiple cognitiva después de 25 minutos.</li>
	<li>Tener informe de los alumnos a una estación, con un alumno presente en cada estación. Restantes los estudiantes pueden esperar en una sala separada. Tienen estudiantes proporcionar su código de identificación de cuatro dígitos a la Facultad para su lista de acción crítica.</li>
	<li>Tienen la Facultad de leer el caso tallo al alumno. Permiten a los estudiantes un máximo de diez minutos por estación de trabajo a través de un escenario. No administrar comentarios durante el caso. En la conclusión de la situación, despedir a estudiantes para volver a su cuarto.</li>
	<li>Tienen facultad llenar listas de acción crítica para cada alumno al finalizar cada caso. Gire el aprendizaje a través de todas las estaciones individualmente hasta que todos los estudiantes hayan completado todas las estaciones. Administrar 10 minutos post-curriculum encuesta a todos los estudiantes.</li>
</ol>

<ol>
	<li>Slutsky, A. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=History+of+mechanical+ventilation.+From+vesalius+to+ventilator-induced+lung+injury.">History of mechanical ventilation. From vesalius to ventilator-induced lung injury.</a> Am J Respir Crit Care Med. 191 (10), 1106-1115 (2015).</li><li>Ahmed, N., Devitt, K. S., Keshet, I., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+Systematic+Review+of+the+Effects+of+Resident+Duty+Hour+Restrictions+in+Surgery.">A Systematic Review of the Effects of Resident Duty Hour Restrictions in Surgery.</a> Ann Surg. 259 (6), 1041-1053 (2014).</li><li>Ziv, A., Wolpe, P. R., Small, S. 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L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+medical+simulation-based+educational+intervention+for+emergency+medicine+residents+in+neonatal+resuscitation.">A medical simulation-based educational intervention for emergency medicine residents in neonatal resuscitation.</a> Acad Emerg Med. 19 (5), 577-585 (2012).</li><li>Barsuk, J. H., Cohen, E. R., Caprio, T., McGaghie, W. C., Simuni, T., Wayne, D. B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Simulation-based+education+with+mastery+learning+improves+residents'+lumbar+puncture+skills.">Simulation-based education with mastery learning improves residents' lumbar puncture skills.</a> Neurology. 79 (2), 132-137 (2012).</li><li>Barsuk, J. H., Cohen, E. R., Vozenilek, J. A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Simulation-based+education+with+mastery+learning+improves+paracentesis+skills.">Simulation-based education with mastery learning improves paracentesis skills.</a> J Grad Med Educ. 4 (1), 23-27 (2012).</li><li>Sohmer, B., Hudson, C., Hudson, J., Posner, G. D., Naik, V. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Transesophageal+echocardiography+simulation+is+an+effective+tool+in+teaching+psychomotor+skills+to+novice+echocardiographers.">Transesophageal echocardiography simulation is an effective tool in teaching psychomotor skills to novice echocardiographers.</a> Can J Anaesth. 61 (3), 235-241 (2014).</li><li>Sigounas, V. J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Evaluation+of+simulation-based+training+model+on+vascular+anastomotic+skills+for+surgical+residents.">Evaluation of simulation-based training model on vascular anastomotic skills for surgical residents.</a> Simul Healthc. 7 (6), 334-338 (2012).</li><li>Dawe, S. R., Windsor, J. A., Broeders, J. A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+systematic+review+of+surgical+skills+transfer+after+simulation-based+training:+laparoscopic+cholecystectomy+and+endoscopy.">A systematic review of surgical skills transfer after simulation-based training: laparoscopic cholecystectomy and endoscopy.</a> Ann Surg. 259 (2), 236-248 (2014).</li><li>Spadaro, S., Karbing, D. 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H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+Importance+of+Debriefing+in+Simulation-Based+Learning:+Comparison+Between+Debriefing+and+No+Debriefing.">The Importance of Debriefing in Simulation-Based Learning: Comparison Between Debriefing and No Debriefing.</a> Comput Inform Nurs. 33 (12), 538-545 (2015).</li><li>Shinnick, M. A., Woo, M., Horwich, T. B., Steadman, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Debriefing:+The+Most+Important+Component+in+Simulation?.">Debriefing: The Most Important Component in Simulation?.</a> Clin Simul Nurs. 7 (3), e105-e111 (2011).</li></ol>

Los autores no tienen nada que revelar.

El campamento de arranque consiste en tres sesiones separadas. Durante el primer día, los estudiantes completan un pre-test prueba de encuesta de confianza y conocimiento médico antes de someterse a un escenario de cinco minutos. Facultad de evaluar el aprendizaje mediante acciones predeterminadas. Leaners luego dan lectura asincrónica para completar antes del día 2. El segundo día se compone de la etapa de intervención, donde grupos de 2-3 estudiantes trabajan a través de cinco escenarios diferentes. Facultad se ...

Este campamento de entrenamiento fue desarrollado para enseñar a los residentes cómo manejar a un paciente ventilado mecánicamente, así como solucionar problemas de alarmas del ventilador. Tratamiento de esta población de pacientes puede ser intimidante para el practicante novato que puede tienen una limitada experiencia con pacientes en estado crítico. Enseñanza de principios de cuidados críticos en la cabecera es hecha más difícil por las restricciones de horas de trabajo nacionales1,2y problemas médico-legales3 en los Estados Unidos. La simulación es una modalidad eficaz para desarrollar y perfeccionar habilidades de cuidados críticos4,5, así como procedimientos invasivos6,7,8,9,10 . A través de simulación, los estudiantes pueden experimentar lo que las consecuencias de sus decisiones médicas es sin poner pacientes en riesgo. Este plan de estudios permite una variedad de modalidades de aprendizaje, incluyendo enseñanza de cabecera de un intensivista, prácticas con un ventilador y complementaria lectura asincrónica.
Estudios anteriores han demostrado mayor conocimiento con la educación basada en el maniquí de la ventilación mecánica11,12. Spadaro et al. 11 compararon el entrenamiento basado en computadora con maniquí de entrenamiento para residentes de Anestesiología, sometidos a enseñanza basada en simulación de la ventilación mecánica. Los residentes sometidos a entrenamiento basado en el maniquí tenían mayor acción clave y puntajes de calificación global. Como se ha señalado en nuestro anterior estudio12, los residentes de primer año demostraron mayor conocimiento, confianza y competencia después de la conclusión de este plan de estudios de campo.
Como escrito, este plan de estudios de tres días permite que los educadores inicialmente evaluar conocimientos de base de sus estudiantes el primer día, así como evaluar los cambios en la competencia, conocimiento y confianza sobre la terminación del plan de estudios en tres días. Días uno y tres están dedicados a la evaluación, mientras que el segundo día se centra en la enseñanza de cabecera por expertos. Condiciones patológicas (aguda síndrome de dificultad respiratoria [SDRA], atelectasia secundaria y taponamiento de moco, neumotórax) fueron utilizadas para la evaluación inicial y los días de exámenes finales, mientras que una estación de estado mental alterado fue añadida durante la enseñanza día para repasar lo básico del ventilador. Hiperinflación dinámica también fue agregada al día de la enseñanza en cuanto a reforzar ventilador diagnóstico y gestión, incluyendo el examen en pacientes con una presión de meseta. Educadores pueden sustituir las patologías como consideran apropiados para sus necesidades de enseñanza.
En preparación, Facultad de simulación celebró un día de ensayo inicial para que todos los educadores participantes eran conscientes de sus funciones y para asegurar el equipo funcionaba adecuadamente. Mientras que utilizamos Facultad de simulación para la evaluación y los médicos de atención crítica para la enseñanza, educadores pueden ajustar las funciones de la Facultad como recursos dictan. Ejecución de este campo requiere una planificación de la preparación logística. Los residentes de primer año deben ser horario protegido para asegurar que pueden completar todos los tres días del plan de estudios. Intensivistas, necesitará programar hora apagado de antemano a asistir a las sesiones de enseñanza cabecera. Equipos de simulación como de respiración simuladores, ventiladores mecánicos y simuladores de paciente humano pueden tener que ser comprado, alquilado o prestado.

<table><tbody><tr><td>Puritan Bennett 840 Ventilator</td><td>Medtronic</td><td>4-840120EMC-01</td><td>http://www.medtronic.com/covidien/en-us/products/acute-care-ventilation/puritan-bennett-pb840-ventilator.html</td></tr><tr><td>ASL 5000 Breathing Simulator</td><td>IngMar</td><td>31 00 117</td><td>https://www.ingmarmed.com/</td></tr><tr><td>Smart Stat Basic</td><td>Simulaids</td><td>101-8002</td><td>https://www.simulaids.com/product/101-8002</td></tr></tbody></table>

mechanical ventilation boot camp curriculum

El manejo médico de pacientes con ventilación mecánica es un desafío a los proveedores de principiante. Gestión incorrecta de esta población puede llevar a aumento de la morbilidad y mortalidad. Un campo de entrenamiento basado en la simulación de tres días sirve para proporcionar la instrucción uno-a-uno con un proveedor de cuidados críticos. Los intensivistas pueden dispensar retroalimentación inmediata personalizada como estudiantes realizar prácticas con un ventilador mecánico real. Pueden verse múltiples patologías diferentes que no pueden ser encontradas en el ajuste clínico. Estudiantes pueden visualizar consecuencias inmediatas de sus actos y puede solucionar problemas y preguntas, mientras que en un ambiente de aprendizaje seguro. Describimos el uso de simuladores de paciente humano conectado a respiración simuladores y ventiladores mecánicos. Potenciales ejecutores del currículo deben tener en cuenta el costo de los equipos y el tiempo necesario para dedicar a la ejecución de campo de entrenamiento; sin embargo, este entrenamiento intensivo interactivo se ha demostrado para aumentar la competencia de proveedores, conocimiento y confianza en la gestión de ventilador. Este esquema de plan de estudios proporciona orientación sobre cómo realizar un campamento de arranque basado en la simulación para capacitar a los proveedores en el manejo de pacientes con ventilación mecánica.

Como se señaló en Yee et al., los residentes de primer año que experimentó este campo demostraron confianza, conocimientos y rendimiento significativamente mejorado12. Cognitivo conocimiento, evaluado antes y después de la intervención pruebas de elección múltiple, pasó de una puntuación media de 40,3% y 67.1%, con un cambio medio en la puntuación de 26,8% (figura 1).
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Watch this Scientific Journal Video about Mechanical Ventilation Boot Camp Curriculum at JoVE.com

Mechanical Ventilation Boot Camp Curriculum

Este currículo describe cómo ejecutar un campo basado en la simulación para enseñar a los proveedores administrar a pacientes con ventilación mecánica.

Plan de estudios campo de inicio de ventilación mecánica

Medical management of mechanically ventilated patients is challenging to novice providers. Incorrect management of this population may lead to increased ...

mechanical-ventilation-boot-camp-curriculum

Research

Education

JoVE Core

JoVE Journal

Medical-Surgical Nursing

Medicine

Unit 1

Fundamentals of Respiratory Care: Techniques and Management

SCIENTISTS IN ACTION

10.1K vistas.  The Ohio State University. Este currículo describe cómo ejecutar un campo basado en la simulación para enseñar a los proveedores administrar a pacientes con ventilación mecánica.

Video: Mechanical Ventilation Boot Camp Curriculum

Evaluation of Respiratory System Mechanics in Mice using the Forced Oscillation Technique

The forced oscillation technique (FOT) is a powerful, integrative and translational tool permitting the experimental assessment of lung function in mice in a comprehensive, detailed, precise and reproducible manner. It provides measurements of respiratory system mechanics through the analysis of pressure and volume signals acquired in reaction to predefined, small amplitude, oscillatory airflow waveforms, which are typically applied at the subject's airway opening. The present protocol details the steps required to adequately execute forced oscillation measurements in mice using a computer-controlled piston ventilator (flexiVent; SCIREQ Inc, Montreal, Qc, Canada). The description is divided into four parts: preparatory steps, mechanical ventilation, lung function measurements, and data analysis. It also includes details of how to assess airway responsiveness to inhaled methacholine in anesthetized mice, a common application of this technique which also extends to other outcomes and various lung pathologies. Measurements obtained in na&iuml;ve mice as well as from an oxidative-stress driven model of airway damage are presented to illustrate how this tool can contribute to a better characterization and understanding of studied physiological changes or disease models as well as to applications in new research areas.

The present protocol provides a detailed step-by-step description of the procedures required to execute measurements of respiratory system mechanics as well as the assessment of airway responsiveness to inhaled methacholine in mice using the forced oscillation technique (flexiVent; SCIREQ Inc, Montreal, Qc, Canada).

Evaluación de la mecánica del sistema respiratorio en ratones utilizando la técnica de oscilación forzada

The  forced oscillation technique (FOT) is a powerful, integrative and translational  tool permitting the experimental assessment of lung function in mice ...

Investigación

Biología

Setup and Execution Of the Blindfolded Code Training Exercise

Miscommunication is the most common cause of preventable patient harm in medicine. Currently, there is limited knowledge of innovative techniques to improve resident physician communication and leadership strategies in high-acuity situations. The blindfolded code training exercise removes visual stimuli from the team leader, forcing the team leader to effectively utilize closed-loop communication. The simple act of blindfolding the team leader creates a learning environment where the leader must utilize a conceptual framework and critical thinking strategies to organize the team and manage the resuscitation. An advantage to this teaching technique is that it does not require any special simulation equipment, making it a low-cost approach. The blindfolded code training exercise can be applied to the management of any critically ill patient where the primary objective is to focus on developing communication skills in acute resuscitations. The purpose of the description of the blindfolded code training exercise is to provide guidance on how to perform this innovative teaching technique to force effective closed-loop communication.

The blindfolded code training exercise, which blindfolds the team leader in a code resuscitation simulation, is an advanced teaching technique to improve closed-loop communication, organizational skills, and critical thinking.&#160;

Configuración y ejecución del ejercicio de entrenamiento de código con los ojos vendados

Miscommunication is the most common cause of preventable patient harm in medicine. Currently, there is limited knowledge of innovative techniques to ...

Medicina

Use of an Integrated Low-Flow Anesthetic Vaporizer, Ventilator, and Physiological Monitoring System for Rodents

Low-flow digital vaporizers commonly utilize a syringe pump to directly administer volatile anesthetics into a stream of carrier gas. Per animal welfare recommendations, animals are warmed and monitored during procedures requiring anesthesia. Common anesthesia and physiological monitoring equipment include gas tanks, anesthetic vaporizers and stands, warming controllers and pads, mechanical ventilators, and pulse oximeters. A computer is also necessary for data collection and to run equipment software. In smaller spaces or when performing field work, it can be challenging to configure all this equipment in limited space.
The goal of this protocol is to demonstrate best practices for use of a low-flow digital vaporizer using both compressed oxygen and room air, along with an integrated mechanical ventilator, pulse oximeter, and far infrared warming as an all-inclusive anesthesia and physiological monitoring suite ideal for rodents.

Here, we present a protocol to safely and effectively administer anesthetic gas to mice using a digital, low flow anesthesia system with integrated ventilator and physiological monitoring modules.

Uso de un vaporizador anestésico de bajo flujo integrado, ventilador y sistema de monitoreo fisiológico para roedores

Low-flow digital vaporizers commonly utilize a syringe pump to directly administer volatile anesthetics into a stream of carrier gas. Per animal welfare ...

Normothermic Negative Pressure Ventilation Ex Situ Lung Perfusion: Evaluation of Lung Function and Metabolism

Lung transplantation (LTx) remains the standard of care for end-stage lung disease. A shortage of suitable donor organs and concerns over donor organ quality exacerbated by excessive geographic transportation distance and stringent donor organ acceptance criteria pose limitations to current LTx efforts. Ex situ lung perfusion (ESLP) is an innovative technology that has shown promise in attenuating these limitations. The physiologic ventilation and perfusion of the lungs outside of the inflammatory milieu of the donor body affords ESLP several advantages over traditional cold static preservation (CSP). There is evidence that negative pressure ventilation (NPV) ESLP is superior to positive pressure ventilation (PPV) ESLP, with PPV inducing more significant ventilator-induced lung injury, pro-inflammatory cytokine production, pulmonary edema, and bullae formation. The NPV advantage is perhaps due to the homogenous distribution of intrathoracic pressure across the entire lung surface. The clinical safety and feasibility of a custom NPV-ESLP device have been demonstrated in a recent clinical trial involving extender criteria donor (ECD) human lungs. Herein, the use of this custom device is described in a juvenile porcine model of normothermic NPV-ESLP over a 12 h duration, paying particular attention to management techniques. Pre-surgical preparation, including ESLP software initialization, priming, and de-airing of the ESLP circuit, and the addition of anti-thrombotic, anti-microbial, and anti-inflammatory agents, is specified. The intraoperative techniques of central line insertion, lung biopsy, exsanguination, blood collection, cardiectomy, and pneumonectomy are described. Furthermore, particular focus is paid to anesthetic considerations, with anesthesia induction, maintenance, and dynamic modifications outlined. The protocol also specifies the custom device's initialization, maintenance, and termination of perfusion and ventilation. Dynamic organ management techniques, including alterations in ventilation and metabolic parameters to optimize organ function, are thoroughly described. Finally, the physiological and metabolic assessment of lung function is characterized and depicted in the representative results.

Normothermic Negative Pressure Ventilation Ex Situ Lung Perfusion: Evaluation of Lung Function and Metabolism

This paper describes a porcine model of negative pressure ventilation ex situ lung perfusion, including procurement, attachment, and management on the custom-made platform. Focus is made on anesthetic and surgical techniques, as well as troubleshooting.

Ventilación Normatérmica con Presión Negativa Perfusión Pulmonar Ex Situ : Evaluación de la Función Pulmonar y el Metabolismo

Lung transplantation (LTx) remains the standard of care for end-stage lung disease. A shortage of suitable donor organs and concerns over donor organ ...

Employing the Forced Oscillation Technique for the Assessment of Respiratory Mechanics in Adults

There is increasing interest in the use of the forced oscillation technique (FOT) or oscillometry to characterize respiratory mechanics in healthy and diseased individuals. FOT, a complementary method to traditional pulmonary function testing, utilizes a range of oscillatory frequencies superimposed on tidal breathing to measure the functional relationship between airway pressure and flow. This passive assessment provides an estimate of respiratory system resistance (Rrs) and reactance (Xrs) that reflect airway caliber and energy storage and dissipation, respectively. Despite the recent increase in popularity and updated Technical Standards, clinical adoption has been slow which relates, in part, to the lack of standardization regarding the acquisition and reporting of FOT data. The goal of this article is to address the lack of standardization across laboratories by providing a comprehensive written protocol for FOT and an accompanying video. To illustrate that this protocol can be utilized irrespective of a particular device, three separate FOT devices have been employed in the case examples and video demonstration. This effort is intended to standardize the use and interpretation of FOT, provide practical suggestions, as well as highlight future questions that need to be addressed.

As the use of forced oscillation technique (FOT) is increasingly utilized to characterize respiratory mechanics, there is a need to standardize methods with respect to nascent technical guidelines and various manufacturer's recommendations. A detailed protocol is provided including FOT assessment and interpretation for two cases to facilitate the standardization of methods.

Empleo de la técnica de oscilación forzada para la evaluación de la mecánica respiratoria en adultos

There is increasing interest in the use of the forced oscillation technique (FOT) or oscillometry to characterize respiratory mechanics in healthy and ...

Ex Vivo Porcine Experimental Model for Studying and Teaching Lung Mechanics

Mechanical ventilation is widely used and requires specific knowledge for understanding and management. Health professionals in this field may feel insecure and lack knowledge because of inadequate training and teaching methods. Therefore, the objective of this article is to outline the steps involved in generating an ex vivo porcine lung model to be used in the future, to study and teach lung mechanics. To generate the model, five porcine lungs were carefully removed from the thorax following the guidelines of the Animal Research Ethics Committee with adequate care and were connected to the mechanical ventilator through a tracheal cannula. These lungs were then subjected to the alveolar recruitment maneuver. Respiratory mechanics parameters were recorded, and video cameras were used to obtain videos of the lungs during this process. This process was repeated for five consecutive days. When not used, the lungs were kept refrigerated. The model showed different lung mechanics after the alveolar recruitment maneuver every day; not being influenced by the days, only by the maneuver. Therefore, we conclude that the ex vivo lung model can provide a better understanding of lung mechanics and its effects, and even of the alveolar recruitment maneuver through visual feedback during all stages of the process.

Ex Vivo Porcine Experimental Model for Studying and Teaching Lung Mechanics

We present an ex vivo pig lung model for the demonstration of pulmonary mechanics and alveolar recruitment maneuvers for teaching purposes. The lungs can be used for more than one day (up to five days) with minimal changes in pulmonary mechanics variables.

Ex Vivo Modelo experimental porcino para el estudio y la enseñanza de la mecánica pulmonar

Mechanical ventilation is widely used and requires specific knowledge for understanding and management. Health professionals in this field may feel ...

Basic Life Support Part II:  Airway/Breathing and Continued Cardiopulmonary Resuscitation

Source: <a href="https://www.jove.com/author/Julianna_Jung">Julianna Jung</a>, MD, FACEP, Associate Professor of Emergency Medicine, The Johns Hopkins University School of Medicine, Maryland, USA
High-quality cardiopulmonary resuscitation (CPR) and defibrillation are the most important interventions for patients with cardiac arrest, and should be the first steps that rescuers perform. This is reflected in the American Heart Association's new "CAB" mnemonic. While rescuers were once taught the "ABCs" of cardiac arrest, they now learn "CAB" - circulation first, followed by airway and breathing. Only once CPR is underway (and defibrillation has been performed, if a defibrillator is available) do we consider providing respiratory support. This video will describe the correct technique for providing respiratory support to a patient in cardiac arrest, and how to continue basic life support over the period of time until help arrives.
This video assumes that all the steps described in "Basic Life Support Part I: Cardiopulmonary Resuscitation and Defibrillation" have already been completed. This video does NOT depict the initial steps taken when arriving at the scene of a cardiac arrest.

Basic Life Support II: Airway/Breathing &amp; Cardiopulmonary Resuscitation

Soporte vital básico Parte II: Vía aérea y reanimación cardiopulmonar continua

Source: Julianna Jung, MD, FACEP, Associate Professor of Emergency Medicine, The Johns Hopkins University School of Medicine, Maryland, USA
High-quality ...

Educación

JoVE Science Education

Habilidades clínicas

Medicina de Urgencias y Cuidados Intensivos

Mechanical Ventilation I: Indication and Settings

Mechanical ventilation is a life-saving technique for managing acute respiratory failure and other respiratory complications. The process involves using a machine known as a ventilator to supply oxygen to the lungs and assist in removing carbon dioxide. It serves as a bridge to long-term mechanical ventilation or a temporary measure until ventilatory support is discontinued. The ventilator can maintain this function for a prolonged period, providing critical support for patients until they can breathe independently.
Indications
Mechanical ventilation may be necessary for a variety of reasons. These include managing acute respiratory failure, controlling the patient&#39;s breathing during surgery or treatment, providing adequate oxygenation when the patient&#39;s own ventilatory efforts are insufficient, and allowing the respiratory muscles to rest. Several factors, including thoracic or abdominal surgery, drug overdose, neuromuscular disorders, inhalation injury, Chronic Obstructive Pulmonary Disease (COPD), multiple trauma, circulatory shock, multisystem failure, and coma, can result in respiratory failure and the need for mechanical ventilation. It allows patients on a ventilator to breathe spontaneously, alleviating the exhausting effort it would otherwise require.
Settings of Mechanical Ventilator
The settings of a mechanical ventilator are adjusted based on the patient&#39;s condition, level of consciousness, respiratory muscle strength, chest x-ray, and arterial blood gases (ABGs). These settings include:
<ol style="list-style-type: circle;">
	<li>Respiratory rate: It refers to the number of breaths the ventilator delivers per minute.</li>
	<li>Tidal volume (VT): It is the volume of gas delivered to the patient during each ventilator breath.</li>
	<li>O2 concentration (FIO2): This fraction of inspired O2 delivered to the patient can be set between 30% and 100%.</li>
	<li>Positive-end-expiratory pressure (PEEP): Positive pressure is applied at the end of the expiration of ventilator breaths.</li>
	<li>Pressure support: This is used to augment a patient&#39;s inspiratory pressure during spontaneous breathing.</li>
	<li>I/E ratio: This is the duration of inspiration (I) to the duration of expiration (E).</li>
	<li>Inspiratory flow rate and time: This is the speed with which the VT is delivered.</li>
	<li>Sensitivity: This determines the patient&#39;s effort to initiate a breath from the ventilator.</li>
	<li>Peak inspiratory pressure (PIP): This is the maximal pressure the ventilator can generate to deliver the VT.</li>
</ol>
Manipulating these settings can help correct hypoxemia and hypercarbia. As the patient&#39;s condition improves, the settings can be adjusted to allow them to take more control over their work of breathing.
Types of Mechanical Ventilation
Mechanical ventilators can be classified into two general categories: Negative pressure ventilators and positive-pressure ventilators.
Negative-pressure ventilators, also known as &#34;iron lungs,&#34; are older modes of ventilatory support that are rarely used today.
Positive-pressure ventilators inflate the lungs by exerting positive pressure on the airway, pushing air in, similar to a bellows mechanism, and forcing the alveoli to expand during inspiration. Expiration occurs passively. These ventilators are widely used in hospital settings and include:
<ol style="list-style-type: circle;">
	<li>Volume-Cycled Ventilators</li>
	<li>Pressure-Cycled Ventilators</li>
	<li>High-Frequency Oscillatory Support Ventilators</li>
	<li>Noninvasive Positive-Pressure Ventilation (NIPPV)</li>
	<li>Continuous positive airway pressure (CPAP)</li>
	<li>Bilevel positive airway pressure (BiPAP)</li>
</ol>
Each ventilator has distinctive features and is employed based on the patient&#39;s needs. The selection of the ventilator type is a critical decision made by healthcare professionals, made by considering the patient&#39;s current health status and the potential benefits and risks associated with each ventilator type.

Ventilación mecánica I: Indicación y ajustes

Mechanical ventilation is a method of using a ventilator machine to deliver oxygen and remove carbon dioxide from the lungs when spontaneous breathing is ...

KEY TERMS AND CONCEPTS

Mechanical Ventilation II: Invasive Ventilation

Ventilators are essential medical equipment used to aid patients with respiratory difficulties. Their primary function is to assist or replace spontaneous breathing by providing mechanical ventilation. There are two general classes of mechanical ventilators: negative-pressure and positive-pressure ventilators.
Negative-Pressure Ventilators
Negative-pressure ventilators create a vacuum around the chest or body to draw air into the lungs, simulating breathing. This method does not require an artificial invasive airway; as a result, it is categorized as a form of non-invasive ventilation (NIV).
The &#34;iron lung,&#34; developed in the 1950s during the polio epidemic, was the first form of negative pressure ventilation. It intermittently reduces intrathoracic pressure, causing air to rush into the upper airway, followed by passive expiration when the machine cycles off. Portable negative-pressure ventilators are available for home use, primarily for patients with chronic neuromuscular diseases and central nervous system problems.
Positive-Pressure Ventilators
Positive-pressure ventilators differ from negative-pressure ventilators in their mechanism of lung inflation. Instead of exerting negative pressure to draw air into the lungs, positive-pressure ventilators apply positive pressure to the airway, expanding the alveoli and facilitating inspiration. Expiration occurs passively. These ventilators require ET intubation or tracheostomy and are widely used in hospitals and homes.
Volume-Cycled Ventilators
Volume-cycled ventilators deliver a preset volume of air with each inspiration. The ventilator cycles off after this volume is delivered, allowing passive exhalation. Volume-cycled ventilators ensure consistent breaths but may cause barotrauma due to the potentially excessive pressures needed to deliver breaths.
Pressure-Cycled Ventilators
Pressure-cycled ventilators deliver airflow until a preset pressure is reached, and then they cycle off for passive expiration. The air volume can vary with changes in the patient&#39;s airway resistance or compliance, possibly leading to inconsistent tidal volumes and compromised ventilation.
High-Frequency Oscillatory Support Ventilators
These ventilators deliver high respiratory rates, low tidal volumes, and high airway pressures. They are used to open alveoli in situations characterized by closed small airways, such as atelectasis and ARDS, and are believed to protect the lungs from pressure injury.

Ventilación Mecánica II: Ventilación Invasiva

Invasive ventilation uses a mechanical ventilator connected to an endotracheal tube or tracheostomy to support breathing.
One common type is ...

Mechanical Ventilation III: Noninvasive Ventilation

Noninvasive positive-pressure ventilation (NIPPV), continuous positive airway pressure (CPAP), and bilevel positive airway pressure (BiPAP) are essential methods in respiratory care. These ventilation techniques offer unique benefits for patients with various respiratory conditions, providing adequate support without requiring intubation. Let&#39;s explore how each method is crucial in improving patient outcomes and enhancing respiratory therapy.
Noninvasive Positive-Pressure Ventilation (NIPPV)
NIPPV is a method of positive pressure ventilation that does not require intubation. It involves using facemasks or nasal devices to maintain prescribed pressure, reducing the risk of nosocomial infections. This method is suitable for patients with acute or chronic respiratory failure, acute pulmonary edema, COPD, chronic heart failure, or sleep-related breathing disorders.
Continuous Positive Airway Pressure (CPAP)
CPAP maintains a constant positive pressure in the airways throughout the breathing cycle, helping to keep alveoli open and prevent respiratory failure. This method is especially beneficial in treating obstructive sleep apnea, ensuring the airways remain open during sleep.
Bilevel Positive Airway Pressure (BiPAP)
BiPAP offers independent control of inspiratory and expiratory pressures while providing pressure support ventilation. It delivers two levels of positive airway pressure via a nasal or oral mask, nasal pillow, or mouthpiece with a tight seal and a portable ventilator. BiPAP is often used for patients who require ventilatory assistance at night.
Each type has advantages and disadvantages, and the choice depends on the patient&#39;s clinical condition, comfort, and the healthcare provider&#39;s expertise.

Ventilación Mecánica III: Ventilación no invasiva

Noninvasive ventilation, or NIV, provides ventilatory support without inserting an artificial airway.
This type of ventilation is used in patients with ...