Titration Definition Sleep Apnea

Reading Sleep Study Results Identifying Sleep Apnea

This is a sleep study that shows someonewith sleep apnea. This channel right here shows a personbreathing and then they stopped breathing for what seems like a long time it's about 40 seconds and then they breathe again, they wake up,and they stopped breathing again and then they breathe again, and younotice every time they start breathing there's a big snort this is the source, then they stopbreathing, the big snort and they resume breathing. Another thingthat occurs

is oxygen fallsthat's the white channel, that goes down and then it comes up when they resumebreathing and it comes down so the oxygen is going up and down youcan see it best here. You can see it sliding up and down. Anotherthing to note his when they're not breathing their chest and abdomen will move. This one here is chest in this down here is abdomen, so they're still trying tobreathe

but they're not getting, they're notgetting any air. During the apnea, when they're notbreathing, the diaphragm is working and sucking thechest in, and you see the chest and abdomen go in differentdirections here and then, when they open their mouth and resume breathing, they start movingsynchronously again, they move together again and then when there's an apnea, they'removing in different directions again

That's one way you know that the apnea is an obstructive apnea.

Adaptive Support Ventilation ASV How does it work

Hello, my name is JeanMichel Arnal. I am an anesthesiologist. I work in the ICU. I want to welcome you in this and now I am going to show you something very interesting. This patient is 69 years old; he was admitted for septic shock after a complicated abdominal surgery. Now he is stabilized so we stopped sedation and he is recovering spontaneous activity. ASV is a closed loop mode of ventilation.

In which the user sets the target minute volume and the ventilator will determine the combination of tidal volume and respiratory rate according to the respiratory mechanics. So the ventilator measures the respiratory mechanics, using a proximal flow sensor, and namely it measures the expiratory time constant. The expiratory time constant

is a mix of the static compliance and inspiratory resistance. So with one number we have an assessment of the full respiratory mechanics of the patient. And it's accurate both in active and passive patients. So this is a panel in ASV where we have to set the target minute volume in terms of percentage of normal minute volume. So the first step

is to set the prodigal body weight, so we set the gender and the height of the patient and the ventilator will display the prodigal body weight. 100% target minute volume is 100ml per kg per minute, which is a normal minute ventilation. Of course, if the patient has a diseased lung, we need a higher minute volume to reach a normal PaCO2. In ASV the oxygenation parameters PEEP and FiO2 are manually set. And then if we go in the settings,

we also have to set the maximum pressure limit and the inspiratory trigger, the expiratory trigger and the pressure ramp. So if the patient is passive, ASV is a pressure control mode with an automatic adjustment of the pressure control to reach the target tidal volume. and the ventilator delivers a mandatory respiratory rate to target

the calculated optimal respiratory rate. If the patient is active it will switch automatically to a pressure support mode with an automatic adjustment of pressure support to reach the target tidal volume. In this case the respiratory rate is controlled by the patient and no more by the ventilator. So on this panel we will see for example what the targets for this patients are. Here we set 130 % of target MinVol, which is 9.6lmin.

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