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Workshop Objective:
To provide healthcare professionals with advanced knowledge and skills necessary for managing complex cases of respiratory failure using mechanical ventilation. The workshop will cover advanced ventilator strategies, modes, patient-ventilator interactions, and management of critically ill patients, with a focus on optimizing patient outcomes.
Target Audience:
Primary Target: Healthcare professionals with experience in critical care, respiratory therapy, and intensive care medicine, who want to enhance their knowledge of advanced mechanical ventilation strategies.
Critical Care Physicians (Intensivists)
Respiratory Therapists (with advanced experience)
Critical Care Nurses
Anesthesiologists
Residents and Fellows in Critical Care Medicine, Anesthesia, Pulmonology
Medical Students in their final stages of training (e.g., ICU rotations)
Advanced Respiratory Mechanics:
Understanding lung compliance, resistance, and airway pressures
The role of transpulmonary pressure and plateau pressure in managing ARDS and mechanical ventilation
Ventilator-Induced Lung Injury (VILI):
Mechanisms of VILI and its relationship with high tidal volume and pressure settings
Strategies to minimize VILI: Low tidal volume ventilation, driving pressure, and individualized ventilator settings
Mechanical Ventilation and Gas Exchange:
Oxygenation versus ventilation: Adjusting ventilator settings to balance PaO2, PaCO2, and pH
Role of recruitment maneuvers and their indications
Overview of Advanced Ventilator Modes:
Pressure-Controlled Ventilation (PCV): Indications and setting up PCV for optimal lung protection
Pressure Regulated Volume Control (PRVC): Using PRVC to manage both volume and pressure in patients with variable lung compliance
Dual-Control Modes: Hybrid approaches like Volume-Assured Pressure Support (VAPS) or Adaptive Support Ventilation (ASV)
Proportional Assist Ventilation (PAV): Using PAV to synchronize with the patient’s own breathing effort
Advanced Adjustments for Difficult-to-Ventilate Patients:
Managing ARDS, COPD exacerbation, obesity, and chest trauma
Fine-tuning the PEEP, FiO2, and other parameters for individualized care
Strategies for recruitment and optimal PEEP titration
Ventilation in ARDS (Acute Respiratory Distress Syndrome):
Low tidal volume ventilation strategy and the ARDSnet protocol
Management of severe ARDS: High PEEP, proning, and adjunctive therapies
COPD and Asthma Exacerbations:
Ventilation in obstructive lung disease: Pressure support vs. volume control and peak inspiratory pressures
Management of auto-PEEP and how to optimize ventilation without causing dynamic hyperinflation
Obesity and Ventilation:
Adjusting ventilation for obese patients: The impact of BMI, abdominal pressure, and compliance on ventilator settings
Neurological Cases:
Ventilation strategies in brain injury, increased intracranial pressure (ICP), and neuromuscular weakness (e.g., Guillain-Barré Syndrome)
Pediatric and Neonatal Ventilation:
Special considerations in pediatric mechanical ventilation, including volume-targeted strategies and pressure control
Unique settings for neonatal ventilators (e.g., CPAP, volume guarantee, and high-frequency ventilation)
Understanding Patient-Ventilator Asynchrony:
Types of asynchrony: Trigger, cycle, and flow asynchrony
Consequences of asynchrony on patient outcomes and comfort
Strategies to Improve Synchrony:
Adjusting flow rates, inspiratory times, and sensitivity to minimize asynchrony
Using esophageal pressure monitoring to optimize ventilator settings
Monitoring Asynchrony:
Tools to detect and quantify asynchrony: Flow-time, pressure-time, and volume-time waveforms
Managing patient-ventilator synchrony in spontaneous breathing modes (e.g., PSV, SIMV)
Monitoring Ventilator Settings:
Monitoring real-time data from ventilator waveforms (pressure, flow, volume, compliance)
Interpreting end-tidal CO2 (ETCO2) and its clinical relevance in managing ventilation
Blood Gas Analysis and Ventilator Adjustments:
Interpreting ABG and deciding adjustments in ventilator settings
Strategies for optimizing oxygenation (PaO2) and ventilation (PaCO2) through ventilator manipulation
Esophageal Pressure Monitoring (Esmarch technique):
Role of esophageal pressure in measuring transpulmonary pressure
Practical use of esophageal pressure in managing ventilation in ARDS and other conditions
Capnography and Lung Volumes:
Use of capnography in monitoring ventilation efficiency and detecting complications
Estimation of lung volumes and compliance from capnography
Session 6: Advanced Strategies for Weaning and Extubation Time: 90 minutesWeaning Criteria and Process:
Assessment tools for evaluating readiness to wean (e.g., spontaneous breathing trial (SBT), rapid shallow breathing index)
Weaning modes: SIMV, pressure support ventilation (PSV), and T-piece trials
Factors influencing weaning: Cardiovascular stability, nutrition, and infection control
Post-Extubation Care:
Airway protection, oxygenation strategies, and management of extubation failure
Use of non-invasive ventilation (NIV) post-extubation in patients at risk of reintubation
Ventilator Liberation in Neurologically Impaired Patients:
Weaning strategies for patients with neuromuscular disorders or spinal cord injury
Simulation-Based Training:
Hands-on practice with high-fidelity mannequins to simulate complex respiratory failure and mechanical ventilation scenarios
Participants manage cases like ARDS, COPD exacerbation, obesity, and trauma
Adjustment of advanced ventilator settings and troubleshooting using a ventilator simulator
Case-Based Discussions:
Real-world cases to apply advanced techniques and discuss decision-making
Group discussion of strategies and challenges in difficult-to-ventilate patients
Lectures and Presentations: Detailed, expert-led explanations of advanced principles and strategies in mechanical ventilation.
Hands-On Simulation: Practical experience in managing complex cases using ventilator simulators.
Case Studies: Interactive group discussions to apply knowledge in real-life clinical scenarios.
Advanced Monitoring Techniques: Introduction to esophageal pressure monitoring, capnography, and advanced ABG interpretation.
Q&A and Discussion: Active participation with experts to clarify doubts and discuss specific clinical challenges.
Key Learning Outcomes:
By the end of the workshop, participants will be able to:
Understand and apply advanced ventilator modes for complex clinical scenarios.
Manage patient-ventilator interactions to minimize asynchrony and optimize ventilator settings.
Monitor and interpret ventilator waveforms, blood gases, and other advanced metrics to adjust ventilation.
Implement evidence-based strategies for weaning and extubation, minimizing complications.
Handle difficult-to-ventilate patients, including those with ARDS, COPD, and neurological conditions.
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2 Comments
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