Deep dive: Evita V600/ V800 the new era of adult ventilation6 Morawiec E, Kindler F, Schmidt M., Am...
Transcript of Deep dive: Evita V600/ V800 the new era of adult ventilation6 Morawiec E, Kindler F, Schmidt M., Am...
Deep dive: Evita V600/ V800 – the new era of
adult ventilation
Dubai October 2nd 2019
Ambassador from Prosperous Luebeck – Katrin Mett
Treatment goals
Deep dive: Evita V600/ V800 – the new era of adult ventilation
Reduce
length of stay
Improve
patient comfort
Reduce
VALI / ARDS
Deep dive: Evita V600/ V800 – the new era of adult ventilation
Prevent
Prevent intubation as long as possible because …
• patients with mechanically-assisted ventilation could develop ventilator-associated-pneumonia (VAP).
• patients with VAP could have a significantly longer ICU and hospital length of stay.
• the treatment of VAP may account for almost half of all antibiotics administered in ICUs.
Deep dive: Evita V600/ V800 – the new era of adult ventilation
• Increase patient comfort
• Prevent intubation while at the same time assuring oxygenation and CO2-removal with minimal ventilatory support
• Prevent and avoid patient-ventilator asynchrony (double triggering and delayed cycling) during non-invasive ventilation
• Provide sufficient ventilatory support despite leakages and with changes in ventilatory demand of the patient
NIVAnti Air
Shower
O2-therapy
Clinical Strategy
Deep dive: Evita V600/ V800 – the new era of adult ventilation
Prevent
Supporting functionality
Deep dive: Evita V600/ V800 – the new era of adult ventilation
In the clinical routine this will …
… Reduce Complication
…Shorten stay in ICU
…Increase quality of life
NIV with automatic leak compensation
▪ Non-invasive ventilation (NIV) in all modes
▪ Automatic leak adaptation complements the
’ f h b h
▪ Adaptation for leakages related to trigger, cycling,
application of pressures and volumes
▪ Not applicable alarms not displayed during NIV
▪ Dedicated Draeger Accessories
1 Ferrer M, et al., Am. J. Respir. Crit. Care Med. 2003; (PubMed)2 Warren DK, et al., Crit Care Med. 2003; (PubMed)3 Nava S, et al., Intensive Care Med. 2006 (PubMed)4 Bülow HH, et al., Anaesthesiol Scand 2007 (PubMed)
Prevent
Supporting functionality
▪ Provision of high flow oxygen even with active
humidification
▪ Smooth and seamless transition from O2-
therapy through NIV to invasive ventilation and
back
▪ Dedicated Draeger Accessories
In the clinical routine this could …
… h f x h F O2 for
optimal oxygen therapy.
O2-therapy
Deep dive: Evita V600/ V800 – the new era of adult ventilation
Prevent
Supporting functionality
Deep dive: Evita V600/ V800 – the new era of adult ventilation
In the clinical routine this could …
… f h
flush to the patient during e.g. mask fitting or
suctioning procedure.
▪ Anti Air Shower reduces flow during disconnect
and automatic resumption of ventilation
▪ Support of the patient when removing the mask
▪ Prevent of unnecessarily high flow through the
removed mask
Anti Air Shower
Stabilize
Stabilize the patient and protect the lung because …
• patients could develop ventilator-associated lung injury (VALI).
• VALI could turn into acute lung injury (ALI) or acute respiratory distress syndrome (ARDS).
• multiple organ failure and mortality rate may increase associated with ALI or ARDS.
Deep dive: Evita V600/ V800 – the new era of adult ventilation
Mechanical Ventilation in Intensive Care
Acute respiratory distress syndrome (ARDS) might be a consequence of ventilator associated lung injury (VALI) that should be prevented rather than treated.1
1) Villar and Slutsky, Crit Care, Feb. 20102) Bellani et al., JAMA, vol. 315, Feb. 2016.3) Kamdar et al., Am J Respir Crit Care Med., Oct. 2017.
Deep dive: Evita V600/ V800 – the new era of adult ventilation
• Find optimal ventilator settings
o Find compromise among collapse and hyperinflation
o Stabilize alveoli and reduce strain and stress, reducing stress due to cyclic opening and closing of alveoli
o Reduce driving pressure for comparable gas exchange
• Adapt ventilator settings to changed patient situations
• Assuring oxygenation and CO2-removal with minimal invasiveness
Clinical Strategy
Low Flow PV
Loop
QuickSet and
PressureLink
Recruitment
trends
APRV –
AutoRelease
Smart
Pulmonary View
PulmoVista 500
PC-AC
AutoFlowIntegrated CO2
monitoring
Deep dive: Evita V600/ V800 – the new era of adult ventilation
• Find optimal ventilator settings
o Find compromise among collapse and hyperinflation
o Stabilize alveoli and reduce strain and stress, reducing stress due to cyclic opening and closing of alveoli
o Reduce driving pressure for comparable gas exchange
• Adapt ventilator settings to changed patient situations
• Assuring oxygenation and CO2-removal with minimal invasiveness
Clinical Strategy
Low Flow PV
Loop
QuickSet and
PressureLink
Recruitment
trends
APRV –
AutoRelease
Smart
Pulmonary View
PulmoVista 500
PC-AC
AutoFlowIntegrated CO2
monitoring
Deep dive: Evita V600/ V800 – the new era of adult ventilation
Stabilize
Supporting functionality
Deep dive: Evita V600/ V800 – the new era of adult ventilation
PROVEN FACTS with Low Flow PV Loop:
▪ The Low Flow PV Loop in the Evita can be used to
optimize ventilator settings.1
▪ The hysteresis of the PV curve can be used to assess
the recruitability of the lung.2
▪ The quasi-static measurement of the P-V curve is a
simple method, easy to interpret, for objective
adjustment of the ventilatory parameters in ARDS
patients as the lung injury evolves.3
1 Takeuchi M et al., Anesthesiology, V 97, No 3, 2002 Sep
2 Demory D et al.,, Intensive Care Med. 2008 Nov
3 Pestaña D et al., Acta Anaesthesiol Scand. 2003 Mar
Stabilize
Supporting functionality
Deep dive: Evita V600/ V800 – the new era of adult ventilation
▪ Breath-by-breath increase of Pinsp and/or
PEEP (QuickSet)
▪ Simultaneous increase of Pinsp and PEEP
(PressureLink)
▪ Conducting recruitment maneuvers
QuickSet and PressureLink
In the clinical routine this will …
… h f h
application of any recruitment procedure.
Stabilize
Image Guided Lung Protection
Deep dive: Evita V600/ V800 – the new era of adult ventilation
See the previously unseen and truly personalise
ventilation with the combination of Evita and PulmoVista.
Stabilize
Supporting functionality
Deep dive: Evita V600/ V800 – the new era of adult ventilation
Homogeneous gas distribution with the lowest
possible ventilation pressures and guaranteed
minute volumes.
▪ Delivers set volume at lowest possible pressure in
all volume modes
▪ Enables spontaneous breathing at anytime
▪ AutoFlow offers automatic flow and pressure
regulation in combination with the VC-AC, VC-
CMV, VC-SIMV and VC-MMV ventilation modes
Stabilize
Supporting functionality
Deep dive: Evita V600/ V800 – the new era of adult ventilation
▪ Non-invasive CO2 measurement
▪ Display of CO2 as etCO2 and continuous CO2 real-time
curves
▪ Volumetric measurement (Evita V-series):
CO2 production (VtCO2 ,VCO2), dead space (Vds) and
the pulmonary dead space fraction (Vds/Vte)
Integrated CO2 monitoring
In the clinical routine this will …
… h f ff f
and of the gas exchange of the patient.
… f O2
serve as an early warning system with regard to
changes in the acuity level of critically ill patients.1
… b h ,
pulmonary perfusion and metabolism to support
optimization of ventilation settings.2
“
1 St. John RE, Crit Care Nurs Vol 23, No. 4, August 2003; 83-88
2 St. John RE,Crit Care Nurs Clin N Am. 1989; 20:363-374
4 AARC Guideline, Respiratory Care, May 2003 Vol. 48 No. 5
5 Behende et al.. Ann Erg Med 1992, 31:142-5
Prevent
Supporting functionality
Deep dive: Evita V600/ V800 – the new era of adult ventilation
▪ Trend and display of pressure related changes
to compliance and tidal volume
▪ Breath-by-breath resolution
▪ End-inspiratory pressure, PEEP, tidal volume
trends and dynamic compliance and can be
calculated with breath-to-breath resolution to
assess changes in compliance and volume.
Recruitment trends
In the clinical routine this will support …
… h f .
… h -up of lung protective ventilation
strategy.
Stabilize
Supporting functionality
Deep dive: Evita V600/ V800 – the new era of adult ventilation
Airway Pressure Release Ventilation:
▪ Spontaneous breathing under continuous
positive airway pressure with brief pressure
release times
▪ Sustained mean airway pressure
APRV ─ AutoRelease:
▪ Automatic adaptation of expiration time
APRV
In the clinical routine this could …
… P V h f
the duration of mechanical ventilation as well
as days in ICU.2
… P V f
injury in high-risk trauma patients, reducing
trauma-related adult respiratory distress
syndrome mortality.3
Wean
Wean the patient quick and safe because ...▪ the incidence of acute lung injuries (ALI) or acute respiratory
distress syndrome (ARDS) could delay the induction of weaning
▪ the delayed induction of weaning may lead to weaning failure
▪ paid attention for early detection of risk factors may contribute to successful weaning to shorten ICU length of stay
Deep dive: Evita V600/ V800 – the new era of adult ventilation
Wean
The six phases of the weaning process
Deep dive: Evita V600/ V800 – the new era of adult ventilation
• Transfer work of breathing: avoid delay in transition to supported and spontaneous breathing and weaning
• Encourage spontaneous breathing while appropriately unloading the patient
• Establish and maintain a physiologic variability in patient’s spontaneous breathing
• Improve room to breathe, reduce sedation and encourage cognitive interaction
• Improve sleep quality
Clinical Strategy
VC-MMV/
AutoFlowATC
SmartCare/PS
Comprehensive
monitoring
PulmoVista 500
SPN-CPAP-VS
Variable PS
P0.1 measurement,
RSBi, NIF
SPN-PPS
Deep dive: Evita V600/ V800 – the new era of adult ventilation
• Transfer work of breathing: avoid delay in transition to supported and spontaneous breathing and weaning
• Encourage spontaneous breathing while appropriately unloading the patient
• Establish and maintain a physiologic variability in patient’s spontaneous breathing
• Improve room to breathe, reduce sedation and encourage cognitive interaction
• Improve sleep quality
Clinical Strategy
VC-MMV/
AutoFlowATC
SmartCare/PS
Comprehensive
monitoring
PulmoVista 500
SPN-CPAP-VS
Variable PS
P0.1 measurement,
RSBi, NIF
SPN-PPS
Deep dive: Evita V600/ V800 – the new era of adult ventilation
Wean
Supporting functionality
Deep dive: Evita V600/ V800 – the new era of adult ventilation
Volume Control ─ Mandatory Minute Volume:
▪ Automatic adaptation the necessary pressure to
guarantee the set tidal volume
▪ Gradual reduction of time cycled strokes
VC-MMV/AutoFlow
In the clinical routine this will …
… h f
assisted spontaneous breathing with a
minimum minute ventilation
… b h AutoFlow, the pressure
is reduced in accordance with the contribution
of the patient to the set tidal volume.
…VC-MMV with AutoFlow allows automatic
weaning by frequency and pressure.
Wean
Supporting functionality
Deep dive: Evita V600/ V800 – the new era of adult ventilation
P0.1 ─ Occlusion pressure:
▪ Determination of neural drive of breathing
Rapid Shallow Breathing index:
▪ D f ─
─
Negative Inspiratory Force:
▪ Determination of inspiratory strength
Automatic P0.1 measurement,
RSBi, NIF
In the clinical routine this could …
… h f h
patients ability to breathe
spontaneously.
Wean
Supporting functionality
Deep dive: Evita V600/ V800 – the new era of adult ventilation
Automatic weaning from pressure
support:
▪ Decrease ventilatory support gradually
▪ Automated Spontaneous Breathing
Trial (SBT)
▪ Increase ventilatory support when
needed
SmartCare/PS
In the clinical routine this will …
… S /PS h b h
to reduce weaning times by up to
40% and ventilation times by up to
33%.
F. Lellouche et al.; Am J Respir Crit Care Med. 2006 Oct 15; 174(8):894-900
Wean
Supporting functionality
Deep dive: Evita V600/ V800 – the new era of adult ventilation
Spontaneous ─ Proportional
Pressure Support:
… h
for elastic and/or resistive work of
breathing.
… h b
of proportional assisted ventilation.
SPN-PPS
Wean
Supporting functionality
Deep dive: Evita V600/ V800 – the new era of adult ventilation
Variable Pressure Support:
▪ Automatic variation of the pressure
support (PS) in SPN-CPAP/PS
▪ Generating random changes in
inspiratory pressure
Variable PS
In the clinical routine this will …
… h ,
surfactant production and pulmonary
perfusion without negative hemodynamic
effects of elevated intrathoracic
pressures. 1, 2, 3, 4
More natural breathing with improved
patient ventilation synchrony. 5, 6, 7
1 Naik BI, Lynch C, Durbin CG. Respir Care. 20152 Mauri T, Lazzeri M, Bronco A, et al., Am J Respir Crit Care Med. 20173 Gama de Abreu M, Spieth PM, Pelosi P, et al.:Crit Care Med 20084 Arold SP, Suki B, Alencar AM et al., Am J Physiol Lung Cell Mol Physiol. 20035 Spieth PM, Güldner A, Huhle R, et al.:Crit Care 20136 Morawiec E, Kindler F, Schmidt M., Am J Respir Crit Care Med.. 20157 Vassilakopoulos T, Zakynthinos S.. Crit Care Med. 2008
Recover
Recover to secure the weaning success because …
• patients could develop acute respiratory failure after extubationand therefore could require reintubation.
• mortality rate could increase with weaning- and extubationfailure.
• extubation failure can be associated with prolonged patient care and significantly increased costs.
Deep dive: Evita V600/ V800 – the new era of adult ventilation
• Avoid re-intubation while at the same time assuring oxygenation and CO2 removal with minimal ventilatory support
• Prevent and avoid patient-ventilator asynchrony (double triggering and delayed cycling) during non-invasive ventilation
• Provide sufficient ventilatory support despite leakages and with changes in ventilatory demand of the patient
• Increase patient comfort
• Ventilatory support with minimal invasiveness
Clinical Strategy
NIVAnti Air
Shower
O2-therapy
Deep dive: Evita V600/ V800 – the new era of adult ventilation
Prevent
Supporting functionality
Deep dive: Evita V600/ V800 – the new era of adult ventilation
In the clinical routine this will …
…
NIV reduces the number of possible complications by
62% and treatment errors by 50%.1
…Sh
NIV shortens stay on intensive care wards and reduces
the length of hospital stay by an average of 3 days.2
… f f
NIV increases the quality of life for patients.1,3,4
NIV with automatic leak compensation
▪ Non-invasive ventilation (NIV) in all modes
▪ Automatic leak compensation complements the
’ f h b h
▪ Adaptation for leakages related to trigger, cycling,
application of pressures and volumes
▪ Not applicable alarms not displayed during NIV
1 Ferrer M, et al., Am. J. Respir. Crit. Care Med. 2003; (PubMed)2 Warren DK, et al., Crit Care Med. 2003; (PubMed)3 Nava S, et al., Intensive Care Med. 2006 (PubMed)4 Bülow HH, et al., Anaesthesiol Scand 2007 (PubMed)
Prevent
Supporting functionality
▪ Provision of high flow oxygen even with active
humidification
▪ Smooth and seamless transition from O2-
therapy through NIV to invasive ventilation and
back
In the clinical routine this could …
… h f x h F O2 for
optimal oxygen therapy.
O2-therapy
Deep dive: Evita V600/ V800 – the new era of adult ventilation
Prevent
Supporting functionality
Deep dive: Evita V600/ V800 – the new era of adult ventilation
In the clinical routine this could …
… f h
flush to the patient during e.g. mask fitting or
suctioning procedure.
▪ Anti Air Shower reduces flow during disconnect
and automatic resumption of ventilation
▪ Support of the patient when removing the mask
▪ Prevent of unnecessarily high flow through the
removed mask
Anti Air Shower
Deep dive: Evita V600/ V800 – the new era of adult ventilation
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