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 技术

IntelliSync®+。 监测病人和呼吸机的人机同步性

采集并处理数字数据的人眼

如何检测异步性? 数字眼

训练有素的通气专家眼睛可以通过分析流量或压力波形的形状来检测人机不同步。

但专家无法始终待在病人床旁,而且病人状况可能会随时改变。

这是 IntelliSync+ 的用途所在。此技术模拟专家的眼睛在波形上识别病人用力(触发)或放松(循环)的征象。

InelliSync 之前和之后

工作原理是什么? IntelliSync+ 工作原理

IntelliSync+ 至少每秒一百次连续分析波形信号。这使 IntelliSync+ 可以立即检测病人用力情况,并实时启动吸气和呼气,因此替代传统的吸气和呼气触发设置。

为了提供最大灵活性,您可以选择激活 IntelliSync+ 吸气触发或呼气触发或两者。

图:病人档案和放大镜

异步性真的是问题吗? 了解证据

约 25% 的机械通气病人出现显著的人机异步性 (Thille AW, Rodriguez P, Cabello B, Lellouche F, Brochard L. Patient-ventilator asynchrony during assisted mechanical ventilation.Intensive Care Med.2006;32(10):1515-1522. doi:10.1007/s00134-006-0301-81​)。人机异步性与呼吸功增加 (Tassaux D, Gainnier M, Battisti A, Jolliet P. Impact of expiratory trigger setting on delayed cycling and inspiratory muscle workload.Am J Respir Crit Care Med.2005;172(10):1283-1289. doi:10.1164/rccm.200407-880OC2​)、通气时间延长 (Thille AW, Rodriguez P, Cabello B, Lellouche F, Brochard L. Patient-ventilator asynchrony during assisted mechanical ventilation.Intensive Care Med.2006;32(10):1515-1522. Doi:10.1007/s00134-006-0301-81​)1​) 和死亡率上升 (Blanch L, Villagra A, Sales B, et al.Asynchronies during mechanical ventilation are associated with mortality.Intensive Care Med.2015;41(4):633-641. Doi:10.1007/s00134-015-3692-63​)3​) 相关。

波形分析是一种可靠、准确的可重复人机交互评估方法。此方法可以自动化运行,因此能够持续监测通气病人和/或改善的呼吸触发和循环 (Mojoli F, Iotti GA, Torriglia F, et al.In vivo calibration of esophageal pressure in the mechanically ventilated patient makes measurements reliable.Crit Care.2016;20:98.Published 2016 Apr 11. doi:10.1186/s13054-016-1278-54​)。

自动循环以改善人机同步性

Mojoli F, Orlando A, Bianchi IM, et al.

最近的一项研究表明,基于波形实时分析的呼吸机循环自动控制提供了一种可靠的方法来改善机械通气病人的人机同步。

呼吸机显示屏 呼吸机显示屏

如何使用? IntelliSync+ 设置和操作

IntelliSync+ 是一种完全无创方法,它不需要任何额外的硬件或附件。您只需激活呼吸机上的选项,并在有创或无创通气模式下将其用于成人和儿童病人。

由于 IntelliSync+ 还可以与常规触发结合使用,您可以选择在吸气、呼气或两者期间使用 IntelliSync+。

图:手持证书的学生

不可不知! IntelliSync+ 培训资源

不同步参考卡

学习发现常见的异步性! 免费参考卡

我们的异步参考卡向您概述了最常见的异步性类型、它们的原因以及如何检测它们。

可用性

IntelliSync+ 可作为 HAMILTON-C6 和 HAMILTON-G5 的选配功能及 HAMILTON-S1 的标准功能提供。

Patient-ventilator asynchrony during assisted mechanical ventilation.

Thille AW, Rodriguez P, Cabello B, Lellouche F, Brochard L. Patient-ventilator asynchrony during assisted mechanical ventilation. Intensive Care Med. 2006;32(10):1515-1522. doi:10.1007/s00134-006-0301-8



OBJECTIVE

The incidence, pathophysiology, and consequences of patient-ventilator asynchrony are poorly known. We assessed the incidence of patient-ventilator asynchrony during assisted mechanical ventilation and we identified associated factors.

METHODS

Sixty-two consecutive patients requiring mechanical ventilation for more than 24 h were included prospectively as soon as they triggered all ventilator breaths: assist-control ventilation (ACV) in 11 and pressure-support ventilation (PSV) in 51.

MEASUREMENTS

Gross asynchrony detected visually on 30-min recordings of flow and airway pressure was quantified using an asynchrony index.

RESULTS

Fifteen patients (24%) had an asynchrony index greater than 10% of respiratory efforts. Ineffective triggering and double-triggering were the two main asynchrony patterns. Asynchrony existed during both ACV and PSV, with a median number of episodes per patient of 72 (range 13-215) vs. 16 (4-47) in 30 min, respectively (p=0.04). Double-triggering was more common during ACV than during PSV, but no difference was found for ineffective triggering. Ineffective triggering was associated with a less sensitive inspiratory trigger, higher level of pressure support (15 cmH(2)O, IQR 12-16, vs. 17.5, IQR 16-20), higher tidal volume, and higher pH. A high incidence of asynchrony was also associated with a longer duration of mechanical ventilation (7.5 days, IQR 3-20, vs. 25.5, IQR 9.5-42.5).

CONCLUSIONS

One-fourth of patients exhibit a high incidence of asynchrony during assisted ventilation. Such a high incidence is associated with a prolonged duration of mechanical ventilation. Patients with frequent ineffective triggering may receive excessive levels of ventilatory support.

Impact of expiratory trigger setting on delayed cycling and inspiratory muscle workload.

Tassaux D, Gainnier M, Battisti A, Jolliet P. Impact of expiratory trigger setting on delayed cycling and inspiratory muscle workload. Am J Respir Crit Care Med. 2005;172(10):1283-1289. doi:10.1164/rccm.200407-880OC



RATIONALE

During pressure-support ventilation, the ventilator cycles into expiration when inspiratory flow decreases to a given percentage of peak inspiratory flow ("expiratory trigger"). In obstructive disease, the slower rise and decrease of inspiratory flow entails delayed cycling, an increase in intrinsic positive end-expiratory pressure, and nontriggering breaths.

OBJECTIVES

We hypothesized that setting expiratory trigger at a higher than usual percentage of peak inspiratory flow would attenuate the adverse effects of delayed cycling.

METHODS

Ten intubated patients with obstructive disease undergoing pressure support were studied at expiratory trigger settings of 10, 25, 50, and 70% of peak inspiratory flow.

MEASUREMENTS

Continuous recording of diaphragmatic EMG activity with surface electrodes, and esophageal and gastric pressures with a dual-balloon nasogastric tube.

MAIN RESULTS

Compared with expiratory trigger 10, expiratory trigger 70 reduced the magnitude of delayed cycling (0.25 +/- 0.18 vs. 1.26 +/- 0.72 s, p < 0.05), intrinsic positive end-expiratory pressure (4.8 +/- 1.9 vs. 6.5 +/- 2.2 cm H(2)O, p < 0.05), nontriggering breaths (2 +/- 3 vs. 9 +/- 5 breaths/min, p < 0.05), and triggering pressure-time product (0.9 +/- 0.8 vs. 2.1 +/- 0.7 cm H2O . s, p < 0.05).

CONCLUSIONS

Setting expiratory trigger at a higher percentage of peak inspiratory flow in patients with obstructive disease during pressure support improves patient-ventilator synchrony and reduces inspiratory muscle effort. Further studies should explore whether these effects can influence patient outcome.

Asynchronies during mechanical ventilation are associated with mortality.

Blanch L, Villagra A, Sales B, et al. Asynchronies during mechanical ventilation are associated with mortality. Intensive Care Med. 2015;41(4):633-641. doi:10.1007/s00134-015-3692-6



PURPOSE

This study aimed to assess the prevalence and time course of asynchronies during mechanical ventilation (MV).

METHODS

Prospective, noninterventional observational study of 50 patients admitted to intensive care unit (ICU) beds equipped with Better Care™ software throughout MV. The software distinguished ventilatory modes and detected ineffective inspiratory efforts during expiration (IEE), double-triggering, aborted inspirations, and short and prolonged cycling to compute the asynchrony index (AI) for each hour. We analyzed 7,027 h of MV comprising 8,731,981 breaths.

RESULTS

Asynchronies were detected in all patients and in all ventilator modes. The median AI was 3.41 % [IQR 1.95-5.77]; the most common asynchrony overall and in each mode was IEE [2.38 % (IQR 1.36-3.61)]. Asynchronies were less frequent from 12 pm to 6 am [1.69 % (IQR 0.47-4.78)]. In the hours where more than 90 % of breaths were machine-triggered, the median AI decreased, but asynchronies were still present. When we compared patients with AI > 10 vs AI ≤ 10 %, we found similar reintubation and tracheostomy rates but higher ICU and hospital mortality and a trend toward longer duration of MV in patients with an AI above the cutoff.

CONCLUSIONS

Asynchronies are common throughout MV, occurring in all MV modes, and more frequently during the daytime. Further studies should determine whether asynchronies are a marker for or a cause of mortality.

In vivo calibration of esophageal pressure in the mechanically ventilated patient makes measurements reliable.

Mojoli F, Iotti GA, Torriglia F, et al. In vivo calibration of esophageal pressure in the mechanically ventilated patient makes measurements reliable. Crit Care. 2016;20:98. Published 2016 Apr 11. doi:10.1186/s13054-016-1278-5

In screening programmes it is important to assess a preliminary effectiveness of the screening method as soon as possible in order to forecast survival figures. In March 1981 a controlled single-view mammographic screening trial for breast cancer was started in the south of Stockholm. The population invited for screening mammography consisted of 40,000 women aged 40-64 years, and 20,000 women served as a well-defined control group. The main aim of the trial was to determine whether repeated mammographic screening could reduce the mortality in the study population (SP) compared to the control population (CP). The cumulative number of advanced mammary carcinomas in the screening and the control populations from the first five years of screening have shown a tendency towards more favourable stages in the screened population aged 40-64 years. A breakdown by age suggests an effect in age group 50-59 years, but not yet in age groups 40-49 and 60-64 years. When comparing the rates of stage II+ cancer, an increased number is found in the study group. As the total rate of breast cancer is higher in SP than in CP, there ought to be a concealed group of stage II+ cancers in the CP which makes the comparison biased. A new approach has been designed, where an estimation of the 'hidden' number of stage II+ cancers in CP is added to the clinically detected cases, and in this respect a comparison has shown a decrease in the cumulative number of advanced cancers in the SP in relation to the CP (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)