https://www.youtube.com/watch?v=4fTtI5RGJDE
- Introduction to Australian balloon manometry and its benefits:
- Balloon manometry is an old but beneficial technology.
- It helps understand respiratory mechanics and pleural pressure.
- Balloon can be inserted through the nose or mouth.
- The deflection in the left upper quadrant confirms placement in the stomach.
- Measurement of airway pressure and alveolar pressure using gel balloons:
- Gel balloons provide measurements of airway opening pressure, alveolar pressure, and pleural pressure.
- Absolute value of pleural pressure cannot be directly measured, but gel balloons parallel it.
- Factors like respiratory mechanics, lung volumes, and posture can influence the absolute value of pleural pressure.
- Gel balloons may experience physical pressure variations, but they provide a close approximation of pleural pressure.
- Importance of transpulmonary pressure in mechanical ventilation:
- Transpulmonary pressure is airway pressure minus esophageal pressure.
- Key measurement for understanding lung mechanics and respiratory physiology.
- Provides valuable insights during ventilation.
- End inspiratory transpulmonary pressure is measured with inspiratory hold.
- Example transpulmonary pressure measurements and their significance:
- Airway pressure is about 25 and pleural pressure is about 15.
- Transpulmonary pressure is 10.
- Recommended pressure is 10-12-14 depending on the case.
- End expiratory transpulmonary pressure is -8.
- PEEP can be set using the transpulmonary pressure method.
- PEEP is increased to 15 to maintain end expiratory transpulmonary pressure between 0 to 5.
- Transpulmonary driving pressure is measured as 20.
- The transpulmonary driving pressure is about 17.
- Role of transpulmonary mechanical power in lung damage:
- Transpulmonary mechanical power is more relevant to lung damage and ventilator-induced lung injury.
- Mechanical power is a hot topic in mechanical ventilation, but transpulmonary mechanical power is more important for lung damage.
- Different formulas to calculate mechanical power depending on the mode.
- Compliance and elastance are important for calculating respiratory system properties.
- Graphs show compliance of the whole respiratory system and its components.
- Measurement of respiratory compliance using pressure-volume curve:
- Obtained using a Hamilton ventilator in volume-controlled mode with constant flow and low flow rate.
- Starts from zero PEEP and ends at zero pressure.
- Area of bad compliance and sudden transition to good linear compliance indicates a patient with ARDS.
- Ventilator shows the low and upper inflection points, indicating respiratory status and tidal volume.
- Understanding respiratory mechanics and compliance of different components:
- Explains concept of airway pressure against volume and compliance of the chest wall.
- Calculation of lung compliance, chest wall compliance, and whole respiratory system compliance.
- Equations provided to calculate the different components' compliance.
- Ventilator usage for recruitment maneuvers and patient effort monitoring:
- Airway pressure triangle with constant square flow in volume control mode.
- Recruitment maneuvers done using pressure-volume curve.
- Difference in airway pressure and transpulmonary pressure can indicate recruitable lung.
- Debate about usefulness of recruitment maneuvers.
- Ventilator can monitor patient effort and calculate work of breathing.
- Visual representation of pressure and volume to understand chest wall compliance:
- Graph shows relationship between inspiratory and expiratory phases.
- Red area represents work of breathing.
- Change in tidal volume observed.
- Aids understanding of patient-ventilator interaction and synchronies.
- Importance of using esophageal balloon during mechanical ventilation weaning.
- Importance of pressure-time product in measuring airflow resistance and work of breathing:
- Pressure-time product is drop in airway pressure over specific time period.
- Measuring filling pressures of the heart assumes only internal pressures, but there is also external pressure.
- Recommended articles on the topic include 'Critical Care' (2014) and 'Respiratory Care' (2020).
- Discuss benefits and details of auto-PEEP, pleural pressure, transpulmonary driving pressure, and transpulmonary mechanical power.
- Other articles explain how to calculate respiratory mechanics, work of breathing during mechanical ventilation, and effects of transvascular and transmural pressures.
- Benefits of using an osu visual balloon:
- Mention of pressure balloon, transformatory, and APRV.
- Acknowledgment that more information could be discussed but would make the video longer and less engaging.
- Expressing gratitude for the viewer's attention and hope that the information was beneficial and convincing of the benefits of Australian balloon manometry.
https://www.youtube.com/watch?v=4fTtI5RGJDE