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Evita Infinity<br />
V500<br />
PulmoVista<br />
500<br />
IMAGE-GUIDED LUNG PROTECTION<br />
to treat the unse<strong>en</strong><br />
MECHANICAL VENTILATION IN INTENSIVE CARE<br />
Acute respiratory distress syndrome (ARDS) might be a consequ<strong>en</strong>ce of v<strong>en</strong>tilator<br />
associated <strong>lung</strong> injury (VALI) that should be prev<strong>en</strong>ted rather than treated. 1<br />
FACTS<br />
23% of all mechanically v<strong>en</strong>tilated<br />
pati<strong>en</strong>ts develop ARDS 2<br />
23%<br />
40%<br />
45%<br />
50%<br />
40% of all ARDS<br />
cases are not being<br />
diagnosed 2<br />
Mortality of ARDS<br />
is up to 45%<br />
dep<strong>en</strong>ding on the<br />
severity of ARDS 2<br />
Almost 50% of ARDS<br />
survivors do not return<br />
to work one year after<br />
ICU discharge due to<br />
int<strong>en</strong>sive careacquired<br />
weakness 3<br />
MECHANISMS OF VALI<br />
VOLU-/BAROTRAUMA<br />
ATELECTRAUMA<br />
Alveolar<br />
Overdist<strong>en</strong>sion<br />
Tidal Recruitm<strong>en</strong>t<br />
(cyclic op<strong>en</strong>ing and closing)<br />
Alveolar<br />
Collapse<br />
Inflammation<br />
Biotrauma<br />
Multisystem Organ<br />
Failure (MSOF)<br />
PROTECT THE LUNG WITH PERSONALIZED VENTILATION<br />
LIMIT<br />
V T /PBW<br />
ΔP<br />
Tidal Volume per<br />
predicted body weight<br />
Driving pressure<br />
P plat Plateau pressure 4<br />
AVOID<br />
<strong>lung</strong> heterog<strong>en</strong>eity<br />
regions of collapse close to op<strong>en</strong> <strong>lung</strong><br />
regions<br />
regional stress and strain 5<br />
Zone of<br />
overdist<strong>en</strong>sion<br />
Volume<br />
Zone of<br />
Derecruitm<strong>en</strong>t/<br />
atelectasis<br />
Pressure<br />
DIFFERENTIATE<br />
betwe<strong>en</strong> responder and non-responder<br />
to a recruitm<strong>en</strong>t maneuver<br />
FIND<br />
personalized PEEP and Driving<br />
pressure (ΔP)<br />
responder<br />
non-responder<br />
ΔP<br />
Pinsp<br />
PEEP<br />
optimal PEEP?<br />
IMAGE-GUIDED LUNG PROTECTION<br />
TURN THE KNOB AND PUSH THE BUTTON<br />
PEEP trial with QuickSet / PressureLink –<br />
Evita® Infinity V500<br />
Conv<strong>en</strong>i<strong>en</strong>tly change PEEP with constant<br />
driving pressure using only one knob<br />
One-step or<br />
multi-step recruitm<strong>en</strong>t<br />
– Perseus® A500<br />
Pinsp<br />
PEEP<br />
SEE THE UNSEEN<br />
Diagnostic View – PulmoVista 500<br />
PEEP<br />
Overdist<strong>en</strong>sion<br />
Collapse<br />
TREAT THE PREVIOUSLY UNSEEN AND FIND THE BALANCE<br />
<strong>Image</strong>-<strong>guided</strong> <strong>lung</strong> <strong>protection</strong> with Evita V500 and PulmoVista 500<br />
• find a compromise to minimize VALI<br />
• adjust the v<strong>en</strong>tilator settings accordingly<br />
Pinsp<br />
PEEP<br />
PULMOVISTA 500 HELPS OPTIMIZE VENTILATION SETTINGS 6<br />
PULMOVISTA 500 HELPS TO REDUCE VILI 7<br />
PULMOVISTA 500 CAN IMPROVE VENTILATION WITH LOWER DRIVING PRESSURE 8<br />
1) Villar and Slutsky, 'Is acute respiratory distress syndrome an iatrog<strong>en</strong>ic<br />
disease?', Crit Care, Feb. 2010.<br />
2) Bellani et al., ‘Epidemiology, Patterns of Care, and Mortality for Pati<strong>en</strong>ts With<br />
Acute Respiratory Distress Syndrome in Int<strong>en</strong>sive Care Units in 50 Countries’,<br />
JAMA, vol. 315, Feb. 2016.<br />
3) Kamdar et al., ‘Joblessness and Lost Earnings after Acute Respiratory Distress<br />
Syndrome in a 1-Year National Multic<strong>en</strong>ter Study.’, Am J Respir Crit Care Med.,<br />
Oct. 2017.<br />
4) Amato et al., ‘Driving Pressure and Survival in the Acute Respiratory Distress<br />
Syndrome’, N. Engl. J. Med., vol. 372, Feb. 2015.<br />
5) Gattinoni et al., ‘Lung recruitm<strong>en</strong>t in pati<strong>en</strong>ts with the acute respiratory distress<br />
syndrome’, N. Engl. J. Med., vol. 354, Apr. 2006.<br />
6) Wolf et al., ‘Mechanical V<strong>en</strong>tilation Guided by Electrical Impedance Tomography<br />
in Experim<strong>en</strong>tal Acute Lung Injury’, Crit. Care Med., vol. 41, May 2013.<br />
7) Kotani et al., ‘Electrical impedance tomography-<strong>guided</strong> prone positioning in a<br />
pati<strong>en</strong>t with acute cor pulmonale associated with severe acute respiratory distress<br />
syndrome’, J. Anesth., vol. 30, Feb. 2016.<br />
8) Roldan et al., ‘PEEP Titration In Severe Acute Respiratory Distress Syndrome:<br />
Differ<strong>en</strong>t Physiological Consequ<strong>en</strong>ces Wh<strong>en</strong> Guided By Electrical Impedance<br />
Tomography Versus Esophageal Pressure’, in B24. CRITICAL CARE: ACUTE<br />
RESPIRATORY FAILURE-MECHANICAL VENTILATION AND BEYOND, May 2017.
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