#4.
Pressure regulated volume control • Volume control • PRVC Pressure Flow Tidal volumes are constant, where airway pressure may vary dependent on compliance and resistance
#5.
#6.
Advanced modes • PRVC: pressure-regulated volume control • APRV: airway pressure release ventilation • PAV: proportional assist ventilation • Closed Loop Ventilation System • ASV: adaptive support ventilation
#7.
Airway pressure release ventilation CPAP with high airway pressure With intermittent pressure release
#8.
#9.
#10.
#11.
#12.
#13.
Case at NCCHD: 挿管時の呼吸状態 人工呼吸器条件（AC-PC） FIO2 0.7, PIP 30 cmH2O, PEEP 13 cmH2O, RR 40 /min OI 22, P/F 91 ➡ PALICC-2基準でsevere PARDS Emeriaud G, et al. Pediatr Crit Care Med. 2023;24(2):143-168. OI: Oxygenation Index, PALICC-2: the Second Pediatric Acute Lung Injury Consensus Conference, PARDS: pediatric ARDS
#14.
全体の経過 人工呼吸器条件（APRV） PaCO2 OI FIO2 0.8, Phigh 30 cmH2O, Plow 0 cmH2O, Thigh 4 s, Tlow 0.4 s, PSなし
#15.
APRV中の呼吸様式 人工呼吸器 自発呼吸は適度に抑制されている EIT 両肺の含気は良好 EIT: Electrical Impedance Tomography
#16.
Advanced modes • PRVC: pressure-regulated volume control • APRV: airway pressure release ventilation • PAV: proportional assist ventilation • Closed Loop Ventilation System • ASV: adaptive support ventilation
#17.
Respiratory muscle pressure and lung mechanics •Pmus = R・dV/dt + (1/C)・V C: compliance R: resistance R↑ → P↑ C↓ → P↑ Pmus （respiratory muscle pressure）
#18.
Proportional assist ventilation; If the patient’s effort is bigger, assist becomes bigger
#19.
#20.
#21.
Advanced modes • PRVC: pressure-regulated volume control • APRV: airway pressure release ventilation • PAV: proportional assist ventilation • Closed Loop Ventilation System • ASV: adaptive support ventilation
#22.
#23.
asv • Settings • Gender • Hight • % minute volume • PEEP • F IO 2
#24.
#25.
Advanced modes • PRVC: pressure-regulated volume control • No clear advantage • APRV: airway pressure release ventilation • One of the modes for moderate to severe ARDS patients • PAV: proportional assist ventilation • Theoretically less asynchrony than PSV • ASV: adaptive support ventilation • Limited experience in children • Closed loop ventilation may provide automated management of mechanical ventilation, from initial management to weaning
