synchronized intermittent mandatory ventilation

呼吸同期性間欠的強制換気

WordNet

1. happen at the same time (同)synchronise, contemporize, contemporise
2. make synchronous and adjust in time or manner; "Lets synchronize our efforts" (同)synchronise, sync
3. cause to indicate the same time or rate; "synchronize your watches" (同)synchronise
4. make (motion picture sound) exactly simultaneous with the action; "synchronize this film" (同)synchronise
5. operate simultaneously; "The clocks synchronize" (同)synchronise
6. arrange or represent events so that they co-occur; "synchronize biblical events" (同)synchronise, contemporize, contemporise
7. the act of supplying fresh air and getting rid of foul air (同)airing
8. a mechanical system in a building that provides fresh air; "she was continually adjusting the ventilation" (同)ventilation system, ventilating system
9. stopping and starting at irregular intervals; "intermittent rain showers"
10. operating in unison; "the synchronized flapping of a birds wings" (同)synchronised

PrepTutorEJDIC

1. 換気,通風 / 換気設備,通風装置 / 世に問うこと,自由討議
2. 断続する,間欠的な
3. (命令によって)強制的な / 委任の / 委任を受けた人(国),委任統治の受任国

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/01/15 00:22:05」(JST)

wiki en

[Wiki en表示]

Intermittent Mandatory Ventilation (IMV) refers to any mode of mechanical ventilation where a regular series of breaths are scheduled but the ventilator senses patient effort and reschedules mandatory breaths based on the calculated need of the patient. Similar to continuous mandatory ventilation in parameters set for the patients pressures and volumes but distinct in its ability to support a patient by either supporting their own effort or providing support when patient effort is not sensed. IMV is frequently paired with additional strategies to improve weaning from ventilator support or to improve cardiovascular stability in patients who may need full life support.

Synchronized intermittent mechanical ventilation (SIMV)

Synchronized Intermittent Mechanical Ventilation is a variation of IMV, in which the ventilator breaths are synchronized with patient inspiratory effort. SIMV, with and without pressure support has not been shown to have any advantages over continuous mandatory ventilation (CMV) in terms of mortality or weaning success, and has been shown to result in longer weaning times when compared to t-piece trials or gradual reductions in pressure support. Some studies have shown an increase in patient work of breathing when switched from CMV to SIMV, and others have demonstrated potential detrimental effects of SIMV on respiratory muscles and respiratory drive.

Mandatory minute ventilation (MMV)

Mandatory minute ventilation is a mode which requires the operator to determine what the appropriate minute ventilation for the patient should be, and the ventilator then monitors the patient's ability to generate this volume every 7.5 seconds. If the calculation suggests the volume target will not be met, SIMV breaths are delivered at the targeted volume to achieve the desired minute ventilation. Allows spontaneous breathing with automatic adjustments of mandatory ventilation to the meet the patient’s preset minimum minute volume requirement. If the patient maintains the minute volume settings for VT x f, no mandatory breaths are delivered. If the patient's minute volume is insufficient, mandatory delivery of the preset tidal volume will occur until the minute volume is achieved. The method for monitoring whether or not the patient is meeting the required minute ventilation (V_E) is different per ventilator brand and model, but generally there is a window of time being monitored and a smaller window being checked against that larger window (i.e., in the Dräger Evita® line of mechanical ventilators there is a moving 20-second window and every 7 seconds the current tidal volume and rate are measured against to make a decision for if a mechanical breath is needed to maintain the minute ventilation). MMV is the most optimal mode for weaning in neonatal and pediatric populations and has been shown to reduce long term complications related to mechanical ventilation.

Proportional Assist Ventilation (PAV)

Proportional assist ventilation is a mode in which the ventilator guarantees the percentage of work regardless of changes in pulmonary compliance and resistance. The ventilator varies the tidal volume and pressure based on the patients work of breathing, the amount it delivers is proportional to the percentage of assistance it is set to give.

Adaptive Support Ventilation

Adaptive Support Ventilation is a positive pressure mode of mechanical ventilation that is closed-loop controlled. In this mode, the frequency and tidal volume of breaths of a patient on the ventilator are automatically adjusted based on the patient’s requirements. The lung mechanics data are used to adjust the depth and rate of breaths to minimize the work rate of breathing. In the ASV mode, every breath is synchronized with patient effort if such an effort exists, and otherwise, full mechanical ventilation is provided to the patient.

ASV is a patented technology originally described as one of the embodiments of US Patent No. 4986268. In this invention, the control algorithm computes the optimal rate of respiration to minimize the work rate of breathing. The rationale is to make the patient's breathing pattern comfortable and natural within safe limits, and thereby stimulate spontaneous breathing and reduce the weaning time.

See also

• Modes of mechanical ventilation

References

UpToDate Contents

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• 1. 機械的人工換気の概要 overview of mechanical ventilation
• 2. 慢性閉塞性肺疾患（COPD）を合併した急性呼吸不全における侵襲性機械的人工換気 invasive mechanical ventilation in acute respiratory failure complicating chronic obstructive pulmonary disease
• 3. 新生児における機械的人工換気 mechanical ventilation in neonates
• 4. 機械的人工換気のモード modes of mechanical ventilation
• 5. 小児における重症喘息の急性増悪：気管内挿管および人工呼吸器の使用 acute severe asthma exacerbations in children endotracheal intubation and mechanical ventilation

English Journal

• Trends in survival among extremely-low-birthweight infants (less than 1000 g) without significant bronchopulmonary dysplasia.

• Botet F, Figueras-Aloy J, Miracle X, Rodríguez-Miguélez JM, Salvia D, Carbonell-Estrany X.AbstractABSTRACT: OBJECTIVE: The aim of this study was to analyze the evolution from 1997 to 2009 of survival without significant (moderate and severe) bronchopulmonary dysplasia (SWsBPD) in extremely-lowbirth-weight (ELBW) infants and to determine the influence of changes in resuscitation, nutrition and mechanical ventilation on the survival rate. Study design In this study, 415 premature infants with birth weights below 1000 g (ELBW) were divided into three chronological subgroups: 1997 to 2000 (n = 65), 2001 to 2005 (n = 178) and 2006 to 2009 (n = 172). Between 1997 and 2000, respiratory resuscitation in the delivery room was performed via a bag and mask (Ambu(R), Ballerup, Sweden) with 40-50% oxygen. If this procedure was not effective, oral endotracheal intubation was always performed. Pulse oximetry was never used. Starting on January 1, 2001, a change in the delivery room respiratory policy was established for ELBW infants. Oxygenation and heart rate were monitored using a pulse oximeter (Nellcor(R)) attached to the newborn's right hand. If resuscitation was required, ventilation was performed using a face mask, and intermittent positive pressure was controlled via a ventilator (Babylog2, Dragger). In 2001, a policy of aggressive nutrition was also initiated with the early provision of parenteral amino acids. We used standardized parenteral nutrition to feed ELBW infants during the first 12-24 hours of life. Lipids were given on the first day. The glucose concentration administered was increased by 1g/kg/minute each day until levels reached 8 mg/kg/minute. Enteral nutrition was started with trophic feeding of milk. In 2006, volume guarantee treatment was instituted and administered together with synchronized intermittent mandatory ventilation (SIMV + VG). The complications of prematurity were treated similarly throughout the study period. Patent ductus arteriosus was only treated when hemodynamic repercussion. Surgical closure of the patent ductus arteriosus was performed when two courses of indomethacin or ibuprofen were not sufficient to close it. Mild BPD were defined by a supplemental oxygen requirement at 28 days of life and moderate BPD if breathing room air or a need for <30% oxygen at 36 weeks postmenstrual age or discharge from the NICU, whichever came first. Severe BPD was defined by a supplemental oxygen requirement at 28 days of life and a need for greater than or equal to 30% oxygen use and/or positive pressure support (IPPV or nCPAP) at 36 weeks postmenstrual age or discharge, whichever came first. Moderate and severe BPD have been considered together as "significant BPD". The goal of pulse oximetry was to maintain a hemoglobin saturation of between 88% and 93%. Patients were considered to not need oxygen supplementation when it could be permanently withdrawn. The distribution of the variables was not normal based on a Kolmogorov-Smirnov test (p < 0.05 in all cases). Therefore, quantitative variables were expressed as the median and interquartile range (IQR; 25th-75th percentile). Statistical analysis of the data was performed using nonparametric techniques (Kruskal-Wallis test and Mann-Whitney U test). A chi-square analysis was used to analyze qualitative variables. Potential confounding variables were those possibly related to BPD in survivors (p between 0.05 and 0.3 in univariate analysis). Logistic regression analysis was performed with variables related to BPD in survivors (p < 0.05) and potential confounding variables. The forward stepwise method adjusted for confounding factors was used to select the variables, and the enter method using selected variables was used to obtain the odds ratios. Results and conclusion There was an increase in the rate of SWsBPD (1997 to 2000: 58.5%; 2001 to 2005: 74.2%; and 2006 to 2009: 75.0%; p = 0.032). In survivors, the occurrence of significant BPD decreased after 2001 (9.5% vs. 2.3%; p = 0.013). The factors associated with improved SWsBPD were delivery by caesarean section, a reduced endotracheal intubation rate and a reduced duration of mechanical ventilation.While the mortality of ELBW infants has not changed since 2001, the frequency of SWsBPD has significantly increased (75.0%) in association with increased caesarean sections and reductions in the endotracheal intubation rate, as well as the duration of mechanical ventilation.
• BMC pediatrics.BMC Pediatr.2012 Jun 8;12(1):63. [Epub ahead of print]
• ABSTRACT: OBJECTIVE: The aim of this study was to analyze the evolution from 1997 to 2009 of survival without significant (moderate and severe) bronchopulmonary dysplasia (SWsBPD) in extremely-lowbirth-weight (ELBW) infants and to determine the influence of changes in resuscitation, nutrition and m
• PMID 22682000

• Randomized Crossover Study of Neurally Adjusted Ventilatory Assist in Preterm Infants.

• Lee J, Kim HS, Sohn JA, Lee JA, Choi CW, Kim EK, Kim BI, Choi JH.SourceDepartment of Pediatrics, Seoul National University College of Medicine, Seoul, Korea.
• The Journal of pediatrics.J Pediatr.2012 Jun 1. [Epub ahead of print]
• OBJECTIVE: To determine whether neurally adjusted ventilatory assist (NAVA), a new method of mechanical ventilation that delivers pressure assistance that is proportional to the electrical activity of the diaphragm (EAdi), could lower the inspiratory pressure and respiratory muscle load in preterm i
• PMID 22658785

Japanese Journal

• Crossover trial comparing pressure support with synchronized intermittent mandatory ventilation

• OLSEN SL
• J Perinatol 22(6), 461-466, 2002
• NAID 30014047102

• Randomized trial of nasal synchronized intermittent mandatory ventilation compared with continuous positive airway pressure after extubation of very low birth weight infants

• BARRINGTON KJ
• Pediatrics 107, 638-641, 2001
• NAID 30012915314

Related Links

• Synchronized Intermittent Mandatory Ventilation

(Synchronized) Intermittent Mandatory Ventilation Intermittent mandatory ventilation was developed as a method of partial ventilatory support to facilitate liberation from mechanical ventilation. A demand ...

• Synchronized Intermittent Mandatory Ventilation

Synchronized Intermittent Mandatory Ventilation Impact on Anesthesia Practice While new ventilation strategies are frequently introduced into pulmonary medicine first, some modes do find there way into anesthesia practice. Among ...

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★リンクテーブル★

リンク元	「人工呼吸」「人工呼吸器」「呼吸同期性間欠的強制換気」「SIMV」
関連記事	「synchronize」「intermittent」「mandatory」「mandator」

「人工呼吸」

　　[★]

英

artificial respiration, artificial ventilation

概念

• 1. 人工的に呼吸を行わせること。このため、伝統的なmouth to mouthからバックアンドバルブマスク、あるいは人工呼吸器を用いて行う。
• 2. 一次救命処置の中における処置　→　人工呼吸#一次救命処置

人工呼吸適応

SAN.422

• 肺活量 < 10ml/kg, PaO2 < 55 mmHg(50%以上の酸素投与下), 呼吸回数 > 35/min, 努力呼吸, 吸引圧 < -25cmH2O

人工呼吸のモード

送気制御パターンによる分類

• 量規定換気 volume controlled ventilation VCV
• 圧規定換気 [[]] PCV

換気モード

• 調節換気 controlled mechanical ventilation CMV

• 間欠的陽圧呼吸 IPPV：間欠的に定容量のガスを換気する
• 持続的陽圧呼吸 CPPV：間欠的に定容量のガスを換気する　＋　呼気終末陽圧の付加

• 同期型間欠的強制換気 synchronized intermittent mandatory ventilation SIMV = 間欠的強制換気 intermittent mandatory ventilation IMV：自発呼吸が不十分な場合に、陽圧呼吸が強制的に行われる。
• 圧支持換気 pressure suppot ventilation
• 持続気道内陽圧 continuous positive airway pressure CPAP：自発呼吸をしている患者に呼気・吸気を通じて陽圧を欠ける。
• 非侵襲的陽圧換気法 noninvasive positive pressure ventilation NPPV

• nasal CPAP

人工呼吸を補助するモード

• 呼気終末陽圧 positive end-inspiratory pressure
• 吸気プラトー →　吸気ガス不均等分布の改善 EID

人工呼吸の合併症

• 1. 血圧低下(静脈還流の低下、心機能低下)
• 2. 圧外傷(気胸・縦隔腫瘍)
• 3. 酸素中毒による無気肺、肺浮腫
• 4. 気管潰瘍、穿孔、狭窄
• 5. 尿量減少(ADH増加、心拍出量減少)
• 6. 脳圧亢進(PEEPによる静脈還流↓)
• 7. 消化管出血(ストレス)
• 8. 精神的苦痛(気管挿入)
• 9. 感染(人工呼吸器関連肺炎)

一次救命処置

ISBN 978-4892695667 p.100

• 口腔内の異物を除去
• 脈拍があり、呼吸がない場合の人工呼吸：成人では10/分、小児では12-20回/分のペースで息を吹き込む。
• 小児の場合、呼吸数が10/分未満の場合、人工呼吸が考慮される。

BLS

• 1秒かけて息を吹き込む。
• 1人法の場合は30回の胸骨圧迫の後に2回人工呼吸を行う。
• 2人法の場合も原則同様。ただし、幼小児の場合のみ15回の胸骨圧迫の後に2回人工呼吸を行う。
• 成人の場合は5-6秒に1回、小児に対しては3-5秒に1回の人工呼吸を行う(AHA BLSヘルスケアプロバイダーマニュアル AHAガイドライン2005年準拠)

「人工呼吸器」

　　[★]

英

ventilator, mechanical ventilator, artificial ventilator

同

ベンチレーター ベンチレータ、レスピレータ respirator artificial respirator

関

手動人工呼吸器

[show details]

ベンチレータ : 約 21,000 件
ベンチレーター : 約 143,000 件

モード

• 補助呼吸 assist ventilation：自発呼吸を残して患者の呼吸に同期して換気補助を行う。
• 間欠的強制換気 intermittent mandatory ventilation, IMV：自発換気量が設定量に達しない場合に間欠的に不足分を補う。

• 呼吸同期性間欠的強制換気 synchronized intermittent mandatory ventilation, SIMV：自発呼吸に調節換気を間欠的に加える。調節換気を漸減するなどして、レスピレーターの離脱などに用いる。

• 調節呼吸 controlled ventilation：自発呼吸を消失させ呼吸を完全に調節下におく。

初期設定

PALS AHAガイドライン2010年準拠 p.176

酸素	94-99%
1回換気量(従量式換気)	6-8ml/kg
吸気時間	0.5-1秒
最大吸気圧(従圧式換気)	20-30cmH2O
呼吸数	乳児	20-30回/分
	小児	16-20回/分
	青少年	8-12回/分
PEEP	3-5cmH2O

「呼吸同期性間欠的強制換気」

　　[★]

mandatory

英

synchronized intermittent mandatory ventilation, SIMV

[show details]

呼吸同期的間欠的強制換気 : nothing
呼吸同期的間欠的強制換気法 : nothing
呼吸同期性間欠的強制換気 : 6 件
呼吸同期性間欠的強制換気法 : 2 件
同期的間欠的強制換気 : 26 件
同期的間欠的強制換気法 : 15 件
同期性間欠的強制換気 : 19 件
同期性間欠的強制換気法 : 2 件

「SIMV」

　　[★] 呼吸同期性間欠的強制換気 synchronized intermittent mandatory ventilation

「synchronize」

　　[★]

• v.

• 同期化する、同期する、同調する、同時発生する

関

coincide、coincidence、concurrence、conform、entrain、entrainment、synchronization、tuning

　 　 　 　 　 　

「intermittent」

　　[★]

• adj.

• 時々とぎれる、断続する。間欠性の、周期性の。時々の

関

episodic、intermission、intermittence、intermittently、interrupted、saccadic

　 　

「mandatory」

　　[★]

• adj.

• 義務的な、絶対的な、

関

duty、essential、incumbent、obligation、obligatory、prerequisite

　

「mandator」

　　[★]

• n.

• 命令者。委任者