intermittent mandatory ventilation

間欠的強制換気

WordNet

1. the act of supplying fresh air and getting rid of foul air (同)airing
2. a mechanical system in a building that provides fresh air; "she was continually adjusting the ventilation" (同)ventilation system, ventilating system
3. stopping and starting at irregular intervals; "intermittent rain showers"
4. an authority who issues a mandate

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）』「2014/09/05 08:56:04」(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. 機械的人工換気のモード modes of mechanical ventilation
• 2. 機械的人工換気の概要 overview of mechanical ventilation
• 3. 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
• 4. 新生児における機械的人工換気 mechanical ventilation in neonates
• 5. 機械的人工換気からの離脱法（ウィーニング） methods of weaning from mechanical ventilation

English Journal

• Mechanism of Reduced Lung Injury by High Frequency Nasal Ventilation in a Preterm Lamb Model of Neonatal Chronic Lung Disease.

• Rehan VK, Fong J, Lee R, Sakurai R, Wang ZM, Janna Dahl M, Lane RH, Albertine KH, Torday JS.SourceDepartment of Pediatrics [V.K.R, J.F., R.L., R.S., J.S.T.], Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, 90502; Department of Pediatrics [Z-M.W., M.J.D., R.H.L., K.H.A.], University of Utah, School of Medicine, Salt Lake City, UT 84132.
• Pediatric research.Pediatr Res.2011 Aug 2. [Epub ahead of print]
• The mechanism underlying the potentially beneficial effects of the "gentler" modes of ventilation on chronic lung disease (CLD) of the premature infant is not known. We have previously demonstrated that alveolar Parathyroid Hormone-related Protein-Peroxisome Proliferator-Activated Receptorγ (PTHrP-
• PMID 21814155

• Airway Pressure Release Ventilation: What Do We Know?

• Daoud EG, Farag HL, Chatburn RL.AbstractAirway Pressure Release Ventilation (APRV) is inverse ratio pressure controlled intermittent mandatory ventilation. It is based on the principle of open lung approach. It has many purported advantages over conventional ventilation including alveolar recruitment, improved oxygenation, preservation of spontaneous breathing, improved hemodynamics, and potential lung protective effects. It has many claimed disadvantages related to risks of volutrauma, increased work of breathing, and increased energy expenditure related to spontaneous breathing. APRV is used mainly as a rescue therapy for the difficult to oxygenate patients with Adult Respiratory Distress Syndrome (ARDS). There is confusion regarding this mode of ventilation due to the different terminology used in the literature. APRV setting include the "P High", "T high", "P Low", and "T Low". Physicians and respiratory therapists should be aware of the different ways and the rationales for setting these variables on the ventilators. Also, they should be familiar with the differences between APRV, BIPAP, and other conventional and non-conventional modes of ventilation. There is no solid proof that APRV improves mortality; however, there are ongoing studies that may reveal further information about this mode of ventilation. This article reviews the different methods proposed for APRV settings, and summarizes the different studies comparing APRV and BIPAP, and the potential benefits and pitfalls for APRV.
• Respiratory care.Respir Care.2011 Jul 12. [Epub ahead of print]
• Airway Pressure Release Ventilation (APRV) is inverse ratio pressure controlled intermittent mandatory ventilation. It is based on the principle of open lung approach. It has many purported advantages over conventional ventilation including alveolar recruitment, improved oxygenation, preservation of
• PMID 21762559

Japanese Journal

• 新生児集中治療室における超低出生体重児への理学療法の介入効果

• 剱物 充,永山 善久
• 理学療法学 37(2), 85-90, 2010-04-20
• 【目的】新生児医療センター(Neonatal Intensive Care Unit,以下NICU)入院時より理学療法(Physical Therapy,以下PT)を介入した超低出生体重児の運動発達の経緯とPTの効果について検討した。【方法】当院NICUに入院し,脳性麻痺がなく独歩獲得までフォローできた19例を対象とし,NICU入院時からPTを開始した群の特性を調査するために周産期因子8項目につい …
• NAID 110007610278

• 持続的強制換気(CMV)と間欠的強制換気(IMV) (特集 呼吸管理プラクティカルガイド) -- (急性呼吸不全に対する換気様式の概念と適応)

• 田勢 長一郎
• 救急医学 34(10), 1273-1277, 2010-09
• NAID 40017320800

Related Links

• Mechanical ventilation - Wikipedia, the free encyclopedia

Synchronized Intermittent Mandatory Ventilation (SIMV). In this mode the ventilator provides a pre-set mechanical breath (pressure or volume limited) every specified number of seconds (determined by dividing the respiratory rate into 60 ...

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★リンクテーブル★

リンク元	「人工呼吸」「人工呼吸器」「間欠的強制換気」「IMV」
拡張検索	「synchronized intermittent mandatory ventilation」
関連記事	「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

「間欠的強制換気」

　　[★]

英

intermittent mandatory ventilation IMV

同

間欠的陽圧人工換気

関

呼吸同期性間欠的強制換気、人工呼吸器

• 用途：人工呼吸器からの離脱
• 換気様式：自発呼吸　＋(間欠的に)強制換気

「IMV」

　　[★]

• 間欠的強制換気 間欠的強制換気法 intermittent mandatory ventilation
• 下腰静脈 inferior lumbar vein

「synchronized intermittent mandatory ventilation」

　　[★] 呼吸同期性間欠的強制換気

「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