Welcome to the 9th EAPS Congress Programme Scheduling

Abstract Body

In Obstructive diseases due to an increase in R, time constant (τ) is longer as it takes longer to fill or empty the lung unit. It may lead to incomplete exhalation causing air-trapping. Accurately the existence of air-trapping and its particular kind is key when adjusting the mechanical ventilation programming (Figures 1 and 2).

If dynamic air-trapping is present the ventilation strategy aims for minimal minute ventilation allowing some degree of permissive hypercapnia and an optimal I:E ratio that allows complete expiration. Traditionally, high inspiratory flow using constant flow (VC modes) to overcome airway resistance and long expiratory times have been recommended. The rationale to use constant flow is that with high inspiratory flows, the inspiratory time would be reduced allowing more time for exhalation.

The presence of a collapse of the wall of the distal airway or secretions can produce dependent PEEP air-trapping. The PEEP degree aims to permeabilise the distal airway. The PEEP that achieves the lowest Pplat should be programmed which would mean that the lung volume at the end of inspiration (VEI) would be reduced and, consequently, the incidence of non-dynamic air-trapping.

Table 1. Air-trapping mechanisms.

Figure 1. Algorithm to guide the ventilatory settings in obstructive pattern patients.

Figure and table reproduced from: ESPNIC/SECIP Handbook of Paediatric and Neonatal Mechanical ventilation

Abstract Body

Mechanical Power (MP) is an emerging concept in the field on Mechanical Ventilation. It summarizes the potential for Ventilator Induced Lung Injury (VILI) in the ergotrauma theory, based on concepts from rheology and materials science. In this talk we will explain the fundamentals of materials science and its application to the knowledge of lung physiopathology. Also we will conjecture the possibility of lowering VILI production by lowering MP applied to the lungs. And finally, we will show the evidence that points in this direction, based in animal studies but also in clinical studies and meta-analysis of randomized trials.