Education&ScienceAPSR ESAP

ESAP China 2010

Mechanical Ventilation Training

18-19 October 2010 Shanghai Zhongshan Hospital

This was a two-day post-graduate training course in mechanical ventilation featuring internationally renowned experts and held in conjunction with the 7th International Symposium on Respiratory Diseases (ISRD2010) in Shanghai, China. One-quarter of the 200 attendees were overseas delegates. This course aimed at improving participants’ understanding of the mechanisms of ventilator management in acute respiratory distress syndrome [ARDS] and chronic obstructive pulmonary disease [COPD].

Dr Zuoqin Yan, vice-president of Zhongshan Hospital, welcomed the overseas faculty warmly in his opening address and also highlighted the impressive line-up of Chinese speakers, and concluded with his hopes for the development of mechanical ventilation in the Asia-Pacific region.

Dr Robert Kacmarek from Massachusetts General Hospital, Harvard Medical School, Boston, USA, reviewed fundamental principles of mechanical ventilation. He discussed the benefits of new modes of ventilation, and focusing on proportional assist ventilation (PAV) and neurally adjusted ventilator assist (NAVA), comparing advantages and disadvantages of each mode and appropriate clinical settings for each one. He briefly described various indications for mechanical ventilation. The primary principles, he iterated, are to avoid inducing further injury, insure patient-ventilatory synchrony, and maintain adequate gas exchange.

Dr Christer Ström, from Sweden, spoke on mechanical ventilators, focusing on the latest technologies and machines and how these can be utilized in various settings to obtain optimal outcomes. He highlighted how neural control is affected by ventilator settings. Electrical activity of the diaphragm (Edi) provides a guide for unloading a patient’s respiratory effort and the setting of positive end-expiratory pressure (PEEP). The NAVA method guarantees synchronous ventilator assistance and natural variability, while the patient controls the ventilator, tidal volume and respiratory rate.

Dr Jerry Yu, professor from University of Louisville, Kentucky, USA, presented on the physiological effects of mechanical ventilation.

Dr John Marini from the University of Minnesota, Minneapolis, USA, provided insights into ventilator management for patients with COPD. He covered ventilation of airflow obstruction, potential advances in care, and provided useful tips for weaning patients off mechanical ventilation.

Dr Yuanlin Song from Zhongshan Hospital, Fudan University presented the mechanisms of ventilator-induced lung injury, outlining the complications of mechanical ventilation and possible prevention strategies. He also provided insights on monitoring during mechanical ventilation, and its importance in ensuring proper use of ventilation and oxygen, to enable proper nutrition to reduce complications and achieve successful weaning.

Dr Kacmarek spoke on how to achieve successful application of non-invasive positive pressure ventilation (NPPV). He compared bi-level pressure and ICU ventilators and discussed the importance of humidification.

Dr Bai delivered a comprehensive overview on conventional respirology support for patients with ARDS, highlighting important topics surrounding the use of mechanical ventilation.

The original programme was as follows:

Monday
(Oct 18th)
ISRD 2010 Special Course:
Modes of Mechanical Ventilation I
0830 – 0930 Introduction to Mechanical Ventilation
Robert M Kacmarek, USA
0930 – 1000 How does the ventilator work?
Ström Christer, Sweden
1000 – 1100 Physiologic effects of mechanical ventilation
Jerry Yu, USA
1100 – 1200 Modes of mechanical ventilation Part 1
Robert M Kacmarek, USA
1200 – 1300 Lunch
1300 – 1400 Mechanisms of ventilator-induced lung injury
Yuanlin Song, China
1400 – 1500 Modes of Mechanical Ventilation Part 2
Robert M Kacmarek, USA
1500 – 1530 How is neural control affected by the ventilator setting?
Ström Christer, Sweden
1530 – 1630 Indication and initial settings for invasive mechanical ventilation
Robert M Kacmarek, Sweden
1630 – 1700 Open lung mechanical ventilation
Ström Christer, Sweden
Tuesday
(Oct 19th)
ISRD Special Course:
Modes of Mechanical Ventilation II
0830 – 0930 Ventilator management for ARDS
Chunxue Bai, China
0930 – 1030 NPPV
Robert M Kacmarek, USA
1030 – 1130 Ventilator management for COPD
John Marini, USA
1130 – 1230 Monitoring during mechanical Ventilation
Yuanlin Song, China
1230 – 1330 Lunch
1330 – 1430 Adjunctive approaches to managing ARDS: Lung Recruitment, High Frequency ventilation, and prone positioning
Robert M Kacmarek, USA
1430 – 1530 The use of ECMO for the management of ARDS
John Marini, USA
1530 – 1630 Weaning
Robert M Kacmarek, USA
1630 – 1700 Closure Discussion
Chunxue Bai, China