Airway Pressure
THE EFFECTS OF AIRWAY PRESSURE RELEASE VENTILATION AND HIGH FREQUENCY OSCILLATION VENTILATION ON THE HEART - SPECIFICALLY WHEN THE PATIENT HAS CONGESTIVE HEART FAILURE.
MECHANICAL VENTILATION
CONGESTIVE HEART FAILURE
AIRWAY PRESSURE RELEASE VENTILATION (APRV)
APRV & CONGESTIVE HEART FAILURE
HIGH FREQUENCY OSCILLATION VENTILATION (HFOV)
HFOV & CONGESTIVE HEART FAILURE
MECHANICAL VENTILATION
Mechanical Ventilation refers to the process of helping the normal breathing process of an individual when his breathing patterns are compromised due to either a pathology within the lung or due to a collective collapse of the related organs. Mechanical ventilation can be of two types: negative pressure ventilation where the air is made to suck into the lungs or positive ventilation where air is forced into the lungs through the airway. During the process of providing ventilation to the lungs it becomes important to "secure the airway" which means that the air should go through the airway passages namely trachea, bronchi and then to lungs rather then going to the esophagus and then to the stomach. This can be done by the process of endotracheal intubation, tracheostomy or simply by airway maneuvers. Mechanical ventilation does have its own complications which include injury to the airway, pneumothorax, alveolar damage, and pneumonia associated to the ventilator.
Many airway complications indicate to mechanical ventilation which include Acute respiratory distress syndrome (ARDS), Apnea due to various conditions, chronic obstructive pulmonary disease (COPD), hypotension due to shock, sepsis or congestive heart failure, diaphragm paralysis leading to respiratory acidosis that maybe caused from muscle relaxant or anesthetic drugs, myasthenia gravis, spinal cord injury or Guillain-Barre syndrome, neurological diseases like Amyotrophic Lateral Sclerosis & Muscular Dystrophy.
Ventilators used for mechanical ventilation can be divided into the following categories: conventional ventilation by breath termination or breath initiation, high frequency ventilation (HFV), airway pressure release ventilation (APRV), non-invasive positive pressure ventilation (NIPPV), proportional assist ventilation (PAV), Adaptive Support Ventilation (ASV), and Neurally Adjusted Ventilatory Assist (NAVA). This paper will focus on the study of two ventilator mechanisms which is APRV and HFV.
CONGESTIVE HEART FAILURE
Congestive heart failure refers to the inadequacy of the heart to supply blood to meet the needs of the entire body. (dorland's medical dictionary, 2009) congestive heart failure can be caused due to various conditions affecting the heart like myocardial infarction, valvular heart diseases, cardiomyopathies or hypertension. The symptoms include leg swelling, exercise intolerance and most importantly shortness of breathe. Usually a blood test or an echocardiograph can diagnose this condition. It is a costly, immobilizing, common and potentially deadly condition (McMurray JJ, 2005) the percentage of people suffering from heart failure in developed countries is 2% which increases to 6-10% in the age group of 65 and above. (Dickstein K, 2008)
The pathophysiology of CHF explains that the type of CHF most commonly affecting ventilation of the lungs is the left sided heart failure which is connecting the heart with the lungs. In this kind of heart failure a condition known as cardiogenic pulmonary edema results which causes fluid to retain within the lungs. As a result the ventilation spare capacity reduces, the lungs stiffen and gaseous blood exchange is impaired because of a greater distance between the two as a result of edema. This pathophysiology exhibits itself in the form of shortness of breath, paroxysmal nocturnal dyspnea and orthopnea as its main symptoms.
Congestive heart failure can be managed in acute conditions by maintaining the airway, breathing and circulation. This is where ventilators come into play. Where as chronically they can be managed by certain drugs and behavioural modifications.
AIRWAY PRESSURE RELEASE VENTILATION (APRV)
Airway pressure release ventilation has been defined as continuous positive airway pressure (CPAP) with brief regular, intermittent releases in airway pressure (H., 1996) APRV facilitates complete removal of carbon dioxide during the release phase and also provides oxygenation and hence has been termed as an improved mode of respiratory support for acute lung injury patients. (Stock MC, 1987) APRV can completely aid the ventilation process for an apneic patient or slightly enhance the ventilation for a spontaneously breathing patient. (Garner W, 1988) APRV provides room for uninterrupted spontaneous breathing through out the ventilation process along with a continuous positive airway pressure that facilitates the oxygenation of the blood and a timed process whichprovides clearance of carbondioxide. Although the advantages of APRV are many but the major ones include the capacity of providing the chance of spontaneous breathing throough out the cycle, at a given tidal volume providing a plateau...
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