Are you over-ventilating your patient

zollMedical Australia
Sunday, 01 August, 2021


Bag-valve masks have been the standard of care for decades, but it’s hard to know how much air a patient is getting with each squeeze. Guidelines suggest a rate of 10 breaths per minute when ventilating a patient, but the average provider has been shown to deliver an average of 30 ventilations per minute — nearly three times the recommended rate.1

实时临床反馈已被证明可以改善患者的预后。新的X系列®来自Zoll®的高级监视器/除颤器提供了CPR和通风的实时临床反馈,以帮助解决心脏骤停,创伤性脑损伤等。

“Science is showing us that to squeeze the bag a little bit inappropriately for one or three or 10 breaths can actually have an impact on outcomes,” said Drew Hoffman, a paramedic and a clinical support specialist on the ZOLL EMS team. “There is no set standard on BVMs, and the volume will vary with the size of hands of the provider, whether or not they’re using one or two hands and how aggressively the BVM is being squeezed.”

没有反馈,很容易(甚至很可能)提供过多的通风,从而导致冠状动脉灌注减少并产生严重的次要问题,例如低压或过度充气。

霍夫曼说:“每次挤压没有定义的音量,因此您只是在看一些对患者至关重要的东西。”

But measuring the patient’s EtCO2 levels and other key metrics during ventilation can eliminate the guesswork when it comes to BVM use.

USE REAL-TIME FEEDBACK TO IMPROVE VENTILATION

Access to real-time clinical feedback on the scene has been shown to improve patient outcomes with CPR. For years, ZOLL devices have provided real-time clinical feedback on CPR to help rescuers deliver high-quality compressions to patients in cardiac arrest.

“We know for a fact that feedback helps us do better CPR,” said Hoffman. “I honestly can’t imagine, as a provider, doing CPR on someone without feedback — it’s unthinkable.”

Now, ZOLL is applying the same approach to ventilation to help Emergency providers better manage a variety of conditions with its new X Series Advanced monitor/defibrillator. With real-time feedback for compressions, ventilation and more, emergency medical providers can better serve each patient with peace of mind that they are doing the right thing at the right time — as well as improve their skills overall.

For cardiac arrest patients, the X Series Advanced monitor/defibrillator offers both Real CPR Help®and Real BVM Help™, giving providers simultaneous real-time feedback on both compression and ventilation quality. In the Real BVM Help Dashboard, providers can view delivered tidal volume and rate on the monitor, as well as ventilation rate and depth, a ventilation quality indicator and a countdown timer.

“未经检查的BVM使用会导致过度换气,这会给您的患者的胸部加压并导致不良的预后。真正的BVM帮助为我们提供了实时的反馈,并且对于我们遇到的每个患者来说都是可调的。”霍夫曼说。“您可以专注于袋子的每一个挤压,并客观地评估您是如何做的?通风是一个问题吗?这是否导致了我们不想要的结果?”

Real BVM帮助与任何标准尺寸的市售气道管理设备一起用于插管和非插管患者,并且数据可以帮助提供者在各种患者状况下保持关键水平的平衡。

BETTER MANAGE TBI PATIENTS WITH FEEDBACK

创伤性脑损伤患者提出了一系列独特的挑战,而早期治疗对于最大程度地减少了常见的继发损伤至关重要。2

传统上,TBI管理包括通过过度换气患者来控制潜在的脑出血,以通过限制氧气并导致大脑中的血管减少颅内压来控制潜在的脑出血。但是,这实际上使大脑饿了,警告助理和Zoll EMS团队的临床支持专家肖恩·卡利尼(Sean Culliney)可能导致了一系列不良事件的级联。

“问题在于它非常快速地脱离了轨道。我们可以绝对控制颅内压,但这是以我们所有神经元为代价的,”他说。“我们正在将这些船只夹住,实际上我们正在饿死大脑,这对我们的患者来说是一件非常糟糕的事情。”

The TBI Dashboard on the X Series Advanced provides real-time data to help guide providers in managing this complex condition.

“The tricky part about the human body is that it is on a tightrope basically at all times, so it’s a very narrow path that we walk, and if we get off of that path a cascade begins to happen,” said Culliney. “If I hyperventilate or hypoventilate — if I go either way off that tightrope — a series of things starts happening, and it’s really difficult to get them back under control. Achieving a good pressure in the brain is useless if now my carbon dioxide level is dropping.”

他说,最终,真正的BVM帮助和TBI仪表板可以帮助提供者为患者实现适当的平衡,并确保提供者提供最好的护理。

他说:“这有助于我们在需要的地方留在中间。”“这是一个很大的难题,真正的BVM有助于稳定我们的手。”

使用数据改善操作,支持远程医疗

除了支持时间敏感的患者护理外,X系列高级的数据也可用于改善整体实践。借助RescuEnet®Casereview,临床医生和医疗主管可以在事实之后查看包括通风和CPR性能在内的数据,以获得有效的质量保证。

该技术还支持到位的远程医疗和治疗,结果大流行。借助Zoll的远程查看远程医疗技术,医疗保健专业人员可以查看从远程位置提出的X系列的数据,以为该领域的紧急救援提供者提供决策支持。

霍夫曼说:“实时反馈绝对是使用BVM的关键优先事项,X系列高级提供了反馈,以帮助每个人提供相同的护理的方式。”“我认为十年后人们会说,‘我不敢相信没有这个,我们曾经做过通风。’”

Visitzoll了解更多信息。

*文章编写并以前发表在EMS1

References:

1. Aufderheide TP,Lurie KG。Crit Care Med。2004年9月; 32(9供应):S345–51。

2. Spaite DW等。Acad Emerm Med。2014; 21:7:818-83

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