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Antonio Giannella Neto
Professor de Engenharia Biomédica
Programa de Engenharia Biomédica - COPPE
Universidade Federal do Rio de Janeiro, RJ, Brasil
Frederico C Jandre UFRJ Electronic Eng
Alysson R Carvalho UFRJ Physiotherapist
Edil L Santos UFRJ Physical Education
Alessandro Beda Dresden Biom Eng
Sergio Pacheco UFRJ Physician
Thiago C Lopes student Physical Education
Fernanda Albuquerque student Physiotherapist
João H Neves Soares student Veterinary physician
Alcendino C Jardim Neto student Physiotherapist
Niedja Carvalho student Physiotherapist
Bruno C Bergamini student Physiotherapist
Gabriel Casulari student Control Eng
Introduction
Mechanical ventilation Small animal’s
Automatic ventilation
Mechanical Monitoring
Cardiorespiratory coupling
Physiology of exercise
Gas exchange, O2 e CO2
Blood reservoir, 10%
Blood filter, embolism
Acid-basic equilibrium, pH
Synthesis of substances
Vocalization
Cardiorespiratory interactions
Emotion
1950, circa
today, circa
Respiratory circuit
Patient
Tidalventilation
Rat / mouse
ECG arterial pressure
Transducers’ Module
Pressure
Transducer
Water seal
PEEP
Flow sensor
Valve
Amplifier
Analog
Digital
Converter
MECHANICAL VENTILATOR
Ins/Exp
On/Off
Valve PC2 - Control
PC1 – Signal Acquisition
Analog
Digital
Converter
h
Air
Diffuser
Water
Reservoir
27
Mode VCV;
VT= 6 ml/kg;
RF= 90 ipm;
ti:te= 1:2;
FIO2= 21 %;
x
Titration 1 Titration 2
time
Time (s) Time (s) Time (s)
slow fast ramp
Slow Pressure Titration
Fast Pressure Titration
Airways
opening
R
C
PEEP
PEEP)t(Volume)C/1()t(flowR)t(Pao
Pao
Raw
E1
E2(Volume)
PEEP
Rtube
PEEP)t(VE)t(VE)t(f)t(fK)t(fK)t(P 2
2121ao
40 45 50 55 60 650
5
10
15
20
25P
Boca
40 45 50 55 60 65-0.8
-0.6
-0.4
-0.2
0
0.2
0.4
0.6
Flu
xo
40 45 50 55 60 65
0
0.2
0.4
0.6
0.8
Volu
me
Tempo (s)
Time (s)
Pairways
Flow
Volume
Patient 2 VCV 10 ml/kg ZEEP
Patient 2 VCV 10 ml/kg ZEEP
35 40 45 50 55 600
5
10
15
20P
Boca
35 40 45 50 55 60-0.8
-0.6
-0.4
-0.2
0
0.2
0.4
0.6
Flu
xo
35 40 45 50 55 60
0
0.2
0.4
0.6
0.8
Volu
me
Tempo (s)
Time (s)
Pairways
Flow
Volume
Patient 2 PCV 10 ml/kg ZEEP
PCV and VCV (at the same settings) presentsimilar indices of recruitment and overdistension
VT of 8 or 10 ml/kg present similar %E2
ZEEP indicates tidal recruitment
PEEP of 10 cmH2O indicates a non harmful tidaloverdistension (careful about this)
PEEP of 5 cmH2O seems to be the best PEEP setting regarding the %E2 (i.e., the compliance is linear)
Respiratory Sinus Arrhythmia
&
Synchronism
time
RR
(m
s)
Fractal ventilation enhances respiratory sinus arrhythmia
W Alan C Mutch*1, M Ruth Graham1, Linda G Girling1 and John F Brewster2
Respiratory Research 2005, 6:41
Why Does the Heartbeat Synchronize With Respiratory Rhythm?Fumihiko Yasuma, MD, FCCP; and Jun-ichiro Hayano, MD, FCCP
CHEST 2004; 125:683–690
Why Does the Heartbeat Synchronize With Respiratory Rhythm?Fumihiko Yasuma, MD, FCCP; and Junichiro Hayano, MD, FCCP
CHEST 2004; 125:683–690
Rest
Task
Example of a volunteer with long periods in CC
A. Beda, F.C. Jandre, A. Giannella-Neto([email protected])
CvO2
CvCO2
CeCO2
CeO2
QC
PAO2,PACO2
VA
PIO2,PICO2
.
INSPEXP
VA
Pb
FICO2
FIO2
ALVEOLI
CAPILLARY
CvO2
CvCO2
CaCO2
CaO2 Q
MCO2 MO2
Vtissue
(Wasserman et al., 1964)
.QCO2
.VCO2
.QO2
.TO2
.VO2.
TCO2
Maximal capacity to uptake, transport, extract and consume oxygen
Time or intensity
.VO2
.VO2max
Plateau de O2
A.V. Hill
.VE (fR, VT)
.VO2 = (VTI . FIO2 – VTE . FEO2) . fR
FE (O2, CO2)
FI (O2, O2)
Claude Gordon Douglas (1882 - 1963)
VO
2, l/
min
-
-
-
-
-
-
-
-
-
-
-
-
-
Oxid
ati
ve
An
aer
ob
icLactate Threshold Ventilatory Threshold
Lactic Acidosis Threshold Respiratory Compensation Point
La-
HCO3-
pH
VE R
VE/VO2 VCO2
PETO2
.
. . .
VE
VE/VCO2
PETCO2
..
.
Metabolism Breathing
.
VO2max.
EJAP, 2004
Sinoatrial Node
Atrioventricular Node
Purkinje Fibers
SympatheticVagal
time
RR
(m
s)
HF: 0.04 – 0.15 HzLF: 0.15 – 0.4 Hz
(Santos and Giannella-Neto, 2010)
80
70
60
50
40
30
20
10
0.0
ATVT ATCV ATRSA VW
Pe
ak
VO
2, %
90
