ブックタイトル第43回日本集中治療医学会学術集会プログラム・抄録集

概要

第43回日本集中治療医学会学術集会プログラム・抄録集

－169－IL3Department of Emergency Medicine, University of Pittsburgh School of Medicine, USAJoe SuyamaClinical Medicine is not an exact science. We make time sensitive decisions in the Emergency Department and in the ICUeveryday. Sometimes we make these critical decisions without a complete clinical picture or full diagnostic certainty. When anundifferentiated patient presents with a critical illness, we work from a differential diagnosis with a number of possible diseasesthat need to be ruled out. Because of this uncertainty, medical errors can occur. These medical errors are generally associatedwith a failure to diagnose, improper initiation of treatment, or some failure to perform a procedure or provide treatment in atimely fashion. Unfortunately, these errors are more likely to occur under critical or emergency circumstances where thepatient has limited time or physiologic reserve to tolerate any mistakes or delay.Over the last 15 years, and with a greater focus on the quality of patient care and the safety of patients when they are underour care, we have learned many ways to decrease medical errors from occurring. Certain practices and process associated withimproving communication, better clinical review of existing information, and learning practices that will improve the quality ofpatient care will all lead to decreased medical error for the benefit of the patient.When errors are avoided or identified early, the likelihood that a patient will do well is increased. However, when medical errorsoccur, it is equally important to recognize when they happen, deal with the circumstances rapidly and appropriately, and learnfrom the situation so it does not happen again. Dealing with medical errors is a multidisciplinary task, and should be withoutblame or punishment. Being open to learning from medical errors is the first step in avoiding them in the future and improvingthe quality of patient care.After this lecture, you should:1. Understand how medical errors occur in the Emergency Department and ICU2. Understand the circumstances that lead to medical errors and how to avoid them3. Understand how to learn from medical errors to create a culture of safety and increase the quality of care that can beprovided for the benefit of patients and the clinical team招聘講演 3 2月12日（金）　16：40～17：30　第8会場Medical ErrorIL4Department of Anaesthesia, Harvard Medical School/ Massachusetts Genaral Hospital, USARobert M KacmarekInappropriate interaction between the patient and the ventilator has a potential of impacting patient outcome! Asynchrony existsin many forms. Most have outlined asynchrony into 4 different categories: Flow, Trigger, Cycle and Mode asynchrony. Flowasynchrony exists when the ventilator‘s flow delivery does not match the inspiratory demand of the patient. This form ofasynchrony is more common in volume ventilation than in pressure ventilation because in volume ventilation precise flowdelivery is set; a specific flow pattern and peak flow are set by the clinician and the patient is requires to conform to thatprecise flow delivery or asynchrony exists.Trigger asynchrony occurs when the ventilator does not rapidly respond to the inspiratory effort of the patient. This can be inthe form of delayed triggering. Missed triggering occurs whenever the patient’s inspiratory effort is NOT sensed by theventilator. This is most commonly a result of auto-PEEP caused by intrinsic lung disease or the actual setting of the ventilator.A recently described from of missed triggering is reverse triggering in which during controlled ventilation a mandatory breathresults in stimulation of the respiratory center to begin inspiration. Generally this is at a fixed mandatory rate to reveredtriggered ratio and phase angle. Double triggering occurs when the patient’s inspiratory time is longer than the ventilatorsinspiratory time or the tidal volume delivered is less than the demand from the patient’s respiratory center. The final type oftrigger asynchrony is auto-triggering; that is the activation of an assisted breath without the patients making an inspiratoryeffort. This most commonly occurs as a result of system leak or hyperdynamic contraction of the heart as observed in somepost-operative cardiac surgical patients.Cycle asynchrony occur most commonly during pressure ventilation and is defined as a mismatching of the time that theventilator is set to end the breath and the time the patients respiratory center indicates the breath should end. Cycleasynchrony can be in the form of long cycling（the ventilators inspiratory time exceeds the patients inspiratory time）or shortcycling（the ventilators inspiratory time is shorter than the patient’s inspiratory time）.Mode asynchrony is the final form of asynchrony, which simply implies that the particular mode of ventilation does not matchwell with the ventilatory pattern dictated by the patient’s respiratory center.Recent data indicates that a high rate of asynchrony is associated with increased length of mechanical ventilation, ICU length ofstay and morality.Trille et al ICM 2006;32:1515De Wit et al CCM Medicine 2009;37:2740Blanch et al ICM 2015;14:633招聘講演 4 2月13日（土）　9：00～9：50　第4会場Patient-Ventilator Asynchrony and Impact on Outcome!