- Email: [email protected]
Conference report: ‘Mechanical Ventilation: Principles and Applications’ 11-14 September 1997 – Minneapolis, Minnesota, USA
/i
'VIA
AUSTRALIAN CRITICAL CARE
tion' rooms, with the monitoring alarms turned down during the night so that they can sleep.
vious and, in any event, it probably encouraged them to reassess the ways in which they currently manage their patients.
The great strength of the conference overall was that highly controversial topics were presented by eminent and experienced clinicians. Obviously, there were no rights or wrongs as far as the questions were concerned, and the point of the seminars was to examine the issues, not find answers. Perhaps the only criticism I would make is that not all the speakers concurred with the view they were asked to put forward; that said, this was not always ob-
Further, the meeting gave those who subscribe to the Critical Care Mailing List (CCM-L) on the lnternet a chance to meet and hear some CCM-L celebrities in person, while the trade displays included products from Anaesthetic Supplies, Hewlett Packard, Roche and Boots Healthcare. All in all, it could indeed have been "the most exciting program" of its kind this year. Well done, Malcolm Fisher and Royal North Shore Hospital.
C c o n f e r t g n c er p r t : I
fle
Mechanical Ventilation: Principles and Applications' 11-14September 1997 - Minneapolis, Minnesota, USA
'
4
Leanne Baxter CCRN BEd Associate Clinical Nurse M a n a g e r , Intensive C a r e Unit
and
Norma Currie Clinical Nurse Specialist, Intensive C a r e Unit Royal M e l b o u r n e Hospital, Victoria
INTRODUCTION Six years ago, faculty members of the University of Minnesota recognised a need to disseminate and receive information in relation to mechanical ventilation. This came about in response to constant changes in daily practice, new technologies and research into innovative treatment modalities. As a result, yearly meetings on the subject were organised, with the sixth annual Mechanical Ventilation: Principles and Applications conference held recently in the USA. The 350 delegates comprised physicians, respiratory therapists and nurses from several countries, among them Australia, Saudi Arabia, Spain, Italy, Hong Kong, Canada and, of course, the United States. Invited speakers included renowned physicians from around the world. Feeling somewhat dishevelled, we arrived at the Hyatt Regency Minneapolis 27 hours after leaving Melbourne. The meeting itself began on Thursday night with an introductory and optional preconference workshop o n modes of ventilation. This was followed by 3 days of topics divided into five main sections: the basic pathology and complications of ventilatory support; acute lung injury;
The three intensive tutorials we attended were as follows. Fundamentals of pressure control ventilation (PCV): attended by about 30 delegates, this began with a 45-minute lecture o n PCV, followed by a 1-hour practical session in which we were given step-by-step instructions on how to commence it. We were given the opportunity to work with five different ventilators, with about five people per machine. The method used was no different from our own but being able to try several different pieces of equipment proved invaluable. Non-invasive ventilation: about 20 delegates attended this interactive session, which ran for an hour and 45 minutes and was designed to illustrate the practical set-up and use of volumecycled and pressure-limited mask ventilation. The emphasis was o n novel strategies for applying these techniques in both the acute and long-term care settings, with the weight, unfor-
weaning from mechanical ventilation; ventilatory failure, and the cutting edge - current and future treatments. VOLUME 10
Each section commenced with a 2-hour plenary session consisting of three or four lectures, with or without panel discussions by international and local specialists. Choosing which to attend was made somewhat difficult by the interesting nature of each area covered. Delegates then had the opportunity to attend one of the several intensive tutorials, case discussions and group workshops which examined the topics from the plenary sessions in more depth. Since the groups attending these were small, participants had the chance to become involved in some 'hands-on' practical workshops, interact with a range of ventilators and join in discussions with invited speakers.
NUMBER 4
DECEMBER 1997
d : AUSTRALIAN CRITICAL CARE tunately for us, on the latter scenario. Although interest~ng, much of the information was not appl~cableto intenswe care. T h e latest options in ventilatory support: thls Intense sesslon for about 30 partlclpants ~llustratedthe advantages and 11mltatlons of some of the newest vent~latorymodes, ~nclud~ng. volume-assured pressure support (VAPS); pressure-regulated volume control; volume support, - alnvay pressure release ventllat~on; - proport~onalasslst vent~lat~on, and - adaptwe support vent~lat~on. Each mode was demonstrated on several different ventilators. We also attended a small group workshop and one case discussion. The former, an interactive session, dealt with 'Inverse ratio ventilationlairway pressure relief/ventilation'. It was attended by about 15 delegates, involved the rationale, benefits and dangers of inverse ratio ventilation and also compared it with airway pressure ventilation. About 20 attended the case discussion, which centred around 'Difficult problems in mechanical ventilation'. In it, Scott Davies, Professor of Medicine at the University of Minnesota, utilised case presentations and attendees were ~ n v ~ t etodoffer alternate treatment modal~t~es. The first case ~nvolvedan ARDS patlent treated ~ n ~ t ~ a l l y In the prone posltlon, w ~ t ha s~gn~ficant but temporary Improvement. Subsequently, he was given high-frequency ventilation and discharged from ICU within 2 weeks. The second case, presented to Scott by David Tuxen from the Alfred Hospital in Melbourne, concerned an asthmatic patient whose condition was complicated by hyperinflation, resulting in a respiratory/cardiac arrest.
with the latter really was interesting. It seems that, in some parts of the United States, these professionals are beginning to prove quite costly (again, very reassuring for us) and this has led many hospitals to seek multi-skilling on the part of their respiratory therapists and nurses. From a social standpoint, the conference got off to an early (too early for us) start with 7.00am breakfasts. Lunch, meanwhile, was a sit-down three-course event and the close of each day was marked by a wine and cheese reception at 6.00pm. Not wishing to upset our hosts, we invariably stayed until stumps. In view of the goingson at the recent CACCN Inc./ANZICS conference, where several of those at his early-morn~nglecture still wore their evening clothes from the night before, John Mar~ni(Professor of Medicine at the University of Minnesota Medical School and director of the conference program) was somewhat taken aback each morning to see that we appeared to have slept, showered and changed! The seventh annual mechanical ventilation conference is scheduled for 24-27 September 1998, once more at the Hyatt Regency Minneapolis, and we encourage other critical care nurses to consider attending what will no doubt be another excellent meeting.
Finally, the subject of 'The cutting edge: current and future treatments' gave us all much food for thought. While certain areas of practice, such as the use of nitrous oxide and SIMV weaning, were questioned, others, like tracheal gas insufflation, partial liquid ventilation and the possible rebirth of high-frequency ventilation for adults, may well alter future treatment. Overall, the conference proved valuable for many reasons, not least the reassurance we gained from realising that our practice and knowledge are on a par with the rest of the world. As nurses responsible for the ventilation management in our hospital, we were certainly in the minority at this event since the majority of participants were either physicians or respiratory therapists. Discussing ventilation and unit management as well as patient care
A
A c t ~ n g I'rofessor
Kathy Daffurn, Co-director of the
Divislon ot Critical Care, Liverpool Health Smke, NSW, wishes to advise all members of CACCN Ino, that this project is currently underway. She asks anyone with information they feel w o ~ l r lbe useful to please contact her as soon a s possible at:
PO Box 103, Liverpool NSW 2 1 7 0 Tel: (02) 9 8 2 8 3 4 1 4 Fax: Your assistance would be much
CCAT INC. VICTORIAN B ~ A N C ~ ion Meeting on Critical A.N.Z.I.C.S. I,
I
11
1111~11
"
-
!,
VOLUME 10 NUMBER 4
DECEMBER 1997
-4 New Zealand .1
-- "mlety
'VIA
AUSTRALIAN CRITICAL CARE
tion' rooms, with the monitoring alarms turned down during the night so that they can sleep.
vious and, in any event, it probably encouraged them to reassess the ways in which they currently manage their patients.
The great strength of the conference overall was that highly controversial topics were presented by eminent and experienced clinicians. Obviously, there were no rights or wrongs as far as the questions were concerned, and the point of the seminars was to examine the issues, not find answers. Perhaps the only criticism I would make is that not all the speakers concurred with the view they were asked to put forward; that said, this was not always ob-
Further, the meeting gave those who subscribe to the Critical Care Mailing List (CCM-L) on the lnternet a chance to meet and hear some CCM-L celebrities in person, while the trade displays included products from Anaesthetic Supplies, Hewlett Packard, Roche and Boots Healthcare. All in all, it could indeed have been "the most exciting program" of its kind this year. Well done, Malcolm Fisher and Royal North Shore Hospital.
C c o n f e r t g n c er p r t : I
fle
Mechanical Ventilation: Principles and Applications' 11-14September 1997 - Minneapolis, Minnesota, USA
'
4
Leanne Baxter CCRN BEd Associate Clinical Nurse M a n a g e r , Intensive C a r e Unit
and
Norma Currie Clinical Nurse Specialist, Intensive C a r e Unit Royal M e l b o u r n e Hospital, Victoria
INTRODUCTION Six years ago, faculty members of the University of Minnesota recognised a need to disseminate and receive information in relation to mechanical ventilation. This came about in response to constant changes in daily practice, new technologies and research into innovative treatment modalities. As a result, yearly meetings on the subject were organised, with the sixth annual Mechanical Ventilation: Principles and Applications conference held recently in the USA. The 350 delegates comprised physicians, respiratory therapists and nurses from several countries, among them Australia, Saudi Arabia, Spain, Italy, Hong Kong, Canada and, of course, the United States. Invited speakers included renowned physicians from around the world. Feeling somewhat dishevelled, we arrived at the Hyatt Regency Minneapolis 27 hours after leaving Melbourne. The meeting itself began on Thursday night with an introductory and optional preconference workshop o n modes of ventilation. This was followed by 3 days of topics divided into five main sections: the basic pathology and complications of ventilatory support; acute lung injury;
The three intensive tutorials we attended were as follows. Fundamentals of pressure control ventilation (PCV): attended by about 30 delegates, this began with a 45-minute lecture o n PCV, followed by a 1-hour practical session in which we were given step-by-step instructions on how to commence it. We were given the opportunity to work with five different ventilators, with about five people per machine. The method used was no different from our own but being able to try several different pieces of equipment proved invaluable. Non-invasive ventilation: about 20 delegates attended this interactive session, which ran for an hour and 45 minutes and was designed to illustrate the practical set-up and use of volumecycled and pressure-limited mask ventilation. The emphasis was o n novel strategies for applying these techniques in both the acute and long-term care settings, with the weight, unfor-
weaning from mechanical ventilation; ventilatory failure, and the cutting edge - current and future treatments. VOLUME 10
Each section commenced with a 2-hour plenary session consisting of three or four lectures, with or without panel discussions by international and local specialists. Choosing which to attend was made somewhat difficult by the interesting nature of each area covered. Delegates then had the opportunity to attend one of the several intensive tutorials, case discussions and group workshops which examined the topics from the plenary sessions in more depth. Since the groups attending these were small, participants had the chance to become involved in some 'hands-on' practical workshops, interact with a range of ventilators and join in discussions with invited speakers.
NUMBER 4
DECEMBER 1997
d : AUSTRALIAN CRITICAL CARE tunately for us, on the latter scenario. Although interest~ng, much of the information was not appl~cableto intenswe care. T h e latest options in ventilatory support: thls Intense sesslon for about 30 partlclpants ~llustratedthe advantages and 11mltatlons of some of the newest vent~latorymodes, ~nclud~ng. volume-assured pressure support (VAPS); pressure-regulated volume control; volume support, - alnvay pressure release ventllat~on; - proport~onalasslst vent~lat~on, and - adaptwe support vent~lat~on. Each mode was demonstrated on several different ventilators. We also attended a small group workshop and one case discussion. The former, an interactive session, dealt with 'Inverse ratio ventilationlairway pressure relief/ventilation'. It was attended by about 15 delegates, involved the rationale, benefits and dangers of inverse ratio ventilation and also compared it with airway pressure ventilation. About 20 attended the case discussion, which centred around 'Difficult problems in mechanical ventilation'. In it, Scott Davies, Professor of Medicine at the University of Minnesota, utilised case presentations and attendees were ~ n v ~ t etodoffer alternate treatment modal~t~es. The first case ~nvolvedan ARDS patlent treated ~ n ~ t ~ a l l y In the prone posltlon, w ~ t ha s~gn~ficant but temporary Improvement. Subsequently, he was given high-frequency ventilation and discharged from ICU within 2 weeks. The second case, presented to Scott by David Tuxen from the Alfred Hospital in Melbourne, concerned an asthmatic patient whose condition was complicated by hyperinflation, resulting in a respiratory/cardiac arrest.
with the latter really was interesting. It seems that, in some parts of the United States, these professionals are beginning to prove quite costly (again, very reassuring for us) and this has led many hospitals to seek multi-skilling on the part of their respiratory therapists and nurses. From a social standpoint, the conference got off to an early (too early for us) start with 7.00am breakfasts. Lunch, meanwhile, was a sit-down three-course event and the close of each day was marked by a wine and cheese reception at 6.00pm. Not wishing to upset our hosts, we invariably stayed until stumps. In view of the goingson at the recent CACCN Inc./ANZICS conference, where several of those at his early-morn~nglecture still wore their evening clothes from the night before, John Mar~ni(Professor of Medicine at the University of Minnesota Medical School and director of the conference program) was somewhat taken aback each morning to see that we appeared to have slept, showered and changed! The seventh annual mechanical ventilation conference is scheduled for 24-27 September 1998, once more at the Hyatt Regency Minneapolis, and we encourage other critical care nurses to consider attending what will no doubt be another excellent meeting.
Finally, the subject of 'The cutting edge: current and future treatments' gave us all much food for thought. While certain areas of practice, such as the use of nitrous oxide and SIMV weaning, were questioned, others, like tracheal gas insufflation, partial liquid ventilation and the possible rebirth of high-frequency ventilation for adults, may well alter future treatment. Overall, the conference proved valuable for many reasons, not least the reassurance we gained from realising that our practice and knowledge are on a par with the rest of the world. As nurses responsible for the ventilation management in our hospital, we were certainly in the minority at this event since the majority of participants were either physicians or respiratory therapists. Discussing ventilation and unit management as well as patient care
A
A c t ~ n g I'rofessor
Kathy Daffurn, Co-director of the
Divislon ot Critical Care, Liverpool Health Smke, NSW, wishes to advise all members of CACCN Ino, that this project is currently underway. She asks anyone with information they feel w o ~ l r lbe useful to please contact her as soon a s possible at:
PO Box 103, Liverpool NSW 2 1 7 0 Tel: (02) 9 8 2 8 3 4 1 4 Fax: Your assistance would be much
CCAT INC. VICTORIAN B ~ A N C ~ ion Meeting on Critical A.N.Z.I.C.S. I,
I
11
1111~11
"
-
!,
VOLUME 10 NUMBER 4
DECEMBER 1997
-4 New Zealand .1
-- "mlety