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Draegerwerk Ag & Co. Kgaa — Drägerwerk AG & Co. KGaA — Technical Presentation (June 2020)

52 slides from Draegerwerk Ag & Co. Kgaa's technical presentation, June 2020

  1. Slide 1: How to set ventilator and wean COVID19 patients

    UNIVERSITA DEGLI STUDI DI PADOVA HOW TO SET VENTILATOR AND WEAN COVID19 PATIENTS Paolo Navalesi, MD, FERS Department of Medicine — DIMED Anesthesia and Intensive Care — Padua University Hospital

  2. Slide 2: COVID-19 pneumonia: ARDS or not?

    UNIVERSITA 2 D is} y DEGLI STUDI DI PADOVA Critical Care (2020) 24:154 EDITORIAL Open Access COVID-19 pneumonia: ARDS or not? Luciano Gattinoni"", Davide Chiumello and Sandra Rossi? “the COVID-19 pneumonia is a specific disease with peculiar phenotypes. Its main characteristic is the dissociation be

  3. Slide 3: Different respiratory treatments for different phenotypes: Type L

    1222+2022 UNIVERSITA )} DEGLI STUDI DI PADOVA Intensive Care Med https://doi.org/10.1007/s00134-020-06033-2 EDITORIAL ee ; ® COVID-19 pneumonia: different respiratory treatments for different phenotypes? Luciano Gattinoni™, Davide Chiumello?, Pietro Caironi?*, Mattia Busana', Federica Romitti', Luca

  4. Slide 4: Different respiratory treatments for different phenotypes: Type H

    1222+2022 UNIVERSITA )} DEGLI STUDI DI PADOVA Intensive Care Med https://doi.org/10.1007/s00134-020-06033-2 EDITORIAL COVID-19 pneumonia: different respiratory == treatments for different phenotypes? Luciano Gattinoni™, Davide Chiumello?, Pietro Caironi?*, Mattia Busana', Federica Romitti', Luca Bra

  5. Slide 5: Time-related disease spectrum; patient comorbidities

    ¢ Time-related disease spectrum ¢ Patient comorbidities

  6. Slide 6: High prevalence of obesity in SARS-CoV-2 requiring mechanical ventilation

    8 1222-2022 : a) D S At "A Obesity (Silver Spring). 2020 Apr 9. doi: 10.1002/oby.22831. [Epub ahead of print] High prevalence of obesity in severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) requiring invasive mechanical ventilation. Jourdain M': Lille Intensive Care COVID-19 and Obesity s

  7. Slide 7: One scheme does not fit all: patient tailored ventilation

    ONE SCHEME PATIENT TAILORED DOES NOT VENTILATION FIT ALL

  8. Slide 8: Basing respiratory management on physiological principles

    UNIVERSITA DEGLI STUDI DI PADOVA American Journal of Respiratory and Critical Care Medicine Basing Respiratory Management of Coronavirus on Physiological Principles Martin J. Tobin “Once a patient is placed on a ventilator, the key challenge is to avoid complications. Mechanical ventilation (in and

  9. Slide 9: Medical ward

    (A) MEDICAL WARD 1222-2022 / TA 8 ) ECLI STUDI SUSPECTED OR CONFIRMED CASE OF COVID-2019 DI PADOVA Sas DVS” Cr SPONTANEOUS REGIONE bet N BREATHING PATIENT SpO2 < 92% {] YES * Face Mask 6-12 L/min or LOW-DOSE OXYGEN Venturi Mask with FiO, up to 60% THERAPY * Do not use Nasal Cannula —, CONTINUE LOW-D

  10. Slide 10: High dependency unit

    . ee ee) HIGH DEPENDENCY UNIT 1222-2022 fA 2, UNIV ‘A OOD S} DECLI STUDI ANNI & J DI PADovA REGIONE pet VENE * Flow 50 L/min with FiO, up to 60% + Put surgical mask on patient above HFNC + Adequate PPE for healthcare workers SpO2 < 92% Respiratory rate >28 bpm Dyspnoea * CPAP 10 cmH,O NIV PSV: Psypp

  11. Slide 11: Intensive care unit

    INTENSIVE CARE UNIT UNIVERSITA DEGLI STUDI DI PADOVA P/F < 150 mmHg with FiO, > 60% rc Early, within 72 hours since tracheal it YES —— [intubation POSITIONING [ How? | https://www.youtube.com/watch? NE ! > [Howe | |_v=E_6iTOR7WJs — (First prone positioning cycle of 16 x HOW hours, then the following

  12. Slide 12: Lung protective ventilation: volume controlled settings

    Journal of Cardiothoracic and Vascular Anesthesia 000 (2020) 1—5 Regional COVID-19 Network for Coordination of DI PADOVA SARS-CoV-2 outbreak in Veneto, Italy Laura Pasin, MD“! Nicold Sella, MD“', Christelle Correale, MD*, Annalisa Boscolo, MD, PhD’, Paolo Rosi, MD’, Mario Saia, MD°, Domenico Mantoan

  13. Slide 13: Lung protective ventilation: pressure controlled settings

    Journal of Cardiothoracic and Vascular Anesthesia 000 (2020) 1—5 8A0 one Regional COVID-19 Network for Coordination of SARS-CoV-2 outbreak in Veneto, Italy Laura Pasin, MD“! Nicold Sella, MD“', Christelle Correale, MD*, Annalisa Boscolo, MD, PhD’, Paolo Rosi, MD’, Mario Saia, MD°, Domenico Mantoan,

  14. Slide 14: High versus low PEEP in non-recruitable collapsed lung tissue

    THE LANCET Respiratory Medicine High versus low PEEP in non-recruitable collapsed lung tissue: possible implications for patients with COVID-19 Marcus J Schultz 4 “If patients with COVID-19 have non-recruitable collapsed lung lesions, intensivists might want to use early prone positioning and . Howe

  15. Slide 15: Higher versus lower PEEP in ARDS

    N Engl J Med 2004;351:327-36. Higher versus Lower Positive End-Expiratory Pressures in Patients with the Acute Respiratory Distress Syndrome The National Heart, Lung, and Blood Institute ARDS Clinical Trials Network* Lower-PEEP group FiO, E } F 05 #05 06 0.7 07 #07 O8 09 09 09 1.0 PEEP 5 8 & <i. 10

  16. Slide 16: High versus low PEEP in non-recruitable collapsed lung tissue

    THE LANCET Respiratory Medicine High versus low PEEP in non-recruitable collapsed lung tissue: possible implications for patients with COVID-19 Marcus J Schultz 4 “If patients with COVID-19 have non-recruitable collapsed lung lesions, intensivists might want to use early prone positioning and . Howe

  17. Slide 17: Bedside estimation of recruitable collapse by electrical impedance tomography

    > Intensive Care Med (2009) 35:1132—1137 a \ UNIVERSITA DOI 10.1007/s00134-009-1447-y PHYSIOLOGICAL AND TECHNICAL NOTES 5) DECLI STUD 3 DECI wns Eduardo L. V. Costa DI PADOVA Joao Batista Borges Bedside estimation of recruitable alveolar Alexandre Melo ne eee collapse and hyperdistension by electric

  18. Slide 18: ANIA HM ily |

    ANIA HM ily |

  19. Slide 19: EIT images at decremental PEEP steps

    Mik LNA ANN i ‘nt iii PEEP 14cmH,0 PEEP 12 cmH,0 PEEP 10 cmH,0 PEEP 8 cmH,0 PEEP 6 cmH,0 PEEP 4 cmH,0

  20. Slide 20: Best PEEP

    Mik LNA ANN i ‘nt iii PEEP 14cmH,0 PEEP 12 cmH,0 PEEP 10 cmH,0 PEEP 8 cmH,0 PEEP 6 cmH,0 PEEP 4 cmH,0 Es har BEST PEEP

  21. Slide 21: EIT for PEEP titration in COVID-19 ARDS

    American Journal of Respiratory and Critical Care Medicine Sac : pect Sru Electrical Impedance Tomography for Positive End-expiratory Pressure Titration in COVID-19 Related ARDS -H- Relative overdistention =H Relative collapse van der Zee P, Somhorst P, Endeman H, and Gommers D —&@ Dynamic complianc

  22. Slide 22: COVID-19 related severe hypercoagulability

    Thromb Haemost. 2020 Apr 21. UNIVERSITA naw COVID-19-Related Severe Hypercoagulability in Patients Admitted to Intensive Care Unit for Acute Respiratory Failure Luca Spiezia! Annalisa Boscolo? Francesco Poletto'! Lorenzo Cerruti! Ivo Tiberio? Elena Campello! Paolo Navalesi? Paolo Simioni! C= » » ° s

  23. Slide 23: Different hypercoagulable profiles in ward and ICU patients

    1222-2022 OO ANNI cK D UNIV TA DEGLI STUDI DI PADOVA Thromb Haemost. In press Different hypercoagulable profiles in patients with COVID-19 admitted to the Internal Medicine Ward and the Intensive Care Unit Annalisa Boscolo, Luca Spiezia, Christelle Correale, Nicolo Sella, Elisa Pesenti, Luca Beghett

  24. Slide 24: COVID-19 cytokine storm: inflammation and coagulation

    Lancet Respir Med. 2020 Apr 27. COVID-19 cytokine storm: the interplay between inflammation and coagulation Jose RJ, Manuel A “This defective procoagulant—anticoagulant balance predisposes to the development of microthrombosis. [...] The finding of increased d-dimer levels in patients with COVID-19

  25. Slide 25: Lung recruitment and ventilation-perfusion mismatch in COVID-19 ARDS

    Crit Care Med. 2020 Apr 17. Potential for Lung Recruitment and Ventilation-Perfusion Mismatch in Patients With the Acute Respiratory Distress Syndrome From Coronavirus Disease 2019 Tommaso Mauri, MD'”; Elena Spinelli, MD’; Eleonora Scotti, MD’; Giulia Colussi, MD'; Maria Cristina Basile, MD’; Stefan

  26. Slide 26: Lung recruitment and ventilation-perfusion mismatch in COVID-19 ARDS

    Crit Care Med. 2020 Apr 17. Potential for Lung Recruitment and Ventilation-Perfusion Mismatch in Patients With the Acute Respiratory Distress Syndrome From Coronavirus Disease 2019 Tommaso Mauri, MD'*; Elena Spinelli, MD; Eleonora Scotti, MD’; Giulia Colussi, MD'; Maria Cristina Basile, MD'; Stefani

  27. Slide 27: Prone position and lung ventilation/perfusion matching

    uoneynuan | > | uoIsnyied Buiyoyew American Journal of Respiratory and Critical Care Medicine Prone Position and Lung Ventilation/Perfusion Matching in Acute Respiratory Failure Due to COVID-19 Francesco Zarantonello ', Giulio Andreatta 2, Nicold Sella 3, Paolo Navalesi 3 4 Dorsal ventilation (%) ®

  28. Slide 28: UNIVERSITA

    UNIVERSITA DEGLI STUDI DI PADOVA

  29. Slide 29: Management of COVID-19 respiratory distress

    UNIVERSITA )} DEGLI STUDI DI PADOVA JAMA Insights | Clinical Update April 24, 2020 Management of COVID-19 Respiratory Distress John J. Marini, MD!; Luciano Gattinoni, MD2 Time period Objective Respiratory support options Rationale Weaning Avoid reversion to Make transitions cautiously Strong spontan

  30. Slide 30: Early extubation

    1222-2022 UNIVERSITA DEGLI STUDI 7 DI PADOVA American Journal of Respiratory and Critical Care Medicine Basing Respiratory Management of Coronavirus on Physiological Principles Martin J. Tobin “The surest way to increase COVID-19 mortality is liberal use of intubation and mechanical ventilation. Wit

  31. Slide 31: Weaning off mechanical ventilation

    Ann Transl Med 2019;7(Suppl 8):S353 \ UNIVERSITA S} DEGLI STUDI SUPADOVA Weaning off mechanical ventilation: much less an art, but not yet a science Paolo Navalesi’’, Andrea Bruni’”, Eugenio Garofalo’, Eugenio Biamonte’, Federico Longhini’”, Pamela Frigerio’ CRITERIA FOR READINESS é Numerous criteri

  32. Slide 32: Weaning off mechanical ventilation

    Ann Transl Med 2019;7(Suppl 8):S353 \ UNIVERSITA S} DEGLI STUDI SUPADOVA Weaning off mechanical ventilation: much less an art, but not yet a science Paolo Navalesi’’, Andrea Bruni’”, Eugenio Garofalo’, Eugenio Biamonte’, Federico Longhini’”, Pamela Frigerio’ CRITERIA FOR READINESS é Numerous criteri

  33. Slide 33: Serum cytokines predict COVID-19 severity

    Emerging Microbes & Infections SAG Pa RS ‘A 2020, VOL. 9 DEGLI 5 ; DI Papova Profiling serum cytokines in COVID-19 patients reveals IL-6 and IL-10 are disease severity predictors Huan Han**, Qingfeng Ma™*, Cong Li, Rui Liu, Li Zhao‘, Wei Wang‘, Pingan Zhang’, Xinghui Liu’, Guosheng Gao’, Fang Liu9,

  34. Slide 34: Inflammatory cytokine signature predicts severity and death

    > medRxiv. 2020 May 30;2020.05.28.20115758. doi: 10.1101/2020.05.28.20115758. Preprint UNIVERSITA DEGLI STUDI bt Papova An Inflammatory Cytokine Signature Helps Predict COVID-19 Severity and Death IL-6 Diane Marie Del Valle, Seunghee Kim-Schulze, Hsin-Hui Huang, et al. === High = Low . . Cytokine le

  35. Slide 35: EIT during spontaneous breathing trials and after extubation

    8 1222+2022 SBT success (n=61) Ann. Intensive Care Electrical impedance tomography during spontaneous breathing trials (2019) 9:88 and after extubation in critically ill patients at high risk for extubation failure: a multicenter observational study Federico Longhini', Jessica Maugeri?, Cristina And

  36. Slide 36: Weaning off mechanical ventilation

    Ann Transl Med 2019;7(Suppl 8):S353 1222-2022 AO e DI PADOVA Weaning off mechanical ventilation: much less an art, but not yet a science Paolo Navalesi’’, Andrea Bruni’”, Eugenio Garofalo’, Eugenio Biamonte’, Federico Longhini’”, Pamela Frigerio’ f Few criteria and x broad thresholds for *. ‘SBT rea

  37. Slide 37: ERS/ATS guidelines: noninvasive ventilation for acute respiratory failure

    Eur Respir J 2017; 50: 1602426 UNI IN peGLI STUDI Official ERS/ATS clinical practice DI PADOVA guidelines: noninvasive ventilation for acute respiratory failure Bram Rochwerg ®', Laurent Brochard”, Mark W. Elliott“, Dean Hess°, Nicholas S. Hill®, Stefano Nava’ and Paolo Navalesi® (members of the ste

  38. Slide 38: Protocolized weaning with early extubation to NIV (Breathe trial)

    JAMA. 2018;320(18):1881-1888. doi:10.1001/jama.2018.13763 8A0 SUAS pecu Stu Effect of Protocolized Weaning With Early Extubation DI PADOVA to Noninvasive Ventilation vs Invasive Weaning on Time to Liberation From Mechanical Ventilation 1752 Patients underwent spontaneous breathing trial Among Patien

  39. Slide 39: Early extubation followed by immediate NIV

    Intensive Care Med (2019) 45:62-71 DI PADOVA 8A0 CANS) pecu Srun Early extubation followed by immediate noninvasive ventilation vs. standard extubation in hypoxemic patients: a randomized clinical trial Rosanna Vaschetto', Federico Longhini?, Paolo Persona’, Carlo Ori>, Giulia Stefani®, Songqiao Liu

  40. Slide 40: NIV as weaning strategy: hospital mortality

    Respiratory Care 2020 UNIV A DEGLI STUDI 2 r 8 F - E . - DI Papova Noninvasive Ventilation as a Weaning Strategy in Subjects with Acute Hypoxemic Respiratory Failure Mengtian Shan, Xiaogian Pang, Wei Wang, Chao Lan, Rongchang Chen, Changju Zhu, and Qi Liu HOSPITAL MORTALITY A NIV weaning Invasive we

  41. Slide 41: NIV as weaning strategy: ICU length of stay

    Respiratory Care 2020 1222-2022 1 STUDI F i are : ‘ ; 3 8 DI PADOVA Noninvasive Ventilation as a Weaning Strategy in Subjects with Acute : Hypoxemic Respiratory Failure Mengtian Shan, Xiaogian Pang, Wei Wang, Chao Lan, Rongchang Chen, Changju Zhu, and Qi Liu ICU LENGTH OF STAY B NIV weaning Invasive

  42. Slide 42: NIV as weaning strategy: adverse events

    Respiratory Care 2020 1222-2022 DEGLI S Z r x ‘ - ‘ - % 8 : pi PApova Noninvasive Ventilation as a Weaning Strategy in Subjects with Acute : Hypoxemic Respiratory Failure Mengtian Shan, Xiaogian Pang, Wei Wang, Chao Lan, Rongchang Chen, Changju Zhu, and Qi Liu ADVERSE EVENTS Table 2. Summary Estimat

  43. Slide 43: Helmet CPAP and prone positioning for early COVID-19 management

    \\ UNIVERSITA 5) DEGLI STUDT DI PADOVA Pulmonol. 2020 Helmet continuous positive airway pressure and prone positioning: A proposal for an early management of COVID-19 patients F. Longhini**, A. Bruni*, E. Garofalo*, P. Navalesi®, G. Grasselli°*, R. Cosentini®, G. Foti’, A. Mattei", M. Ippolito’, G.

  44. Slide 44: Prone positioning in non-intubated patients (PRON-COVID)

    UNIVERSITA Feasibility and physiological effects of prone positioning in non-intubated patients with acute respiratory failure due to COVID-19 (PRON-COVID): a prospective cohort study Anna Coppo, Giacomo Bellani, Dario Winterton, Michela Di Pierro, Alessandro Soria, Paola Faverio, Matteo Cairo, Silv

  45. Slide 45: Use of NIV for COVID-19: a cause for concern?

    UNIVERSITA 5) DECLI STUDI DI PADOVA Lancet Respir Med. 2020 Apr 20. Use of non-invasive ventilation for patients with COVID-19: a cause for concern? Arulkumaran N’1, Brealey D?, Howell D?, Singer M2. ¢ “The potential for transmission of COVID-19 from patients to health- care workers” ¢ “NIV only tem

  46. Slide 46: Use of NIV for COVID-19: a cause for concern?

    UNIVERSITA 5) DECLI STUDI DI PADOVA Lancet Respir Med. 2020 Apr 20. Use of non-invasive ventilation for patients with COVID-19: a cause for concern? Arulkumaran N’1, Brealey D?, Howell D?, Singer M2. ¢ “The potential for from patients to health- care workers” ¢ “NIV only temporarily improves oxygena

  47. Slide 47: Patient monitoring

    SAG iain) UNvensina PATIENT MONITORING DI PADOVA Am J Respir Crit Care Med. 2020 Apr 23. doi: 10.1164/recm.201912-25120C. [Epub ahead of print] Inspiratory Effort Assessment by Esophageal Manometry Early Predicts Noninvasive Ventilation Outcome in de novo Respiratory Failure: A Pilot Study. Tonelli

  48. Slide 48: Use of NIV for COVID-19: a cause for concern?

    UNIVERSITA DEGLI STUDI Lancet Respir Med. 2020 Apr 20. Use of non-invasive ventilation for patients with COVID-19: a cause for concern? Arulkumaran N’, Brealey D?, Howell D°, Singer M2. ¢ “The potential for transmission of COVID-19 from patients to health- care workers” ¢ “NIV only temporarily impro

  49. Slide 49: Protecting healthcare workers from SARS-CoV-2 infection

    Protecting healthcare workers from SARS-CoV-2 infection: practical Martina Ferioli'*°, Cecilia Cisternino”’, Valentina Leo*°, Lara Pisani", Paolo Palange*” and Stefano Nava" 1222-2022 5 UNIVERSITA exe A STUDI DI PADOVA Maximum exhaled air dispersion Method distance Oxygen via nasal cannula 5 L-min-'

  50. Slide 50: Protecting healthcare workers from SARS-CoV-2 infection

    Protecting healthcare workers from SARS-CoV-2 infection: practical Martina Ferioli'*°, Cecilia Cisternino”’, Valentina Leo*°, Lara Pisani", Paolo Palange*” and Stefano Nava" 1222-2022 5 UNIVERSITA exe A STUDI DI PADOVA Maximum exhaled air dispersion Method distance Oxygen via nasal cannula 5 L-min-'

  51. Slide 51: Healthcare workers' safety

    8 VO can HEALTHCARE WORKERS’ SAFETY SJ DI Papov: IN Clinical management of severe acute respiratory infection (SARI) when COVID-19 disease Is suspected. @) de Heeb Interim guidance WS Organization 13 March 2020 “Because of uncertainty around the potential for aerosolization, HFO, NIV, including bubb

  52. Slide 52: UNIVERSITA

    UNIVERSITA DEGLI STUDI DI PaD¢

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