The Alfred ICU has been active in mechanical ventilation research for over 30 years with particular expertise in mechanical ventilation of patients with severe airflow obstruction, patients with adult respiratory distress syndrome and patients with severe respiratory failure that may require lung recruitment, nitric oxide, high frequency oscillation, veno-venous ECMO, lung transplantation or independent lung ventilation.
The Alfred ICU has been running an Alfred ICU Advanced Mechanical Ventilation Conference since 2007 and Waveforms Workshop since 2012, now both part of mechanical ventilation week held in mid year each year ( www.alfredicu.org.au/courses)
Mechanical Ventilation Week
This is held annually around mid year each year and consists of
- One to two visiting international professors with expertise in an aspect of mechanical ventilation.
- The Alfred ICU Advanced Mechanical Ventilation Conference (AAMVC).
This is a one day conference addressing the latest information on different aspect of mechanical ventilation each year, with overseas and interstate experts invited to attend and speak.
- The Mechanical Ventilation Waveforms Workshop.
Many unrecognized patient problems can be primarily detected by ventilator waveforms.
This is a one-day workshop with a combination of lectures and lifelike simulations of multiple ventilator waveform abnormalities to show how they can be recognized, diagnosed, quantified and treated.
Limited to 40 registrants, simulations are demonstrated in small teaching groups.
- The Mechanical Ventilation Research Meeting.
This meeting provides an opportunity for those with an interest and expertise in mechanical ventilation research to present a current research project for information, feedback, suggestions and collaboration opportunities.
- Bronchoscopy for Critical Care
This one day workshop combines lectures and hands on teaching to describe all aspects of the use of Bronchoscopy in critically ill patients, including awake intubations, foreign body retrieval, management of massive haemoptysis and bronchopleural fistulae, per cutaneous tracheostomy and much more. The course uses state of the art simulation equipment and has maximum of three participants per practical session.
- The ICU Physiotherapy Seminar.
This half day Seminar is aimed at senior ICU physiotherapists with a particular interest in mechanical ventilation and techniques that require experience in ventilation. We invite both international guest speakers and local speakers. We use a collaborative, multi-disciplinary approach to combine expertise in clinical work with national and international research to drive best practice in ICU physiotherapy.
Mechanical Ventilation Research
This multicenter randomized controlled trial of a ventilation protocol for patients with adult respiratory distress syndrome is underway. The PHARLAP protocol (Permissive Hypercapnia, Alveolar Recruitment, Low Airway Pressure) is compared with a proven best practice protocol developed by ARDS-net. It is hoped that the PHARLAP protocol will further improve the outcomes of this patient group.
- Ventilator Waveforms
Airway obstruction is not always obvious during mechanical ventilation and may occur in the large or upper airways (requiring tube unblocking or change) or in the small or lower airways (requiring bronchodilators). This study aims to diagnose and quantify airflow obstruction in these mechanically ventilated patients and discriminate between upper and lower airway obstruction by looking at the rate of gas expiration and the shape and related measurements of the inspiratory and expiratory waveforms.
This could lead to the ventilator automatically diagnosing and quantifying these problems.
Staircase Recruitment Manoeuver (SRM)
The staircase recruitment manoeuver (SRM) was developed at the Alfred by Tuxen & Hodgson for patients with acute lung injury (see protocols).
This was primarily developed for patients with acute lung injury and is the basis of the treatment group in the PHARLAP trial.
However it has been used successfully used in a number of clinical situations
- As a rescue treatment in severe flu/pneumonia/ARDS pro prevent the need for ECMO
- To improve lung function in selected patients on ECMO.
- To improve lung function in selected organ donors to enable lung donation that would not have otherwise gone ahead (ref).
- To resolve lung collapse
- To improve chronic lung mucous inspissation