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ADJUNCTS IN TREATMENT OF ARDS  Dr. AKASHDEEP SINGH DEPARTMENT OF PULMONARY  AND CRITICAL CARE MEDICINE PGIMER CHANDIGARH
ABJUNCTS IN TREATMENT OF ARDS   ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
PRONE VENTILATION  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],PP L -3.0 +2.8 P PL -1.0 +1.0 Supine  prone
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
PARTIAL LIQUID VENTILATION  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],Loss of gas by evap.,  cost.  5. Disadvantage  Yes Expt. 4. Feasibility  Filled till FRC by PFC Completely by PFC 3. Lungs are filled  Gas Oxygenated PFC 2. Tidal volume delivered of  Conventional  Liquid  1. Ventilator  PLV TLV
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
TRACHEAL GAS INSUFFLATION (TGI) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object]
HIGH FREQUENCY VENTILATION    ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Comparison of HFV Vs Conv. Ventil. <or> conv <or> conv P mean   < Conv < Conv P PK >> Conv  >> Conv VT x f product for effective V A 1+ 2+ 3+ Potentiation of intrinsic PEEP  Passive  Active  Passive  Expiration  >> V D < V D <or> V D Tidal volume delivered 2-60 b/min  300-3000 b/min upto 600 b/min  Freq avail Conventional Oscillator  JET
EXTRACORPOREAL MEMBRANE OXYGENATION  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
HEMODYNAMIC MANAGEMENT  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
PULMONARY VASCULAR CHANGES IN ARDS/ALI ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
SURFACTANT REPLACEMENT THERAPY ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],Continuous smaller vol. Non uniform distribution. Lab. Studies show efficacy  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Aerosolization  ,[object Object],Instillation  Slow, no optimal device, Filters may plug.  ,[object Object],[object Object],[object Object],[object Object]
GLUCOCORTICOIDS IN ARDS  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
CYCLOOXYGENASE INHIBITORS  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
KETOCONAZOLE    ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Summary of trials of Ketoconazole in ALI/ARDS No – Mortality benefit  No effect on lung function, duration of Ventilat.  234 ALI/ARDS  NIH ARDS Network, 1997  Trial  ,[object Object],[object Object],54 sepsis  Yu & Tomasa, 1993 ,[object Object],[object Object],71 high risk surgical  Slotmann, 1988 Outcome  No. of Pat.  Study, yr
ANTIOXIDANTS  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],Improved – LIS No effect – Pao 2 /Fio 2 , mortality.  Placebo, NAC  42 Domenighetti, 1997 Improve – ALI free days & cardiac index    new organ failure. Mortality – No diff.  Placebo, NAC OTZ  48 Bernard 1997  Improve – Pao 2 /Fio 2 ; Lis; need for M.V.  Mortality – No diff. Placebo, NAC  61  Suter 1994 No effect – Pao 2 /Fio 2  time to improve LIS. Improve – compl. *NS.   Mortality – No diff.  Placebo, NAC 66 Jepsen, 1992   Outcome  Therapy No. of Patients  Study, yr
ANTICOAGULANT THERAPY IN ALI/ARDS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
TF PATHWAY INHIBITORS AND FACTOR Vll ai   ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
ANTITHROMBIN  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

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Ards

  • 1. ADJUNCTS IN TREATMENT OF ARDS Dr. AKASHDEEP SINGH DEPARTMENT OF PULMONARY AND CRITICAL CARE MEDICINE PGIMER CHANDIGARH
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  • 14. Comparison of HFV Vs Conv. Ventil. <or> conv <or> conv P mean < Conv < Conv P PK >> Conv >> Conv VT x f product for effective V A 1+ 2+ 3+ Potentiation of intrinsic PEEP Passive Active Passive Expiration >> V D < V D <or> V D Tidal volume delivered 2-60 b/min 300-3000 b/min upto 600 b/min Freq avail Conventional Oscillator JET
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