This document discusses acute respiratory distress syndrome (ARDS). It defines ARDS as diffuse inflammatory lung injury leading to impaired gas exchange. ARDS is not a primary disorder but occurs due to infectious or non-infectious conditions like pneumonia or sepsis. Treatment involves treating the underlying cause, mechanical ventilation with a protective strategy using low tidal volumes and high PEEP, fluid management to avoid positive balance, and possibly steroids in moderate to severe cases. Outcomes are improved by following evidence-based guidelines for ARDS therapies.
An excellent tool to treat refractory hypoxia. Target audience are ICU junior physicians and Respiratory Therapists. It will take away the fear of "What is APRV?" from your hearts and you will feel ready to give it a try.
An excellent tool to treat refractory hypoxia. Target audience are ICU junior physicians and Respiratory Therapists. It will take away the fear of "What is APRV?" from your hearts and you will feel ready to give it a try.
The “How To” of BiVent
Created by: David Pitts II, RRT
Clinical Applications Specialist, Maquet
Birmingham, Alabama
Sponsored by Maquet, Inc – Servo Ventilators
Mechanical Ventilation of Patient with COPD ExacerbationDr.Mahmoud Abbas
Mechanical Ventilation of Patient with COPD Exacerbation lecture presented by Dr Andres Esteban at the Egyptian Critical care Summit 2015 held at Cairo, egypt.
The Egyptian Critical Care Summit is the leading medical event and exhibition for Intensive Care Medicine in Egypt.
Presentation of Dr. Dean Hess at 10th Pulmonary Medicine Update Course, Cairo, Egypt. Pulmonary Medicine Update Course is organized by Scribe : www.scribeofegypt.com
The “How To” of BiVent
Created by: David Pitts II, RRT
Clinical Applications Specialist, Maquet
Birmingham, Alabama
Sponsored by Maquet, Inc – Servo Ventilators
Mechanical Ventilation of Patient with COPD ExacerbationDr.Mahmoud Abbas
Mechanical Ventilation of Patient with COPD Exacerbation lecture presented by Dr Andres Esteban at the Egyptian Critical care Summit 2015 held at Cairo, egypt.
The Egyptian Critical Care Summit is the leading medical event and exhibition for Intensive Care Medicine in Egypt.
Presentation of Dr. Dean Hess at 10th Pulmonary Medicine Update Course, Cairo, Egypt. Pulmonary Medicine Update Course is organized by Scribe : www.scribeofegypt.com
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...Kumar Satyam
According to TechSci Research report, "India Clinical Trials Market- By Region, Competition, Forecast & Opportunities, 2030F," the India Clinical Trials Market was valued at USD 2.05 billion in 2024 and is projected to grow at a compound annual growth rate (CAGR) of 8.64% through 2030. The market is driven by a variety of factors, making India an attractive destination for pharmaceutical companies and researchers. India's vast and diverse patient population, cost-effective operational environment, and a large pool of skilled medical professionals contribute significantly to the market's growth. Additionally, increasing government support in streamlining regulations and the growing prevalence of lifestyle diseases further propel the clinical trials market.
Growing Prevalence of Lifestyle Diseases
The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
Struggling with intense fears that disrupt your life? At Renew Life Hypnosis, we offer specialized hypnosis to overcome fear. Phobias are exaggerated fears, often stemming from past traumas or learned behaviors. Hypnotherapy addresses these deep-seated fears by accessing the subconscious mind, helping you change your reactions to phobic triggers. Our expert therapists guide you into a state of deep relaxation, allowing you to transform your responses and reduce anxiety. Experience increased confidence and freedom from phobias with our personalized approach. Ready to live a fear-free life? Visit us at Renew Life Hypnosis..
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
Navigating the Health Insurance Market_ Understanding Trends and Options.pdfEnterprise Wired
From navigating policy options to staying informed about industry trends, this comprehensive guide explores everything you need to know about the health insurance market.
3. Diffuse inflammatory injury of the lungs
Neutrophil degranulation damages the capillary
endothelium, leading to exudation of protein-
rich fluid that fills the distal airspaces and
impairs pulmonary gas exchange.
10 % of ICU admissions
25 % of prolonged mechanical ventilation
Most (>90%) cases of ARDS appear within one
week of a known predisposing condition
80% of cases require mechanical ventilation
4. ARDS is not a primary disorder, but is a
consequence of a variety of infectious and
noninfectious conditions
The most frequent offenders are
1. Pneumonia, 59 %
2. Extra-pulmonary sepsis 16 %
3. Aspiration of gastric secretions 14 %
Tendency to triggera systemic inflammatory
response.
5.
6.
7.
8. Anterior sub-pleural consolidations
Absence or reduction of lung sliding
“Spared areas” of normal parenchyma
Pleural line abnormalities (irregular
thickened fragmented pleural line)
Non-homogeneous distribution of B-
lines (a characteristic ultrasound finding
suggestive of fluid accumulation in the
lungs)
11. Decreased PaO2/FiO2 ratio (a decreased
PaO2/FiO2 ratio indicates reduced arterial
oxygenation from the available inhaled
gas):
◦ Mild ARDS: 201 – 300 mmHg (≤ 39.9 kPa)
◦ Moderate ARDS: 101 – 200 mmHg (≤ 26.6 kPa)
◦ Severe ARDS: ≤ 100 mmHg (≤ 13.3 kPa)
Note that the 2012 "Berlin criteria" are a
modification of the prior 1994 consensus
conference definitions
12. Treatment of the underlying cause is crucial.
Appropriate antibiotics therapy is started as
soon as cultures results are available, or if
infection is suspected (whichever is earlier).
Empirical therapy may be appropriate if local
microbiological surveillance is efficient.
Mechanical ventilation
Fluid management
Steroids
Others
13. Goals of MV
(a) limit the stretchimposed on the distal
airspaces during lung inflation ( volutrauma )
(b) prevent the distal airspacesfrom collapsing
during lung deflation. ( Atlectotrauma)
Protective lung strategy
1. Low TV
2. Platue pressure < 30
3. Low fiO2
4. PEEP
5. RECRUITMENT
14.
15.
16.
17. mean airway pressure (to promote
recruitment (opening) of easily collapsible
alveoli and predictor of hemodynamic
effects) and
Plateau pressure (best predictor of alveolar
over-distention)
Ideal body weight rather than actual weight).
improved mortality when people with ARDS
Permissive hypercarbia according to Ph
18. PEEP keep alveoli open
At least 5 cm H2O
high PEEP levels does not improve outcomes in
ARDS.
For cases of hypoxemia that require potentially toxic
concentrations of inhaled O2 (FIO2 >60%),
incremental increases in PEEP can help to improve
arterial oxygenation and reduce the inhaled O2 to
lower (nontoxic) levels.
maximum “safe” level of PEEP is reached when
the plateau pressure reaches 30 cm H2O.
19. The limits of tolerance to hypercapnia are
unclear,
clinical trials of permissive hypercapnia show
that an arterial PCO2 of 60–70 mm Hg and an
arterial are safe for most patientspH of 7.2–
7.25
20. APRV is a modified form of continuous
positive airway pressure
periods of spontaneous breathing with high-
level CPAP, interrupted by brief periods of
pressure release to atmospheric pressure.
The high CPAP level improves arterial
oxygenation by opening collapsed alveoli
(alveolar recruitment), and the pressure
release is designed to facilitate CO2 removal
The increase in arterial oxygenation occurs
gradually, over 24 h
21. Ventilator Settings
high and low airway pressures, and the time
spent at each pressure level.
The high airway pressure = end-inspiratory
alveolar pressure during CMV
The low airway pressure = zero.
The time spent at the high airway pressure
is usually 85–90% of the total cycle time.
Recommended times are 4–6 seconds for
the high pressure level, and 0.6 to 0.8
seconds for the low pressure level
22. Advantages
a. APRV can achieve nearly complete recruitment of
collapsed alveoli, more than can be achieved with
HFOV or high-level PEEP.
b. APRV can increase cardiac output despite the high
airway pressures that are used. This is attributed to
the marked alveolar recruitment that occurs with
APRV, which also reopens blood vessels and
increases pulmonary blood flow.
Disadvantages
a. The benefits of APRV are lost if the patient has no
spontaneous breathing efforts.
b. Severe asthma and COPD are relative
contraindications to APRV because of the inability to
empty the lungs rapidly during the pressure release
phase.
23.
24. Clinical studies have shown that avoiding a
positive fluid balance in patients with ARDS
can reduce the duration of mechanical
ventilation and improve survival rates
A simple protocol for fluid management,
developed by the ARDS Network
25.
26. Steroid therapy can be used for the early
treatment of moderate-to-severe ARDS, and for
unresolving ARDS.
While there is no consistent survival benefit
attributed to steroid therapy in ARDS, there are
other potential benefits, including
◦ a shorter duration of mechanical ventilation,
◦ improved gas exchange
◦ shorter stay in the ICU
27. Early cases of ARDS :
PaO2/FIO2 is <200 mm Hg with PEEP of 10 cm H2O
a Methylprednisolone
1 mg/kg (ideal body weight) over 30 minutes,
1 mg/kg/day by continuous infusion for 14 days,
followed by a gradual taper over the next 14 days.
Long standing ARDS > 14 day
7–14 days after the onset of illness = irreversible pulmonary fibrosis
a Methylprednisolone
2 mg/kg (ideal body weight) over 30 minutes,
2 mg/kg/day by continuous infusion for 14 days,
1 mg/kg/day (continuous infusion) for the next 7 days,
gradual taper that ends 2 weeks after extubation.
There is no evidence that this regimen increases the risk
of infection
29. Evidence –Based Recommendations for ARDS
Therapies
recommendationtreatment
A
C
C
D
Mechanical ventilation:
• Low tidal volume
• High-PEEP or “ open-lung”
• Prone position
• High- frequency ventilation and ECMO
B
Minimize left atrial filling pressures
Cglucocorticoids
DSurfactant replacement ,inhaled nitric oxide and other
anti-inflammatory therapy ( e.g
Ketoconazole,PGE,NSAIDs)
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