Early experience of low flow extracorporeal carbon dioxide removal in managem...alungtech
Dr. Ravi Tiruvoipati presented the initial Australian experience with low-flow extracorporeal carbon dioxide removal (Hemolung RAS) at the 2015 Australian and New Zealand Intensive Care Society (ANZICS) meeting.
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.
Early experience of low flow extracorporeal carbon dioxide removal in managem...alungtech
Dr. Ravi Tiruvoipati presented the initial Australian experience with low-flow extracorporeal carbon dioxide removal (Hemolung RAS) at the 2015 Australian and New Zealand Intensive Care Society (ANZICS) meeting.
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.
Stress & Strain during Lung Protective Ventilation Egypt Pulmonary Critical...Dr.Mahmoud Abbas
Stress & Strain During Lung Protective Ventilation. Presentation of Dr Lluis Blanch at Pulmonary Critical Care Egypt 2014 , the leading educational event and exhibition for Critical Care Medicine in Egypt. www.pccmegypt.com
VHIR Seminar led by Daniel De Backer, PhD., from the Dpt of Intensive Care Erasme University Hospital Brussels - Belgium.
Abstract: Multiple studies have shown that alterations in microcirculatory perfusion are frequently observed in patients with septic shock. These alterations are characterized by heterogeneity of perfusion with capillaries with stop flow in close vicinity to well perfused capillaries. What are the consequences of these alterations? The presence of stop flow capillaries favours development of zones of tissue hypoxia, even though total perfusion to the organ is preserved. In addition, the heterogeneity in perfusion is associated with inadequate matching of flow to metabolism and is hence less well tolerated by tissues than an homogeneous decrease in perfusion. In patients with septic shock, the severity of the microvascular alterations was associated with development of organ dysfunction and an increase risk of death.
Different mechanisms have been implicated in the development of these alterations including loss of communication between vascular segments, impaired endothelial reactivity, alterations in red and white blood cells rheology, alteration in endothelial glycocalyx, platelet aggregation and microthrombosis. In view of the various mechanisms implicated in the development of these alterations, it is unlikely that therapies used in usual hemodynamic resuscitation. Novel therapies should aim at improving the matching of perfusion to metabolism rather than further increasing flow in the already perfused vessels or non selectively dilating microvessels.
The role of the endothelium as a mediator of critical illnessSMACC Conference
Endothelium was once thought to be an inert organ. However, it plays an important role in multiple functions. These include coagulation, inflammation and determination of vascular permeability.
He then gives a brief overview of the endothelial arrangement, function of the glycocalyx layer and how an injury causing a loss of the protective layer results in holes in the endothelium. The inflammatory cells enter via these holes and causes oedema in the affected organs leading to multiple pathologies.
Danny then explains the role of endothelium in controlling cell barrier function.
Activation of cortactin protein and the myosin light-chain kinase (MLCK) enzymes activate stress fibres resulting in pulling of endothelial cells thereby increasing its permeability.
Danny discusses the role of endothelial dysfunction in acute respiratory distress syndrome (ARDS) at macrovascular, microvascular and molecular levels. Macrovascular thrombosis is related to an increase in severity of ARDS, pulmonary hypertension, and mortality.
At a microvascular level there is a loss of vascularity and increased blood vessel thickness. At a microscopic level, endothelial cells appear swollen and damaged in ARDS. Endothelial dysfunction drives organ dysfunction and mortality. Changes in various endothelial markers like increased von Willebrand factor (vWF), decreased protein C and increased pulmonary dead space correlate with increased mortality.
Studies show that endothelial dysfunction is a more specific and sensitive method to predict mortality of critically ill patients when compared to SOFA score, SAPS 2 score and WCC. Danny discusses ventilator strategies for endothelial cells in ARDS patients. Lowering the tidal volume of ventilators and employing recruitment manoeuvres are such strategies.
Both of these cause a decrease in oedema by reducing endothelial permeability. He then shares the various potential pharmacological treatments for treating endothelial damage. These include statins and spingosine-1-phosphate (S1P). Different studies on the effect of statins in ARDS show contradicting result.
However, targeted therapies can be designed by studying the phenotypes and molecular basis of ARDS in each patient.
The role of the endothelium as a mediator of critical illness by Danny McAuley
Finally, for more like this, head to our podcast page. #CodaPodcast
POLYTRAUMA AND DAMAGE CONTROL ORTHOPAEDICSDr Slayer
polytrauma is Injury to 2 or more organ systems leading potentially to a life threatening condition
Damage control orthopaedics is an approach to contain and stabilize an orthopaedic injury to improve patient’s physiology which are designed to avoid worsening pt’s condition due to “second hit” phenomenon
Stress & Strain during Lung Protective Ventilation Egypt Pulmonary Critical...Dr.Mahmoud Abbas
Stress & Strain During Lung Protective Ventilation. Presentation of Dr Lluis Blanch at Pulmonary Critical Care Egypt 2014 , the leading educational event and exhibition for Critical Care Medicine in Egypt. www.pccmegypt.com
VHIR Seminar led by Daniel De Backer, PhD., from the Dpt of Intensive Care Erasme University Hospital Brussels - Belgium.
Abstract: Multiple studies have shown that alterations in microcirculatory perfusion are frequently observed in patients with septic shock. These alterations are characterized by heterogeneity of perfusion with capillaries with stop flow in close vicinity to well perfused capillaries. What are the consequences of these alterations? The presence of stop flow capillaries favours development of zones of tissue hypoxia, even though total perfusion to the organ is preserved. In addition, the heterogeneity in perfusion is associated with inadequate matching of flow to metabolism and is hence less well tolerated by tissues than an homogeneous decrease in perfusion. In patients with septic shock, the severity of the microvascular alterations was associated with development of organ dysfunction and an increase risk of death.
Different mechanisms have been implicated in the development of these alterations including loss of communication between vascular segments, impaired endothelial reactivity, alterations in red and white blood cells rheology, alteration in endothelial glycocalyx, platelet aggregation and microthrombosis. In view of the various mechanisms implicated in the development of these alterations, it is unlikely that therapies used in usual hemodynamic resuscitation. Novel therapies should aim at improving the matching of perfusion to metabolism rather than further increasing flow in the already perfused vessels or non selectively dilating microvessels.
The role of the endothelium as a mediator of critical illnessSMACC Conference
Endothelium was once thought to be an inert organ. However, it plays an important role in multiple functions. These include coagulation, inflammation and determination of vascular permeability.
He then gives a brief overview of the endothelial arrangement, function of the glycocalyx layer and how an injury causing a loss of the protective layer results in holes in the endothelium. The inflammatory cells enter via these holes and causes oedema in the affected organs leading to multiple pathologies.
Danny then explains the role of endothelium in controlling cell barrier function.
Activation of cortactin protein and the myosin light-chain kinase (MLCK) enzymes activate stress fibres resulting in pulling of endothelial cells thereby increasing its permeability.
Danny discusses the role of endothelial dysfunction in acute respiratory distress syndrome (ARDS) at macrovascular, microvascular and molecular levels. Macrovascular thrombosis is related to an increase in severity of ARDS, pulmonary hypertension, and mortality.
At a microvascular level there is a loss of vascularity and increased blood vessel thickness. At a microscopic level, endothelial cells appear swollen and damaged in ARDS. Endothelial dysfunction drives organ dysfunction and mortality. Changes in various endothelial markers like increased von Willebrand factor (vWF), decreased protein C and increased pulmonary dead space correlate with increased mortality.
Studies show that endothelial dysfunction is a more specific and sensitive method to predict mortality of critically ill patients when compared to SOFA score, SAPS 2 score and WCC. Danny discusses ventilator strategies for endothelial cells in ARDS patients. Lowering the tidal volume of ventilators and employing recruitment manoeuvres are such strategies.
Both of these cause a decrease in oedema by reducing endothelial permeability. He then shares the various potential pharmacological treatments for treating endothelial damage. These include statins and spingosine-1-phosphate (S1P). Different studies on the effect of statins in ARDS show contradicting result.
However, targeted therapies can be designed by studying the phenotypes and molecular basis of ARDS in each patient.
The role of the endothelium as a mediator of critical illness by Danny McAuley
Finally, for more like this, head to our podcast page. #CodaPodcast
POLYTRAUMA AND DAMAGE CONTROL ORTHOPAEDICSDr Slayer
polytrauma is Injury to 2 or more organ systems leading potentially to a life threatening condition
Damage control orthopaedics is an approach to contain and stabilize an orthopaedic injury to improve patient’s physiology which are designed to avoid worsening pt’s condition due to “second hit” phenomenon
Cities are the main consumers of resources, despite a small surface geographically speaking, in the Latin American region. While the approach that leading cities have followed has been to reduce activities that generate greenhouse gases and energy consumption, mainly in buildings and transport, in developing countries this trend has not materialized. This presentation will include an analysis of barriers that inhibit the transition to sustainable cities, with low-carbon emissions, particularly around the issue of sustainable transport. Emphasis will be given on transport patterns and the need to make a transition that allows a modal integrated transport system that maximizes the reduction of greenhouse gases and the co-benefits associated with clean transport, as well as its cost - effectiveness, and considering appropriate technologies for developing countries.
La sostenibilidad como estrategia competitivaRicohES
La Responsabilidad Social Corporativa y el respeto hacia el medio ambiente están en el corazón de nuestras actividades. No solo nos centramos en desarrollar un modelo de negocio sostenible, sino que damos un paso más y ayudamos a que nuestros clientes también lo sean.
Project:
Documentation of the entire product fleet (Pre-Sales, Post-Sales)
Product:
Solar inverter
Tasks:
Installation guide with 9 languages
Texts, increased illustration rate for massive text reduction
Coordination with product certification and translation
Used Systems:
CMS
Translation Memory System
Ernest Mendoza va exposar la seva visió de com es fa el salt d’un projecte de recerca a la creació d’una empresa spinoff. Fent servir la seva experiència com a model, va relatar aquest procés des de la descoberta al laboratori, la patent, la creació de l’empresa i el seu finançament.
La sessió forma part del cicle "Dijous amb l'OSRT", organitzat per l'Oficina de Suport a la Recerca i la Transferència (OSRT) de la UOC.
OXYGEN THERAPY is vast diversified topic.
in the slide share, we have tried to compile all detailed information in brief.
the slides are well versed and all information have been garnered from verified sources.
all recent guidelines, standard textbooks have been referred.
COURTESY- DEPARTMENT OF CRITICAL CARE MEDICINE,
ABVIMS & DR RML HOSPITAL, NEW DELHI.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
2. zmfu www.biomechanics.de
Weil MH & Shubin H: The "VIP" approach to the
bedside management of shock.
JAMA 1969;207:337-40
“…ventilate (oxygen administration), infuse
(fluid resuscitation), pump (vasoactive drugs)..”
Vincent JL & De Backer D: Circulatory Shock.
NEJM 2013;369:1726-34
“. “…administration of oxygen should be started
immediately to increase oxygen delivery and
prevent pulmonary hypertension...”
4. zmfu www.biomechanics.de
„For as a candle burns much faster
indephlogisticated (oxygen-enriched) than
incommon air, so we might live out too fast,
and the animal powers be too soon exhausted
in this pure kind of air. A moralist, at least,
may say, that the air which nature has
provided for us is as good as we deserve.“
In:THE DISCOVERY OF OXYGEN, section 3:
„Experiments and Observations on Different Kinds of Airs“
Joseph Priestley 1733- 1804
5. zmfu www.biomechanics.de
Mitochondrial cytochrome oxidases
2
-
O2
O2
2
H O
H2O2
+ e-
+ e-
+ 2 e
-
(OH)
.
+ 4 e-+ 2 ATP + 6 ATP
Xanthine-
oxidase
Superoxide-
dismutase
Catalase
Why is O2 a poison? The radicals
6. zmfu www.biomechanics.de
Why is O2 a poison? The radicals
Target Mechanism Effect
Membrane Lipid peroxidation Membran damage
Proteins Protein oxidation Enzyme inhibition
Nucleic acids DNA strand breaks Mutagenesis
Enzymes SH-depletion Enzyme inhibition
Carraway & Piantadosi: Oxygen toxicity. Respir Care Clin N Am 1999;5:265
7. zmfu www.biomechanics.de
Warum ist O2 ein Gift? Die RadikaleWhy is O2 a poison? The radicals
O2-Radicals
H2O ATP
ADP
Respiration
Cell
Work
O2
8. zmfu www.biomechanics.de
75 150 225 300 375 75 150 225 300 37
mmHg mmHg
PO2 radicals ?
Khaw et al: Effects of high inspired oxygen fraction during elective
Caesarean section under spinal anaesthesia on maternal and fetal
oxygenation and lipid peroxidation. BJA 2002;88:18
24 patients, FiO2 0.21 % vs. 0.6 (Venturi-mask)
15. zmfu www.biomechanics.de
„…Taken together, these
clincial studies indicate
that hypoxia promotes
inflammation…“
„…We stress that in the
case of inflamed tissue,
hypoxia is not a
bystander but instead
can influence the
environment of the
itssue by regulating
oxygen-dependent gene
epxression…“
(Eltzschig & Carmeliet:
Hypoxia and inflammation.
NEJM 2011;364:656)
Hyperoxia and inflammation
18. zmfu www.biomechanics.de
• 100% O2 over 25 h: modest reduction of vital capacity,
symptoms of tracheitis at 6 h
Comroe et al. JAMA 1945
• 100% O2 over 6-12 h, A-aDO2, Compliance, extravascular
lung water unchanged
De Water et al. N Eng J Med 1970
• 100% O2 over 6 h, symptoms of tracheitis
Sackner et al. Ann Intern Med 1975
• 95% O2 over 17 h, increased albumin levels in BAL fluid
Davis et al. N Eng J Med 1983
• 100 vs. 30% O2 over 8 h, normal bronchoscopy
Kotani et al. Anesthesiology 2000
Hyperoxia and the lung
19. zmfu www.biomechanics.de
Interstitium
15 mechanically ventilated patients
FiO2 60 – 100 %, 14 hours – 30 days
Kapanci et al: Oxygen pneumonitis in man. Chest 1972;62:162
Gould et al: Oxygen pneumonitis in man. Lab Invest 1972;26:499
Hyperoxia and the lung
20. zmfu www.biomechanics.de
Interstitium
14 hrs
3 days
6 days
13 days
15 mechanically ventilated patients
FiO2 60 – 100 %, 14 hours – 30 days
Kapanci et al: Oxygen pneumonitis in man. Chest 1972;62:162
Gould et al: Oxygen pneumonitis in man. Lab Invest 1972;26:499
Hyperoxia and the lung
23. zmfu www.biomechanics.de
Hopf HW et al: Wound Tissue Oxygen Tension Predicts the Risk of
Wound Infection in Surgical Patients. Arch Surg 1997; 32: 997-1005
24. zmfu www.biomechanics.de
O2 as an „antibiotic“
• Antibiotics
• Normothermia
• Adequate fluid resuscitation
• Adequate hematocrite
• Normoglycemia
• Hyperoxia
Mauermann WJ:
The Anesthesiologist`s Role in the
Prevention of Surgical Site Infections
Anesthesiology 2006;105:413-21
32. zmfu www.biomechanics.de
Cortés et al: Normobaric hyperoxia alters the microcirculation in healthy volunteers.
Microvasc Res 2015;98:23
Hyperoxia and blood flow
38. zmfu www.biomechanics.de
Hyperoxia Normoxia P-value
Mean peak CKMB [U/L]
1948 (1721-2205) 1543 (1348-1776) 0.01
Peak troponin [g/L]
57 (48-69) 48 (40-58) 0.18
Arrhythmia [%]
40 31 0.05
Recurrent MI (at
hospital discharge) [%]
5.5 0.9 < 0.01
Infarct size @ 6 mo [g]
20 (10-30) 13 (5-24) 0.04
Mortality [%]
1.8 4.5 0.11
Hyperoxia and ACS
Stub D, et al: Air versus oxygen in ST-segment-elevation myocardial infarction.
Circulation 2015;131:2143-50
39. zmfu www.biomechanics.de
Hyperoxia Normoxia P-value
Mean peak CKMB [U/L]
1948 (1721-2205) 1543 (1348-1776) 0.01
Peak troponin [g/L]
57 (48-69) 48 (40-58) 0.18
Arrhythmia [%]
40 31 0.05
Recurrent MI (at
hospital discharge) [%]
5.5 0.9 < 0.01
Infarct size @ 6 mo [g]
20 (10-30) 13 (5-24) 0.04
Mortality [%]
1.8 4.5 0.11
Hyperoxia and ACS
Stub D, et al: Air versus oxygen in ST-segment-elevation myocardial infarction.
Circulation 2015;131:2143-50
40. zmfu www.biomechanics.de
Asher et al: Survival advantage and
PaO2 threshold in severe traumatic
brain injury. J Neurosurg Anesthesiol
2013:25:168
n=193; GCS < 8
PaO2 > 250 mmHg
60 mmHg < PaO2 < 250 mmHg
Hyperoxia and the brain
41. zmfu www.biomechanics.de
Ray et al: Hyperoxemia and long-term outcome after traumatic
brain injury. Crit Care 2013;17:R177
n=1016; 2003-12; 6 months post SHT
< 75 75-100 > 100 mHg
< 75 75-100 > 100 mHg
Hyperoxia and the brain
42. zmfu www.biomechanics.de
Ray et al: Hyperoxemia and long-term outcome after traumatic
brain injury. Crit Care 2013;17:R177
n=1016; 2003-12; 6 months post SHT
< 75 75-100 > 100 mHg
< 75 75-100 > 100 mHg
The emerging clinical experience
demonstrates that hyperoxia is safe and
beneficial to the brain, and does not
injure the lung as previously feared.
Narotam, Crit Care 2013:17:197
Hyperoxia and the brain
44. zmfu www.biomechanics.de
Rincon et al: Hyperoxemia and long-term outcome after traumatic
brain injury. Crit Care Med 2014;42:387
n=2894 (AIS 19%; SAH 32%; ICH 49%)
Hyperoxia and the brain
45. zmfu www.biomechanics.de
Rincon et al: Hyperoxemia and long-term outcome after traumatic
brain injury. Crit Care Med 2014;42:387
n=2894 (AIS 19%; SAH 32%; ICH 49%)
Hyperoxia (n = 1084)
PaO2 > 300 mmHg 60 %
Hypoxia (n = 450)
PaO2 < 60 mmHg 53 %
SAH, ICB, AIS
Hyperoxia and the brain
48. zmfu www.biomechanics.de
Air
Kilgannon JAMA 2010
6326 patients
Bellomo Crit Care 2011
12108 patients
Intra-hospital
mortality (%)
3561 (56) 6968 (58)
Discharge
home (%)
1203 (19) 3341 (28)
Highest T °C
(mean ± SD)
38 ± 3 37.1 ± 1.5
Lowest T °C
(mean ± SD)
36 ± 3 34.9 ± 1.7
Hyperoxie and CPR
49. zmfu www.biomechanics.de
Air
Kilgannon JAMA 2010
6326 patients
Bellomo Crit Care 2011
12108 patients
Intra-hospital
mortality (%)
3561 (56) 6968 (58)
Discharge
home (%)
1203 (19) 3341 (28)
Highest T °C
(mean ± SD)
38 ± 3 37.1 ± 1.5
Lowest T °C
(mean ± SD)
36 ± 3 34.9 ± 1.7
Hyperoxie and CPR
50. zmfu www.biomechanics.de
Air
Hyperoxie and CPR
Kilgannon JAMA 2010
6326 patients
Bellomo Crit Care 2011
12108 patients
Intra-hospital
mortality (%)
3561 (56) 6968 (58)
Discharge
home (%)
1203 (19) 3341 (28)
Highest T °C
(mean ± SD)
38 ± 3 37.1 ± 1.5
Lowest T °C
(mean ± SD)
36 ± 3 34.9 ± 1.7
51. zmfu www.biomechanics.de
Air
Hyperoxie and CPR
Helmerhorst et al: Associations of arterial carbon dioixde and
arterial oxygen concentrations with hospital mortaltiy after
resuscitation from cardiac arrest. Crit Care 2015;19:348
6496 patients!
Lowest mortality art. PO2 150-200 mmHg!!
52. zmfu www.biomechanics.de
Air
Lowest mortality art. PO2 150 mmHg!!
Hyperoxie and outcome
de Jonge et al: Association between administered oxygen, arterial
partial oxygen pressure and mortality in mechanically ventilated
intensive care patients. Crit Care 2008;12:R156
53. zmfu www.biomechanics.de
Air
Helmerhorst et al: Association between
arterial hyperoxia and outcome in
subsets of critical illness: a systematic
review, meataanalysis, and meta-
regression of cohort studies. Crit Care
Med 2015 in press
“..Considering the substantial
heterogeneity..more evidence is
needed..“
Damiani et al: Arterial hyperoxia and
mortality in critically ill patients: a
systematic review and meta-analysis.
Crit Care 2014;18:711
“..However,..results are limited
by the high heterogeneity..“
Hyperoxie and outcome
54. zmfu www.biomechanics.de
Air
Helmerhorst et al: Association between
arterial hyperoxia and outcome in
subsets of critical illness: a systematic
review, meataanalysis, and meta-
regression of cohort studies. Crit Care
Med 2015 in press
“..Considering the substantial
heterogeneity..more evidence is
needed..“
Damiani et al: Arterial hyperoxia and
mortality in critically ill patients: a
systematic review and meta-analysis.
Crit Care 2014;18:711
“..However,..results are limited
by the high heterogeneity..“
Hyperoxie and outcome
55. zmfu www.biomechanics.de
“…Consequently,… “conservative” O2
therapy, i.e. targeting an arterial hemoglobin
O2 saturation of 88 – 95 % as suggested by the
guidelines of the ARDS Network and the
Surviving Sepsis Campaign, represents the
treatment of choice to avoid exposure to both
hypoxemia and excess hyperoxemia.”…
Can you have too much oxygen?
Hafner S, Beloncle F, Koch A, Radermacher P, Asfar P.
Hyperoxia in intensive care, emergency, and peri-operative medicine: Dr. Jekyll or
Mr. Hyde? A 2015 update.
Ann Intensive Care 2015;5:42