Gordon Flynn is an Intensivist and an Anaesthetist from Prince of Wales hospital in Sydney. Here he gives an entertaining and thought provoking talk on the big topic of obesity in ICU. Leave comments below on ICN!
Malnutrition is common in critically ill ICU patients and can lead to organ dysfunction and poor outcomes. Enteral nutrition is preferred over parenteral nutrition due to lower risks of infection and other complications. Early initiation of enteral feeding within 48 hours for stable patients is recommended. Formulas are tailored to patient needs and disease states. Monitoring for complications like hyperglycemia, liver issues, and electrolyte imbalances is important during nutrition support. Overall goals are to prevent further malnutrition while avoiding overfeeding and its risks.
This document provides information on bariatric surgery. It begins with definitions of bariatric and discusses the increasing prevalence of bariatric procedures over time. It then covers topics like the causes and pathophysiology of obesity, degrees of obesity based on BMI, obesity-related comorbidities, options for treatment like diet, drugs and surgery. It provides details on various bariatric surgical procedures that are either restrictive, malabsorptive or a combination. Risks, guidelines for candidacy, pre and post-op care are discussed. In summary, the document is a comprehensive overview of bariatric surgery, its increasing use and role in treating severe obesity and related health conditions.
This document discusses anaesthesia considerations for obese patients. It covers physiological disturbances in obese patients that impact anaesthesia like reduced lung volumes, cardiac strain and risk of pulmonary embolism. It recommends pre-operative evaluation, premedication to reduce aspiration risk, induction and maintenance techniques like using ideal body weight for dosing and PEEP to improve oxygenation. Post-operative monitoring is important due to risks of hypoventilation, wound infections and thromboembolic events. Analgesia should be dosed based on ideal body weight and include multimodal options. Safety features of anaesthesia machines like pressure regulators, flow meters and vaporizers are highlighted.
Management of persistent hypoxemic respiratory failure in the icu garpestadDang Thanh Tuan
The document discusses management of persistent hypoxemic respiratory failure in ICU patients. It describes a case of a patient who developed this after abdominal surgery and peritonitis. It then discusses various ventilator strategies and their risks and benefits for improving oxygenation while minimizing lung injury, including low tidal volume ventilation, optimal levels of PEEP, recruitment maneuvers, prone positioning, and permissive hypercapnia. It summarizes several key clinical trials that have informed best practices.
Anaesthesia for morbidly obese patients and bariatric surgery- Dr.Sandeepdeepmbbs04
This document discusses anaesthesia considerations for morbidly obese patients undergoing bariatric surgery. It defines morbid obesity and discusses the increased prevalence worldwide. It explores the physiological changes that occur with obesity, including effects on the cardiovascular, respiratory, gastrointestinal and renal systems. It also discusses specific conditions like obstructive sleep apnea. The document provides guidelines on preoperative evaluation and optimization of morbidly obese patients, including screening for common comorbidities. It discusses modifications to anaesthetic management including dosing based on adjusted body weight and techniques to address challenges with airway management and positioning for this patient population.
Laparoscopy involves inserting surgical instruments through small incisions in the abdomen while insufflating carbon dioxide gas to elevate the abdominal wall for better visualization. This document discusses the physiological changes that occur during laparoscopy, including cardiovascular, respiratory, renal, and metabolic effects. Cardiovascular changes are initially due to increased venous return but later decreased blood flow from elevated pressures. Respiratory changes involve decreased lung capacity but CO2 is typically eliminated through increased breathing. Renal effects include reduced filtration but are usually mild and reversible.
Malnutrition is common in critically ill ICU patients and can lead to organ dysfunction and poor outcomes. Enteral nutrition is preferred over parenteral nutrition due to lower risks of infection and other complications. Early initiation of enteral feeding within 48 hours for stable patients is recommended. Formulas are tailored to patient needs and disease states. Monitoring for complications like hyperglycemia, liver issues, and electrolyte imbalances is important during nutrition support. Overall goals are to prevent further malnutrition while avoiding overfeeding and its risks.
This document provides information on bariatric surgery. It begins with definitions of bariatric and discusses the increasing prevalence of bariatric procedures over time. It then covers topics like the causes and pathophysiology of obesity, degrees of obesity based on BMI, obesity-related comorbidities, options for treatment like diet, drugs and surgery. It provides details on various bariatric surgical procedures that are either restrictive, malabsorptive or a combination. Risks, guidelines for candidacy, pre and post-op care are discussed. In summary, the document is a comprehensive overview of bariatric surgery, its increasing use and role in treating severe obesity and related health conditions.
This document discusses anaesthesia considerations for obese patients. It covers physiological disturbances in obese patients that impact anaesthesia like reduced lung volumes, cardiac strain and risk of pulmonary embolism. It recommends pre-operative evaluation, premedication to reduce aspiration risk, induction and maintenance techniques like using ideal body weight for dosing and PEEP to improve oxygenation. Post-operative monitoring is important due to risks of hypoventilation, wound infections and thromboembolic events. Analgesia should be dosed based on ideal body weight and include multimodal options. Safety features of anaesthesia machines like pressure regulators, flow meters and vaporizers are highlighted.
Management of persistent hypoxemic respiratory failure in the icu garpestadDang Thanh Tuan
The document discusses management of persistent hypoxemic respiratory failure in ICU patients. It describes a case of a patient who developed this after abdominal surgery and peritonitis. It then discusses various ventilator strategies and their risks and benefits for improving oxygenation while minimizing lung injury, including low tidal volume ventilation, optimal levels of PEEP, recruitment maneuvers, prone positioning, and permissive hypercapnia. It summarizes several key clinical trials that have informed best practices.
Anaesthesia for morbidly obese patients and bariatric surgery- Dr.Sandeepdeepmbbs04
This document discusses anaesthesia considerations for morbidly obese patients undergoing bariatric surgery. It defines morbid obesity and discusses the increased prevalence worldwide. It explores the physiological changes that occur with obesity, including effects on the cardiovascular, respiratory, gastrointestinal and renal systems. It also discusses specific conditions like obstructive sleep apnea. The document provides guidelines on preoperative evaluation and optimization of morbidly obese patients, including screening for common comorbidities. It discusses modifications to anaesthetic management including dosing based on adjusted body weight and techniques to address challenges with airway management and positioning for this patient population.
Laparoscopy involves inserting surgical instruments through small incisions in the abdomen while insufflating carbon dioxide gas to elevate the abdominal wall for better visualization. This document discusses the physiological changes that occur during laparoscopy, including cardiovascular, respiratory, renal, and metabolic effects. Cardiovascular changes are initially due to increased venous return but later decreased blood flow from elevated pressures. Respiratory changes involve decreased lung capacity but CO2 is typically eliminated through increased breathing. Renal effects include reduced filtration but are usually mild and reversible.
This document discusses nutritional support for ICU patients. It begins with a brief history of ICU nutrition and outlines the basis for nutritional support. Providing nutrition is important to prevent the physiologic effects of malnutrition, which can lead to organ dysfunction and poor outcomes. The nutritional requirements of ICU patients, including calories, protein, fluids and micronutrients are described. Enteral and parenteral routes of feeding administration are covered, along with their indications. Guidelines for initiating feeding, monitoring for complications, and calculating nutritional needs are provided. The goal of nutritional support is to improve patient outcomes by preventing and treating critical illness-related malnutrition.
This document discusses anesthesia considerations for bariatric surgery. It begins with definitions of obesity classifications based on BMI. It then discusses the increased risks that obese patients face from cardiovascular and pulmonary complications. Key points in the anesthetic management include careful preoperative evaluation and optimization of comorbidities, strategies for airway management and ventilation given the increased risk of difficulties, appropriate patient positioning and monitoring during surgery, and thromboprophylaxis given the risk of VTE. Overall anesthetic goals are to prevent hypoxemia and carefully manage any cardiovascular or pulmonary issues.
Obesity presents unique challenges for anaesthesia. Obese patients have decreased lung volumes which increases the risk of hypoxemia during induction and intubation. Preoxygenation in a slightly head-up position can help reduce this risk. Intubation may be difficult due to obesity related anatomical changes. Regional anaesthesia can also be challenging due to obscured landmarks and extensive adipose tissue. Postoperatively, obese patients are at higher risk of respiratory failure, DVT, and wound infections requiring close monitoring. Careful consideration of dosing, positioning, and postoperative monitoring is needed to safely manage anaesthesia for obese patients.
Acid-base disorders occur when pH levels fall outside the normal range of 7.35-7.45. Precise pH regulation is vital for cellular functions and physiological processes. Buffers like bicarbonate help control hydrogen ion concentration. Disorders are classified as metabolic, affecting bicarbonate levels, or respiratory, affecting carbon dioxide levels. The kidneys and lungs work to compensate for changes and return pH to normal ranges through bicarbonate and carbon dioxide regulation. However, compensation cannot fully correct pH without also treating the underlying cause.
Effects of Mechanical Ventilation onPATIENT BODYHI HI
The document discusses the effects of mechanical ventilation on various body systems. It describes how mechanical ventilation can decrease lung compliance and increase dead space. It also explains how mechanical ventilation affects the cardiovascular system by decreasing preload and afterload, the renal system by reducing renal blood flow if cardiac output decreases, and the central nervous system by potentially increasing intracranial pressure. The document provides an overview of the goals and indications for mechanical ventilation and different ventilation modes.
Provides a simple organized way for ABG analysis with special emphasis on Acid-base balance interpretation & its crucial rule in clinical toxicology practice.
The document discusses the rising problem of obesity in India, summarizing key statistics from NFHS surveys. It then covers the genetic, dietary, lifestyle, and environmental factors that contribute to obesity. The major sections discuss the medical management of obesity through diet, exercise and drugs, as well as the various bariatric surgery procedures like gastric bypass, gastric banding, and sleeve gastrectomy. Key details are provided on the indications, mechanisms, techniques and complications of different surgical options. Post-operative care and long-term follow up are also highlighted.
This document discusses nutrition in critically ill patients. It covers nutritional assessment, calculating caloric and protein requirements, and options for nutritional support including enteral and parenteral nutrition. The key points are that enteral nutrition is preferred when possible as it is more physiologic and protects gut function, and nutrition should be started early in critically ill patients to prevent catabolism and support recovery. Contraindications and complications of enteral feeding are also reviewed.
This document discusses acid-base disorders and interpretation of arterial blood gases (ABGs). It defines acidosis and alkalosis, and describes respiratory and metabolic causes. Simple and mixed acid-base disorders are explained. Compensation by the lungs and kidneys in response to primary disorders is discussed. A stepwise approach to ABG interpretation is provided, including determining the primary disorder, checking for compensation, calculating the anion gap, and identifying specific etiologies. Characteristics of simple acid-base disturbances and combined disorders are summarized.
This document provides national guidelines and protocols for critical care nutrition practice in India. It discusses why adequate nutrition is important for critically ill patients, when to start enteral or parenteral nutrition, how to determine caloric and protein needs based on patient characteristics, appropriate routes of administration, contraindications, complications, and disease-specific nutrition protocols. The key recommendations are to start early enteral nutrition within 48 hours when possible, provide 1.2-2 g/kg protein and 20-35 kcal/kg calories based on weight status, and use enteral over parenteral nutrition when GI function allows.
This presentation explains change physiological changes occurs in obesity. Which pre op investigation should be done of those patient before scheduling them for surgery. What in the end anaesthesia consideration of obesity with post op care.
This document discusses endocrine diseases and their implications for anesthesia. It covers both hyperthyroidism and hypothyroidism in detail. For hyperthyroidism, it describes the signs and symptoms, causes, effects on the cardiovascular system, and treatment approaches including antithyroid medications, beta blockers, iodine, and surgery. It provides guidance on preoperative preparation and intraoperative management. For hypothyroidism, it discusses signs and symptoms, effects on the cardiovascular system, diagnosis, and treatment with levothyroxine. It notes risks for anesthesia and importance of rendering patients euthyroid prior to elective surgery.
In critical care medicine the invasive life saving techniques are often employed and when all goes well such interventions will be withdrawn to all for normal physiology to resume. Identifying this point for safe withdrawal for the resumption of normal respiratory function is of utmost importance.
Acid base balance & ABG interpretation,Dept of anesthesiology,JJMMC,DavangereGopan Gopalakrisna Pillai
Acid base balance and ABG interpretation presented by Dr.Gopan.G,Post-Graduate student. Chairperson : Dr.Ravi.R,Professor, Department of Anaesthesiology & Critical care,JJMMC,Davangere.
A 41-year-old female presented with right upper quadrant abdominal pain and was diagnosed with symptomatic gallstones and acute cholecystitis. She underwent a laparoscopic cholecystectomy under general anesthesia. General anesthesia was induced and tracheal intubation was performed. Pneumoperitoneum was created and maintained at 12 mmHg during the laparoscopic procedure. The surgery was completed without complications and the patient was extubated and transferred to the recovery unit in a stable condition.
Anaesthesia and the perioperative management of hepatic resectionDhritiman Chakrabarti
The document discusses liver anatomy, regeneration, and indications for liver resection surgery. It covers preoperative assessment of patient risk factors, anesthesia techniques used, and postoperative considerations. Liver resection is used to remove tumors, cysts, or following trauma. Patient comorbidities, liver function, and extent of resection impact risks. Anesthesia aims to maintain low central venous pressure through techniques like epidural analgesia.
This document provides a summary of an arterial blood gas interpretation presentation. It discusses the objectives, procedure, and precautions for arterial blood gas sampling. It then covers the interpretation of oxygenation status and acid-base status using a six step approach. The six steps include determining if acidemia or alkalemia is present, if the primary disturbance is respiratory or metabolic, if a respiratory disorder is acute or chronic, if compensation is adequate, evaluating the anion gap if metabolic, and identifying the cause of a high anion gap metabolic acidosis.
This document discusses various calculations used to diagnose and distinguish between different types of acid-base disorders, including anion gap, delta gap, urine anion gap, and osmolar gap. It provides detailed explanations of how to calculate each value and what they indicate. The anion gap is useful for determining the cause of metabolic acidosis. The delta gap can identify mixed acid-base disorders. A negative urine anion gap suggests GI bicarbonate loss while a positive value suggests renal tubular acidosis. An increased osmolar gap may indicate ethylene glycol or methanol poisoning in the setting of an unexplained metabolic acidosis.
Bariatric surgery can help treat obesity and related health conditions through restrictive and malabsorptive techniques. Key hormonal changes may contribute to reduced appetite and improved metabolism. Specifically, surgeries like Roux-en-Y gastric bypass and sleeve gastrectomy may lower levels of the appetite-stimulating hormone ghrelin in the short term. Long-term nutritional deficiencies are less common with restrictive procedures but still require monitoring and supplementation. Bariatric surgery has been shown to resolve or improve conditions like diabetes, hypertension, and sleep apnea in the majority of patients.
This document discusses nutritional support for critically ill patients. It notes that these patients are hypermetabolic and have increased nutritional needs. Malnutrition can develop rapidly in critically ill patients and exert deleterious effects. Nutritional assessment in critically ill patients is difficult but includes anthropometric measurements, biochemical tools, and clinical and dietary assessments. The timing and route of providing nutrition is complex, and enteral nutrition via a feeding tube is generally preferred over parenteral nutrition when possible. Ongoing monitoring is important for patients receiving nutritional support.
This document discusses the history and potential future of neurosurgery being available to more people. It describes trephination procedures that were historically performed to treat skull fractures and injuries. It suggests that opening the skull through self-trephination may allow one to return to a childlike state of consciousness. The document then outlines indications and procedures for burr hole evacuation to drain blood from an extradural hematoma as a potential emergency treatment option in areas where neurosurgery availability is delayed. It acknowledges the need for prospective studies but presents preliminary mortality and outcome data supporting potential benefits over doing nothing in some cases.
1) Obesity poses several clinical challenges in the ICU such as difficulties with monitoring, vascular access, nursing care, airway management, and drug dosing.
2) Obese patients are at higher risk for respiratory complications due to reduced lung volumes and compliance. They require specialized ventilator settings including higher PEEP and targeting tidal volumes based on ideal body weight.
3) Nutrition is also complex in obese ICU patients. Overfeeding can cause complications while underfeeding risks protein-energy malnutrition. Initial calorie targets are based on obesity-adjusted body weight.
This document discusses nutritional support for ICU patients. It begins with a brief history of ICU nutrition and outlines the basis for nutritional support. Providing nutrition is important to prevent the physiologic effects of malnutrition, which can lead to organ dysfunction and poor outcomes. The nutritional requirements of ICU patients, including calories, protein, fluids and micronutrients are described. Enteral and parenteral routes of feeding administration are covered, along with their indications. Guidelines for initiating feeding, monitoring for complications, and calculating nutritional needs are provided. The goal of nutritional support is to improve patient outcomes by preventing and treating critical illness-related malnutrition.
This document discusses anesthesia considerations for bariatric surgery. It begins with definitions of obesity classifications based on BMI. It then discusses the increased risks that obese patients face from cardiovascular and pulmonary complications. Key points in the anesthetic management include careful preoperative evaluation and optimization of comorbidities, strategies for airway management and ventilation given the increased risk of difficulties, appropriate patient positioning and monitoring during surgery, and thromboprophylaxis given the risk of VTE. Overall anesthetic goals are to prevent hypoxemia and carefully manage any cardiovascular or pulmonary issues.
Obesity presents unique challenges for anaesthesia. Obese patients have decreased lung volumes which increases the risk of hypoxemia during induction and intubation. Preoxygenation in a slightly head-up position can help reduce this risk. Intubation may be difficult due to obesity related anatomical changes. Regional anaesthesia can also be challenging due to obscured landmarks and extensive adipose tissue. Postoperatively, obese patients are at higher risk of respiratory failure, DVT, and wound infections requiring close monitoring. Careful consideration of dosing, positioning, and postoperative monitoring is needed to safely manage anaesthesia for obese patients.
Acid-base disorders occur when pH levels fall outside the normal range of 7.35-7.45. Precise pH regulation is vital for cellular functions and physiological processes. Buffers like bicarbonate help control hydrogen ion concentration. Disorders are classified as metabolic, affecting bicarbonate levels, or respiratory, affecting carbon dioxide levels. The kidneys and lungs work to compensate for changes and return pH to normal ranges through bicarbonate and carbon dioxide regulation. However, compensation cannot fully correct pH without also treating the underlying cause.
Effects of Mechanical Ventilation onPATIENT BODYHI HI
The document discusses the effects of mechanical ventilation on various body systems. It describes how mechanical ventilation can decrease lung compliance and increase dead space. It also explains how mechanical ventilation affects the cardiovascular system by decreasing preload and afterload, the renal system by reducing renal blood flow if cardiac output decreases, and the central nervous system by potentially increasing intracranial pressure. The document provides an overview of the goals and indications for mechanical ventilation and different ventilation modes.
Provides a simple organized way for ABG analysis with special emphasis on Acid-base balance interpretation & its crucial rule in clinical toxicology practice.
The document discusses the rising problem of obesity in India, summarizing key statistics from NFHS surveys. It then covers the genetic, dietary, lifestyle, and environmental factors that contribute to obesity. The major sections discuss the medical management of obesity through diet, exercise and drugs, as well as the various bariatric surgery procedures like gastric bypass, gastric banding, and sleeve gastrectomy. Key details are provided on the indications, mechanisms, techniques and complications of different surgical options. Post-operative care and long-term follow up are also highlighted.
This document discusses nutrition in critically ill patients. It covers nutritional assessment, calculating caloric and protein requirements, and options for nutritional support including enteral and parenteral nutrition. The key points are that enteral nutrition is preferred when possible as it is more physiologic and protects gut function, and nutrition should be started early in critically ill patients to prevent catabolism and support recovery. Contraindications and complications of enteral feeding are also reviewed.
This document discusses acid-base disorders and interpretation of arterial blood gases (ABGs). It defines acidosis and alkalosis, and describes respiratory and metabolic causes. Simple and mixed acid-base disorders are explained. Compensation by the lungs and kidneys in response to primary disorders is discussed. A stepwise approach to ABG interpretation is provided, including determining the primary disorder, checking for compensation, calculating the anion gap, and identifying specific etiologies. Characteristics of simple acid-base disturbances and combined disorders are summarized.
This document provides national guidelines and protocols for critical care nutrition practice in India. It discusses why adequate nutrition is important for critically ill patients, when to start enteral or parenteral nutrition, how to determine caloric and protein needs based on patient characteristics, appropriate routes of administration, contraindications, complications, and disease-specific nutrition protocols. The key recommendations are to start early enteral nutrition within 48 hours when possible, provide 1.2-2 g/kg protein and 20-35 kcal/kg calories based on weight status, and use enteral over parenteral nutrition when GI function allows.
This presentation explains change physiological changes occurs in obesity. Which pre op investigation should be done of those patient before scheduling them for surgery. What in the end anaesthesia consideration of obesity with post op care.
This document discusses endocrine diseases and their implications for anesthesia. It covers both hyperthyroidism and hypothyroidism in detail. For hyperthyroidism, it describes the signs and symptoms, causes, effects on the cardiovascular system, and treatment approaches including antithyroid medications, beta blockers, iodine, and surgery. It provides guidance on preoperative preparation and intraoperative management. For hypothyroidism, it discusses signs and symptoms, effects on the cardiovascular system, diagnosis, and treatment with levothyroxine. It notes risks for anesthesia and importance of rendering patients euthyroid prior to elective surgery.
In critical care medicine the invasive life saving techniques are often employed and when all goes well such interventions will be withdrawn to all for normal physiology to resume. Identifying this point for safe withdrawal for the resumption of normal respiratory function is of utmost importance.
Acid base balance & ABG interpretation,Dept of anesthesiology,JJMMC,DavangereGopan Gopalakrisna Pillai
Acid base balance and ABG interpretation presented by Dr.Gopan.G,Post-Graduate student. Chairperson : Dr.Ravi.R,Professor, Department of Anaesthesiology & Critical care,JJMMC,Davangere.
A 41-year-old female presented with right upper quadrant abdominal pain and was diagnosed with symptomatic gallstones and acute cholecystitis. She underwent a laparoscopic cholecystectomy under general anesthesia. General anesthesia was induced and tracheal intubation was performed. Pneumoperitoneum was created and maintained at 12 mmHg during the laparoscopic procedure. The surgery was completed without complications and the patient was extubated and transferred to the recovery unit in a stable condition.
Anaesthesia and the perioperative management of hepatic resectionDhritiman Chakrabarti
The document discusses liver anatomy, regeneration, and indications for liver resection surgery. It covers preoperative assessment of patient risk factors, anesthesia techniques used, and postoperative considerations. Liver resection is used to remove tumors, cysts, or following trauma. Patient comorbidities, liver function, and extent of resection impact risks. Anesthesia aims to maintain low central venous pressure through techniques like epidural analgesia.
This document provides a summary of an arterial blood gas interpretation presentation. It discusses the objectives, procedure, and precautions for arterial blood gas sampling. It then covers the interpretation of oxygenation status and acid-base status using a six step approach. The six steps include determining if acidemia or alkalemia is present, if the primary disturbance is respiratory or metabolic, if a respiratory disorder is acute or chronic, if compensation is adequate, evaluating the anion gap if metabolic, and identifying the cause of a high anion gap metabolic acidosis.
This document discusses various calculations used to diagnose and distinguish between different types of acid-base disorders, including anion gap, delta gap, urine anion gap, and osmolar gap. It provides detailed explanations of how to calculate each value and what they indicate. The anion gap is useful for determining the cause of metabolic acidosis. The delta gap can identify mixed acid-base disorders. A negative urine anion gap suggests GI bicarbonate loss while a positive value suggests renal tubular acidosis. An increased osmolar gap may indicate ethylene glycol or methanol poisoning in the setting of an unexplained metabolic acidosis.
Bariatric surgery can help treat obesity and related health conditions through restrictive and malabsorptive techniques. Key hormonal changes may contribute to reduced appetite and improved metabolism. Specifically, surgeries like Roux-en-Y gastric bypass and sleeve gastrectomy may lower levels of the appetite-stimulating hormone ghrelin in the short term. Long-term nutritional deficiencies are less common with restrictive procedures but still require monitoring and supplementation. Bariatric surgery has been shown to resolve or improve conditions like diabetes, hypertension, and sleep apnea in the majority of patients.
This document discusses nutritional support for critically ill patients. It notes that these patients are hypermetabolic and have increased nutritional needs. Malnutrition can develop rapidly in critically ill patients and exert deleterious effects. Nutritional assessment in critically ill patients is difficult but includes anthropometric measurements, biochemical tools, and clinical and dietary assessments. The timing and route of providing nutrition is complex, and enteral nutrition via a feeding tube is generally preferred over parenteral nutrition when possible. Ongoing monitoring is important for patients receiving nutritional support.
This document discusses the history and potential future of neurosurgery being available to more people. It describes trephination procedures that were historically performed to treat skull fractures and injuries. It suggests that opening the skull through self-trephination may allow one to return to a childlike state of consciousness. The document then outlines indications and procedures for burr hole evacuation to drain blood from an extradural hematoma as a potential emergency treatment option in areas where neurosurgery availability is delayed. It acknowledges the need for prospective studies but presents preliminary mortality and outcome data supporting potential benefits over doing nothing in some cases.
1) Obesity poses several clinical challenges in the ICU such as difficulties with monitoring, vascular access, nursing care, airway management, and drug dosing.
2) Obese patients are at higher risk for respiratory complications due to reduced lung volumes and compliance. They require specialized ventilator settings including higher PEEP and targeting tidal volumes based on ideal body weight.
3) Nutrition is also complex in obese ICU patients. Overfeeding can cause complications while underfeeding risks protein-energy malnutrition. Initial calorie targets are based on obesity-adjusted body weight.
David Bihari is an Intensivist from Prince of Wales Hospital in Sydney. He is particularly interested and passionate about nutrition in the critically ill, and has been involved in research in this area for many years. Here he talks about how we feed in ICU.
Rehab Select is an inpatient rehabilitation and long-term care facility with four locations in Alabama. It offers rehabilitation services, specialty services, exceptional nursing staff, specialized physicians, and rigorous physical and occupational therapy to get patients back to everyday life as quickly as possible, with the average length of stay being 14-16 days. What makes Rehab Select different includes state-of-the-art therapy equipment, therapy offered up to seven days a week, on-site specialized services, a one-on-one approach to therapy, and physician coverage up to seven days a week.
Able Rehabilitation Equipment is an Australian family-owned business that has supplied mobility and healthcare products since 1981. They offer a wide range of high-quality, locally and globally sourced products including wheelchairs, beds, seating, bathing, and daily living equipment. Customers can expect exceptional service from experienced specialists and a friendly customer care team. The company aims to provide independence and dignity for their customers.
1) Hospital acquired acute kidney injury (AKI) is a problem for clinicians due to the complex renal physiology, limited clinically useful biomarkers for renal injury, difficulties with fluid management in sepsis, and limited therapies for early AKI.
2) The kidney is at risk of both hyperoxia and hypoxia due to its oxygen regulation and blood flow, making renal function difficult to assess. Global renal blood flow may not correlate with glomerular filtration rate, medullary flow, or oxygenation.
3) While a positive fluid balance and elevated central venous pressure are associated with worse outcomes in septic shock, fluid management remains challenging without reliable ways to directly measure renal blood flow or the integrity of the endothelial glyc
Rehabilitation of patient with pleural effusionAdemola Adeyemo
1) Pulmonary embolism occurs when a blood clot blocks an artery in the lungs, and can cause pleural effusions in about 30% of cases. Physiotherapy is an important part of managing patients with pleural effusions secondary to pulmonary embolism.
2) Physiotherapy includes techniques like incentive spirometry, chest physiotherapy, and exercises to improve cardiopulmonary function and endurance. Drainage of fluid from chest tubes is also facilitated.
3) As the patient's condition improves with physiotherapy, their ability to exercise intensifies and shortness of breath decreases, with the goal of restoring independence and fitness.
David Juurlink - Drug Interactions That Can Kill (and How to Avoid Them)SMACC Conference
David Juurlink SMACC Chicago talk 'Drug Interactions That Can Kill (and How to Avoid Them)’ takes us on a journey of drug interactions, case studies, and avoidance strategies.
Juurlink starts by educating us on the two different drug-drug interactions (DDI) - effects of one drug altered by the use of another . First of which is Pharmacokinetic where by one drug alters the level of another, the second Pharmacodynamic being no change in drug levels, and uses this as a basis for his following case studies.
Juurlink speaks of the dreadful literature that is available on the thousands of drug interaction per year, stating that most information comes from case reports and volunteer studies, and suggests that majority of these interaction are avoidable.
Juurlink goes on to discuss the findings of 4 case studies involving the following Drug-Drug Interactions and their effects on the patients.
SMX/TMP + sulfonylureas
Macrolides + digoxin
APAP + warfarin
SMX/TMP + ACEI/ARB
Juurlink provides us with a short list of trigger drugs that we should be aware of, a list of meds that warrant extra caution and list of possible safer alternatives. He also suggests that it is of the up most importance to have a good pharmacist to turn to as they are given more information on drugs interactions then physicians. And, to utilise resources such as pharmacy times - where you can get information on drug interactions at a push of the button.
Juurlink also suggests that an Informed patient is a very useful safety mechanism.
Breathing exercises are designed to improve lung function and endurance in patients with lung diseases or injuries. They are often combined with medications, drainage, and exercise. Goals include improving ventilation, cough effectiveness, and mobility while preventing complications. Types of breathing exercises include diaphragmatic breathing, segmental breathing targeting different lung areas, and pursed lip breathing. Precautions are taken to avoid forced exhalation or using accessory muscles.
Jo Anna Leuck discusses how to learn from error in paediatric sepsis.
Rory was a healthy 12-year-old boy, known for his smile and for standing up for others. A simple fall during basketball practice caused an abrasion on his arm. This is the suspected beginning of a cascade of events that led to his death from sepsis.
Rory was seen by both his paediatrician and a local Emergency Department and was sent home with a diagnosis of a viral illness.
He returned the next day in septic shock and died shortly thereafter. A review of the medical records revealed that there were errors that occurred during his emergency department visit.
This talk will attempt to move away from the controversy of the actual article and instead focus on how these common errors could have occurred during any busy shift and what we can do to prevent them in the future.
Jo Anna’s intention in giving this talk is to continue to use this case to raise awareness of both paediatric sepsis and common medical error.
When considering paediatric sepsis Jo Anna asks - Was this preventable? Were there clues? Why was this missed?
Jo Anna discusses what we can we do better.
Recognition is the first step. Often procedures are used in this case. The Paediatric Sepsis Score is one such example.
Jo Anna talks about vital signs and how they are tricky in kids due to the changing reference ranges depending on age. Jo Anna recommends having easily accessed charts and stresses thinking twice about the size and age of the child in front of you.
The physical exam is as important as always. In kids, there are certain signs that should raise suspicion such as skin mottling. And in terms of treatment Jo Anna stresses rapid access, rapid fluid boluses and thorough re-evaluation alongside age-appropriate empirical antibiotics.
Lastly, Jo Anne touches on the errors that this case highlights. She provides some strategies to improve your practice.
Before discharge consider three main components. Vital signs, diagnostic studies, and communication!
Simple, but careful attention to these components of care will lead to the medical profession learning from errors and preventing them in the future.
For more like this, head to our podcast page. #CodaPodcast
This document discusses obesity, including its historical aspects, definitions, classifications based on BMI, etiology, pathophysiology involving hormones like leptin and ghrelin, patterns of body fat distribution, health risks associated with obesity like increased risk of mortality, type 2 diabetes, cardiovascular disease, and certain cancers. It also discusses medical management of obesity through approaches like weight reduction, weight maintenance, drug therapy, and very low calorie diets.
PRESENTED BY: AYESHA KABEER
FROM: UNIVERSITY OF GUJRAT SIALKOT SUBCAMPUS
Obesity and Cardiovascular Diseases
1. Causes of Overweight and Obesity
2. Accessing Obesity
-Body Mass Index
3. Cardiovascular Diseases caused by Obesity
This document discusses obesity and related topics. It defines obesity as abnormal or excessive fat accumulation that presents health risks. It provides BMI classifications for different regions including South East Asia. Key points are that globally obesity rates are rising, and factors influencing obesity are complex, involving genes, environment, behavior, and their interactions. Measuring obesity includes BMI, waist circumference, body fat percentage, and fat distribution. The regulation of energy balance and factors influencing obesity risk are multifaceted.
Management Of Obesity In Family Practice Cme 30 May08Gauranga Dhar
The document discusses obesity management in family practice. It defines obesity as a BMI of 30 kg/m2 or higher and notes that obesity is now a global epidemic according to the WHO. The management of obesity involves assessment to determine the degree and overall health status, followed by management focusing on weight loss, weight maintenance, and controlling other risk factors like cardiovascular disease and diabetes. Lifestyle and diet changes, physical activity, and behavior modification are emphasized as the primary non-pharmacological treatment approaches.
This document discusses obesity and provides information about its causes, health risks, and measurements. It defines obesity as an excess of adipose tissue mass caused by an imbalance of calorie intake and expenditure. Obesity is a worldwide health concern and increases the risk of numerous chronic diseases like diabetes, cardiovascular disease, and certain cancers. The document examines several methods for measuring obesity, such as BMI, waist circumference, and skin fold thickness, and provides BMI categories and health risk levels.
This document provides information about bariatric/metabolic surgery and what patients should know. It discusses why weight loss is important for improving health and quality of life. The goals of surgery are lower body weight, improved quality of life, reduced morbidity, and cost effectiveness. Different types of operations are described, including gastric band, gastric bypass, and sleeve gastrectomy. Expected weight loss is 25-30% of excess weight long term. Surgery resolves many obesity-related health conditions and complications are rare. Close follow up is required after surgery. Surgery is now being considered as a treatment for type 2 diabetes and other metabolic conditions even in patients with mild obesity.
This document discusses clinically severe or morbid obesity. It defines morbid obesity as a BMI over 40 or being 100 or more pounds overweight. Morbid obesity is considered an independent disease that leads to numerous health risks and reduced life expectancy. While medical treatments can achieve modest short-term weight loss, bariatric surgery is the most effective treatment for morbid obesity and results in significant and long-term weight loss for most patients. The Roux-en-Y gastric bypass, gastric sleeve, and laparoscopic gastric banding are discussed as surgical options for weight loss.
Obesity is defined as excess body fat accumulation that can impair health. It is assessed using body mass index (BMI), waist circumference, and other measures. While some argue it is not a true disease, others believe it is as it is associated with numerous comorbidities. Treating obesity involves diet, exercise and behavior changes. Pharmacotherapy or surgery may be used for more severe obesity, especially if comorbidities are present. Maintaining weight loss is challenging as the number of fat cells does not decrease significantly with dieting.
This document provides an overview of obesity, including its definition, prevalence, assessment, complications, and management. Some key points:
- Obesity is defined as abnormal growth of adipose tissue due to enlarged fat cells or increased fat cell number.
- Over 1.5 billion adults worldwide are overweight or obese, with the highest rates in the US. Obesity is a risk factor for many chronic diseases.
- Assessment methods include BMI, skin fold thickness, and waist circumference. Complications include increased risk of heart disease, diabetes, and some cancers.
- Management involves diet, exercise, behavior modification, pharmacotherapy, and sometimes surgery. Treatment aims to reduce calorie intake and increase energy expenditure to promote weight loss
This document discusses obesity, its prevalence, and management. It notes that obesity produces complications like hypertension, diabetes, and heart disease. The prevalence of obesity is increasing globally and is a leading risk factor for death. Obesity is defined as abnormal growth of adipose tissue due to enlarged fat cells or increased fat cell number. The document discusses factors contributing to obesity like diet, physical inactivity, and genetics. It also outlines methods for measuring obesity and classifications based on BMI. Prevention and treatment options for obesity like diet, exercise, and surgery are mentioned.
This document discusses the pathophysiology of bariatric surgery. It notes that obesity is a global epidemic impacting over 1.7 billion people. Obesity is associated with numerous serious health conditions and comorbidities. Diet and pharmaceutical interventions have proven ineffective for treating severe or morbid obesity. The document outlines the various medical comorbidities of obesity including metabolic, mechanical, degenerative, neoplastic, and psychological conditions. It discusses the criteria for indicating bariatric surgery including BMI over 40 or over 35 with comorbidities. The goals and various procedures of bariatric surgery including restrictive, malabsorptive, and hybrid techniques are summarized.
Webinar+presentation info mb+ppt-120422Ron Haugland
Overweight and obesity are global issues that have more than doubled since 1980. Poor nutrition, especially a diet high in carbohydrates, and lack of exercise are the main drivers of increasing weight worldwide. The metabolic balance program addresses this by recommending a diet with 3 meals per day, fewer and higher quality carbohydrates, and normal calorie intake instead of low-calorie or low-fat diets. An independent study found that over 60% of participants following the metabolic balance program lost over 5% of their body weight and maintained the loss for at least one year.
This document discusses anaesthetic considerations for morbidly obese patients. Key points include:
- Morbid obesity is defined as a body weight more than twice the ideal body weight or 100kg heavier.
- It is associated with increased risks of cardiovascular, respiratory, endocrine and other medical conditions.
- Anaesthetic challenges include difficulties with airway management, ventilation, increased drug volumes of distribution and altered pharmacokinetics.
- Thorough pre-operative evaluation of co-morbidities and risks is important for planning anaesthesia.
the obesity and nutrition biochemistry,Lecture no 6muti ullah
Obesity is an excess accumulation of body fat that results from consuming more calories than burned. It increases the risk of diseases like heart disease, diabetes, and liver disease. Body mass index (BMI) is used to measure obesity, with a BMI over 30 indicating obesity. Obesity can be endogenous from genetic or hormonal factors, or exogenous from overeating and lack of exercise. Weight loss treatments include diet, exercise, pharmacological aids like Orlistat that block fat absorption, and sometimes surgery for severe obesity.
This document discusses exercise and its role in weight management for obesity. It begins by outlining the epidemiology of obesity, noting its increasing prevalence globally and associated health risks like reduced life expectancy and increased risk of heart disease and diabetes. It then defines overweight and obesity based on body mass index, and discusses the heterogeneity of obesity and importance of identifying those at high cardiovascular risk. The document outlines adipose tissue metabolism and how excess abdominal fat is particularly linked to an atherogenic metabolic profile. It concludes by discussing the role of exercise in improving insulin sensitivity and impacting adipose tissue metabolism.
Presentation by Prof. Francesco Rubino, Chair of Bariatric and Metabolic Surgery King's College London Consultant (Hon) Surgeon, King’s College Hospital during ECIPE Roundtable: Fighting the Burden of Obesity, Brussels 07/02/2017
An obese patient presents additional challenges for anesthesia. Their cardiovascular system must work harder to meet increased metabolic demands, which can lead to left ventricular hypertrophy, pulmonary hypertension, and right heart failure. Respiratory function is also impaired with reduced lung volumes, ventilation/perfusion mismatch, and increased risk of obstructive sleep apnea. Careful consideration of fluid management and vascular access is needed due to differences in physiology compared to non-obese patients.
This document discusses bariatric surgery as a treatment for obesity, diabetes, and hypertension - known as the "dangerous triad". It outlines the obesity epidemic globally and in India. Bariatric surgery is presented as the most effective long-term treatment, as other options like diet, exercise, and medication often only achieve temporary weight loss. The document describes various bariatric surgical procedures and their mechanisms for weight loss and resolving comorbidities. Case studies are presented demonstrating successful weight loss and comorbidity resolution through bariatric surgery. Risks are low but include leaks, strictures, and potential for weight regain. A multidisciplinary team approach is emphasized for best outcomes.
Care of the bariatric patient for the OR Nurselaurelabaker
This document discusses care considerations for bariatric or obese patients. It defines bariatric as relating to weight and discusses classifications of obesity using body mass index. Morbid obesity is defined as a BMI of 40 or higher and is associated with numerous health risks and comorbidities. Providing care for obese patients requires awareness of physiological changes, risks of procedures, appropriate drug dosing, and mobilization to prevent complications like blood clots.
Systematic review of 26 studies with 55,792 patients found that dedicated neurocritical care (NCC) was associated with decreased risk of mortality (17% relative risk reduction) and decreased risk of poor functional outcomes (17% relative risk reduction) in critically ill brain-injured adults. A survey of Australian ICUs found limited availability of NCC, with only 4 centers specializing in it and 9 employing an intensivist subspecializing in NCC. Continuous EEG monitoring was found to have higher sensitivity for detecting nonconvulsive seizures than routine EEG monitoring, and was associated with reduced in-hospital mortality, though barriers to its universal use include infrastructure and personnel requirements.
CORTICAL SPREADING DEPOLARISATION IN NEUROLOGICAL DISEASE – AN INTRODUCTION
By Toby Jeffcote
Cortical spreading depolarization (CSD) is a spreading loss of ion homeostasis, altered vascular response, change in synaptic architecture, and subsequent depression in electrical activity following an inciting neurological injury.
It was first described by Leão in 1944, a disturbance in neuronal electrophysiology has since been demonstrated in a number of animal studies, and recently a few human studies that examine the occurrence of this depolarizing phenomenon in the setting of a variety of pathological states, including migraines, cerebrovascular accidents, epilepsy, intracranial hemorrhages, and traumatic brain injuries. The onset of CSD has been demonstrated experimentally following a disruption in the neuronal environment leading to glutamate-induced toxicity. This initial event leads to pathological changes in the activity of ion channels that maintain membrane potential. Recovery mechanisms such as sodium-potassium pumps that aim to restore homeostasis fail, leading to osmolar shifts of fluid, swelling of the neuron, and ultimately a measurable depression in cortical activity that spreads in the order of millimeters per minute. Equally important is the resulting change in vascular response. In healthy tissue, increased electrical activity is coupled with release of vasodilatory factors such as nitric oxide and arachidonic acid metabolites that increase local blood flow to meet increased energy expenditure. In damaged tissue, not only is the restorative vascular response lacking but a vasoconstrictive response is promoted and the ischemia that follows adds to the severity of the initial injury. Tissue threatened by this ischemic response is then at elevated risk for CSD propagation and falls into a vicious cycle of electrical and hemodynamic disturbance. Efforts have been made to halt this spreading cortical depression using N-methyl-D-aspartate receptor antagonists and other ion channel blockers to minimize the damaging effects of CSD that can persist long after the triggering insult.
Celia Bradford takes us through the latest on the management of subdural haemorrhage (SDH). She covers acute SDH, chronic SDH and middle meningeal artery embolisation, a novel treatment for chronic SDH management in certain circumstances.
Andy Neill - More neuroanatomy pearls for neurocritical careSMACC Conference
Andy Neill shares some more neuroanatomy wisdom that's highly practical for anyone working with neuro emergencies. This time he covers brain herniation syndromes, hydrocephalus, extradural vs subdural haematomas, cervical spinal imaging, vertebral artery dissection and "things you read on CT reports but don't know what they mean"!
Andrew Udy talks about Brain Tissue Oxygen Monitoring:
It’s Not What You’ve Got It’s What You Do With It
The BONANZA Trial
Andrew Udy talks about the ongoing BONANZA Trial which is assessing whether an algorithm that incorporates both ICP and brain tissue oxygen (PbTO2) can improve outcomes after traumatic brain injury (TBI). Like with all monitoring, how the PbTO2 is interpreted and managed is critical and the devil is in the detail!
More on BONANZA here
More on BOOST3 here
R. Loch Macdonald, M.D., Ph.D.
Community Neurosciences Institute
Fresno, California, USA
Angiographic vasospasm and more accurately, delayed cerebral ischemia, continue to contribute to morbidity and mortality in patients with aneurysmal subarachnoid hemorrhage (SAH). It is known that angiographic vasospasm is common after SAH, occurring in two-thirds of patients. Cerebral infarctions that developed days after the SAH have been attributed to angiographic vasospasm, occuring in about a third of patients, although this has always been controversial. Angiographic vasospasm theoretically can only damage the brain by restricting blood flow but there is no easy, accurate, widely available method to measure cerebral blood flow and this is not the measurement we need. Blood flow depends on metabolic demand so what we need to know to determine if angiographic vasospasm is causing ischemia is oxygen extraction fraction in the brain tissue supplied the the spastic artery. Without this measurement, the attribution of ischemia to vasospasm is subjective. Since angiographic vasospasm is essentially the only detectable delayed phenomenon after SAH, we focus on it and apply tremendous resources to preventing or reversing the vasospasm. Undoubtedly angiographic vasospasm can cause cerebral infarctions, but it has to be severe and flow limiting. But SAH is a complex disease. There are many other causes for cerebral infarctions after SAH, the most common being due to the aneurysm repair procedure. And a given degree of vasospasm may cause infarction in a volume-depleted patient with poor collateral blood supply but not in a patient without these things. There also are hypodense brain lesions after SAH that are due to intracerebral hemorrhages. There can be hypodensities in the brain directly under usually thick SAH where the brain dies. This observation in particular supports a role for cortical spreading depolarizations/ischemia as a cause of infarction after SAH. Other macromolecular processes that are hypothesized to cause brain damage after SAH include microthromboembolism, changes in the microcirculation, delayed brain cell apoptosis and capillary transit time heterogeneity. Determining the importance of these things is hindered by the lack of an easy way to detect them in patients. It is also known that poor grade patients, who presumably have more early brain injury and ischemia than good grade patients, are more prone to delayed cerebral ischemia, suggesting increased sensitivity to secondary insults of the already injured brain. We also assume delayed neurological deterioration when attributed to vasospasm or delayed cerebral ischemia, is purely due to ischemia. While knowledge about what happens pathophysiologically after SAH is increasing, management of delayed cerebral ischemia still focuses on detecting angiographic vasospasm and then augmenting the blood pressure to improve cerebral blood flow or dilating the spastic arteries with balloons or drugs.
By Catherine Bell and Andrew Udy
Catherine Bell takes us through how to troubleshoot problems commonly encountered when looking after patients who have an external ventricular drain (EVD) in situ. Issues with using brain tissue oxygen monitors are also discussed. A highly practical session aimed at bedside clinicians.
There is no such thing as mild, moderate and severe TBI - by Andrew UdySMACC Conference
Part 2 of a debate over the classification of TBI. Andrew Udy then argues that this classification is fundamentally flawed. He discusses the issues with the Glasgow Coma Scale, and therefore the follow-on issues in TBI classification, including all the confounders to the GCS, the issues with timing of the score as well as GCS not taking baseline function or specifics subtypes of TBI into account. He makes teh argument that biomarkers may better categorise the diffuse entity we call TBI.
TBI Debate - Mild, moderate and severe categories workSMACC Conference
Andrew Chow, Intensivist with a neurosurgical background, argues that the current categorisation system for traumatic brain injury (TBI) works, and makes sense! He tackles us through the history of this system, and why it’s important to differentiate different types of TBI. The arguments in favour of this categorisation include the consistency and benefits of a universal language, the implications for triage and management, and the fact that this system has been endorsed by all major organisations
Dr Nick Little is an experienced Neurosurgeon who's looked after patients with traumatic brain injury for his whole career. Here he discusses the difficulties of prognostication following traumatic brain injury (TBI). He talks about the statistics of outcomes following mild, moderate and severe TBI and then goes on to tackle the harder topic of how we try to work out what an individual would want if they knew the spectrum of outcomes that they may face. The issues with the clinical examination findings we use to prognosticate are covered, as well as which imaging findings he finds most helpful. He also mentions the difficulties with current prognostic calculators.
Historically, when it came to brain injury, ketamine had a bad rap. Much of that dogma was dispelled in the last decade, and ketamine is now frequently used as an induction agent in acute brain injury, especially traumatic brain injury, due to it’s favorable effects on haemodynamics.
However a new application of ketamine is now being explored - whether ketamine may be able to reduce secondary brain injury.
Managing Complications of Chronic SCI by Bonne LeeSMACC Conference
20 million people around the world are living with a spinal cord injury (SCI). The medical issues they develop over the years differ to any other patient cohort.
These complications include autonomic dysreflexia, management of pressure areas, specific infections, nuanced peri-operative care and highly specific issues such as baclofen pump management and syringomyelia
Do look at the NeuroResus section on this and listen to Spinal Rehab Specialist Bonne Lee talk about this side of SCI care.
Keywords
SCI, spinal, spinal cord injury, autonomic dysreflexia, pressure areas, infection, peri-operative care, baclofen pump, syringomyelia, chronic SCI, spinal trauma, spinal rehab, incomplete SCI
Tania is a neurologist and epileptologist with expertise in continuous EEG (cEEG) and status epilepticus (SE). This talk covers what a seizure is, what status is, including focal and generalised status epilepticus.
So why do we do cEEGs for patients with suspected SE?
To confirm the diagnosis
To see if patient just post ictal or still seizing
To establish that the clinical and electric seizures have stopped
To see if burst suppression is achieved
To exclude other differential diagnoses
She makes a good argument for why cEEG is such an important tool in managing SE.
In the questions after the talk, the issue of availability of cEEG in the Australian setting was discussed. Limited montage EEGs are discussed including their pros and cons.
Stuart Browne is a Neuro Rehab specialist from Sydney. These slides accompany a talk he gave at the Brian Symposium in 2023. He discusses what "severe disability" really means.
Severe disability is more common than many realise - about 6% of the Australian population.
Stuart discusses how health is more than simply physical recovery and how it is a multidimensional construct. He covers how permanent disability doesn't necessarily equate to a poor quality of life. He also discusses the long timespan of recovery, which is often much longer than appreciated.
He specifically discusses "Locked-in Syndrome" and how the survivors have surprisingly positive self-reported health-related quality of life and well-being.
Stuart also covers how severely disabled people face various forms of discrimination.
Shree Basu is a Paediatirc Intensivist in Sydney. These slides from the Brain Symposium 2023 accompany the talk she gave. She discusses how Paediatric stroke presents, what neuroimaging is required and what interventions are available, including thrombolysis and the role of endovascular thrombectomy.
Hypertensing Spinal Cord Injury - gold standard or wacky?SMACC Conference
This document discusses the concept of maintaining higher blood pressure levels, known as hypertension, after a spinal cord injury to improve spinal cord perfusion pressure and reduce secondary injury. It notes that while animal studies and some human trials have shown improved neurological outcomes, the evidence is still limited. It calls for larger randomized controlled trials in humans that also incorporate multi-modal monitoring and standardized outcome measures to further evaluate if inducing hypertension after spinal cord injury should be considered the gold standard of care.
Mark Weedon takes us through the increasingly utilised concept of an optimal cerebral perfusion pressure (CPPopt) for each unique patient. He discusses the background to CPPopt, including intrcranial pressure (ICP), the Monroe Kelly hypothesis, neurovascular coupling, and cerebral autoregulation in health and following brain injury. He shows how intracranial pressure is affected by intracranial compliance and how this affects ICP waveforms. Cerebral perfusion pressure in relation to the Brain Trauma Foundation guidelines is covered including management of elevated ICP (EICP). The currently recommended tiered approach to managing cerebral perfusion pressure and EICP is mentioned citing recent guidelines. He uses a clinical case of a TBI to illustrate how the CPPopt can be ascertained and used to guide therapy, including the easy to perform “MAP Challenge”. Mark also describes the Pressure Reactivity Index (PRx) and how it can be used as a target for therapy. Finally, he covers the exciting results of the preliminary COGiTATE pilot study.
Social Worker Victoria Whitfield and Bereavement councilor Louise Sayers discuss the power of words when health professionals are communicating topics around of death and serious injury with relatives and patients in critical care. They use role plays to bring theories to life.
Sepsis and Antimicrobial Stewardship - Two Sides of the Same CoinSMACC Conference
Undertreatment of sepsis can lead to mortality, while overdiagnosis and overtreatment can increase future risk of antimicrobial resistance. Antimicrobial stewardship aims to balance these risks by prioritizing patient safety and appropriate antimicrobial use. Data shows variability in appropriateness of antimicrobial prescribing between different types of hospitals. Embedding antimicrobial stewardship principles throughout sepsis diagnosis and treatment, from initial microbiology testing to post-treatment review, can help standardize care and optimize outcomes.
Being able to prognosticate in the aftermath of a traumatic brain injury (TBI) is important as it assists with counselling patients and families. Moreover, it helps rationally allocate healthcare resources.
However, due to the heterogenous nature of TBI and variable pre brain injury patient factors and post brain injury course, this has proven to be a difficult task.
Large cohort studies have enabled improved accuracy in the prediction of 6 month mortality and unfavourable outcome.
Furthermore, many of the factors that contribute to long-term outcome have also emerged. However, it is not yet possible to use them in prediction algorithms or mathematical models.
There is emerging evidence that pre injury psychosocial and demographic factors may be of more relevance than injury severity. Moreover, that 'outcome' becomes increasingly subjective and complex as the post injury duration increases.
We end with three brief vignettes which highlight the fraught nature of long term outcome prediction.
Giloy in Ayurveda - Classical Categorization and SynonymsPlanet Ayurveda
Giloy, also known as Guduchi or Amrita in classical Ayurvedic texts, is a revered herb renowned for its myriad health benefits. It is categorized as a Rasayana, meaning it has rejuvenating properties that enhance vitality and longevity. Giloy is celebrated for its ability to boost the immune system, detoxify the body, and promote overall wellness. Its anti-inflammatory, antipyretic, and antioxidant properties make it a staple in managing conditions like fever, diabetes, and stress. The versatility and efficacy of Giloy in supporting health naturally highlight its importance in Ayurveda. At Planet Ayurveda, we provide a comprehensive range of health services and 100% herbal supplements that harness the power of natural ingredients like Giloy. Our products are globally available and affordable, ensuring that everyone can benefit from the ancient wisdom of Ayurveda. If you or your loved ones are dealing with health issues, contact Planet Ayurveda at 01725214040 to book an online video consultation with our professional doctors. Let us help you achieve optimal health and wellness naturally.
Pictorial and detailed description of patellar instability with sign and symptoms and how to diagnose , what investigations you should go with and how to approach with treatment options . I have presented this slide in my 2nd year junior residency in orthopedics at LLRM medical college Meerut and got good reviews for it
After getting it read you will definitely understand the topic.
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- 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
Know the difference between Endodontics and Orthodontics.Gokuldas Hospital
Your smile is beautiful.
Let’s be honest. Maintaining that beautiful smile is not an easy task. It is more than brushing and flossing. Sometimes, you might encounter dental issues that need special dental care. These issues can range anywhere from misalignment of the jaw to pain in the root of teeth.
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
Nano-gold for Cancer Therapy chemistry investigatory projectSIVAVINAYAKPK
chemistry investigatory project
The development of nanogold-based cancer therapy could revolutionize oncology by providing a more targeted, less invasive treatment option. This project contributes to the growing body of research aimed at harnessing nanotechnology for medical applications, paving the way for future clinical trials and potential commercial applications.
Cancer remains one of the leading causes of death worldwide, prompting the need for innovative treatment methods. Nanotechnology offers promising new approaches, including the use of gold nanoparticles (nanogold) for targeted cancer therapy. Nanogold particles possess unique physical and chemical properties that make them suitable for drug delivery, imaging, and photothermal therapy.
How to Control Your Asthma Tips by gokuldas hospital.Gokuldas Hospital
Respiratory issues like asthma are the most sensitive issue that is affecting millions worldwide. It hampers the daily activities leaving the body tired and breathless.
The key to a good grip on asthma is proper knowledge and management strategies. Understanding the patient-specific symptoms and carving out an effective treatment likewise is the best way to keep asthma under control.
The skin is the largest organ and its health plays a vital role among the other sense organs. The skin concerns like acne breakout, psoriasis, or anything similar along the lines, finding a qualified and experienced dermatologist becomes paramount.
Breast cancer: Post menopausal endocrine therapyDr. Sumit KUMAR
Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
Staging involves determining the size of the tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). The American Joint Committee on Cancer (AJCC) staging system is commonly used. Accurate staging is critical as it guides treatment decisions.
Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
2. BMI can we squeeze themBMI can we squeeze them
in?in?
3.
4. ObjectivesObjectives
Increasing prevalence of obesityIncreasing prevalence of obesity
Definition and types of obesityDefinition and types of obesity
Pathophysiology of obesityPathophysiology of obesity
Effects on drug distribution and handlingEffects on drug distribution and handling
Physical challenges of the bariatric patientPhysical challenges of the bariatric patient
5. Size of the problem!Size of the problem!
Growing epidemic in developed countriesGrowing epidemic in developed countries
Estimated 250 million obese people worldwideEstimated 250 million obese people worldwide
In the USA 66% of the adult population are overweightIn the USA 66% of the adult population are overweight
and make up 30% of ICU admissions.and make up 30% of ICU admissions.
Obesity is a global epidemicObesity is a global epidemic
WHO estimates in 2002 there were 2.5 million weightWHO estimates in 2002 there were 2.5 million weight
related deathsrelated deaths
Problem of social and psychological dimension thatProblem of social and psychological dimension that
affects all ages and socioeconomic groupsaffects all ages and socioeconomic groups
Australia by 2010 predicted prevalence of BMI >30Australia by 2010 predicted prevalence of BMI >30
kg/m2kg/m2
27.4% of males27.4% of males
29.1% of females29.1% of females
6.
7.
8. Quetelet IndexQuetelet Index
Category BMI range -kg/mCategory BMI range -kg/m22
Starvation less than 14.9Starvation less than 14.9
Underweight from 15 to 18.4Underweight from 15 to 18.4
Normal from 18.5 to 24.9Normal from 18.5 to 24.9
Overweight from 25 to 29.9Overweight from 25 to 29.9
Obese from 30 to 39.9Obese from 30 to 39.9
Morbidly Obese greater than 40Morbidly Obese greater than 40
12. ObesityObesity
Waist circumference >102cm in Males andWaist circumference >102cm in Males and
>88cm in females indicates high risk of>88cm in females indicates high risk of
metabolic and cardiovascular complicationsmetabolic and cardiovascular complications
18. Outcomes from ICUOutcomes from ICU
APACHE and SAPS scoring do not take BMIAPACHE and SAPS scoring do not take BMI
into account.into account.
Several studies looking at obesity and risk ofSeveral studies looking at obesity and risk of
death with conflicting results.death with conflicting results.
Two recent meta-analyses demonstrated noTwo recent meta-analyses demonstrated no
difference in mortality between critically ill obesedifference in mortality between critically ill obese
and those with a normal BMI.and those with a normal BMI.
There may even be an improved survivalThere may even be an improved survival
““The Obesity Survival Paradox”The Obesity Survival Paradox”
19.
20. Causes of obesityCauses of obesity
GeneticGenetic
EnvironmentalEnvironmental
PsychologicalPsychological
SocialSocial
Control of appetite and satietyControl of appetite and satiety
Lectin, adiponectin, insulin, ghrelin, peptide YYLectin, adiponectin, insulin, ghrelin, peptide YY
Leptin satiety, decreases appetiteLeptin satiety, decreases appetite
ObeseObese
increased leptin (produced by adipose cells)increased leptin (produced by adipose cells)
Decreased sensitivity to leptinDecreased sensitivity to leptin
21. Pathophysiology of obesityPathophysiology of obesity
Type II diabetesType II diabetes
HypertensionHypertension
Heart disease and strokeHeart disease and stroke
OsteoarthritisOsteoarthritis
DyslipidaemiaDyslipidaemia
Cancer (endometrial breast and colon)Cancer (endometrial breast and colon)
Liver diseaseLiver disease
Obesity hypoventilation syndromeObesity hypoventilation syndrome
22. Drug administration and kineticsDrug administration and kinetics
Increased body massIncreased body mass
Fat distribution in organsFat distribution in organs
Increased blood volumeIncreased blood volume
Increased muscle massIncreased muscle mass
Increased clearanceIncreased clearance
Decreased water to lipid ratioDecreased water to lipid ratio
23. PharmacokineticsPharmacokinetics
Lipophilic drugs Total body weightLipophilic drugs Total body weight
BenzodiazepenesBenzodiazepenes
PropofolPropofol
Fentanyl – loading dose TBW then IBWFentanyl – loading dose TBW then IBW
Hydrophobic drugsHydrophobic drugs
Neuromuscular blockers IBWNeuromuscular blockers IBW
Vancomycin TBWVancomycin TBW
Gentamicin / ciprofloxacin IBW + fractionGentamicin / ciprofloxacin IBW + fraction
Increased renal and hepatic clearanceIncreased renal and hepatic clearance
(increased blood flow)(increased blood flow)
24. Ideal body weightIdeal body weight
Mathematical conceptMathematical concept
Brocca (French surgeon 1871)Brocca (French surgeon 1871)
Wt (kg) = ht (cm) – 100 = ideal body wtWt (kg) = ht (cm) – 100 = ideal body wt
+/- 15% for women and 10% for men+/- 15% for women and 10% for men
““Corrected” body weight = IBW + 40%Corrected” body weight = IBW + 40%
excessexcess
25. NutritionNutrition
Prone to protein malnutrition as a result ofProne to protein malnutrition as a result of
metabolic stressmetabolic stress
Elevated basal insulin, supresses lipolysisElevated basal insulin, supresses lipolysis
leading to accelerated conversion ofleading to accelerated conversion of
protein to glucoseprotein to glucose
Start feeding within 24 hours of admissionStart feeding within 24 hours of admission
Most calories should be carbs and fat toMost calories should be carbs and fat to
prevent FFA deficiencyprevent FFA deficiency
Hypo caloric feeding maybe beneficialHypo caloric feeding maybe beneficial
Dickerson RN, Boschert KJ,Kudsk KA, Brown RO. Hypocaloric enteral tube feeding inDickerson RN, Boschert KJ,Kudsk KA, Brown RO. Hypocaloric enteral tube feeding in
26. AirwayAirway
PositionPosition
TongueTongue
EquipmentEquipment
Mouth openingMouth opening
Short neckShort neck
Neck circumferenceNeck circumference: 5%: 5%
chance difficult intubationchance difficult intubation
if > 40cmif > 40cm butbut 35%35%
chance if >60cm!chance if >60cm!
Best indicator of potentialBest indicator of potential
difficult airwaydifficult airway
STOPBANG risk of OSASTOPBANG risk of OSA
28. Respiratory systemRespiratory system
VentilationVentilation
Position ReversePosition Reverse
Trendelenburg,Trendelenburg,
FRC decreases withFRC decreases with
increasing BMI,increasing BMI,
increased A-aincreased A-a
gradient,gradient,
Rapidly desaturateRapidly desaturate
29. Respiratory systemRespiratory system
Restrictive lung diseaseRestrictive lung disease
Decreased chest wall complianceDecreased chest wall compliance
Diaphragm forced cephaladDiaphragm forced cephalad
Decreased lung volumesDecreased lung volumes
Accentuated by supine and TrendelenbergAccentuated by supine and Trendelenberg
positionspositions
FRC may fall below closing capacityFRC may fall below closing capacity
Alveolar collapseAlveolar collapse
Ventilation / perfusion mismatchVentilation / perfusion mismatch
30.
31.
32. Cardiovascular PathophysiologyCardiovascular Pathophysiology
For every 13.5 kg of fat gained:For every 13.5 kg of fat gained:
25 miles of neovascularization occurs25 miles of neovascularization occurs
Increased blood volumeIncreased blood volume
Increased CO of 0.1 L/min for each kg of fat.Increased CO of 0.1 L/min for each kg of fat.
The blood volume and CO of a person weighingThe blood volume and CO of a person weighing
170 kg are twice that of a 70 kg person170 kg are twice that of a 70 kg person
Regional blood flows are normal, except in theRegional blood flows are normal, except in the
splanchnic bed where it is increased 20%splanchnic bed where it is increased 20%
33.
34. CardiovascularCardiovascular
HypertensiveHypertensive
Difficult to measure BPDifficult to measure BP
Difficult to measure saturationsDifficult to measure saturations
Cardiopulmonary resuscitationCardiopulmonary resuscitation
Pulmonary hypertension right ventricularPulmonary hypertension right ventricular
failurefailure
Fatty infiltration of the myocardiumFatty infiltration of the myocardium
35.
36. Nutrition and metabolismNutrition and metabolism
Malnourished group of patientsMalnourished group of patients
Metabolic syndromeMetabolic syndrome
ObesityObesity
Insulin resistanceInsulin resistance
DyslipidaemiaDyslipidaemia
HyperglycaemiaHyperglycaemia
Proteolytic rather than lipolyticProteolytic rather than lipolytic
Feed regimesFeed regimes
15-20kcal/kg/day IBW15-20kcal/kg/day IBW
Protein 1.5-2g/kg/day IBWProtein 1.5-2g/kg/day IBW
Essential fatty acidsEssential fatty acids
37. Beauty is in the eye of theBeauty is in the eye of the
beholder.beholder.
38. Optimal PositioningOptimal Positioning
Least beneficialLeast beneficial
Supine, Trendelenburg, lithotomy, proneSupine, Trendelenburg, lithotomy, prone
Promote dyspnea, atelectasis, hypoxemiaPromote dyspnea, atelectasis, hypoxemia
Most beneficialMost beneficial
Lateral decubitusLateral decubitus
Displaces the abdomen and allows greater diaphragmDisplaces the abdomen and allows greater diaphragm
excursionexcursion
303000
-45-4500
semirecumbant positionsemirecumbant position
After gastric surgeryAfter gastric surgery
39.
40.
41. Positioning and RehabilitationPositioning and Rehabilitation
Back injuries to staff is a real and constant threatBack injuries to staff is a real and constant threat
Scheduled positioning imperative:Scheduled positioning imperative:
Takes 5 staff to move patient, 3 staff if using aTakes 5 staff to move patient, 3 staff if using a
specialized moving mattressspecialized moving mattress
Physical Therapist provides education related toPhysical Therapist provides education related to
correct body mechanics to prevent injury to staffcorrect body mechanics to prevent injury to staff
and patientand patient
42.
43. Physical AssessmentPhysical Assessment
BPBP: use thigh cuff or regular cuff on forearm: use thigh cuff or regular cuff on forearm
Breath soundsBreath sounds: displace skin folds: displace skin folds
Bowel soundsBowel sounds: girth measurements accurately: girth measurements accurately
identify distentionidentify distention
HeartHeart: auscultate over L lateral chest when pt is: auscultate over L lateral chest when pt is
turned toward L sideturned toward L side
ABGs more reliable that pulse oximeter due toABGs more reliable that pulse oximeter due to
poor peripheral perfusionpoor peripheral perfusion
Hurst S et al (2004)Hurst S et al (2004)
44. Procedures and DiagnosticProcedures and Diagnostic
TestingTesting
Before ordering & transporting patientBefore ordering & transporting patient
Assure the diagnostic site and equipment canAssure the diagnostic site and equipment can
accommodate pts sizeaccommodate pts size
Consult with the techs beforehandConsult with the techs beforehand
Many recommend transport in patient’s bedMany recommend transport in patient’s bed
Be aware that some elevators may not accommodateBe aware that some elevators may not accommodate
weight of bed, patient, equipment and caregiversweight of bed, patient, equipment and caregivers
45.
46. Prevention of VTEPrevention of VTE
Pulmonary EmbolismPulmonary Embolism
Morbid obesity is an independent risk factorMorbid obesity is an independent risk factor
Primary prevention is key (Mobilization)Primary prevention is key (Mobilization)
Obese patient excluded from trials on effectiveObese patient excluded from trials on effective
prophylactic regimenprophylactic regimen
LMWH Study: nonrandomized prospective study ofLMWH Study: nonrandomized prospective study of
481 bariatric surgery pts (BMI> 50 kg/m2)481 bariatric surgery pts (BMI> 50 kg/m2)
40 mg q 12 hrs was superior to 30 mg q 12 hrs40 mg q 12 hrs was superior to 30 mg q 12 hrs
No difference in bleeding events reportedNo difference in bleeding events reported
Sholten DJ et al (2002)Sholten DJ et al (2002)
IV heparin: weight based dosing, need frequent aPPTIV heparin: weight based dosing, need frequent aPPT
monitoringmonitoring
47. Venous AccessVenous Access
Central linesCentral lines
Obese patients have double the use and lines are inObese patients have double the use and lines are in
longer than non-obese ptslonger than non-obese pts
One study suggests no difference in mechanicalOne study suggests no difference in mechanical
insertion complication rateinsertion complication rate
El-Solh A et al (2001)El-Solh A et al (2001)
Switch to PICC lines as soon as possibleSwitch to PICC lines as soon as possible
48. Impact of Obesity inImpact of Obesity in
mechanically ventilated patients:mechanically ventilated patients:
a prospective studya prospective study
Intensive care medicine 2008 34:1991-1998Intensive care medicine 2008 34:1991-1998
French studyFrench study
MeasurementsMeasurements
Tracheal intubationTracheal intubation
Catheter placementCatheter placement
Nosocomial infectionsNosocomial infections
Development of pressure ulcersDevelopment of pressure ulcers
ICU and hospital outcomeICU and hospital outcome
49. ResultsResults
82 severely obese patients (mean BMI 42+/- 682 severely obese patients (mean BMI 42+/- 6
kg/mkg/m22
))
124 non-obese patients (mean BMI 24 +/- 4124 non-obese patients (mean BMI 24 +/- 4
kg/mkg/m22
))
ICU course the same exceptICU course the same except
Difficulties during tracheal intubation (15 vsDifficulties during tracheal intubation (15 vs
6%)6%)
Post extubation stridor (15 vs 3%)Post extubation stridor (15 vs 3%)
P<0.05P<0.05
Mortality rates (24 and 25%)Mortality rates (24 and 25%)
No difference in risk-adjusted hospital mortalityNo difference in risk-adjusted hospital mortality
50. Obesity is associated with increasedObesity is associated with increased
morbidity but not mortality in critically illmorbidity but not mortality in critically ill
patientspatients
Intensive care medicine 2008 34:1999-2009Intensive care medicine 2008 34:1999-2009
Data from the SOAP studyData from the SOAP study
ResultsResults
198 ICUs in 24 European countries198 ICUs in 24 European countries
BMI available in 2878 pts (91%) of the 3147BMI available in 2878 pts (91%) of the 3147
SOAP study ptsSOAP study pts
120 patients 4.2% underweight120 patients 4.2% underweight
1206 patients 41.9% normal BMI1206 patients 41.9% normal BMI
1047 patients 36.4% overweight1047 patients 36.4% overweight
424 patients 14.7% obese424 patients 14.7% obese
81 patients 2.8% very obese81 patients 2.8% very obese
51. ResultsResults
Obese and very obese BMI>30Obese and very obese BMI>30
More frequent ICU acquired infectionsMore frequent ICU acquired infections
Very obese BMI>40Very obese BMI>40
Trend towards longer ICU and hospitalTrend towards longer ICU and hospital
lengths of staylengths of stay
4.1 (1.8-12.1) vs 3.1 (1.7-7.2) p=0.0564.1 (1.8-12.1) vs 3.1 (1.7-7.2) p=0.056
14.3 (8.4-27.4) vs 12.3 (5.1-24.4) p=0.07714.3 (8.4-27.4) vs 12.3 (5.1-24.4) p=0.077
No significant differences in mortality ratesNo significant differences in mortality rates
None of the BMI categories was associated withNone of the BMI categories was associated with
an increased risk of 60-day in hospital deathan increased risk of 60-day in hospital death
57. ConclusionConclusion
The only difference in morbidity of obeseThe only difference in morbidity of obese
patients who were mechanically ventilatedpatients who were mechanically ventilated
was increased difficulty with intubation andwas increased difficulty with intubation and
higher incidence of post extubation stridor.higher incidence of post extubation stridor.
BMI did not significantly impact onBMI did not significantly impact on
mortality in this mixed population of ICUmortality in this mixed population of ICU
patientspatients
58. SummarySummary
Increasing prevalence of obesityIncreasing prevalence of obesity
Definition and types of obesityDefinition and types of obesity
Pathophysiology of obesityPathophysiology of obesity
Effects on drug distribution and handlingEffects on drug distribution and handling
Physical challenges of the bariatric patientPhysical challenges of the bariatric patient
There really is no increase in mortality!There really is no increase in mortality!