The document discusses the components and functions of the heart-lung machine (HLM). It describes:
1. The HLM takes over the pumping function of the heart and gas exchange function of the lungs during cardiac surgery using extracorporeal circulation (ECC).
2. The basic components of the HLM include blood pumps, an oxygenator, tubing systems, blood filters, a cardiotomy reservoir, and cannulae. Additional components are a heater-cooler device and a mobile console.
3. Roller pumps and centrifugal pumps are used as blood pumps. The oxygenator contains a semipermeable membrane that allows gas exchange. Tubing connects the components to
The heart-lung machine consists of three main components - a pump, oxygenator, and heat exchanger. It is used during open heart surgery to take over the functions of the heart and lungs by circulating and oxygenating the patient's blood. The key components include roller or centrifugal pumps to circulate blood, a membrane oxygenator to oxygenate and remove carbon dioxide from the blood, and a heating/cooling system to regulate the blood temperature. Cannulae connect the heart-lung machine to the patient's circulatory system while tubing connects the various components to circulate the blood extracorporeally during surgery.
1. The document discusses heart-lung bypass units, which provide temporary circulation, oxygenation, and blood filtration during cardiac surgery such as bypass grafting or valve replacement.
2. It describes the components of a typical heart-lung bypass unit including oxygenators, pumps, filters, heat exchangers, and monitoring equipment. Roller pumps and centrifugal pumps are discussed.
3. Safety features are highlighted such as bubble detectors, level detectors, and backup systems to ensure continuous blood flow and oxygenation in case of equipment issues.
A medical equipment that provides Cardiopulmonary bypass, (temporary mechanical circulatory support) to the stationary heart and lungs)
Heart and Lungs are made “functionless temporarily” , in order to perform surgeries
CABG
Energy transmission system for artificial heartIshwar Bhoge
In medical implant systems high efficiency and improving the patient’s mobility. Artificial organs and monitoring devices to be implanted into human body for the extension and the improvement of human lives. The implants must operate inside the body for the considerable period and communicate with outside world wirelessly for exchange of medical data and commands. Rechargeable batteries are recharged remotely through the human skin via inductive links. In my project transformer model, a remote power supply for use in the artificial hearts for easy controllability and high efficiency, which can monitor the charging level of the battery has been designed and implemented. To recharge the battery, the electro-magnetic coupling between primary coil and secondary coil has been used. Primary and secondary windings of the transformer are positioned outside and inside the human body respectively. In such a transformer, the alignment and gap may change with external positioning. The coupling coefficient of the transformer is also varying, and so are the tool to large leakage inductances and the mutual inductance. Resonance-tank circuits with varying resonance frequency are formed from the transformer inductors and external capacitors. A control method is proposed to lock the switching frequency at just above the load insensitive frequency for optimized efficiency at heavy loads. Specifically, operation at above resonant of the resonance circuits is maintained under varying coupling coefficient. A transcutaneous power regulator is built and found to perform excellently with high efficiency and tight regulation under variations of the alignment or gap of the transcutaneous transformer load and input voltage.
The document summarizes the key components and functions of the heart-lung machine. The heart-lung machine is used during open heart surgery to oxygenate blood and pump it through the body while the heart is stopped. It consists of pumps, an oxygenator, and a heat exchanger to circulate and oxygenate blood before returning it to the body. The first successful use in a human was in 1953. Automation of the heart-lung machine is needed to more precisely monitor pressures and detect faults to ensure patient safety during surgery.
The document describes the key components and functioning of a heart-lung machine or cardiopulmonary bypass (CPB) machine. The CPB machine temporarily takes over the heart and lung functions during cardiac surgery by pumping and oxygenating the patient's blood before returning it to the circulation. It consists of a reservoir to collect blood, pumps to circulate it, a heat exchanger to regulate temperature, an oxygenator to add oxygen and remove carbon dioxide, and filters to remove particles before the blood is returned. Different types of oxygenators are discussed that facilitate gas exchange through various mechanisms like diffusion, bubbles, or rotating discs.
CPB provides cardiopulmonary support during cardiac surgery by diverting blood flow away from the heart and through an external circuit that oxygenates the blood and returns it. John Gibbon performed the first successful open heart surgery using CPB in 1953. The key components of a CPB circuit include a venous reservoir, oxygenator, heat exchanger, pump, and arterial filter. Membranous oxygenators are now most commonly used due to reduced blood trauma compared to bubble oxygenators. Proper priming of the circuit is also important for safe initiation of CPB.
This document discusses the design of an energy transmission system for an artificial heart. It begins with background on the human heart and blood flow. It then discusses the development of artificial hearts, including their major components and how they are implanted. The document focuses on the design of an energy transfer scheme using compensation of leakage inductance. It describes determining an optimal control region of operation and the system design specifications. Finally, it discusses control of the system and concludes that the proposed converter offers high efficiency with a minimized device configuration.
The heart-lung machine consists of three main components - a pump, oxygenator, and heat exchanger. It is used during open heart surgery to take over the functions of the heart and lungs by circulating and oxygenating the patient's blood. The key components include roller or centrifugal pumps to circulate blood, a membrane oxygenator to oxygenate and remove carbon dioxide from the blood, and a heating/cooling system to regulate the blood temperature. Cannulae connect the heart-lung machine to the patient's circulatory system while tubing connects the various components to circulate the blood extracorporeally during surgery.
1. The document discusses heart-lung bypass units, which provide temporary circulation, oxygenation, and blood filtration during cardiac surgery such as bypass grafting or valve replacement.
2. It describes the components of a typical heart-lung bypass unit including oxygenators, pumps, filters, heat exchangers, and monitoring equipment. Roller pumps and centrifugal pumps are discussed.
3. Safety features are highlighted such as bubble detectors, level detectors, and backup systems to ensure continuous blood flow and oxygenation in case of equipment issues.
A medical equipment that provides Cardiopulmonary bypass, (temporary mechanical circulatory support) to the stationary heart and lungs)
Heart and Lungs are made “functionless temporarily” , in order to perform surgeries
CABG
Energy transmission system for artificial heartIshwar Bhoge
In medical implant systems high efficiency and improving the patient’s mobility. Artificial organs and monitoring devices to be implanted into human body for the extension and the improvement of human lives. The implants must operate inside the body for the considerable period and communicate with outside world wirelessly for exchange of medical data and commands. Rechargeable batteries are recharged remotely through the human skin via inductive links. In my project transformer model, a remote power supply for use in the artificial hearts for easy controllability and high efficiency, which can monitor the charging level of the battery has been designed and implemented. To recharge the battery, the electro-magnetic coupling between primary coil and secondary coil has been used. Primary and secondary windings of the transformer are positioned outside and inside the human body respectively. In such a transformer, the alignment and gap may change with external positioning. The coupling coefficient of the transformer is also varying, and so are the tool to large leakage inductances and the mutual inductance. Resonance-tank circuits with varying resonance frequency are formed from the transformer inductors and external capacitors. A control method is proposed to lock the switching frequency at just above the load insensitive frequency for optimized efficiency at heavy loads. Specifically, operation at above resonant of the resonance circuits is maintained under varying coupling coefficient. A transcutaneous power regulator is built and found to perform excellently with high efficiency and tight regulation under variations of the alignment or gap of the transcutaneous transformer load and input voltage.
The document summarizes the key components and functions of the heart-lung machine. The heart-lung machine is used during open heart surgery to oxygenate blood and pump it through the body while the heart is stopped. It consists of pumps, an oxygenator, and a heat exchanger to circulate and oxygenate blood before returning it to the body. The first successful use in a human was in 1953. Automation of the heart-lung machine is needed to more precisely monitor pressures and detect faults to ensure patient safety during surgery.
The document describes the key components and functioning of a heart-lung machine or cardiopulmonary bypass (CPB) machine. The CPB machine temporarily takes over the heart and lung functions during cardiac surgery by pumping and oxygenating the patient's blood before returning it to the circulation. It consists of a reservoir to collect blood, pumps to circulate it, a heat exchanger to regulate temperature, an oxygenator to add oxygen and remove carbon dioxide, and filters to remove particles before the blood is returned. Different types of oxygenators are discussed that facilitate gas exchange through various mechanisms like diffusion, bubbles, or rotating discs.
CPB provides cardiopulmonary support during cardiac surgery by diverting blood flow away from the heart and through an external circuit that oxygenates the blood and returns it. John Gibbon performed the first successful open heart surgery using CPB in 1953. The key components of a CPB circuit include a venous reservoir, oxygenator, heat exchanger, pump, and arterial filter. Membranous oxygenators are now most commonly used due to reduced blood trauma compared to bubble oxygenators. Proper priming of the circuit is also important for safe initiation of CPB.
This document discusses the design of an energy transmission system for an artificial heart. It begins with background on the human heart and blood flow. It then discusses the development of artificial hearts, including their major components and how they are implanted. The document focuses on the design of an energy transfer scheme using compensation of leakage inductance. It describes determining an optimal control region of operation and the system design specifications. Finally, it discusses control of the system and concludes that the proposed converter offers high efficiency with a minimized device configuration.
This document discusses different types of blood pumps used for cardiopulmonary bypass, including roller pumps, centrifugal pumps, pulsatile pumps, and nonocclusive roller pumps. It focuses on describing the structure, function, and complications of roller pumps and centrifugal pumps. Roller pumps work by compressing tubing with rollers to propel blood flow, while centrifugal pumps use a rapidly spinning impeller to generate blood flow. Centrifugal pumps are generally safer due to less risk of overpressurization or air embolism, but retrograde flow can occur if power fails or flow is too low.
This document provides an overview of extracorporeal membrane oxygenation (ECMO), including its history, principles, components, indications, and complications. Some key points:
- ECMO is a form of extracorporeal life support that oxygenates blood and removes carbon dioxide outside of the body, then returns the blood to the patient. It has been used since the 1950s and is now standard treatment for some cardiac and respiratory conditions.
- The basic ECMO circuit includes a blood pump, membrane oxygenator, heat exchanger, cannulas, and tubing. There are various configurations depending on whether it is used for respiratory (VV ECMO) or cardiac (VA ECMO) support.
-
An anesthesia workstation integrates components for anesthesia administration into one unit. It consists of an anesthesia machine, vaporizers, ventilator, breathing system, scavenging system, and monitors. Key components include the gas supply system, which receives gases from cylinders and pipelines and regulates pressures, and the vaporizer manifold and anesthetic vaporizers. Modern workstations have additional safety features to prevent delivery of hypoxic gas mixtures and other hazards.
- Terminal units provide connection points for gas delivery from the pipeline system to anesthesia machines and other medical devices. They contain primary and secondary valves to prevent backflow and shut off gas delivery.
- Gas specific connectors like DISS fittings and quick connectors provide non-interchangeable connections between terminal units and equipment outlets to prevent mixing of different gases.
- Alarms monitor the central gas supply and distribution systems for issues like pressure changes, which are indicated on master and local alarm panels. The pipeline network branches from main lines and risers to deliver gases at standardized pressures.
Pumps, oxygenators, and priming solutions are essential components of cardiopulmonary bypass. There are two main types of pumps - roller pumps and centrifugal pumps. Roller pumps work by rolling blood through tubing while centrifugal pumps use centrifugal force to move blood. Membrane oxygenators allow for gas exchange through a semi-permeable barrier, separating blood from gas, and eliminating the damage caused by bubble oxygenators. Proper selection of the components depends on factors such as flow needs, biocompatibility and minimizing trauma to blood during bypass.
The haemodialysis machine controls the cycling of blood through an artificial kidney and dialyzer. It monitors and controls important parameters like blood flow rate, dialysate composition and temperature. The machine mixes dialysate, pumps blood and removes waste and excess fluid from the blood through the semipermeable dialyzer membrane. Safety systems include clamps, pressure monitoring and detectors to prevent air embolism and ensure treatment proceeds safely.
The document discusses the heart-lung machine, which provides temporary circulatory support during cardiac surgery when the heart and lungs are bypassed. It summarizes that the first successful use in a human was in 1953 to repair a heart defect. Modern machines have five pump assemblies, cannulas, reservoirs, oxygenators, heat exchangers, and filters to oxygenate and circulate the blood while regulating temperature and removing microemboli. They allow surgeons to operate on a still heart by diverting blood flow and maintaining systemic circulation, gas exchange, and temperature regulation.
A medical equipment that provides Cardiopulmonary bypass, (temporary mechanical circulatory support) to the stationary heart and lungs)
Heart and Lungs are made “functionless temporarily” , in order to perform surgeries
CABG
Valve repair
Aneurysm
Septal Defects
Ventricular assist device of cardiac Cathetherizationvasanth7pv
The TandemHeart is an extracorporeal ventricular assist device that pumps blood from the left atrium to the femoral arteries. It consists of an external centrifugal pump connected to a transseptal cannula in the left atrium and outflow cannulae in the femoral arteries. It is used to provide temporary circulatory support in cardiogenic shock. Potential complications include bleeding, vascular issues, and limb ischemia which require monitoring and adjustments to cannula placement or addition of distal perfusion catheters.
This document discusses different types of chromatography techniques and the pumps used in each. It covers high performance liquid chromatography (HPLC), ion-exchange chromatography, and size-exclusion chromatography. For HPLC, it describes reciprocating piston pumps that are able to deliver precise, pulse-free flow at high pressures up to 10,000 psi. For ion-exchange chromatography, it mentions pumps must provide pulse-free flow for sensitive detectors and single piston pumps are commonly used. Size-exclusion chromatography utilizes small volume reciprocating pumps for accurately controlled flow rates at pressures up to 7,250 psi.
1. The document discusses the components and functions of a light aircraft hydraulic system, including an engine-driven pump, accumulator, unloading valve, selector valves, pressure relief valves, and filter.
2. An advanced hydraulic system contains more components than a basic system and is used in aircraft to power functions that require higher power and efficiency.
3. The key components and their functions are described: the pump provides pressure and flow, the accumulator stores hydraulic pressure, the unloading valve relieves pressure when not needed, and filters remove small particles from the fluid to protect components.
The document summarizes the key components of a water treatment plant that uses reverse osmosis (RO) technology. It describes the process flow from the raw water intake through various filtration and pumping stages to the RO modules and storage of the filtered permeate water. The main components discussed include raw water and filtrate tanks, multi-media and cartridge filters, high pressure pumps, RO pressure vessels, permeate storage tanks, and associated piping and instrumentation.
Anesthetic equipment and breathing systems are used to deliver precise concentrations of oxygen, anesthetic gases, and ventilation to patients during procedures requiring anesthesia. Key components include:
1) An anesthetic machine with flow meters to control gas delivery and a vaporizer to add anesthetic gas to the carrier gas.
2) An anesthetic breathing system, such as a semi-closed circle system, to transport gases between the machine and patient while preventing excessive rebreathing and absorbing carbon dioxide using a reservoir bag and absorbent canister.
3) Monitoring devices to ensure proper gas delivery and ventilation are provided to the patient.
An anesthesia machine uses gas supply and delivery systems to provide precise mixtures of medical gases like oxygen, nitrous oxide, and anesthetic vapors to patients during surgery. Key components include connections to hospital gas lines, reserve gas cylinders, flow meters, vaporizers, and monitors. Modern machines also integrate ventilators and monitors for vital signs. Anesthesia machines allow anesthesiologists to safely induce and maintain general anesthesia, while carefully controlling gas concentrations and supporting patient breathing.
The heart-lung machine provides temporary circulatory and respiratory support during cardiac surgery, allowing the heart to be stopped and the lungs bypassed. It oxygenates and pumps blood, maintaining circulation while the surgery is performed. Key components include venous and arterial cannulas, pumps, an oxygenator, filters, heat exchangers, and tubing. Membranous oxygenators facilitate gas exchange without bubbles, while roller pumps propel blood flow. Advances aim to further reduce complications like microemboli and post-operative cognitive issues.
Central venous pressure monitoring - Pooja Murkarpooja murkar
Hemodynamic monitoring involves continuously measuring and recording vital physiological parameters in critically ill patients using indwelling catheters and electronic monitoring equipment. It refers to measuring pressures, flows, and oxygenation within the cardiovascular system. There are invasive and non-invasive methods, with invasive methods including central venous pressure monitoring and pulmonary pressure monitoring using catheters and transducers to obtain pressure readings and waveforms. The goal is to detect life-threatening conditions early and evaluate a patient's response to treatment.
Basic Principle of Cardiopulmonary Bypass (CPB).pptxrafiqsumardiomar1
Rafiq Sumardi Omar, BSN, RN, G-CVTS, Malaysia-CCP, Level 5 Cardiovascular Perfusionist, MMed, PhD, is a distinguished expert in the field of cardiovascular perfusion. His lecture on the "Basic Principle of Cardiopulmonary Bypass (CPB)" covers essential concepts and techniques critical to the effective management of CPB procedures. This topic is fundamental for understanding how blood circulation and oxygenation are maintained during heart surgery, ensuring patient safety and successful surgical outcomes.
- ECMO is a form of extracorporeal life support that removes blood from the body, oxygenates it using an artificial lung, then returns it to the body.
- It was first developed in the 1950s and has been increasingly used since the 1970s for conditions like respiratory failure and cardiac failure.
- There are two main types - venovenous ECMO which only supports the lungs, and venoarterial ECMO which also supports the heart.
- ECMO is used as a temporary bridge for patients with severe, potentially reversible conditions while waiting for recovery, a decision on next steps, or an organ transplant.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
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This document discusses different types of blood pumps used for cardiopulmonary bypass, including roller pumps, centrifugal pumps, pulsatile pumps, and nonocclusive roller pumps. It focuses on describing the structure, function, and complications of roller pumps and centrifugal pumps. Roller pumps work by compressing tubing with rollers to propel blood flow, while centrifugal pumps use a rapidly spinning impeller to generate blood flow. Centrifugal pumps are generally safer due to less risk of overpressurization or air embolism, but retrograde flow can occur if power fails or flow is too low.
This document provides an overview of extracorporeal membrane oxygenation (ECMO), including its history, principles, components, indications, and complications. Some key points:
- ECMO is a form of extracorporeal life support that oxygenates blood and removes carbon dioxide outside of the body, then returns the blood to the patient. It has been used since the 1950s and is now standard treatment for some cardiac and respiratory conditions.
- The basic ECMO circuit includes a blood pump, membrane oxygenator, heat exchanger, cannulas, and tubing. There are various configurations depending on whether it is used for respiratory (VV ECMO) or cardiac (VA ECMO) support.
-
An anesthesia workstation integrates components for anesthesia administration into one unit. It consists of an anesthesia machine, vaporizers, ventilator, breathing system, scavenging system, and monitors. Key components include the gas supply system, which receives gases from cylinders and pipelines and regulates pressures, and the vaporizer manifold and anesthetic vaporizers. Modern workstations have additional safety features to prevent delivery of hypoxic gas mixtures and other hazards.
- Terminal units provide connection points for gas delivery from the pipeline system to anesthesia machines and other medical devices. They contain primary and secondary valves to prevent backflow and shut off gas delivery.
- Gas specific connectors like DISS fittings and quick connectors provide non-interchangeable connections between terminal units and equipment outlets to prevent mixing of different gases.
- Alarms monitor the central gas supply and distribution systems for issues like pressure changes, which are indicated on master and local alarm panels. The pipeline network branches from main lines and risers to deliver gases at standardized pressures.
Pumps, oxygenators, and priming solutions are essential components of cardiopulmonary bypass. There are two main types of pumps - roller pumps and centrifugal pumps. Roller pumps work by rolling blood through tubing while centrifugal pumps use centrifugal force to move blood. Membrane oxygenators allow for gas exchange through a semi-permeable barrier, separating blood from gas, and eliminating the damage caused by bubble oxygenators. Proper selection of the components depends on factors such as flow needs, biocompatibility and minimizing trauma to blood during bypass.
The haemodialysis machine controls the cycling of blood through an artificial kidney and dialyzer. It monitors and controls important parameters like blood flow rate, dialysate composition and temperature. The machine mixes dialysate, pumps blood and removes waste and excess fluid from the blood through the semipermeable dialyzer membrane. Safety systems include clamps, pressure monitoring and detectors to prevent air embolism and ensure treatment proceeds safely.
The document discusses the heart-lung machine, which provides temporary circulatory support during cardiac surgery when the heart and lungs are bypassed. It summarizes that the first successful use in a human was in 1953 to repair a heart defect. Modern machines have five pump assemblies, cannulas, reservoirs, oxygenators, heat exchangers, and filters to oxygenate and circulate the blood while regulating temperature and removing microemboli. They allow surgeons to operate on a still heart by diverting blood flow and maintaining systemic circulation, gas exchange, and temperature regulation.
A medical equipment that provides Cardiopulmonary bypass, (temporary mechanical circulatory support) to the stationary heart and lungs)
Heart and Lungs are made “functionless temporarily” , in order to perform surgeries
CABG
Valve repair
Aneurysm
Septal Defects
Ventricular assist device of cardiac Cathetherizationvasanth7pv
The TandemHeart is an extracorporeal ventricular assist device that pumps blood from the left atrium to the femoral arteries. It consists of an external centrifugal pump connected to a transseptal cannula in the left atrium and outflow cannulae in the femoral arteries. It is used to provide temporary circulatory support in cardiogenic shock. Potential complications include bleeding, vascular issues, and limb ischemia which require monitoring and adjustments to cannula placement or addition of distal perfusion catheters.
This document discusses different types of chromatography techniques and the pumps used in each. It covers high performance liquid chromatography (HPLC), ion-exchange chromatography, and size-exclusion chromatography. For HPLC, it describes reciprocating piston pumps that are able to deliver precise, pulse-free flow at high pressures up to 10,000 psi. For ion-exchange chromatography, it mentions pumps must provide pulse-free flow for sensitive detectors and single piston pumps are commonly used. Size-exclusion chromatography utilizes small volume reciprocating pumps for accurately controlled flow rates at pressures up to 7,250 psi.
1. The document discusses the components and functions of a light aircraft hydraulic system, including an engine-driven pump, accumulator, unloading valve, selector valves, pressure relief valves, and filter.
2. An advanced hydraulic system contains more components than a basic system and is used in aircraft to power functions that require higher power and efficiency.
3. The key components and their functions are described: the pump provides pressure and flow, the accumulator stores hydraulic pressure, the unloading valve relieves pressure when not needed, and filters remove small particles from the fluid to protect components.
The document summarizes the key components of a water treatment plant that uses reverse osmosis (RO) technology. It describes the process flow from the raw water intake through various filtration and pumping stages to the RO modules and storage of the filtered permeate water. The main components discussed include raw water and filtrate tanks, multi-media and cartridge filters, high pressure pumps, RO pressure vessels, permeate storage tanks, and associated piping and instrumentation.
Anesthetic equipment and breathing systems are used to deliver precise concentrations of oxygen, anesthetic gases, and ventilation to patients during procedures requiring anesthesia. Key components include:
1) An anesthetic machine with flow meters to control gas delivery and a vaporizer to add anesthetic gas to the carrier gas.
2) An anesthetic breathing system, such as a semi-closed circle system, to transport gases between the machine and patient while preventing excessive rebreathing and absorbing carbon dioxide using a reservoir bag and absorbent canister.
3) Monitoring devices to ensure proper gas delivery and ventilation are provided to the patient.
An anesthesia machine uses gas supply and delivery systems to provide precise mixtures of medical gases like oxygen, nitrous oxide, and anesthetic vapors to patients during surgery. Key components include connections to hospital gas lines, reserve gas cylinders, flow meters, vaporizers, and monitors. Modern machines also integrate ventilators and monitors for vital signs. Anesthesia machines allow anesthesiologists to safely induce and maintain general anesthesia, while carefully controlling gas concentrations and supporting patient breathing.
The heart-lung machine provides temporary circulatory and respiratory support during cardiac surgery, allowing the heart to be stopped and the lungs bypassed. It oxygenates and pumps blood, maintaining circulation while the surgery is performed. Key components include venous and arterial cannulas, pumps, an oxygenator, filters, heat exchangers, and tubing. Membranous oxygenators facilitate gas exchange without bubbles, while roller pumps propel blood flow. Advances aim to further reduce complications like microemboli and post-operative cognitive issues.
Central venous pressure monitoring - Pooja Murkarpooja murkar
Hemodynamic monitoring involves continuously measuring and recording vital physiological parameters in critically ill patients using indwelling catheters and electronic monitoring equipment. It refers to measuring pressures, flows, and oxygenation within the cardiovascular system. There are invasive and non-invasive methods, with invasive methods including central venous pressure monitoring and pulmonary pressure monitoring using catheters and transducers to obtain pressure readings and waveforms. The goal is to detect life-threatening conditions early and evaluate a patient's response to treatment.
Basic Principle of Cardiopulmonary Bypass (CPB).pptxrafiqsumardiomar1
Rafiq Sumardi Omar, BSN, RN, G-CVTS, Malaysia-CCP, Level 5 Cardiovascular Perfusionist, MMed, PhD, is a distinguished expert in the field of cardiovascular perfusion. His lecture on the "Basic Principle of Cardiopulmonary Bypass (CPB)" covers essential concepts and techniques critical to the effective management of CPB procedures. This topic is fundamental for understanding how blood circulation and oxygenation are maintained during heart surgery, ensuring patient safety and successful surgical outcomes.
- ECMO is a form of extracorporeal life support that removes blood from the body, oxygenates it using an artificial lung, then returns it to the body.
- It was first developed in the 1950s and has been increasingly used since the 1970s for conditions like respiratory failure and cardiac failure.
- There are two main types - venovenous ECMO which only supports the lungs, and venoarterial ECMO which also supports the heart.
- ECMO is used as a temporary bridge for patients with severe, potentially reversible conditions while waiting for recovery, a decision on next steps, or an organ transplant.
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Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
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Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
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There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
2. Extracorporeal Circulation
ECC or perfusion is defined as a procedure
carried out with the aid of HLM
In the early stages, cardiac surgery was
mainly concerned with the treatment of
congenital heart defects. Today, the main
focus is on acquired heart defects.
Access path to the operation area is kept
as small as possible to reduce the patient’s
surgical trauma this surgical technique
usually has a direct influence on the
configuration of the HLM and on the way
the perfusion is carried out
OPCAB (off-pump coronary artery bypass)
refer to cardiac surgeries carried out
without the support of an HLM
The HLM can never be looked at in
isolation additional components, mainly in
the form of sterile disposables such as an
oxygenator, heat exchanger, or reservoir,
take on other important functions during
ECC
3. Structure and Function of the Heart–Lung Machine
The HLM is the basis of ECC and cover
two important organ functions :-
1. Pump function of the heart
2. Gas exchange function of the lungs
It must ensure :-
A sufficient perfusion volume that
corresponds to the normal cardiac
output of the patient under
anesthetic
An adequate perfusion pressure (50–
90 mmHg)
It must also ensure sufficient
oxygenation, elimination of CO2, and
control of the blood temperature
The following components make up the
basic equipment of the ECC that is used
during modern cardiac surgery:
1. Blood pumps
2. Oxygenator
3. Tubing system with various tubing
diameters
4. Blood filters with various functions
5. Cardiotomy reservoir
6. Cannulae and intracardiac suction
tubes
4. Blood Pumps and Their Function
Blood pumps can generally be
categorized into two groups, depending
on their function:
1. Roller pumps
2. Centrifugal pumps
Essentially, both pump types should
meet certain criteria when used with
the HLM:
1. Dosed delivery of liquids, with
precise display of the actual flow rate
and delivered volume
2. External control mechanism (e.g.
monitoring functions)
3. Sufficient pressure or vacuum
generation
5. Minimal blood damage
6. Adjustable occlusion settings
(roller pumps only)
7. Pulsatile flow generation
8. High efficiency
9. High reliability and safety
10 . Option for emergency
operation (e.g., manual
operation)
5. Blood Pumps and Their Function
Roller Pumps:-
De Bakey blood pumps are based on the
displacement principle and deliver blood
through a tubing segment from the pump
housing using rotating rollers
The roller pump consists of :-
1. Rotating pump arm with two attached
cylindrical rollers
2. Pump housing into which a semicircular
silicone tubing segment is inserted and
then secured using special tubing
inserts
The rotating rollers alternately compress
the tubing segment and deliver the liquid
contained in the tubing in accordance
with the rotational speed and direction
The exact adjustment of the two rollers
determines the delivery
rollers move outward symmetrically and
block the inserted tube evenly to reduces
erythrocyte damage caused by shear
stress or direct crushing.
6. Blood Pumps and Their Function
Centrifugal Pumps:-
Such pumps use centrifugal
forces to transport the blood instead
of tubing compression.
Because of the technical principle of
operation, the centrifugal pump has
a limited application.
Centrifugal pumps have the
advantage of :-
delivering limited amounts of air
causing less blood damage in the
long run.
An additional flow meter is required
to determine the delivered flow is a
disadvantage.
Centrifugal Pump from www.britannica.com
7. Oxygenator and Gas Exchange Function
Oxygenator:-
The artificial lung, also called the
oxygenator, takes on the lung function
during ECC and is therefore responsible for
the exchange of vital gases.
The membrane oxygenators:-
Are now used as standard.
They contain a semipermeable membrane
in the shape of a microporous hollow fiber.
This liquid-impermeable membrane
separates the gas side from the
bloodstream.
Due to the partial pressure gradients, O2
and CO2 diffuse through the microporous
membrane
Today, most membranes are made of
polypropylene or polyethylene and permit
operating times of 6–8 h
The oxygenator must be able to
oxygenate about 5 litres per minute
of venous blood from 65% oxygen
saturation to above 95% oxygen
saturation before the blood enters
the body systems.
oxygenator
8. The oxygenator
The oxygenator consists of :-
1. A cylindrical glass vessel of 15 cm
internal diameter, 38 cm long
2. 80–100 stainless steel discs of 0.6 mm
thickness and 14 cm diameter are
mounted axially with 3 mm spacers
between discs.
The shaft on which the discs are mounted
is hollow and is supported by three ball
bearings at the ends.
The oxygen is fed through the axis of the
shaft and it enters the oxygenator through
the distributing apertures on the
circumference of the shaft.
The oxygen feed system permits use of disc
diameters close to the diameter of the
oxygenator cylinder so that for a given
blood priming volume maximum utilization
of the available surface area is made.
The optimum blood level in the oxygenator
that provides the maximum film area for a
given volume is 0.7 R where R is the radius
of the disc
9. Tubing Systems for Extracorporeal Circulation
The tubing system is used to connect the
individual components of the
extracorporeal system and forms a closed
circuit with the vascular system of the
patient.
Depending on the location, either PVC or
silicone tubing is used
Tubes are available in different diameters
and wall thicknesses.
Tubing sizes range from a diameter of
1/8" and a wall thickness of 1/16" to
3/16" and 1/4 " for pediatric applications
(with correspondingly low flow rates).
Tubing for adult applications is usually
3/8 " or 1/2 " with a wall thickness of
3/32", facilitating flow rates of more than
10 l/min
Completely preassembled tubing
system with infant oxygenator
(Sorin Group S.p.A., Milan)
10. Blood Filters
Blood filters are integrated into the
ECC system mainly to avoid micro-
embolisms caused by autologous
effect , foreign particles, and
microbubbles
Depth Filters
made of Dacron wool or
polyurethane foam, are inserted into
cardiotomy reservoirs and are used
mainly for particle filtration.
The pore size can vary from 80 -
100μm (coarse separation of
particles) to 20–40μm (micropore
range).
Mesh Filters:-
Made of a mesh of woven polyester
strands.
Used as arterial blood filters and work
on the principle of sieves.
The pore size of mesh filters ranges
from 20 to 40μm.
Unlike depth filters, mesh filters have
little adhesive force.
Their air retention properties are
excellent as air bubbles can only pass
the filter medium when a certain
pressure difference (bubble point
pressure) is reached.
11. Cardiotomy Reservoir
The cardiotomy reservoir functions:-
1. Collects and filters the blood
aspirated from the operation area
and feeds it back into the ECC as
required.
2. Provides volume storage
3. The transparent housing facilitates
continuous level control
A detailed scale makes it easy to
quantify the level and detect
corresponding changes in volume
A minimum residual volume always
remains in the reservoir during the
entire ECC to prevent air delivery
into the extracorporeal system
12. Cannulae
Cannulae are the interface between the
ECC system and the vascular system of the
patient.
They are inserted into the relevant vessels
by a surgeon, where they are secured and
deaerated before their sterile connection
to the tubing system of the HLM.
Two types of cannulae:--
1. Arterial Cannulation
2. Venous Cannulation
Arterial Cannulation:-
Arterial cannulae are used to return the
oxygenated blood to the systemic
circulation of the patient
The aorta ascendens is the most
frequently used site.
The type and size of the selected cannula
depends on both the required blood flow
and the anatomic conditions
Venous Cannulation:-
Venous cannulae drain the patient’s blood
from the venous vascular system to the
HLM.
The type and size of the selected cannula is
determined by conditions that are similar
to those on the arterial side.
Vent Catheters:-
Inserted to protect the temporarily
arrested heart and especially the left
ventricle from overextension due to blood
flowing back from the bronchial
circulation.
Using this vent suction tube, excessive
blood is drained usually via the auricle of
the left atrium or into the cardiotomy
reservoir of the HLM
13. Components of the Heart–Lung Machine
HLM Basic Components:-
1. Mobile console for mounting
multiple pumps
2. Adjustable mast system for
mounting Blood pumps
3. Control and monitoring devices
4. Display and control panel
5. Electronic or mechanical gas
blender
6. Anesthetic gas vaporizer
7. Electronic documentation system
Additional HLM Components:-
1. water mattress
2. Heater–Cooler Device
During ECC, the heat exchanger of the
oxygenator indirectly regulates the
patient’s body temperature by heating or
cooling the blood flow. Patients can also
be placed on a water mattress that
increases or decreases body temperature
14. Components of the Heart–Lung Machine
Mobile console:-
for mounting :-
1. Multiple pumps
2. The power supply
3. Emergency power supply
4. Electronics parts
Adjustable mast system:-
for mounting the holders for:-
1. The oxygenator
2. Filters
3. Cardiotomy reservoirs
4. External pumps, and additional
devices
Figure : shows a modern HLM.
15. Blood pumps:-
Large roller pump:
pump with a longer tubing path in the
pump housing that produces higher flow
rates, required for the arterial blood flow,
suction, or vent pump
Small roller pump:
pump with a shorter tubing path in the
pump housing for lower flow rates, e.g.,
for the perfusion of infants and children
or for the administration of cardioplegic
solutions, usually a double pump
Centrifugal pumps:
pumps for the arterial blood flow.
Components of the Heart–Lung Machine
16. Components of the Heart–Lung Machine
Control and monitoring devices:-
Include :-
1. Pressure monitor:- including
sensors, for measuring different
pressures in the extracorporeal
system and for controlling the flow
rates.
2. Temperature monitor:- including
sensors, for measuring and
displaying different system
temperatures and, if required,
patient temperatures.
3. Level monitor :- including sensors,
for measuring and controlling the
volume level in the cardiotomy
reservoir.
4. Bubble monitor :- in the form of
ultrasonic sensors that regulate the
flow rate of the affected pump
when air is detected in the system.
5. Pulsatile flow control :-for creating
and controlling a pulsatile flow
profile.
6. Cardioplegia control:- including pressure
and bubble sensor, for controlling
cardioplegia delivery.
7. Timer for measuring important times
and intervals during perfusion such as total
perfusion time, aortic clamping time, and
reperfusion time
17. Display and control panel:-
providing access to all display and
control elements described above as
well as to additional system
information and alarm management
Electronic or mechanical gas
blender:-
1. For controlling and displaying the
ventilation gases (air, O2, and CO2)
that are delivered to the gas side of
the oxygenator; vacuum controller.
2. For the precise control and display
of a permanent vacuum on the
venous reservoir
Components of the Heart–Lung Machine
Figure : shows a modern HLM.
18. Components of the Heart–Lung Machine
Anesthetic gas vaporizer:-
Allowing and displaying the
administration of a precisely dosed
amount of anesthetic gas to the
oxygenator.
Electronic documentation system
That displays and stores all relevant data
during perfusion.
All data are stored centrally and
displayed instantly as a perfusion report
which allows for data evaluation at a later
stage for statistical and scientific
purposes.
perfusion report
19. Additional HLM Components:-
Heater–Cooler Device (Heat exchanger ):-
The heater–cooler device delivers water with
a temperature ranging from 2 to 42°C.
The Heat exchanger contain:-
1. Two chamber pumps ensure that the
delivered water does not cause a
buildup of overpressure in the circuits.
2. Two circuits supply the oxygenator and
the heating/cooling mattress
3. Third circuit is connected to the heat
exchanger in the cardioplegia system.
4. Two independent tanks with different
temperatures, which allows instant
switching from cold to warm or vice
versa
Modern heater–cooler devices feature
several circuits with different
temperatures
Heater–cooler devices have always presented
a hygiene challenge because
1. The system parts that transport water
inevitably become contaminated by
germs.
Regular water changes and the use of
appropriate chemical cleaning agents are
the two most effective cleaning and
maintenance strategies.
Components of the Heart–Lung Machine
20. References
Springer Handbook of Medical Technology
Rüdiger Kramme, Klaus-Peter Hoffmann,
Robert S. Pozos
Springer-Verlag Berlin Heidelberg 2011