This document discusses goal-directed hemodynamic therapy and perioperative fluid management. It provides an overview of the following key points:
1) Goal-directed hemodynamic therapy aims to optimize tissue oxygenation through titration of fluids and inotropic agents based on physiologic flow-related endpoints.
2) Liberal fluid management can lead to positive fluid balance and increased complications, while restrictive fluid therapy and avoiding overhydration may improve outcomes.
3) Goal-directed therapy may decrease postoperative infections and complications by optimizing tissue oxygen delivery. Maintaining adequate perfusion pressures is also important.
4) Variables like stroke volume variation and pleth variability index can help indicate fluid responsiveness, unlike central venous and
Assessment of haemodynamics a critically ill patient and its management has always been a matter if debate. Over time a lot of studies and therapeutic interventions have been carried out. This presentation is a review of such interventions and their impact on the outcome.
Erector spinae plane block is a relatively novel approach to pain management for a variety of surgical procedures. ESP block is a challenging anesthesia and analgesia technique that needs more research.
Introduction of organ donation .
Introduction of brain death and pathophysiology following it.
Perioperative problems in organ retrieval .
Goals of management of these patients .
Anesthetic management of the cadaver during organ harvesting.
Assessment of haemodynamics a critically ill patient and its management has always been a matter if debate. Over time a lot of studies and therapeutic interventions have been carried out. This presentation is a review of such interventions and their impact on the outcome.
Erector spinae plane block is a relatively novel approach to pain management for a variety of surgical procedures. ESP block is a challenging anesthesia and analgesia technique that needs more research.
Introduction of organ donation .
Introduction of brain death and pathophysiology following it.
Perioperative problems in organ retrieval .
Goals of management of these patients .
Anesthetic management of the cadaver during organ harvesting.
Iv fluid therapy (types, indications, doses calculation)kholeif
All what you need to know intravenous fluids, types, indications, contraindications, how to calculate fluid rate and drug dosages.
Embed code (http://www.slideshare.net/slideshow/embed_code/16138690)
Minimaly invasive hemodynamic monitoring for hepatic patients Dr.Mahmoud Abbas
Minimaly invasive Cardiovascular monitoring in hepatic patients in the icu lecture presented by Dr Khaled Yassen at the Egyptian African Critical care Summit
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
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ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
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Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
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The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
4. Perioperative fluid management (1)
• Previous concept of assumed perioperative fluid
management: insensible perspiration + third space
loss + NPO (fasting and operative period) fluid loss
• Assumptions & myths:
– The preoperatively fasted patient is hypovolemic (ongoing
perspiration and urinary output)
– The insensible perspiration increases dramatically when the
operation begins
– An unpredictable fluid shift toward the third space requires
generous substitution
– Hypervolemia is harmless because the kidneys regulate the
overload
5. Perioperative fluid management (2)
• Consequence of liberal fluid management:
positive fluid balance and weight gain increased
incidence of complications
• Truth:
– Blood volume after fasting is normal
– Fluid-consuming third space has never been reliably
shown
– Crystalloids physiologically load the interstitial space
– Colloids deteriorates a vital part of the vascular barrier
– Undifferentiated fluid handling increases the shift
toward the interstitial space
6. Perioperative fluid management (3)
• Perioperative fluid therapy:
– Lack of standardization
– Liberal (18-20 ml/kg/h) vs. restrictive (≤ 10
ml/kg/h) regimen
– Target:
• Outcome
• Type of surgery: high-risk vs. low-risk surgery
• Demographs of patients
• Cardiac preload
• Volume (fluid) responsiveness
7. Fluid (volume) responsiveness
• Frank-Starling curve
• Volume responsive – respond
to fluid administration by
increasing C.O.
– e.g. C.I. ≥ 15%
• Predictors
– Spontaneous respiration: PLR
(reversible self-volume
challenge)
– Mechanical ventilation:
respiratory variation of
hemodynamic parameters
8. Limitations of “volume responsiveness” in
measuring blood volume
• There is no proof that volume responsiveness enables
to maximize stroke volume to achieve the optimal
cardiac preload
• PCWP, CVP, LVEDD, early/late diastolic wave ratio,
and duration of LV ejection time all do not
discriminate responders and non-responders to fluid
therapy
• Systolic pressure variation and pulse pressure
variation: low predictive value in low tidal volume
ventilation (e.g. ARDS), cardiac arrhythmic patients,
and spontaneous ventilation
9. CVP and PCWP are not appropriate
predictor of volume responsiveness
• Volume resuscitation targets on severe sepsis & septic shock
– CVP 8-12 mmHg: Surviving Sepsis Campaign guidelines (Dellinger et
al., Crit Care Med 2004)
– PCWP 12-15 mmHg: the American College of Critical Care Medicine
(Hollenberg et al., Crit Care Med 2004)
• Osman et al. (Crit Care Med 2007)
– 96 severe septic or septic shock patients monitored with PA catheter
and mechanically ventilated in MICU
– 150 volume challenges (500 ml of 6% hydroxyethyl starch infusion for
20 min)
– Fluid responsiveness: increase in C.I. induced by the volume challenge
of ≥ 15% as responder
– In septic patients receiving mechanical ventilation, cardiac filling
pressures (PCWP & CVP) afford a poor prediction of fluid
responsiveness
10. SVV and pleth variability index: valid
indicator of fluid responsiveness
Zimmermann et al. Eur J Anaesthsiol 2010
• Compare the accuracy of arterial pressure-based stroke
volume variation (SVV) and variations in the pulse oximeter
plethysmographic waveform amplitude as evaluated with the
noninvasive calculated pleth variability index (PVI) with CVP
to predict the response of stroke volume index (SVI) to
volume replacement in patients undergoing major surgery.
• 20 patients (M/F = 13/7) scheduled for elective major
abdominal surgery
• After induction of anesthesia, all haemodynamic variables
were recorded immediately before (T1) and subsequent to
volume replacement (T2) by infusion of 6% hydroxy-ethyl
starch (HES) 130/0.4 (7 ml/kg) at a rate of 1ml/kg/min
• Fluid responder to volume loading: increase in SVI ≥ 15%.
Time
A-line (FloTrac/Vigileo system)
Pulse oximeter (Masimo Radical-7 monitor)
CVP After
induction
of GA
T1
(Baseline
)
T2 (1 min after
fluid loading)
Fluid loading with 6%
HES 130/0.4 (7 ml/kg) at
a rate of 1 ml/kg/min
11. SVV and pleth variability index: valid
indicator of fluid responsiveness
Zimmermann et al. Eur J Anaesthsiol 2010
• Baseline SVV and PVI correlate significantly with
∆SVI whereas baseline CVP do not correlate with
∆SVI
• The best threshold value to predict fluid
responsiveness:
– SVV > 11%
– PVI > 9.5%
12. Current suggestion of perioperative
fluid management
• The extracellular deficit after usual fasting is
low
• The basal fluid loss via insensible perspiration
is approximately 0.5-1 ml/kg/h during major
abdominal surgery
• A primarily fluid-consuming third space does
not exist
• Avoid over-hydration and keep an adequate
fluid replacement improve outcome
17. Decrease the postoperative infection
• Systemic review and meta-analysis: 26 randomized, controlled
trials with a total of 4188 surgical patients (Dalfino et al., Crit
Care 2011)
• Significant reduction in surgical site infection, pneumonia,
urinary tract infection, and total infectious episodes
• Flow-directed hemodyanamic therapy to optimize O2 delivery
protects surgical patients against postoperative hospital-
acquired infections
• Strategies to prevent infection in surgical patients:
– Strict asepsis
– Antibiotic prophylaxis
– Avoidance of glucose imbalance
– Normothermia
– Flow-directed hemodynamic therapy to optimize O2 delivery
18. Decrease the risks of GI complications
and renal dysfunction
• Reduces GI complications (Giglio et al., Br J
Anaesth 2009)
– 16 RCTs (3410 patients)
– Maintain adequate tissue oxygenation
reduction in GI complications
• Reduction in complicaitons, renal
dysfunction and duration of hospital stay
(Brienza et al., Crit Care Med 2009)
– 20 RCTs on goal-directed therapy (4220
patients)
19. Reduces hospital stay duration & postoperative
complications Mayer et al., Crit Care 2010
25. References
• Chappell D, Jacob M, Hofmann-Kiefer K, Conzen P, Rehm M. A Rational
approach to perioperative fluid management. Anesthesiology 2008;
109(4):723-740.
• Monnet X, Teboul JL. Volume responsiveness. Curr Opin Crit Care 2007;
13(5):549-553.
• Zimmermann M, Feibicke T, Keyl C, Prasser C, Moritz S, Graf BM,
Wiesenack C. accuracy of stroke volume variation compared with pleth
variability index to predict fluid responsiveness in mechanically ventilated
patients undergoing major surgery. Eur J Anaesthesiol 2010; 27(6):551-
561.
• Cannesson M. Arterial pressure variation and goal-directed fluid therapy. J
Cardiothorac Vasc Anesth 2010; 24(3):487-97.
• Osman D, Ridel C, Ray P, Monnet X, Anguel N, Richard C, Teboul JL.
Cardiac filling pressures are not appropriate to predict hemodynamic
response to volume challenge. Crit Care Med 2007; 35(1):64-68.