Mechanical ventilation is used to support patients with respiratory failure by controlling parameters like tidal volume, respiratory rate, and pressure. It requires careful setting and monitoring to prevent complications. Modes include controlled, assisted, and combined settings. Pulmonary rehabilitation uses exercise, education, and breathing techniques to improve symptoms and quality of life for patients with chronic lung disease.
Respiratory conditions in Critically ill Surgical patientMohamed Alasmar
للزملاء المتقدمين لامتحانات اجنبية زي MRCS
و للزملاء اللي منتقلين حديثا للعمل بالمملكة المتحدة او بينوو العمل فيها
تابعونا علي الصفحة الجراح
https://www.facebook.com/algarra7/
الفيديو على اليوتيوب
https://youtu.be/gLuRAzmCchI
Respiratory conditions in Critically ill Surgical patientMohamed Alasmar
للزملاء المتقدمين لامتحانات اجنبية زي MRCS
و للزملاء اللي منتقلين حديثا للعمل بالمملكة المتحدة او بينوو العمل فيها
تابعونا علي الصفحة الجراح
https://www.facebook.com/algarra7/
الفيديو على اليوتيوب
https://youtu.be/gLuRAzmCchI
Acute Respiratory Failure
Impending Respiratory Failure
Prophylactic Ventilatory Support
Hyperventilation Therapy
Respiratory failure is imminent in spite of therapies
Patient is barely maintaining (or experiencing gradual deterioration) of normal blood gases at the expense of significant WOB
Clinical conditions in which there is a high risk of future respiratory failure
Ventilatory support is instituted to:
Decrease the WOB
Minimize O2 consumption and hypoxemia
Reduce cardiopulmonary stress
Control airway with sedation
Examples: Brain injury, heart muscle injury, major surgery, prolonged shock, smoke injury
Ventilatory support is instituted to control and manipulate PaCO2 to lower than normal levels
Acute head injury
Caring patient on Mechanical Ventilator Shanta Peter
Mechanical ventilators are used now in general wards , not only in ICU -to save patient's life. We need to care patient and ventilator while working with it ..
Critically ill patients requiring noninvasive or invasive ventilation often present to emergency departments, and due to hospital crowding and constrained critical care services, may remain in the emergency department for a prolonged duration. Compared with their intensive care unit counterparts, emergency department clinicians may have variable exposure to management of this patient population and may lack knowledge and expertise, particularly in their
longitudinal management beyond initial stabilization. This
review has discussed several key aspects of management
of noninvasive and invasive ventilation, with a particular emphasis on initiation and ongoing monitoring priorities,
and focused on maintaining patient safety and improving
patient outcomes.
Acute Respiratory Failure
Impending Respiratory Failure
Prophylactic Ventilatory Support
Hyperventilation Therapy
Respiratory failure is imminent in spite of therapies
Patient is barely maintaining (or experiencing gradual deterioration) of normal blood gases at the expense of significant WOB
Clinical conditions in which there is a high risk of future respiratory failure
Ventilatory support is instituted to:
Decrease the WOB
Minimize O2 consumption and hypoxemia
Reduce cardiopulmonary stress
Control airway with sedation
Examples: Brain injury, heart muscle injury, major surgery, prolonged shock, smoke injury
Ventilatory support is instituted to control and manipulate PaCO2 to lower than normal levels
Acute head injury
Caring patient on Mechanical Ventilator Shanta Peter
Mechanical ventilators are used now in general wards , not only in ICU -to save patient's life. We need to care patient and ventilator while working with it ..
Critically ill patients requiring noninvasive or invasive ventilation often present to emergency departments, and due to hospital crowding and constrained critical care services, may remain in the emergency department for a prolonged duration. Compared with their intensive care unit counterparts, emergency department clinicians may have variable exposure to management of this patient population and may lack knowledge and expertise, particularly in their
longitudinal management beyond initial stabilization. This
review has discussed several key aspects of management
of noninvasive and invasive ventilation, with a particular emphasis on initiation and ongoing monitoring priorities,
and focused on maintaining patient safety and improving
patient outcomes.
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@Pi_vendor_247
The European Unemployment Puzzle: implications from population agingGRAPE
We study the link between the evolving age structure of the working population and unemployment. We build a large new Keynesian OLG model with a realistic age structure, labor market frictions, sticky prices, and aggregate shocks. Once calibrated to the European economy, we quantify the extent to which demographic changes over the last three decades have contributed to the decline of the unemployment rate. Our findings yield important implications for the future evolution of unemployment given the anticipated further aging of the working population in Europe. We also quantify the implications for optimal monetary policy: lowering inflation volatility becomes less costly in terms of GDP and unemployment volatility, which hints that optimal monetary policy may be more hawkish in an aging society. Finally, our results also propose a partial reversal of the European-US unemployment puzzle due to the fact that the share of young workers is expected to remain robust in the US.
Poonawalla Fincorp and IndusInd Bank Introduce New Co-Branded Credit Cardnickysharmasucks
The unveiling of the IndusInd Bank Poonawalla Fincorp eLITE RuPay Platinum Credit Card marks a notable milestone in the Indian financial landscape, showcasing a successful partnership between two leading institutions, Poonawalla Fincorp and IndusInd Bank. This co-branded credit card not only offers users a plethora of benefits but also reflects a commitment to innovation and adaptation. With a focus on providing value-driven and customer-centric solutions, this launch represents more than just a new product—it signifies a step towards redefining the banking experience for millions. Promising convenience, rewards, and a touch of luxury in everyday financial transactions, this collaboration aims to cater to the evolving needs of customers and set new standards in the industry.
Falcon stands out as a top-tier P2P Invoice Discounting platform in India, bridging esteemed blue-chip companies and eager investors. Our goal is to transform the investment landscape in India by establishing a comprehensive destination for borrowers and investors with diverse profiles and needs, all while minimizing risk. What sets Falcon apart is the elimination of intermediaries such as commercial banks and depository institutions, allowing investors to enjoy higher yields.
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Turin Startup Ecosystem 2024 - Ricerca sulle Startup e il Sistema dell'Innov...Quotidiano Piemontese
Turin Startup Ecosystem 2024
Una ricerca de il Club degli Investitori, in collaborazione con ToTeM Torino Tech Map e con il supporto della ESCP Business School e di Growth Capital
what is the future of Pi Network currency.DOT TECH
The future of the Pi cryptocurrency is uncertain, and its success will depend on several factors. Pi is a relatively new cryptocurrency that aims to be user-friendly and accessible to a wide audience. Here are a few key considerations for its future:
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1. Mainnet Launch: As of my last knowledge update in January 2022, Pi was still in the testnet phase. Its success will depend on a successful transition to a mainnet, where actual transactions can take place.
2. User Adoption: Pi's success will be closely tied to user adoption. The more users who join the network and actively participate, the stronger the ecosystem can become.
3. Utility and Use Cases: For a cryptocurrency to thrive, it must offer utility and practical use cases. The Pi team has talked about various applications, including peer-to-peer transactions, smart contracts, and more. The development and implementation of these features will be essential.
4. Regulatory Environment: The regulatory environment for cryptocurrencies is evolving globally. How Pi navigates and complies with regulations in various jurisdictions will significantly impact its future.
5. Technology Development: The Pi network must continue to develop and improve its technology, security, and scalability to compete with established cryptocurrencies.
6. Community Engagement: The Pi community plays a critical role in its future. Engaged users can help build trust and grow the network.
7. Monetization and Sustainability: The Pi team's monetization strategy, such as fees, partnerships, or other revenue sources, will affect its long-term sustainability.
It's essential to approach Pi or any new cryptocurrency with caution and conduct due diligence. Cryptocurrency investments involve risks, and potential rewards can be uncertain. The success and future of Pi will depend on the collective efforts of its team, community, and the broader cryptocurrency market dynamics. It's advisable to stay updated on Pi's development and follow any updates from the official Pi Network website or announcements from the team.
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how can I sell my pi coins for cash in a pi APPDOT TECH
You can't sell your pi coins in the pi network app. because it is not listed yet on any exchange.
The only way you can sell is by trading your pi coins with an investor (a person looking forward to hold massive amounts of pi coins before mainnet launch) .
You don't need to meet the investor directly all the trades are done with a pi vendor/merchant (a person that buys the pi coins from miners and resell it to investors)
I Will leave The telegram contact of my personal pi vendor, if you are finding a legitimate one.
@Pi_vendor_247
#pi network
#pi coins
#money
What website can I sell pi coins securely.DOT TECH
Currently there are no website or exchange that allow buying or selling of pi coins..
But you can still easily sell pi coins, by reselling it to exchanges/crypto whales interested in holding thousands of pi coins before the mainnet launch.
Who is a pi merchant?
A pi merchant is someone who buys pi coins from miners and resell to these crypto whales and holders of pi..
This is because pi network is not doing any pre-sale. The only way exchanges can get pi is by buying from miners and pi merchants stands in between the miners and the exchanges.
How can I sell my pi coins?
Selling pi coins is really easy, but first you need to migrate to mainnet wallet before you can do that. I will leave the telegram contact of my personal pi merchant to trade with.
Tele-gram.
@Pi_vendor_247
how to swap pi coins to foreign currency withdrawable.DOT TECH
As of my last update, Pi is still in the testing phase and is not tradable on any exchanges.
However, Pi Network has announced plans to launch its Testnet and Mainnet in the future, which may include listing Pi on exchanges.
The current method for selling pi coins involves exchanging them with a pi vendor who purchases pi coins for investment reasons.
If you want to sell your pi coins, reach out to a pi vendor and sell them to anyone looking to sell pi coins from any country around the globe.
Below is the contact information for my personal pi vendor.
Telegram: @Pi_vendor_247
how to sell pi coins in South Korea profitably.DOT TECH
Yes. You can sell your pi network coins in South Korea or any other country, by finding a verified pi merchant
What is a verified pi merchant?
Since pi network is not launched yet on any exchange, the only way you can sell pi coins is by selling to a verified pi merchant, and this is because pi network is not launched yet on any exchange and no pre-sale or ico offerings Is done on pi.
Since there is no pre-sale, the only way exchanges can get pi is by buying from miners. So a pi merchant facilitates these transactions by acting as a bridge for both transactions.
How can i find a pi vendor/merchant?
Well for those who haven't traded with a pi merchant or who don't already have one. I will leave the telegram id of my personal pi merchant who i trade pi with.
Tele gram: @Pi_vendor_247
#pi #sell #nigeria #pinetwork #picoins #sellpi #Nigerian #tradepi #pinetworkcoins #sellmypi
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Latino Buying Power - May 2024 Presentation for Latino CaucusDanay Escanaverino
Unlock the potential of Latino Buying Power with this in-depth SlideShare presentation. Explore how the Latino consumer market is transforming the American economy, driven by their significant buying power, entrepreneurial contributions, and growing influence across various sectors.
**Key Sections Covered:**
1. **Economic Impact:** Understand the profound economic impact of Latino consumers on the U.S. economy. Discover how their increasing purchasing power is fueling growth in key industries and contributing to national economic prosperity.
2. **Buying Power:** Dive into detailed analyses of Latino buying power, including its growth trends, key drivers, and projections for the future. Learn how this influential group’s spending habits are shaping market dynamics and creating opportunities for businesses.
3. **Entrepreneurial Contributions:** Explore the entrepreneurial spirit within the Latino community. Examine how Latino-owned businesses are thriving and contributing to job creation, innovation, and economic diversification.
4. **Workforce Statistics:** Gain insights into the role of Latino workers in the American labor market. Review statistics on employment rates, occupational distribution, and the economic contributions of Latino professionals across various industries.
5. **Media Consumption:** Understand the media consumption habits of Latino audiences. Discover their preferences for digital platforms, television, radio, and social media. Learn how these consumption patterns are influencing advertising strategies and media content.
6. **Education:** Examine the educational achievements and challenges within the Latino community. Review statistics on enrollment, graduation rates, and fields of study. Understand the implications of education on economic mobility and workforce readiness.
7. **Home Ownership:** Explore trends in Latino home ownership. Understand the factors driving home buying decisions, the challenges faced by Latino homeowners, and the impact of home ownership on community stability and economic growth.
This SlideShare provides valuable insights for marketers, business owners, policymakers, and anyone interested in the economic influence of the Latino community. By understanding the various facets of Latino buying power, you can effectively engage with this dynamic and growing market segment.
Equip yourself with the knowledge to leverage Latino buying power, tap into their entrepreneurial spirit, and connect with their unique cultural and consumer preferences. Drive your business success by embracing the economic potential of Latino consumers.
**Keywords:** Latino buying power, economic impact, entrepreneurial contributions, workforce statistics, media consumption, education, home ownership, Latino market, Hispanic buying power, Latino purchasing power.
2. Expected outcome
• Understand the function of mechanical ventilator and identify its components
• Identify patients that need mechanical Ventilation or Pulmonary rehabilitation
• Justify the need for different modes of ventilator
• Plan the care of patients on a mechanical ventilator
• Identify weaning parameters
• Identify Complications and prevention
3. Outline
• Introduce the equation of motion for respiratory system
• Indications for mechanical Ventilation
• Modes
• Care of the ventilated patient
• Complications of mechanical ventilation and prevention
• Pulmonary rehabilitation
4. Understanding function of mechanical
ventilation
• Mechanical ventilator is a machine used to augment or takeover the
function of the respiratory system.
• Interaction of airway pressure, respiratory muscle pressure, flow,
volume and respiratory mechanics cause the flow of air between the
atmosphere and the lungs
• The equation of motion
• Paw + Pmus = Flow X resist+ Vol /Compliance
• Pvent + Pmus = Flow X resist + Vol/ Compliance
5. Parameters that can be controlled in MV
• Tidal volume
• Respiratory rate
• Pressure
• PEEP
• FiO2
6. Indications for mechanical ventilation
• Treatment of hypoxemic respiratory failure
• Treatment of hypercapnic respiratory failure
• Treatment of combined hypoxemic and hypercapnic respiratory
failure
7. Mechanical ventilator components
• Ventilator interface: a set of flexible tubes thro the Ventilator delivers
gas to the patient
• Power source
• Control system
• Patient monitoring system
• Pressure
• Alarms
• Graphic displays
9. Modes of a mechanical Ventilator
• Method of inspiratory support during MV
• Controlled
• Assist control Pressure or
• Assist control volume: full ventilator control
• Supported
• Pressure support
10. Modes of a mechanical Ventilator
Combined
• SIMV(PC) + PS
• SIMV (VC) +PS
• Advanced modes
• PRVC pressure regulated volume controlled
• APRV airway pressure release ventilation
• HFOV high frequency oscillatory ventilation
11. Setting the ventilator
• Determined by the target
• Volume, RR
• pressure
• FiO2, PEEP,
• Target delivered
• each breath (assist control)
• breaths from the ventilator only ( Intermittent Mandatory Ventilation
• Ideal body weight used for volume calculation
• Men 50 + 2.3 X Ht(in) - 60
• females 45.5 + 2.3 X Ht(in) - 60
12. Setting the ventilator ..2
• Initial tidal vol 6-8ml/Kg IBW , RR 2/3 pre-intubation rate or IBW X100
= Minute ventilation
• Pressure start at 20cmH2O
• FiO2 start at 100 and titrate based on PaO2 from ABG or SPO2
• PEEP start at 5cmH2O
• Flow rate 60L/min
• I :E
13. Setting trade offs
• FiO2 fraction of inspired oxygen; use the lowest that achieves
targeted oxygenation. Avoid prolonged use of high FiO2 (0.60)
• Respiratory rate 10-20/min
• (Hypo..Resp acidosis
• Hyper ..resp alka)
• Tidal vol(6-8ml/kg IBW)vol of air exchanged at each breath , reduce if
lungs are stiff
• Trigger may be
• ventilator-initiated prompted by timer from set RR or frequency
• patient initiated
14. • Inspiration: Expiration (I:E) ratio
• normal 1:2
• Inverse ratio 1:1, 2:1, 3:1, 4:1;
• Reduced I:E in COPD with resp acidosis to encourage longer expiration
• Peak inspiratory pressure (PIP) < 35 cmH2O
• low PIP may cause hypoventilation
• high PIP may cause lung damage
• Minute ventilation 5-10L/minute;
• volume of gas exchanged per minute
• VE = RR X VT
15. • Plateau pressure (Pplat) reflects lung compliance (brief inspiratory
pause after ventilation)
• normal Pplat and high PIP indicates resistance to air flow as in bronchospasm
or endotrachael tube obstruction
• high Pplat and high PIP ..reduced compliance pulmonary edema, ARDs ;
• Positive End Expiratory Pressure (PEEP)
• keeps alveoli open and recruits more alveoli to improve oxygenation.
• High levels may cause barotrauma, increased ICP and decreased cardiac
output
16. • Pressure support (PS) 8-20cmH2O provides extra pressure during
inspiration to increase ventilation with minimal patient effort. It is
used to reduce the work of breathing through ventilator tubing
18. • ARDS permissive hypercapnia may be accepted to minimize lung
injury,
• PH >7.25, low tidal volume 6mL/Kg IBW,
• low Pplat <30cmH2O, low driving P <15cmH2O,
• optimize PEEP gently by gradual increment to prevent atelectasis and recruit
alveoli
• Proning when PaO2:FiO2 <150 persistently, watch ETT
19. Ventilator patient care
• Daily assessment (team work):
• status,
• full clinical examination,
• sedation interruption,
• assess for readiness for SBT
• Be systematic, document, ETT position, connections, humidifier in
use, water level, control system
• PEEP
20. Spontaneous breath trial SBT
• Patient stable and improving medically
• FiO2 </= 0.5
• PEEP <10cmH2O
• Patient can make spontaneous effort
• 2 minute test of readiness for SBT
• Reduce all pressure settings to 0 for 2 minutes
• If RSBI < 105 (rapid shallow breath index)
• RR/Tidal vol (L)
21. SBT
• Minimum time 30 minutes max 2hours
• With pt on pressure support Ventilation, remove all support from
ventilator but allow RR and minute ventilation to be monitored.
Monitor RR, oxygen saturation, HR, Systolic BP
• SpO2 > 90%, hemodynamic stability, sufficient cough, alert mark
success
23. Complications of Mechanical ventilation
• Larnygeal edema, lacerations, vocal cord injury correct cuff pressure
• Aspiration of oral and gastric secretions suction, head at angle 30-45
• Auto PEEP Baro and volutrauma avoid high auto peep, pressure,
reduce tidal volume, keep Pplat<30cmH20
• Asynchrony with ventilator identify early and correct
• Hemodynamic compromise identify early and correct
24. Complications of Mechanical ventilation
• Ventilator ass pneumonia nurse head up, daily interruption of
sedation, suction of secretions,early mobility, infrequent change of
ventilator tubes
• Gastritis, ulcers, malnutrition, constipation nutrition plan, early
mobility, gastrointestinal prophylaxis,
• Sleep deprivation, anxiety,
• Muscle deconditioning, ventilator dependence plan for early
weaning:assess SBT daily
• Renal, hepatic dysfunction assess function clinically and chemistry
25. Pulmonary rehabilitation
• Inter disciplinary program of care for patients with chronic respiratory
impairment that is individually designed to optimize patient’s physical
and social performance and autonomy. Use of exercise, education
and behavioral intervention to improve symptoms, restore functional
ability and improve quality of life in patients with chronic lung
disease.
• Evaluation: med hx, exam, review of medical records, lab results: lung
function tests, EKG,6 minutes walk
• Components of PR
• Inspiratory muscle training
26. Pulmonary rehabilitation
• Evaluation: med hx, exam, review of medical records, lab results: lung
function tests, EKG,6 minutes walk
• Components of PR
• Inspiratory muscle training
• Education
27. Inspiratory muscle training
• Control breathing
• Breathing exercise,
• pursed lip, slow deep, diaphragmatic, segmental breathing
• Diaphragmatic breathing -/+ pursed lip breathing significantly improved tidal
volume, reduced breathing frequency without causing dyspnea
Liliane et al.
28. Inspiratory muscle training
• Clearance of secretion: postural drainage, chest percussion &
vibration, control cough
• Trunk flexibility
• Upper extremity exercise: strengthening upper back, shoulder girdle
muscles
• Reconditioning: aerobic @ least 30 minutes, 3-4times a week
29. Education
• Smoking cessation
• Disease prognosis, information on the medications
• Lifestyle change to adapt to the disease
• Goals and benefit of the PR program
30. Duration
• 6- 12 weeks @ least 12 supervised sessions
• Encouraged to continue the exercises at the end of the sessions
31. Indication
• Motivated patients
• Functional limitation due to the disease
• Symptomatic patients who are stable on their medications.
• Pre or post thoracic surgery
33. References
• Pierson DJ. Complications associated with mechanical ventilation. Crit
Care Clin. 1990 Jul; 6(3): 711-24
• Strieter RM, Lynch JP 3rd. Complications in the ventilated patient.
Clin. Chest Med. 1988Mar; 9(1): 127-39
• Haribhai S, Mahboobi SK. Ventilator complications( updated 2021
October) In: StatPearls (internet). Treasure Island (Fl): StatPearls
Publishing: 2022 Jan.available at ncbi.nlm.nih.gov
• Moied S, Athar M. Mechanical ventilation in patients with chronic
obstructive pulmonary disease and asthma. Indian J Anaesth. 2015
Sep; 59(9): 589-598.
34. • Bolton CE, Bevan-Smith EF, Blakkey JD, Crowe P, Elkin SL Garrod R et
al. British Thoracic Society guideline on pulmonary rehabilitation in
adults: accredited by NICE. Thorax 68(2) suppl2.
http://dx.doi.org/10.1136/thoraxjnl-2013-203808.
• National Institute for Health and Clinical Excellence. Chronic
obstructive pulmonary disease. Management of chronic of chronic
obstructive lung disease in adults in primary and secondary care
(partial update). 2010.
http://www.nice.org.uk/nicemedia/live/13029/4