There might be no safe ventilation. Much too often, all there is for us to measure at the bedside are nothing but global indicators of stress/strain, more or less refined. Heterogeneity at the alveolar level-inhomogeneities or stress raisers - render global parameters less useful than previously predicted. In fact, Mead had already stated it through his work on stress distribution at the alveolar level.
ECMO (VA ECMO) might be regarded as one other way of decatecholaminization (M.Singer). Stop stressing the already stressed heart. Unfortunately, fem-fem VA ECMO still needs inotropic support to lessen the LV distension. Levosimendan and IABP combined could help decrease the catecholamine usage in this context.
Guytonian approach to shock - mean systemic filling pressure centeredCosmin Balan
In a world of binary decision there remains little room for applied maths and physiology. Or maybe not...
Parkin's approach brings out a forgotten tool-the volume state. Although reductionistic as well as Guyton's entire view, it might be a better language for us, for clinicians and for all those lost in translation when they've stumbled across loose binary decisions such as SVV,PPV,SPV etc.
Mean systemic filling pressure has been resurrected.
Parkin, Maas, Pinsky and Geerts have come a long way from Versprille.
Paradigms have been shifting.
Flow-centered ideas, ventriculo-arterial coupling and redistributions between compartments with different time constants.
we are teleologically cardioprotected. we are already cardioprotected. nature has given us everything we need to be unbreakable.we just have to push the right buttons.
please, pay heed to the turtles! they know best!
Edelman-derived quantification of dyselectrolytemias.
Equation-based monitoring of hyponatremia therapy with a focus on safely and predictably increasing sodium as per guideline advice using a strategy involving desmopressin administration in severe hyponatremias, especially those patients at risk of becoming overcorrectors. Explanation of risk factors responsible for overshooting when correcting hyponatremia. Adrogue-Madias, Barsoum, Nguyen-Kurtz equations are explained and proven to be of help at least conceptually when attempting to have a desmopressin-guided therapy in hyponatremia. All recommendations are done in accordance with European and American guidelines published in 2013 and 2014.
Buying time in situations of extreme hemodynamic instability by partially reversing acidemia with a controlled strategy involving bicarbonate, calcium and hyperventilation.
Minimizing CO2 buildup as well as resulting hypocalcemia after alkalinization improves hemodynamics in a rat-derived french study.
Math modelled approach to gas-exchange monitoring Cosmin Balan
mathematical modelled approach to gas exchange monitoring.
overview of one parameter models and description of Sapsford and Kjaergaard's two parameter models.computer algorithm in assessing gas exchange at the bedside in a MIGET fashion. prediction of hypoxemia and full description of gas exchange through models that fit perfectly to patient data.
There might be no safe ventilation. Much too often, all there is for us to measure at the bedside are nothing but global indicators of stress/strain, more or less refined. Heterogeneity at the alveolar level-inhomogeneities or stress raisers - render global parameters less useful than previously predicted. In fact, Mead had already stated it through his work on stress distribution at the alveolar level.
ECMO (VA ECMO) might be regarded as one other way of decatecholaminization (M.Singer). Stop stressing the already stressed heart. Unfortunately, fem-fem VA ECMO still needs inotropic support to lessen the LV distension. Levosimendan and IABP combined could help decrease the catecholamine usage in this context.
Guytonian approach to shock - mean systemic filling pressure centeredCosmin Balan
In a world of binary decision there remains little room for applied maths and physiology. Or maybe not...
Parkin's approach brings out a forgotten tool-the volume state. Although reductionistic as well as Guyton's entire view, it might be a better language for us, for clinicians and for all those lost in translation when they've stumbled across loose binary decisions such as SVV,PPV,SPV etc.
Mean systemic filling pressure has been resurrected.
Parkin, Maas, Pinsky and Geerts have come a long way from Versprille.
Paradigms have been shifting.
Flow-centered ideas, ventriculo-arterial coupling and redistributions between compartments with different time constants.
we are teleologically cardioprotected. we are already cardioprotected. nature has given us everything we need to be unbreakable.we just have to push the right buttons.
please, pay heed to the turtles! they know best!
Edelman-derived quantification of dyselectrolytemias.
Equation-based monitoring of hyponatremia therapy with a focus on safely and predictably increasing sodium as per guideline advice using a strategy involving desmopressin administration in severe hyponatremias, especially those patients at risk of becoming overcorrectors. Explanation of risk factors responsible for overshooting when correcting hyponatremia. Adrogue-Madias, Barsoum, Nguyen-Kurtz equations are explained and proven to be of help at least conceptually when attempting to have a desmopressin-guided therapy in hyponatremia. All recommendations are done in accordance with European and American guidelines published in 2013 and 2014.
Buying time in situations of extreme hemodynamic instability by partially reversing acidemia with a controlled strategy involving bicarbonate, calcium and hyperventilation.
Minimizing CO2 buildup as well as resulting hypocalcemia after alkalinization improves hemodynamics in a rat-derived french study.
Math modelled approach to gas-exchange monitoring Cosmin Balan
mathematical modelled approach to gas exchange monitoring.
overview of one parameter models and description of Sapsford and Kjaergaard's two parameter models.computer algorithm in assessing gas exchange at the bedside in a MIGET fashion. prediction of hypoxemia and full description of gas exchange through models that fit perfectly to patient data.
2024 State of Marketing Report – by HubspotMarius Sescu
https://www.hubspot.com/state-of-marketing
· Scaling relationships and proving ROI
· Social media is the place for search, sales, and service
· Authentic influencer partnerships fuel brand growth
· The strongest connections happen via call, click, chat, and camera.
· Time saved with AI leads to more creative work
· Seeking: A single source of truth
· TLDR; Get on social, try AI, and align your systems.
· More human marketing, powered by robots
ChatGPT is a revolutionary addition to the world since its introduction in 2022. A big shift in the sector of information gathering and processing happened because of this chatbot. What is the story of ChatGPT? How is the bot responding to prompts and generating contents? Swipe through these slides prepared by Expeed Software, a web development company regarding the development and technical intricacies of ChatGPT!
Product Design Trends in 2024 | Teenage EngineeringsPixeldarts
The realm of product design is a constantly changing environment where technology and style intersect. Every year introduces fresh challenges and exciting trends that mold the future of this captivating art form. In this piece, we delve into the significant trends set to influence the look and functionality of product design in the year 2024.
How Race, Age and Gender Shape Attitudes Towards Mental HealthThinkNow
Mental health has been in the news quite a bit lately. Dozens of U.S. states are currently suing Meta for contributing to the youth mental health crisis by inserting addictive features into their products, while the U.S. Surgeon General is touring the nation to bring awareness to the growing epidemic of loneliness and isolation. The country has endured periods of low national morale, such as in the 1970s when high inflation and the energy crisis worsened public sentiment following the Vietnam War. The current mood, however, feels different. Gallup recently reported that national mental health is at an all-time low, with few bright spots to lift spirits.
To better understand how Americans are feeling and their attitudes towards mental health in general, ThinkNow conducted a nationally representative quantitative survey of 1,500 respondents and found some interesting differences among ethnic, age and gender groups.
Technology
For example, 52% agree that technology and social media have a negative impact on mental health, but when broken out by race, 61% of Whites felt technology had a negative effect, and only 48% of Hispanics thought it did.
While technology has helped us keep in touch with friends and family in faraway places, it appears to have degraded our ability to connect in person. Staying connected online is a double-edged sword since the same news feed that brings us pictures of the grandkids and fluffy kittens also feeds us news about the wars in Israel and Ukraine, the dysfunction in Washington, the latest mass shooting and the climate crisis.
Hispanics may have a built-in defense against the isolation technology breeds, owing to their large, multigenerational households, strong social support systems, and tendency to use social media to stay connected with relatives abroad.
Age and Gender
When asked how individuals rate their mental health, men rate it higher than women by 11 percentage points, and Baby Boomers rank it highest at 83%, saying it’s good or excellent vs. 57% of Gen Z saying the same.
Gen Z spends the most amount of time on social media, so the notion that social media negatively affects mental health appears to be correlated. Unfortunately, Gen Z is also the generation that’s least comfortable discussing mental health concerns with healthcare professionals. Only 40% of them state they’re comfortable discussing their issues with a professional compared to 60% of Millennials and 65% of Boomers.
Race Affects Attitudes
As seen in previous research conducted by ThinkNow, Asian Americans lag other groups when it comes to awareness of mental health issues. Twenty-four percent of Asian Americans believe that having a mental health issue is a sign of weakness compared to the 16% average for all groups. Asians are also considerably less likely to be aware of mental health services in their communities (42% vs. 55%) and most likely to seek out information on social media (51% vs. 35%).
AI Trends in Creative Operations 2024 by Artwork Flow.pdfmarketingartwork
This article is all about what AI trends will emerge in the field of creative operations in 2024. All the marketers and brand builders should be aware of these trends for their further use and save themselves some time!
A report by thenetworkone and Kurio.
The contributing experts and agencies are (in an alphabetical order): Sylwia Rytel, Social Media Supervisor, 180heartbeats + JUNG v MATT (PL), Sharlene Jenner, Vice President - Director of Engagement Strategy, Abelson Taylor (USA), Alex Casanovas, Digital Director, Atrevia (ES), Dora Beilin, Senior Social Strategist, Barrett Hoffher (USA), Min Seo, Campaign Director, Brand New Agency (KR), Deshé M. Gully, Associate Strategist, Day One Agency (USA), Francesca Trevisan, Strategist, Different (IT), Trevor Crossman, CX and Digital Transformation Director; Olivia Hussey, Strategic Planner; Simi Srinarula, Social Media Manager, The Hallway (AUS), James Hebbert, Managing Director, Hylink (CN / UK), Mundy Álvarez, Planning Director; Pedro Rojas, Social Media Manager; Pancho González, CCO, Inbrax (CH), Oana Oprea, Head of Digital Planning, Jam Session Agency (RO), Amy Bottrill, Social Account Director, Launch (UK), Gaby Arriaga, Founder, Leonardo1452 (MX), Shantesh S Row, Creative Director, Liwa (UAE), Rajesh Mehta, Chief Strategy Officer; Dhruv Gaur, Digital Planning Lead; Leonie Mergulhao, Account Supervisor - Social Media & PR, Medulla (IN), Aurelija Plioplytė, Head of Digital & Social, Not Perfect (LI), Daiana Khaidargaliyeva, Account Manager, Osaka Labs (UK / USA), Stefanie Söhnchen, Vice President Digital, PIABO Communications (DE), Elisabeth Winiartati, Managing Consultant, Head of Global Integrated Communications; Lydia Aprina, Account Manager, Integrated Marketing and Communications; Nita Prabowo, Account Manager, Integrated Marketing and Communications; Okhi, Web Developer, PNTR Group (ID), Kei Obusan, Insights Director; Daffi Ranandi, Insights Manager, Radarr (SG), Gautam Reghunath, Co-founder & CEO, Talented (IN), Donagh Humphreys, Head of Social and Digital Innovation, THINKHOUSE (IRE), Sarah Yim, Strategy Director, Zulu Alpha Kilo (CA).
Trends In Paid Search: Navigating The Digital Landscape In 2024Search Engine Journal
The search marketing landscape is evolving rapidly with new technologies, and professionals, like you, rely on innovative paid search strategies to meet changing demands.
It’s important that you’re ready to implement new strategies in 2024.
Check this out and learn the top trends in paid search advertising that are expected to gain traction, so you can drive higher ROI more efficiently in 2024.
You’ll learn:
- The latest trends in AI and automation, and what this means for an evolving paid search ecosystem.
- New developments in privacy and data regulation.
- Emerging ad formats that are expected to make an impact next year.
Watch Sreekant Lanka from iQuanti and Irina Klein from OneMain Financial as they dive into the future of paid search and explore the trends, strategies, and technologies that will shape the search marketing landscape.
If you’re looking to assess your paid search strategy and design an industry-aligned plan for 2024, then this webinar is for you.
5 Public speaking tips from TED - Visualized summarySpeakerHub
From their humble beginnings in 1984, TED has grown into the world’s most powerful amplifier for speakers and thought-leaders to share their ideas. They have over 2,400 filmed talks (not including the 30,000+ TEDx videos) freely available online, and have hosted over 17,500 events around the world.
With over one billion views in a year, it’s no wonder that so many speakers are looking to TED for ideas on how to share their message more effectively.
The article “5 Public-Speaking Tips TED Gives Its Speakers”, by Carmine Gallo for Forbes, gives speakers five practical ways to connect with their audience, and effectively share their ideas on stage.
Whether you are gearing up to get on a TED stage yourself, or just want to master the skills that so many of their speakers possess, these tips and quotes from Chris Anderson, the TED Talks Curator, will encourage you to make the most impactful impression on your audience.
See the full article and more summaries like this on SpeakerHub here: https://speakerhub.com/blog/5-presentation-tips-ted-gives-its-speakers
See the original article on Forbes here:
http://www.forbes.com/forbes/welcome/?toURL=http://www.forbes.com/sites/carminegallo/2016/05/06/5-public-speaking-tips-ted-gives-its-speakers/&refURL=&referrer=#5c07a8221d9b
ChatGPT and the Future of Work - Clark Boyd Clark Boyd
Everyone is in agreement that ChatGPT (and other generative AI tools) will shape the future of work. Yet there is little consensus on exactly how, when, and to what extent this technology will change our world.
Businesses that extract maximum value from ChatGPT will use it as a collaborative tool for everything from brainstorming to technical maintenance.
For individuals, now is the time to pinpoint the skills the future professional will need to thrive in the AI age.
Check out this presentation to understand what ChatGPT is, how it will shape the future of work, and how you can prepare to take advantage.
A brief introduction to DataScience with explaining of the concepts, algorithms, machine learning, supervised and unsupervised learning, clustering, statistics, data preprocessing, real-world applications etc.
It's part of a Data Science Corner Campaign where I will be discussing the fundamentals of DataScience, AIML, Statistics etc.
Time Management & Productivity - Best PracticesVit Horky
Here's my presentation on by proven best practices how to manage your work time effectively and how to improve your productivity. It includes practical tips and how to use tools such as Slack, Google Apps, Hubspot, Google Calendar, Gmail and others.
The six step guide to practical project managementMindGenius
The six step guide to practical project management
If you think managing projects is too difficult, think again.
We’ve stripped back project management processes to the
basics – to make it quicker and easier, without sacrificing
the vital ingredients for success.
“If you’re looking for some real-world guidance, then The Six Step Guide to Practical Project Management will help.”
Dr Andrew Makar, Tactical Project Management
2024 State of Marketing Report – by HubspotMarius Sescu
https://www.hubspot.com/state-of-marketing
· Scaling relationships and proving ROI
· Social media is the place for search, sales, and service
· Authentic influencer partnerships fuel brand growth
· The strongest connections happen via call, click, chat, and camera.
· Time saved with AI leads to more creative work
· Seeking: A single source of truth
· TLDR; Get on social, try AI, and align your systems.
· More human marketing, powered by robots
ChatGPT is a revolutionary addition to the world since its introduction in 2022. A big shift in the sector of information gathering and processing happened because of this chatbot. What is the story of ChatGPT? How is the bot responding to prompts and generating contents? Swipe through these slides prepared by Expeed Software, a web development company regarding the development and technical intricacies of ChatGPT!
Product Design Trends in 2024 | Teenage EngineeringsPixeldarts
The realm of product design is a constantly changing environment where technology and style intersect. Every year introduces fresh challenges and exciting trends that mold the future of this captivating art form. In this piece, we delve into the significant trends set to influence the look and functionality of product design in the year 2024.
How Race, Age and Gender Shape Attitudes Towards Mental HealthThinkNow
Mental health has been in the news quite a bit lately. Dozens of U.S. states are currently suing Meta for contributing to the youth mental health crisis by inserting addictive features into their products, while the U.S. Surgeon General is touring the nation to bring awareness to the growing epidemic of loneliness and isolation. The country has endured periods of low national morale, such as in the 1970s when high inflation and the energy crisis worsened public sentiment following the Vietnam War. The current mood, however, feels different. Gallup recently reported that national mental health is at an all-time low, with few bright spots to lift spirits.
To better understand how Americans are feeling and their attitudes towards mental health in general, ThinkNow conducted a nationally representative quantitative survey of 1,500 respondents and found some interesting differences among ethnic, age and gender groups.
Technology
For example, 52% agree that technology and social media have a negative impact on mental health, but when broken out by race, 61% of Whites felt technology had a negative effect, and only 48% of Hispanics thought it did.
While technology has helped us keep in touch with friends and family in faraway places, it appears to have degraded our ability to connect in person. Staying connected online is a double-edged sword since the same news feed that brings us pictures of the grandkids and fluffy kittens also feeds us news about the wars in Israel and Ukraine, the dysfunction in Washington, the latest mass shooting and the climate crisis.
Hispanics may have a built-in defense against the isolation technology breeds, owing to their large, multigenerational households, strong social support systems, and tendency to use social media to stay connected with relatives abroad.
Age and Gender
When asked how individuals rate their mental health, men rate it higher than women by 11 percentage points, and Baby Boomers rank it highest at 83%, saying it’s good or excellent vs. 57% of Gen Z saying the same.
Gen Z spends the most amount of time on social media, so the notion that social media negatively affects mental health appears to be correlated. Unfortunately, Gen Z is also the generation that’s least comfortable discussing mental health concerns with healthcare professionals. Only 40% of them state they’re comfortable discussing their issues with a professional compared to 60% of Millennials and 65% of Boomers.
Race Affects Attitudes
As seen in previous research conducted by ThinkNow, Asian Americans lag other groups when it comes to awareness of mental health issues. Twenty-four percent of Asian Americans believe that having a mental health issue is a sign of weakness compared to the 16% average for all groups. Asians are also considerably less likely to be aware of mental health services in their communities (42% vs. 55%) and most likely to seek out information on social media (51% vs. 35%).
AI Trends in Creative Operations 2024 by Artwork Flow.pdfmarketingartwork
This article is all about what AI trends will emerge in the field of creative operations in 2024. All the marketers and brand builders should be aware of these trends for their further use and save themselves some time!
A report by thenetworkone and Kurio.
The contributing experts and agencies are (in an alphabetical order): Sylwia Rytel, Social Media Supervisor, 180heartbeats + JUNG v MATT (PL), Sharlene Jenner, Vice President - Director of Engagement Strategy, Abelson Taylor (USA), Alex Casanovas, Digital Director, Atrevia (ES), Dora Beilin, Senior Social Strategist, Barrett Hoffher (USA), Min Seo, Campaign Director, Brand New Agency (KR), Deshé M. Gully, Associate Strategist, Day One Agency (USA), Francesca Trevisan, Strategist, Different (IT), Trevor Crossman, CX and Digital Transformation Director; Olivia Hussey, Strategic Planner; Simi Srinarula, Social Media Manager, The Hallway (AUS), James Hebbert, Managing Director, Hylink (CN / UK), Mundy Álvarez, Planning Director; Pedro Rojas, Social Media Manager; Pancho González, CCO, Inbrax (CH), Oana Oprea, Head of Digital Planning, Jam Session Agency (RO), Amy Bottrill, Social Account Director, Launch (UK), Gaby Arriaga, Founder, Leonardo1452 (MX), Shantesh S Row, Creative Director, Liwa (UAE), Rajesh Mehta, Chief Strategy Officer; Dhruv Gaur, Digital Planning Lead; Leonie Mergulhao, Account Supervisor - Social Media & PR, Medulla (IN), Aurelija Plioplytė, Head of Digital & Social, Not Perfect (LI), Daiana Khaidargaliyeva, Account Manager, Osaka Labs (UK / USA), Stefanie Söhnchen, Vice President Digital, PIABO Communications (DE), Elisabeth Winiartati, Managing Consultant, Head of Global Integrated Communications; Lydia Aprina, Account Manager, Integrated Marketing and Communications; Nita Prabowo, Account Manager, Integrated Marketing and Communications; Okhi, Web Developer, PNTR Group (ID), Kei Obusan, Insights Director; Daffi Ranandi, Insights Manager, Radarr (SG), Gautam Reghunath, Co-founder & CEO, Talented (IN), Donagh Humphreys, Head of Social and Digital Innovation, THINKHOUSE (IRE), Sarah Yim, Strategy Director, Zulu Alpha Kilo (CA).
Trends In Paid Search: Navigating The Digital Landscape In 2024Search Engine Journal
The search marketing landscape is evolving rapidly with new technologies, and professionals, like you, rely on innovative paid search strategies to meet changing demands.
It’s important that you’re ready to implement new strategies in 2024.
Check this out and learn the top trends in paid search advertising that are expected to gain traction, so you can drive higher ROI more efficiently in 2024.
You’ll learn:
- The latest trends in AI and automation, and what this means for an evolving paid search ecosystem.
- New developments in privacy and data regulation.
- Emerging ad formats that are expected to make an impact next year.
Watch Sreekant Lanka from iQuanti and Irina Klein from OneMain Financial as they dive into the future of paid search and explore the trends, strategies, and technologies that will shape the search marketing landscape.
If you’re looking to assess your paid search strategy and design an industry-aligned plan for 2024, then this webinar is for you.
5 Public speaking tips from TED - Visualized summarySpeakerHub
From their humble beginnings in 1984, TED has grown into the world’s most powerful amplifier for speakers and thought-leaders to share their ideas. They have over 2,400 filmed talks (not including the 30,000+ TEDx videos) freely available online, and have hosted over 17,500 events around the world.
With over one billion views in a year, it’s no wonder that so many speakers are looking to TED for ideas on how to share their message more effectively.
The article “5 Public-Speaking Tips TED Gives Its Speakers”, by Carmine Gallo for Forbes, gives speakers five practical ways to connect with their audience, and effectively share their ideas on stage.
Whether you are gearing up to get on a TED stage yourself, or just want to master the skills that so many of their speakers possess, these tips and quotes from Chris Anderson, the TED Talks Curator, will encourage you to make the most impactful impression on your audience.
See the full article and more summaries like this on SpeakerHub here: https://speakerhub.com/blog/5-presentation-tips-ted-gives-its-speakers
See the original article on Forbes here:
http://www.forbes.com/forbes/welcome/?toURL=http://www.forbes.com/sites/carminegallo/2016/05/06/5-public-speaking-tips-ted-gives-its-speakers/&refURL=&referrer=#5c07a8221d9b
ChatGPT and the Future of Work - Clark Boyd Clark Boyd
Everyone is in agreement that ChatGPT (and other generative AI tools) will shape the future of work. Yet there is little consensus on exactly how, when, and to what extent this technology will change our world.
Businesses that extract maximum value from ChatGPT will use it as a collaborative tool for everything from brainstorming to technical maintenance.
For individuals, now is the time to pinpoint the skills the future professional will need to thrive in the AI age.
Check out this presentation to understand what ChatGPT is, how it will shape the future of work, and how you can prepare to take advantage.
A brief introduction to DataScience with explaining of the concepts, algorithms, machine learning, supervised and unsupervised learning, clustering, statistics, data preprocessing, real-world applications etc.
It's part of a Data Science Corner Campaign where I will be discussing the fundamentals of DataScience, AIML, Statistics etc.
Time Management & Productivity - Best PracticesVit Horky
Here's my presentation on by proven best practices how to manage your work time effectively and how to improve your productivity. It includes practical tips and how to use tools such as Slack, Google Apps, Hubspot, Google Calendar, Gmail and others.
The six step guide to practical project managementMindGenius
The six step guide to practical project management
If you think managing projects is too difficult, think again.
We’ve stripped back project management processes to the
basics – to make it quicker and easier, without sacrificing
the vital ingredients for success.
“If you’re looking for some real-world guidance, then The Six Step Guide to Practical Project Management will help.”
Dr Andrew Makar, Tactical Project Management
4. Lost in translation
A cloud is made of billows upon billows
upon billows that look like clouds.As you
come closer to a cloud you don’t get something
smooth,but irregularities at a smaller scale.
Benoit Mandelbrot
7. Fractali si power-law
•Pattern self-similar
•Iteratie la infinit
•Marime nontopologica-euclidiana ci fractala
•Forma complexa,neregulata
•Matematic functii nederivabile
•Sunt descriptibili matematic prin ecuatii de tip power-law
8. Fractali si power-law
11.5•200=2300
28•100=2800
70•50=3500
Cat de lunga este coasta Marii Britanii?
11. Box counting
Studiu in cancerul oral-melanom
Patrate mai mari patrate mai
putine
Relatie de tip power law intre
numarul de patrate si marimea
patratului
Power law e afisata de fractalitate
tgα=dlogN/dlog1/S tgα=1.4181 N=S-1.4181 D=-1.4181
12. Viata inseamna SOC
Avalansele pot fi intelese doar intelegand intregul
Avalansele pot fi descrise din punct de vedere al relatiei marime- numar prin power law
Gramajoara de nisip e un exemplu de complexitate
Ea sta intr-o stare de criticalitate auto-organizata
Coeficientul power-law este -1
Evolutia in timp a avalanselor are un profil descris matematic de tip power-law(marime vs intervale de timp)
26. Modularea MSFP
Volumul creste intoarcerea venoasa.
Acelasi tip de curba este valabil pentru
cresterea tonusului vasomotor(scaderea
capacitantei).
Scaderea SVR muta MSFP in aval si
astfel RVR scade=>VR
28. Modulare simultana cu Frank
Starling
Suprapunerea celor doua
curbe nu este matematic
corecta.
Ramane un element didactic.
Pe abscisa se afla o presiune
pentru curba venoasa si
o diferenta presionala pentru
curba Frank Starling(presiune
transmurala).
Pcrit=>
colaps
36. De ce ai monitoriza MSFP?
Este un bun indicator de volemie
Poate fi un indicator dinamic al capacitantei venoase
Poate fi folosit pentru estimarea compliantei vasculare
Concomitent masurat cu PVC,pot fi folosite pentru aprecierea functiei pompei si a responsivitatii la fluid
37. ‘Masurarea’ MSFP in STI
•MSFP-Pcv=Rv•Dc
•MSFP-Pcv1=Rv•Dc1
•MSFP-Pcv2=Rv•Dc2
•2 necunoscute Rv si MSFP
•2 ecuatii
•Rv=(Pcv2-Pcv1)/(Dc1-Dc2)
Maas,Pinsky 2009
•MSFP-Pcv1=Rv•Dc1
Dc1
Pcv1
39. Modelul Parkin
“The Navigator systematizes cardiovascular management to simplify cognitive tasks, reduce side effects and to ensure better achievement of therapeutic targets.”
Pmsa = 0.96•RAP+0.04•MAP+0.96•1/26•SVRnBW•CO
EH=(Pmsa-RAP)/Pmsa
40. Frank Starling -recapitulare-
Capacitatea inimii de a-si creste forta de contractie
ca raspuns la cresterea presarcinii.
42. Responsivitatea la fluid -Frank Starling-
De ce parametrii statici presionali nu sunt indicatori de responsivitate la fluid. Parametrii statici volumetrici sunt mai apropiati de ceea ce inseamna Lsarcomer.
dP=dV/C
43. Principiile responsivitatii la fluid
Administrezi fluid avand drept scop cresterea debitului cardiac.
Cresterea debitului cardiac trebuie individualizata(unde e necesar).
Administrezi fluid atunci cand pacientul ar raspunde la acesta
prin cresterea debitului cardiac(reiese necesitatea de a prezice).
Ai nevoie de 2 ventriculi preload-dependenti.
47. Cum se traduce asta la patul bolnavului?
PPV
SVV
PEPV
AoBFV
EEP
SVC CI
IVC DI
INDICI DE RESPONSIVITATE INRUDITI -DINAMICI-
13%
11%
17%
12%
15%
18%
36%
48. Dinamic vs static in predictia responsivitatii la fluid
Michard 2000
51. Sensibilitatea TA la presarcina
Ees=tgα=Pes/(EDV-SV-Vo)
Ea=tgβ=Pes/SV
Pes=a•(Ved-Vo) unde a=1/(1/Ea+1/Ees)
52. Sensibilitatea TA la presarcina
PPV
SVV
PPV/SVV= Eadyn
0.89
Eadyn echivaleaza cu tonus vasomotor.
53. Sensibilitatea la presarcina
Pentru Eadyn>0.89 cresterile tensionale pentru acelasi SVV sunt mai pronuntate si denota un tonus vasomotor mai accentuat.
54. Limitele SVV/PPV in predictia responsivitatii la fluid.
Aritmii (SV mult neregulat)
VT mic (dPpl prea mic)-ex.ARDS
Rata respiratorie mare
Cord pulmonar (PVR mare)
IAP mare (Ecw mare=>dPpl f.mare)
Respiratie spontana
Doze mari de vasopresoare
61. PICCO
2 catetere-unul venos central si altul arterial
2 metode complementare-dilutie si PCA
Pe cateterul venos se injecteaza un indicator
Pe cateterul arterial se citeste conc. indicatorului
si se analizeaza unda arteriala
62. PICCO
O galeata cu apa Vx pura
4 mg indicator
Concentratia indicatorului devine 2
Care este volumul de apa?
Vx= cantitate indicator/Δconcentratie
Flux=Vx/timp