This document discusses neonatal respiratory mechanics, including compliance, resistance, time constant, lung volumes, oxygenation, and carbon dioxide removal. It defines key terms and explores their clinical implications. Compliance refers to lung distensibility, resistance is the oppositional force to airflow, and time constant is the time to empty the lungs. Together these properties determine ventilation and gas exchange effectiveness. Various ventilation strategies aim to optimize these factors to achieve goals of oxygenation and carbon dioxide removal.
This presentation deals with the basic physics of human ventillation. I have made an effort to clarify most of the venti lingo , so as to make way for further discussions on ventilator use. Hope it turns out to be helpful for you. Thank you.
This presentation deals with the basic physics of human ventillation. I have made an effort to clarify most of the venti lingo , so as to make way for further discussions on ventilator use. Hope it turns out to be helpful for you. Thank you.
Basic concepts in neonatal ventilation - Safe ventilation of neonatemohamed osama hussein
Lecture by by dr Muhammad Ezzat Abdel-Shafy MB.BCh, M.Sc Pediatrics Neonatology Sp. , Benha Children Hospital, provided during our Doctors neonatology workshop, 20th of January 2017
This is a detailed presentation on Non-Invasive Ventilation in Neonates. it includes modes of NIV, Evidence related to CPAP vs NIV, use of NIV/CPAP and detailed description of CPAP and its use, complications associated with NIV and related management
This gives a brief idea about the:
Techniques, Response To NIV, Clinical indications, Contraindications and Evidence Based Decisions on the use of noninvasive ventilation with neonates
Respiratory physiology & Respiratory Distress syndrome in a newborn.Sonali Paradhi Mhatre
Hi guys, This ppt shows the pathophysiology of pulmonary surfactant in newborn and respiratory distress syndrome. Main focus is towards management of RDS esp. exogenous surfactant administration. Your comments are welcome. Thank you.
Basic concepts in neonatal ventilation - Safe ventilation of neonatemohamed osama hussein
Lecture by by dr Muhammad Ezzat Abdel-Shafy MB.BCh, M.Sc Pediatrics Neonatology Sp. , Benha Children Hospital, provided during our Doctors neonatology workshop, 20th of January 2017
This is a detailed presentation on Non-Invasive Ventilation in Neonates. it includes modes of NIV, Evidence related to CPAP vs NIV, use of NIV/CPAP and detailed description of CPAP and its use, complications associated with NIV and related management
This gives a brief idea about the:
Techniques, Response To NIV, Clinical indications, Contraindications and Evidence Based Decisions on the use of noninvasive ventilation with neonates
Respiratory physiology & Respiratory Distress syndrome in a newborn.Sonali Paradhi Mhatre
Hi guys, This ppt shows the pathophysiology of pulmonary surfactant in newborn and respiratory distress syndrome. Main focus is towards management of RDS esp. exogenous surfactant administration. Your comments are welcome. Thank you.
The “How To” of BiVent
Created by: David Pitts II, RRT
Clinical Applications Specialist, Maquet
Birmingham, Alabama
Sponsored by Maquet, Inc – Servo Ventilators
Protective ventilation, the way I do it - Anders Larsson - SSAI2017scanFOAM
A talk by Anders Larsson at the 2017 meeting of the Scandinavian Society of Anaestesiology and Intensive Care Medicine.
All of the conference content can be found here: https://scanfoam.org/ssai2017/
Developed in collaboration between scanFOAM, SSAI and SFAI.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- 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
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
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
Best Ayurvedic medicine for Gas and IndigestionSwastikAyurveda
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
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
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
4. Compliance
Measurement of distensibility
C= Volume change (V) / Pressure
change(P)
Volume change per unit pressure
Lung which is more compliant is more
distensible and vice versa
6. Clinical Implications (cont.)
Role of Surfactant
Improves compliance
Results in a rapid decline in pressures
required to deliver the tidal volumes
after surfactant administration
7. Lets try this
3kg neonate, tidal volume delivered-
14ml, pressure required to drive this
volume is PIP of 18 and PEEP of 4
Calculate compliance=??
8. So we got…
Compliance=
Tidal volume/ Pressure gradient
=14/ (PIP-PEEP)
=14/14
=1ml/cm Hg
9. Clinical Implications (cont.)
Collapsed/ overstretched lungs poor
compliance
PEEP Pressure required to open the
lungs and keep it inflated
High PIP (excess pressure) which over
distends the lungs, does not result in
better volume delivery
10. Clinical Implications (cont.)
These lung
propertiesTypical
sigmoid shape curve
to pressure-volume
loop
Operate on the
rapid slope (middle
segment) during
ventilation
Fig.1
12. Resistance
The oppositional force for air flow into
the lungs
Higher the resistance, greater is the
pressure required to drive the gases
into the lungs
Depends on:
Airway diameter
Airway length
Viscosity of gas
13. Resistance
Resistance is directly proportional to:
Length
Viscosity
1/r4
Pressure required to drive 1L/min of gas
flow into the lungs
14. Clinical Implications
As length increases- resistance
increases
Eg: long ET tube
flow sensor or capnograph
Trim the ET tube to 2.5cm outside the
upper lip
15. Clinical Implications (cont.)
A small decrease in airway diameter
causes a large change in resistance
Removal of airway secretions and
largest diameter ET tube that fits the
glottis to be chosen
Higher air flows increases the
resistance by causing turbulence to gas
flow
17. Time Constant
Time taken to empty the gases from
lungs
It nearly takes 3-5 time constants to
completely empty the lungs
Time constant(sec)= Compliance x
Resistance
20. Clinical Implications
RDS:
Low compliance, normal resistance
Hence time constant-> less
Time required to inflate (Ti) or deflate
(Te) the lungs ->Hence short
21. Clinical Implications(cont.)
MAS
Resistance is high, Compliance
decreases little bit
Hence, time constant increases
Time required to inflate (Ti) or deflate
(Te) the lungs hence is long
A short set expiratory time on
ventilator can lead to inadequate lung
emptying and hence gas trapping
26. Tidal Volume
Volume of the gas going in and out with
each breath
5-8ml/kg
Ideally inspiratory and expiratory tidal
volumes are equal
27. Clinical Implications
Whenever peritubal leak during MV, air
leaks more during inspiration (higher
PIP and wider airways)
Hence, in modes of ventilation where
tidal volume is being targeted, it is
better to measure the expiratory
volume (volume of gas that actually goes
to the lungs)
29. Dead Space
Respiratory component-
Terminal bronchiole,
Alveolar sacs
Alveoli
Anatomical dead space- Part of tidal
volume which is not a part of gas exchange
(airways)
2ml/kg
30. Dead Space
Some gas in alveoli, due to ill
perfusion, is not a part of gas
exchange
Physiological dead space- Anatomical+ ill
perfused alveoli
31. So Tidal Volume is…
Alveolar tidal volume+ Anatomical dead
space+ ill perfused alveoli’s vol
Alveolar tidal volume+ Physiological dead
space
33. Minute Volume
Total volume of the gas moving in and
out of the lungs per minute
MV=TV X RR
200-480 ml/kg/min
Alveolar MV= ??
34. Clinical Implications
MV, esp the alveolar MV, is determinant
of CO2 removal
Co2 removal hastened either by
increasing the TV or rate
Better to increase the TV more
energy efficient (Increasing TV--dead
space is constant but increasing rate–
increases dead space too)
36. FRC
Volume of the gas present in the lungs
at the end of expiration
Allows gas exchange to be a continuous
process
25-30ml/kg
RDS-FRC low
MAS-FRC high
37. Clinical Implications
PVR- Least at normal FRC
PVR increases as FRC increases of decreases
Indicators of normal FRC:
6-8 intercostal spaces on CXR
Fall in FiO2 when increasing the PEEP when a
neonate is on CPAP or MV
CPAP and surfactant—Interventions done to allow
normal FRC in neonatal lungs
40. Mean Airway Pressure
The average pressure exerted on the
airway and the lungs from the beginning
of inspiration until the beginning of
next inspiration
Most powerful influence on oxygenation
MAP=K(PIP*Ti)+(PEEP*Te) / Ti+Te
41. Pressure-Time Graph
MAP is the area
under the curve
for one
respiratory cycle
Slope of pressure
rise is dependent
on flow
K depends on the
slope
42. High MAP will lead to…
Decreased cardiac output
Pulmonary hypoperfusion
Increased risk of barotrauma
(Levels>12cm H2O contributes to
barotrauma)
43. Clinical Implications
MAP can be increased by:
Increasing PIP
Increasing PEEP
Increasing I/E ratio
Increase the flow rate( converts the
sign wave pressure time graph to a
square wave)
44. So for increasing oxygenation…
Prefer increasing MAP when:
Lung disease is severe (Pneumonia)
Lung volume is small (RDS)
Prefer increasing FiO2 when:
Lung volume is increased(MAS)
When there is air leak
48. CO2 Elimination
Depends on MV (alveolar minute volume
more specifically) and RR
CO2 elimination directly proportional to
alveolar tidal volume and respiratory
rate
=(PIP-PEEP)*RR
49. Achieve CO2 elimination by:
Decreasing dead space
Excess ET tube
Secretions
Partial block
Increasing PIP
Increasing rate
Decreasing PEEP (only if there is lung
hyperinflation)
51. Question 1
1]True about RDS is?
A] Low compliance, High resistance
B]High compliance, Low resistance
C]Low compliance, Normal Resistance
D]High compliance, High resistance
52. Question 2
2]Which of the following will affect
PaCO2 maximum?
A]Secretions in the ET tube
B]Respiratory Rate
C]Tidal volume
D]Dead space
53. Question 3
3] Which is a wrong match?
A] FRC—PVR
B] PaO2—MAP
C] PaCO2—TV
D] MAP—FiO2
55. Key Concepts
Compliance is distensibility, resistance
is the oppositional force and time
constant is the time required to empty
the lungs
Lung tissue determine the compliance,
airways determine the resistance and
both compliance and resistance
determine the time constant
56. Key Concepts(cont…)
Ventilation is intermittent but gas
exchange is continuous. Alveolar Minute
Volume is a measure of ventilation and
FRC influences gas exchange
MAP and FiO2 regulate oxygenation
while alveolar tidal volume and
respiratory rate regulate PaCO2 when a
neonate is on MV