Clinical Decision Support in Mechanical Ventilation- Egyptian Critical Care S...Dr.Mahmoud Abbas
Clinical Decision Support in Mechanical Ventilation- Egyptian Critical Care Summit. Presented by Dr Lluis Blanch
Egyptian Critical care Summit is the leading medical event and exhibition in Egypt
Mechanical Ventilation in COPD Lecture presented by Dr Lluis Blanch at Venti Cairo Mechanical Ventilation Course held on 14-15 November at Cairo, Egypt.
Mechanical Ventilation of Patient with COPD ExacerbationDr.Mahmoud Abbas
Mechanical Ventilation of Patient with COPD Exacerbation lecture presented by Dr Andres Esteban at the Egyptian Critical care Summit 2015 held at Cairo, egypt.
The Egyptian Critical Care Summit is the leading medical event and exhibition for Intensive Care Medicine in Egypt.
Presented by D.Niall Ferguson at 9th Pulmonary Medicine Update Course held at Cairo, Egypt.
This course is the leading Pulmonary Critical Care event in Egypt. The course is organized by Scribe (www.scribeofegypt.com)
Under Appreciated Signs In Ventilator MonitoringDr.Mahmoud Abbas
Presentation of Dr. Lluis Blanch at 10th Pulmonary Medicine Update Course, Cairo, Egypt. Pulmonary Medicine Update Course is organized by Scribe : www.scribeofegypt.com
Clinical Decision Support in Mechanical Ventilation- Egyptian Critical Care S...Dr.Mahmoud Abbas
Clinical Decision Support in Mechanical Ventilation- Egyptian Critical Care Summit. Presented by Dr Lluis Blanch
Egyptian Critical care Summit is the leading medical event and exhibition in Egypt
Mechanical Ventilation in COPD Lecture presented by Dr Lluis Blanch at Venti Cairo Mechanical Ventilation Course held on 14-15 November at Cairo, Egypt.
Mechanical Ventilation of Patient with COPD ExacerbationDr.Mahmoud Abbas
Mechanical Ventilation of Patient with COPD Exacerbation lecture presented by Dr Andres Esteban at the Egyptian Critical care Summit 2015 held at Cairo, egypt.
The Egyptian Critical Care Summit is the leading medical event and exhibition for Intensive Care Medicine in Egypt.
Presented by D.Niall Ferguson at 9th Pulmonary Medicine Update Course held at Cairo, Egypt.
This course is the leading Pulmonary Critical Care event in Egypt. The course is organized by Scribe (www.scribeofegypt.com)
Under Appreciated Signs In Ventilator MonitoringDr.Mahmoud Abbas
Presentation of Dr. Lluis Blanch at 10th Pulmonary Medicine Update Course, Cairo, Egypt. Pulmonary Medicine Update Course is organized by Scribe : www.scribeofegypt.com
Presentation of Dr. Lluis Blanch at 10th Pulmonary Medicine Update Course, Cairo, Egypt. Pulmonary Medicine Update Course is organized by Scribe : www.scribeofegypt.com
Stress & Strain during Lung Protective Ventilation Egypt Pulmonary Critical...Dr.Mahmoud Abbas
Stress & Strain During Lung Protective Ventilation. Presentation of Dr Lluis Blanch at Pulmonary Critical Care Egypt 2014 , the leading educational event and exhibition for Critical Care Medicine in Egypt. www.pccmegypt.com
PROSEVA trial - Prone position in severe ARDS.
Why did prone position improve outcome of ARDS while other measures aimed at improving oxygenation such as high PEEP, RM and HFO have failed to do so?
Presentation of Dr. Lluis Blanch at 10th Pulmonary Medicine Update Course, Cairo, Egypt. Pulmonary Medicine Update Course is organized by Scribe : www.scribeofegypt.com
Stress & Strain during Lung Protective Ventilation Egypt Pulmonary Critical...Dr.Mahmoud Abbas
Stress & Strain During Lung Protective Ventilation. Presentation of Dr Lluis Blanch at Pulmonary Critical Care Egypt 2014 , the leading educational event and exhibition for Critical Care Medicine in Egypt. www.pccmegypt.com
PROSEVA trial - Prone position in severe ARDS.
Why did prone position improve outcome of ARDS while other measures aimed at improving oxygenation such as high PEEP, RM and HFO have failed to do so?
Patient ventilator interactions during mechanical ventilationDr.Mahmoud Abbas
Patient Ventilator Interaction during Mechanical Ventilation lecture presented by Dr.Lluis Blanch at Pulmonary Critical Care Egypt Meeting and Exhibition, January 2014. www.pccmegypt.com
Presentation of Dr.Lluis Blanch at Pulmonary Critical Care Egypt 2014 , January2014, the leading critical care conference and medical exhibition in Egypt.www.pccmegypt.com
Acute Response of Manual Hyperinflation In Addition To Standard Chest Physiot...iosrjce
Background: Physiotherapists use manual hyperinflation (MHI) as a treatment for the recruitment of
collapsed lung and mobilization of excess pulmonary secretions .Purpose: To investigate the acute effect of
manual hyperinflation (MHI) on oxygenation and volume of secretions cleared in mechanically ventilated
patients.
Subjects and Methods: Manual hyperinflation was delivered in 30 medically stable, mechanically ventilated
patients . patients were randomly selected from Cairo university hospitals (critical care department). Their ages
ranged from 50 to 60 years .The study group A received both manual hyperinflation and standard chest
physiotherapy while control group B received standard chest physiotherapy only. Oxygenation parameters were
recorded before and after 30 minutes of treatment while secretion volume was recorded after 30 minutes of
treatment.
Results: The results of this study revealed statistically significant improvement in oxygenation parameters and
the amount of drained chest secretions in patients of both groups which was highly significant in favor of study
group A with P value ≤ 0.05.
Conclusion: Use of manual hyperinflation in combination with standard chest physiotherapy is a beneficial
method to clear lung secretions and improve oxygenation parameters in mechanically ventilated patients .
An excellent tool to treat refractory hypoxia. Target audience are ICU junior physicians and Respiratory Therapists. It will take away the fear of "What is APRV?" from your hearts and you will feel ready to give it a try.
Similar to New Directions in Mechanical Ventilation (20)
The Changing Role of the Coronary Care Cardiologist & The Emerging Role of Ca...Dr.Mahmoud Abbas
The Changing Role of the Coronary Care Cardiologist
&
The Emerging Role of Cardiac Intensive Care Specialists lecture presented by Dr Sherif Mokhtar, President ECCCP at the Egyptian Spanish Critical care Symposium held at Cairo, Egypt on 11 May 2023
Drug induced Kidney Injury in the ICU. Presentation by Dr Sandra Kane Gill , President Society of Critical Care Medicine (SCCM) , USA at the Egyptian Critical care Summit 2022 conference , organized by the Egyptian College of Critical care Physicians (ECCCP) , Egypt
Using Novel Kidney Biomarkers to Guide Drug Therapy.pdfDr.Mahmoud Abbas
Using Novel Kidney Biomarkers to Guide Drug Therapy: Presentation by Dr Sandra Gill , President SCCM at the Egyptian Critical Care Summit 2022 held at Cairo, Egypt and organized by the Egyptian College of Critical care Physicians (ECCCP)
Presentation by Dr Marwa Atef , National Research Center, Cairo, Egypt . Presented at Cairo Textile Week 2021 , the leading textiles conference in Egypt
Cairo Textile Week 2021 Conference -Egypt Textiles & Home Textiles Export Cou...Dr.Mahmoud Abbas
Egyptian Textiles Export
Opportunities & Requirements
Presentation by Engineer Hany Salam, CEO Salam Textiles, Board member Egypt Textiles & Home Textiles
Export Council (THTEC)
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
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.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
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.
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stockrebeccabio
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Hot Selling Organic intermediates
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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
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.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Phone Us ❤85270-49040❤ #ℂall #gIRLS In Surat By Surat @ℂall @Girls Hotel With...
New Directions in Mechanical Ventilation
1. Dr. Lluís Blanch
Senior Critical Care
Director of Research and Innovation
Corporació Sanitària Parc Taulí
Cairo, 12th of January 2015
New directions
in Mechanical
Ventilation
D
r.Lluís
Blanch
2. L.Blanch is inventor of one Corporació Sanitaria Parc
Taulí owned US patent: “Method and system for
managed related patient parameters provided by a
monitoring device,” US Patent No. 12/538,940.
L.Blanch owns 10% of BetterCare S.L. which is a
research and development company, spin off of
Corporació Sanitària Parc Taulí.
Financial Disclosures
Lluis Blanch MD, PhDD
r.Lluís
Blanch
3. Objectives MV
• Safety
• Efficacy
– Oxygenation
– Ventilation
– Work of Breathing
• Comfort / Synchrony
– Surveillance of Flow & Pressure
D
r.Lluís
Blanch
4. Daily Use of Modes of Mechanical Ventilation
2010
Esteban A et al. AJRCCM 2013;188:220-30
VCV
PSV
PCV
D
r.Lluís
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6. • Volume Control
- Set VT
- Set Flow waveform
- Set Flow rate
- Set Inspiratory Time
- Variable pressure
- Linear Rate/VE
• Pressure Control
- Set Pressure
- Set Inspiratory Time
- Variable VT
- Variable Flow waveform
- Variable Flow rate
- Non-linear Rate/VE
Pressure vs Volume ControlPressure vs Volume Control
D
r.Lluís
Blanch
7. Effect of VT & PEEP on Compliance
Suter PM et al. Chest 1978; 73:158
D
r.Lluís
Blanch
8. Amato MBP et al.
N Eng J Med 1998; 338:347-54
Targets during MV in Patients with ARDS
VT 12
PEEP
VT 6
PEEP VT 6
VT 12
ARDS Network
N Eng J Med 2000; 342:1301-8
ARDS Network
N Eng J Med 2004; 351:327-36
VT 6
D
r.Lluís
Blanch
9. Protective ventilation strategy during general
anesthesia for abdominal surgery improves post-
operative pulmonary function: a randomized trial
N Engl J Med 2013;369:428-37.
D
r.Lluís
Blanch
10. A Trial of Intraoperative Lung Protective
Ventilation in Abdominal Surgery
• VT 6 to 8 ml/kg PBW
• PEEP 6 to 8 cmH2O
• Recruitment Maneuver
• VT 10 to 12 ml/kg PBW
• No PEEP
• No Recruitment Maneuver
Recruitment maneuver = CPAP 30 cmH2O during 30 sec
after intubation and every 30 min thereafter
VS.
Lung-Protective Ventilation Traditional Ventilation
In both groups:
- Plateau pressure < 30 cmH2O
- Volume-controlled ventilation mode
- FiO2 adjusted to maintain SpO2 ≥ 95%
- RR adjusted to maintain ETCO2 between 35 and 40 mmHg
D
r.Lluís
Blanch
11. 0.000.100.200.300.50
Days since surgery
Probabilityofevent
1 3 7 15 30
0.40
Protective ventilation
Traditional ventilation
No. at Risk
Traditional ventilation 182 163 145 142 142
Lung-protective ventilation 192 184 179 176 175
P<0.001
Major Pulmonary and Extra-pulmonary Complications
within 30 days after surgery
A Trial of Intraoperative Lung Protective
Ventilation in Abdominal Surgery
D
r.Lluís
Blanch
12. Need for intubation or NIV for ARF
within 30 days after surgery
No. at Risk
Traditional ventilation 190 175 166 164 163
Lung-protective ventilation 191 190 190 187 187
1 3 7 15 30
0.000.100.200.300.500.40
Probabilityofevent
Days since surgery
Protective ventilation
Traditional ventilation
P<0.001
A Trial of Intraoperative Lung Protective
Ventilation in Abdominal Surgery
D
r.Lluís
Blanch
13. AJRCCM December-2014 as 10.1164/rccm.201409-1598OC
Timing of Low Tidal Volume Ventilation and ICU Mortality in
ARDS:Study of 482 ARDS patients with 11,558 twice-daily VT assessments
D
r.Lluís
Blanch
15. Relationship between the initial response to
changes in PEEP following randomization and
mortality.
(1,732) patients
D
r.Lluís
Blanch
16. Am J Respir Crit Care Med 2002; 165: 165-170
D
r.Lluís
Blanch
17. 40 studies (1,185 patients) met inclusion criteria.
Ventilatory parameters were not
significantly altered by an RM, except
for higher PEEP post-RM (11 vs 16
cmH2O)
Hypotension (12%) and desaturation
(9%) were the most common adverse
events.
Given the uncertain benefit of transient oxygenation
improvements in patients with ALI and the lack of information
on their influence on clinical outcomes, the routine use of
RMs cannot be recommended or discouraged at this time.
Am J Respir Crit Care Med Vol 178. pp 1156–1163, 2008
P/F Ratio
D
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18. N Engl J Med 2013;368:806-13.
N Engl J Med 2013;368:795-805.
Why?: deleterious effects of heavy sedation and NBA,
hemodynamic compromise due to adverse effects of
high mean airway pressure on the right ventricle, or
increased VALI among HFOV non-responders.
Durbin CG, Blanch L, Fan E, Hess D. Respir Care 2014
D
r.Lluís
Blanch
19. 20
+5
20
-5
Influence of Chest Wall Compliance & IAP & Obesity in
Transpulmonary Pressure and Lung Volume
Ptp = 25 Ptp = 15
Ptp = Paw - Peso
D
r.Lluís
Blanch
22. PEEP titrated in order to obtain values of end-expiratory
transpulmonary pressure ranging between 0 and 10 cmH2O
Airway Pressure
Esophageal Pressure
Transpulmonary Pressure
D
r.Lluís
Blanch
26. Crit Care Med 2013; 41:536–545
4 groups of 7 rabbits
VT 5-7 ml/kg. Pplat<30 cmH2O. PEEP 9-11 cmH2O
Mild ALI
+ NMBA
Mild ALI
+ SB
Severe ALI
+ NMBA
Severe ALI
+ SB
D
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27. n engl j med 363;12 nejm.org september 16, 2010
Once the assigned Ramsay
sedation score was 6 and the
ventilator settings were adjusted,
a 3-ml rapid intravenous infusion
of 15 mg of cisatracurium
besylate or placebo was
administered, followed by a
continuous infusion of 37.5 mg
per hour for 48 hours.
177 162
cisatracurium placebo
D
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28. n engl j med 363;12 nejm.org september 16, 2010
At 28 days in cisatracurium
group more:
- ventilator-free days
- days without organ failure
- less pneumothorax
At 28 days in cisatracurium
group similar number of
patients with ICU-acquired
paresis
D
r.Lluís
Blanch
29. The mechanisms underlying the beneficial effect of
neuromuscular blocking agents remain speculative. A brief
period of paralysis early in the course of ARDS may facilitate lung-
protective mechanical ventilation by improving patient–ventilator
synchrony and allowing for the accurate adjustment of tidal volume
and pressure levels, thereby limiting the risk of both asynchrony related
alveolar collapse and regional alveolar pressure increases with
overdistention. Another possible mechanism of the benefit involves a
decrease in lung or systemic inflammation.
n engl j med 363;12 nejm.org september 16, 2010
D
r.Lluís
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35. PSV from
20 to 13 cmH2O
Cycling off 45%
D
r.Lluís
Blanch
36. Murias G, Villagrá A, Blanch L. Minerva Anestesiol 2013;79:434-44
Ppl
Ppl
Paw
Paw
Increase
respiratory
effort
ASV PAV NAVA
SmartCare IntelVentVCV
PSV
PCV
Normal
respiratory
effort
D
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40. Respiratory Physiology & Neurobiology 203 (2014) 82–89
The weak EAdi–PTPdi linear relationship during NAVA and poor
triggering function during PAV+ may limit the effectiveness o fthese
modes to proportionally assist the inspiratory effort
Short term study in
22 difficult to wean
critically ill
patients:
PAV+, NAVA, PSV
D
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42. Crit Care Med 2011;39 (on line)
45 patients (47%) reported dyspnea (respiratory effort in
seven cases, air hunger in 15, both in 16, and neither of
these in seven).
Dyspneic and nondyspneic patients did not differ in terms
of age, SAPS II or indication for MV.
Dyspnea was significantly associated with anxiety (OR,
8.84; 95%CI, 3.26 –24.0), assistcontrol ventilation (OR,
4.77; 95% CI, 1.60–4.3), and heart rate (OR, 1.33 per 10
beats/min; 95% CI, 1.02–1.75).
D
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43. J Crit Care. 2009 March ; 24(1): 74–80
Patient ventilator asynchrony was assessed by determining the number of
breaths demonstrating ineffective triggering, double triggering, short cycling,
and prolonged cycling.
In 20 ICU patients airway pressure and airflow were recorded for 15 minutes.
For one unit decrease in RASS,
ITI increased by 2.7%, p = 0.04
ITI=
ineffectively triggered breaths
total number breaths
D
r.Lluís
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44. Crit Care Med 2014; 42:74–82
14 pts. PSV & NAVA.
Propofol, BIS & RSS
PSV
NAVA
D
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45. Vaschetto R et al. Crit Care Med 2014; 42:74–82
D
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46. Alexopoulou C et al.
ICM 2013;39:1040-47
Sleep Architecture
in 14 patients.
PAV+
PSV
% Total
Sleep Time
PAV+ improved
synchrony but failed
to improve sleep
D
r.Lluís
Blanch
47. New Directions in MV
Low VT and Paw: always
PEEP yes: attention to the effects
NMB drugs: short period in early
ARDS
HFOV: gone after RCTs
P-V interaction: pay attention
Proportional modes: slow entry
Comfort & Sleep: still work to do
D
r.Lluís
Blanch