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
High frequency oscillatory ventilation (HFOV) is a type of mechanical ventilation that uses a constant distending pressure (mean airway pressure [MAP]) with pressure variations oscillating around the MAP at very high rates (up to 900 cycles per minute). This creates small tidal volumes, often less than the dead space.
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
High frequency oscillatory ventilation (HFOV) is a type of mechanical ventilation that uses a constant distending pressure (mean airway pressure [MAP]) with pressure variations oscillating around the MAP at very high rates (up to 900 cycles per minute). This creates small tidal volumes, often less than the dead space.
High frequency ventilation ppt dr vinit patelVINIT PATEL
HIGH FREQUENCY VENTILATOR FOR NEONATES
NEONATAL VENTILATOR
PPHN,MECHANICAL VENTILATION,ADVANCE VENTILATION,NITRIC OXIDE,SLE 5000,SENSOR MEDICS
DR VINIT PATEL
HFO is a well debated topic but still man ICU physicians and respiratory therapists seem to be afraid of it and avoid this therapy. If in expert hands and utilized judicially it has saved lives and still has a lot of potential in it nit yet explored. Although this presentation is very long but it is drafted by keeping in ind to explain every thing about high frequency oscillatory ventilator to a beginner.
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.
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
High frequency ventilation ppt dr vinit patelVINIT PATEL
HIGH FREQUENCY VENTILATOR FOR NEONATES
NEONATAL VENTILATOR
PPHN,MECHANICAL VENTILATION,ADVANCE VENTILATION,NITRIC OXIDE,SLE 5000,SENSOR MEDICS
DR VINIT PATEL
HFO is a well debated topic but still man ICU physicians and respiratory therapists seem to be afraid of it and avoid this therapy. If in expert hands and utilized judicially it has saved lives and still has a lot of potential in it nit yet explored. Although this presentation is very long but it is drafted by keeping in ind to explain every thing about high frequency oscillatory ventilator to a beginner.
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.
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
High-frequency oscillatory ventilation (HFOV) is an advanced mechanical ventilation strategy utilized in the management of respiratory failure, particularly in critically ill patients. It employs small tidal volumes delivered at rapid rates to maintain lung recruitment and gas exchange while minimizing the risk of ventilator-induced lung injury (VILI). HFOV is commonly employed in neonates, infants, and adults with acute respiratory distress syndrome (ARDS) or other conditions characterized by severe respiratory compromise.
The fundamental principle of HFOV involves the delivery of very small tidal volumes (often in the range of 1-3 mL/kg) at high frequencies (typically between 3 and 15 Hz). This approach differs from conventional mechanical ventilation, where larger tidal volumes are delivered at slower rates. The goal of HFOV is to provide adequate ventilation and oxygenation while minimizing the risk of lung injury associated with high tidal volumes and pressures.
In HFOV, gas is delivered into the airways in the form of rapid oscillations, creating small pressure changes that promote lung recruitment and gas exchange. These oscillations are superimposed on a baseline level of continuous positive airway pressure (CPAP), which helps to maintain lung volume and prevent atelectasis during expiration. The combination of high-frequency oscillations and continuous positive pressure facilitates gas exchange by improving alveolar ventilation and reducing intrapulmonary shunting.
The oscillations in HFOV are typically generated by a piston or a diaphragm within the ventilator circuit. The rapid oscillatory motion of the ventilator creates pressure fluctuations that are transmitted to the airways, causing the lungs to expand and contract at high frequencies. This cyclical stretching and relaxation of the lung tissue help to open collapsed alveoli, redistribute lung volume, and improve overall lung compliance.
One of the key advantages of HFOV is its ability to deliver ventilation while minimizing the risk of VILI. By using very small tidal volumes and high frequencies, HFOV reduces the mechanical forces applied to the lungs, thereby decreasing the likelihood of barotrauma (pressure-related lung injury) and volutrauma (overdistension of the alveoli). This makes HFOV particularly suitable for patients with ARDS or other conditions where lung injury may be exacerbated by conventional ventilation strategies.
HFOV can be used as a primary mode of ventilation or as a rescue therapy for patients who fail to respond to conventional ventilation. It is often initiated when patients exhibit severe respiratory distress, hypoxemia, or signs of impending respiratory failure. HFOV may also be used prophylactically in high-risk patients to prevent the development of ARDS or other complications.
Despite its potential benefits, HFOV requires careful patient selection, monitoring, and management to optimize outcomes.
Pulmonary function tests (PFT) are series of tests that measure lung function and aid in the management of patients with respiratory disease.
They are performed using standardized equipment and can be used for diagnosis, prognostication, management and follow-up of patients with pulmonary pathology.
Although PFT may not identify the exact pathology, it broadly classifies respiratory disorders as either obstructive or restrictive. In this session , the role of PFT in the measurement of lung mechanics and diagnosis of various diseases will be discussed in detail.
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.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Title: Sense of Taste
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 structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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
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.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
2. Introduction
• Delivers a small tidal volume, usually less
than or equal to anatomical dead space
volume.
• While HFV’s are frequently described by
their delivery method, they are usually
classified by their exhalation mechanism
(active or passive)
3. Introduction
• Henderson first published his findings in
1915, assessing dead space relationship in
ventilation.
• He stated, “there may easily be a gaseous
exchange sufficient to support life even
when Vt is considerably less than dead
space
4. High Frequency Ventilation
• Types of HFV’s Approved for use in both Neonates
and Pediatrics
• SLE5000 HFOV
• SensorMedics 3100A HFOV
• Bird Volumetric Diffusive HFPPV
• Types of HFV’s Approved for use in Neonates Only
• Bunnell Life Pulse HFJV
• Infrasonics Infant Star (discontinued) HFFI
5. SLE5000
• Electrically powered,
electronically controlled
• Conventional and HFOV
ventilator
• Paw of 3 - 35 mbar
• Delta P from 4 – 180 mbar
• Frequency of 3 - 20 Hz
• I:E Ratio 1:1
• Active exhalation
8. Absence of Surfactant
Atelactasis
High Distending Pressures
Airway Stretch / Distortion
Cellular Membrane Disruption
Edema
Higher FIO2 , Volumes,
Pressures
PIE, BPD
Pulmonary Injury Sequence
of the neonatal patient:
9. Pulmonary Injury Sequence
If we cannot prevent the injury
sequence , then the target goal is to
interrupt the sequence of events.
High Frequency Oscillation does not
reverse injury, but will interrupt the
progression of injury.
11. Pulmonary Injury Sequence
• There are two injury
zones during
mechanical ventilation
• Low Lung Volume
Ventilation tears
adhesive surfaces
• High Lung Volume
Ventilation over-
distends, resulting in
“Volutrauma”
• The difficulty is finding
the “Sweet Spot” Froese AB, Crit Care Med 1997;
25:906
13. Ventilator Induced Lung Injury
• HFOV with Surfactant as Compared to
CMV with Surfactant in the Premature
Primate
–HFOV resulted in
•Less Radiographic Injury
•Less Oxygenation Injury
•Less Alveolar Proteinaceous
Debris
15. Theory of Operation
• Oxygenation is primarily controlled by the
Mean Airway Pressure (Paw) and the FiO2
• Ventilation is primarily determined by the
stroke volume (Delta-P) and the frequency
of the ventilator.
18. Optimized Lung Volume Strategy:
Increase Lung Volume above critical opening
pressure to the Optimum and keep it there in
Inspiration and Expiration.
Benefits: - homogenous gas distribution
- reduced regional atelectasis
- maximized gas exchange area and
pulmonary blood flow
- better matching of ventilation/perfusion
- reduction of intrapulmonary shunting
- reduced Oxygen exposure
19. Optimized Lung Volume Strategy:
Decrease Tidal Volumes to less or equal to
dead space and increase frequency.
Benefits: - enhanced gas exchange due to
combined gas transport mechanisms
- no excessive volume swings
- reduced regional over-inflation and
stretching
- reduced Volutrauma
20. “Open up the lung up
and keep it open!”
Burkhard Lachmann, 1992
21. Primary control of CO2 is by the stroke volume
produced by the Delta P Setting.
22. Regulation of stroke volume
• The stroke volume will increase if
– The amplitude increases (higher delta P)
Stroke
volume
24. Regulation of stroke volume
• The stroke volume will increase if
– The amplitude increases (higher delta P)
– The frequency decreases (longer cycle time)
Stroke
volume
31. Mechanisms of HFOV Gas Exchange
There are six mechanisms of gas
exchange during HFOV
Convective Ventilation
Asymmetrical Velocity Profiles
Taylor Dispersion
Pendeluft
Molecular Diffusion
Cardiogenic Mixing
32.
33. Practical preparation
Avoid leak around the E.T tube
Tc PO2,CO2,Pulse oxymeter and invasive
blood pressure monitoring
Baseline CXR
Optimize blood pressure and
perfusion(volume replacement and
inotropes)
Muscle relaxant/sedation
Reusable low compliance circuits must be
used
34. NURSING CARE
Perform through suction before connecting
to the oscillator.
Assess patient upon commencement of
HFOV.
Monitor vital signs, chest wiggle must be
evaluated upon initiation and followed
closely thereafter.
35. Precautions
If chest wiggle diminishes it may be
ET tube moved or obstructed.
Chest wiggle on one side indicates
patient developed pneumothorax,thus
chest wiggle assessment should be
performed after repositioning
36. Precautions
Auscultation the chest by putting in standby
mode.
A closed suction should be used.
It is not necessary to disconnect the patient
to suction as this will potentially derecruit
lung volumes.
The point at which the ET tube is cut and
secured at lips should be initially noted this
measurement is reference
37. Precautions
Evaluation of lung expansion on CXR
Check capillary refill, skin color and
temperature
Comparing central and peripheral
pulses
Monitoring of ECG Tracing
Frequent CXR’s blood gases in initial
stabilization period
38. Precautions
Optimal lung volume for oxygenation
is 8-9 rib inflation
Blood pressure and perfusion should
be optimized prior to HFOV,any
volume replacement should be
completed and inotropes commenced
if necessary
39. Precautions
Muscle relaxants are not indicated
since spontaneous respiratory effort
will be a clinical indicator of adequacy
of ventilation
Sedation with opiates is often
indicated