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difficult weaning from Mechanical ventilator
1) Difficult weaning refers to patients who fail initial weaning attempts or require up to three spontaneous breathing trials (SBTs) over seven days to be successfully weaned.
2) Causes of difficult weaning include imbalance between respiratory muscle strength and load, cardiac dysfunction, neuromuscular impairment, and metabolic or nutritional deficiencies.
3) Management of difficult weaning involves addressing potentially reversible causes, using ventilator modes like pressure support ventilation (PSV) to aid the weaning process, and considering non-invasive ventilation (NIV) in selected patients.
Ventilator Induced Lung Injury
This document discusses ventilator induced lung injury (VILI) from barotrauma to biotrauma. It explores how injurious ventilator strategies can increase cytokines and lead to inflammation in isolated rat lung models. High pulmonary vascular flow and pulmonary capillary pressure were shown to promote lung damage, edema, and hemorrhage independent of ventilator settings. A study on isolated perfused rabbit lungs found that high pulmonary vascular flow and low positive end-expiratory pressure (PEEP) led to increased lung weight gain and hemorrhage scores compared to low flow and high PEEP settings, particularly in a two-hit lung injury model using oleic acid pre-injury.
Role of ultrasound in ICU
Ultrasound has many advantages for critically ill patients in the ICU. It enables rapid, repeated, and inexpensive bedside evaluation. There are two main probe types: B-mode produces 2D images while M-mode shows motion over time, analogous to video. Ultrasound can assess volume status by measuring the diameter and collapse of the inferior vena cava. It can diagnose pneumothorax by lung sliding signs or stratosphere and seashore artifacts. Ultrasound is also used for vascular access, intubation, diaphragm assessment, and identifying pleural effusions and hemothorax. Critical care physicians should receive training to utilize ultrasound's benefits for critically ill patients.
Reusable resuscitator
This document describes an ideal reusable resuscitator bag. It should be lightweight, easy to use with one hand, and durable. It should deliver high volumes of oxygen with each breath, refill rapidly, and maintain a tight seal. The bag is intended for respiratory emergencies like arrest and ventilator failure. It must function properly across a range of temperatures and pressures while minimizing dead space. The document provides guidelines on proper placement of oral/nasal airways and techniques for manual ventilation using the resuscitator bag.
Mechanical Ventilation
The document provides an overview of mechanical ventilation, including indications for intubation and ventilation, principles of mechanical ventilation, patterns of assisted ventilation, ventilator dependence and complications, liberation from mechanical ventilation through weaning, and troubleshooting arterial blood gases. Key topics covered include indications for intubation, objectives of mechanical ventilation, strategies for mechanical ventilation including use of airway pressures and compliance, patterns of assisted ventilation such as assist control ventilation and pressure control ventilation, complications of mechanical ventilation, parameters for bedside weaning, and low volume ventilation strategies for ARDS.
Basic Mechanical Ventilation
This document provides an overview of mechanical ventilation, including:
1) How mechanical ventilation helps reduce the work of breathing and restore gas exchange through invasive and noninvasive positive pressure ventilation.
2) The basics of monitoring pressure, volume, flow, and pressure-time curves at the bedside.
3) Important considerations for mechanical ventilation including potential adverse effects on hemodynamics, lungs, and gas exchange, and how to address issues like auto-PEEP.
Weaning from mechanical ventilation
This document provides an overview of evidence and guidelines for weaning patients from mechanical ventilation, with a focus on neurological patients. It discusses definitions of weaning, the interaction between the brain and lungs, weaning algorithms, classifications of weaning difficulty, factors influencing weaning success, and assessments used to determine patient readiness for weaning trials. The execution of weaning involves conducting spontaneous breathing trials to assess tolerance of breathing without support before considering extubation. Research studies are referenced that evaluated outcomes of protocolized versus non-protocolized weaning approaches in ICU patients.
Recommended
difficult weaning from Mechanical ventilator
1) Difficult weaning refers to patients who fail initial weaning attempts or require up to three spontaneous breathing trials (SBTs) over seven days to be successfully weaned.
2) Causes of difficult weaning include imbalance between respiratory muscle strength and load, cardiac dysfunction, neuromuscular impairment, and metabolic or nutritional deficiencies.
3) Management of difficult weaning involves addressing potentially reversible causes, using ventilator modes like pressure support ventilation (PSV) to aid the weaning process, and considering non-invasive ventilation (NIV) in selected patients.
Ventilator Induced Lung Injury
This document discusses ventilator induced lung injury (VILI) from barotrauma to biotrauma. It explores how injurious ventilator strategies can increase cytokines and lead to inflammation in isolated rat lung models. High pulmonary vascular flow and pulmonary capillary pressure were shown to promote lung damage, edema, and hemorrhage independent of ventilator settings. A study on isolated perfused rabbit lungs found that high pulmonary vascular flow and low positive end-expiratory pressure (PEEP) led to increased lung weight gain and hemorrhage scores compared to low flow and high PEEP settings, particularly in a two-hit lung injury model using oleic acid pre-injury.
Role of ultrasound in ICU
Ultrasound has many advantages for critically ill patients in the ICU. It enables rapid, repeated, and inexpensive bedside evaluation. There are two main probe types: B-mode produces 2D images while M-mode shows motion over time, analogous to video. Ultrasound can assess volume status by measuring the diameter and collapse of the inferior vena cava. It can diagnose pneumothorax by lung sliding signs or stratosphere and seashore artifacts. Ultrasound is also used for vascular access, intubation, diaphragm assessment, and identifying pleural effusions and hemothorax. Critical care physicians should receive training to utilize ultrasound's benefits for critically ill patients.
Reusable resuscitator
This document describes an ideal reusable resuscitator bag. It should be lightweight, easy to use with one hand, and durable. It should deliver high volumes of oxygen with each breath, refill rapidly, and maintain a tight seal. The bag is intended for respiratory emergencies like arrest and ventilator failure. It must function properly across a range of temperatures and pressures while minimizing dead space. The document provides guidelines on proper placement of oral/nasal airways and techniques for manual ventilation using the resuscitator bag.
Mechanical Ventilation
The document provides an overview of mechanical ventilation, including indications for intubation and ventilation, principles of mechanical ventilation, patterns of assisted ventilation, ventilator dependence and complications, liberation from mechanical ventilation through weaning, and troubleshooting arterial blood gases. Key topics covered include indications for intubation, objectives of mechanical ventilation, strategies for mechanical ventilation including use of airway pressures and compliance, patterns of assisted ventilation such as assist control ventilation and pressure control ventilation, complications of mechanical ventilation, parameters for bedside weaning, and low volume ventilation strategies for ARDS.
Basic Mechanical Ventilation
This document provides an overview of mechanical ventilation, including:
1) How mechanical ventilation helps reduce the work of breathing and restore gas exchange through invasive and noninvasive positive pressure ventilation.
2) The basics of monitoring pressure, volume, flow, and pressure-time curves at the bedside.
3) Important considerations for mechanical ventilation including potential adverse effects on hemodynamics, lungs, and gas exchange, and how to address issues like auto-PEEP.
Weaning from mechanical ventilation
This document provides an overview of evidence and guidelines for weaning patients from mechanical ventilation, with a focus on neurological patients. It discusses definitions of weaning, the interaction between the brain and lungs, weaning algorithms, classifications of weaning difficulty, factors influencing weaning success, and assessments used to determine patient readiness for weaning trials. The execution of weaning involves conducting spontaneous breathing trials to assess tolerance of breathing without support before considering extubation. Research studies are referenced that evaluated outcomes of protocolized versus non-protocolized weaning approaches in ICU patients.
Ultrasound use in shock
Ultrasound can be useful in the evaluation and diagnosis of patients presenting in shock. Integrating bedside ultrasound allows for a more accurate initial diagnosis and earlier treatment. The RUSH protocol assesses the heart, IVC, pericardial space and lungs to help classify the type of shock. Ultrasound findings of a dilated and collapsing IVC along with evidence of free fluid suggest the patient has hypovolemic shock likely due to internal bleeding.
Weaning from mechanical Ventilation
Hippocrates first described endotracheal intubation in the 5th century BC. Mechanical ventilation progressed through the centuries with innovations like Paracelsus using bellows in 1530 and Vesalius recognizing artificial respiration through tracheostomy in dogs in the 16th century. The development of positive pressure ventilation in the 1950s helped greatly during polio epidemics. Key events included the iron lung in 1929 and intensive use of positive pressure ventilation in Scandinavia and the US in the 1950s. The document outlines the historical aspects and developments of mechanical ventilation from ancient times through the modern era.
aprv
APRV is a ventilation mode that applies CPAP at a high pressure for a prolonged period of time to recruit and maintain lung volume, followed by brief releases to a lower pressure to allow for exhalation and CO2 removal. It aims to preserve spontaneous breathing. APRV is indicated for ARDS management and postoperative atelectasis and has benefits like improved oxygenation and reduced sedation needs but risks include increased work of breathing and worsening of air leaks. Studies comparing APRV to other modes in ARDS patients have found similar outcomes but more research is still needed to determine its full utility.
Acute Respiratory Distress Syndrome
Acute respiratory distress syndrome (ARDS) is characterized by acute lung injury and hypoxemia caused by a profound inflammatory response and diffuse alveolar damage. ARDS has an incidence of 5-71 per 100,000 people and costs $5 billion annually to treat in the US. Standard treatment focuses on treating the underlying cause, maintaining adequate oxygen levels through ventilator support using lung-protective strategies, and considering approaches like prone positioning to improve oxygenation. While mortality was historically high, outcomes have improved with application of evidence-based protocols, though ARDS still carries significant morbidity and risk of long-term complications.
Transpulmonary driving pressure determined by a PEEP step
1) Transpulmonary pressure, the difference between airway opening and pleural space pressures, is the relevant pressure for the lung, but determining it requires measuring esophageal pressure, which is complicated.
2) A new simple method determines transpulmonary pressure using PEEP steps - by changing PEEP levels, one can measure the change in end-expiratory lung volume (EELV) and use it to calculate lung compliance and transpulmonary pressure without complex measurements.
3) This PEEP step method allows clinicians to monitor transpulmonary pressures at the bedside and optimize ventilation settings to prevent ventilator-induced lung injury, which is caused by high transpulmonary pressures.
Jet vent 2 8.2021.
Jet ventilation is a form of mechanical ventilation that uses very high respiratory rates and small tidal volumes delivered via a jet of gas. It can be used supraglottically or subglottically for procedures involving the airway. Key indications are subglottic and tracheal stenosis. The jet ventilator provides active insufflation of gas while exhalation is passive. Gas exchange occurs via mechanisms like laminar flow and Taylor dispersion. Precautions must be taken to ensure adequate ventilation and monitoring of end-tidal CO2. Complications can include barotrauma, pneumothorax, or difficulty ventilating.
Evolution of Boyle's Anaesthesia apparatus
The machine which is used to give general anaesthesia is generally called as Boyle's machine even though there are many other names for that machine.This presentation tries to trace the development of the Boyles machine from 1846.
Basics of mechanical ventilation
This document provides an overview of mechanical ventilation, including indications, modes, settings, and alarms. It discusses the different modes of ventilation such as controlled, assisted-control, SIMV. It explains various ventilation settings including tidal volume, respiratory rate, pressure and flow. It also describes the purpose and meaning of different ventilator alarms.
Mode of ventilation
This document discusses respiratory failure and various modes of mechanical ventilation. It begins by distinguishing between respiratory failure and respiratory insufficiency. It then covers initiating mechanical ventilation using either volume ventilation or pressure ventilation. Various modes are discussed including volume-targeted modes like control, assist, SIMV+PS. Pressure-targeted modes like pressure control ventilation and PSV are also covered. The document discusses the challenges of ventilating ARDS patients and how newer dual modes and closed-loop modes can help minimize ventilator-induced lung injury while maintaining lung recruitment and pressures. It also introduces APRV and bi-level ventilation as newer modes to apply PEEP above the lower inflection point.
Vortex Approach to Unexpected Difficult Airway
The document outlines a team-based approach for preventing and managing airway emergencies using a difficult airway algorithm. It discusses the need for such an algorithm given that past incidents have shown failures to properly execute basic techniques or abandon failed intubation attempts in a timely manner. The algorithm consists of Plan A which is the initial intubation plan, Plan B which is secondary intubation options if Plan A fails, Plan C which focuses on maintaining oxygenation if intubation continues to fail, and Plan D which are rescue techniques for "can't intubate, can't ventilate" situations involving interventions like cannula or surgical cricothyroidotomy. It provides step-by-step details for executing each plan.
HFOV - High Frequency Oscillatory Ventilation
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.
Ventilator strategies in ARDS
1) ARDS is characterized by hypoxemia, bilateral lung infiltrates, and respiratory failure not fully explained by cardiac failure. The Berlin definition classifies ARDS as mild, moderate, or severe based on oxygenation levels.
2) Management of ARDS focuses on treating underlying causes, preventing complications, and using ventilator strategies like low tidal volume ventilation to prevent ventilator-induced lung injury.
3) Other ventilator strategies discussed include prone positioning, neuromuscular blockade, recruitment maneuvers, and extracorporeal membrane oxygenation for severe cases, though evidence on benefits is mixed.
Mechanical ventilation sharath
1) The document discusses various aspects of mechanical ventilation including its history, classification, parameters, modes, and complications.
2) Key aspects covered include negative pressure ventilation devices like iron lungs, classification of ventilators based on pressure support, important parameters like compliance and resistance, and modes of ventilation including controlled, assisted, and spontaneous modes.
3) Complications of mechanical ventilation discussed are barotrauma, increased lung water, reduced cardiac output, and organ perfusion issues related to high airway pressures.
Difficult airway
This document discusses the assessment and management of difficult airways. It defines a difficult airway as one where adequate ventilation cannot be achieved with a mask or oxygen saturation cannot be maintained above 90%. It notes the prevalence of difficult airways is about 1 in 10,000 cases in general surgery and 1 in 300 in obstetrics. Basic airway evaluation involves examining the patient's history, neck, face, jaw movement, and oropharynx. The document outlines causes of difficult intubation related to both the anesthesiologist and patient factors. It emphasizes the importance of advance planning, having backup equipment and senior support available when anticipating a difficult airway. Various airway devices and techniques are presented for managing both anticipated and
Principles of icu ventilators
Mechanical ventilators are machines that assist or replace patient breathing. They have several key components, including an input power source, drive mechanism, control circuit, and ability to generate specific output waveforms. Ventilators are classified based on whether they use positive or negative pressure to support breathing. Positive pressure ventilators are now more commonly used and deliver gas by exerting pressure on the airway. They can control ventilation based on parameters like pressure, volume, flow, or time. Modern microprocessor-controlled ventilators provide closed-loop servo control to precisely match patient needs.
PEEP:Bring the Evidence to the Bedside
This document discusses the use of positive end-expiratory pressure (PEEP) in patients receiving mechanical ventilation. It describes a 19 year old female patient with immunosuppression and CMV pneumonia who requires intubation and mechanical ventilation. The goal of using PEEP in this patient is to decrease the risk of ventilator-induced lung injury while also aiming to increase oxygen levels and decrease the need for high oxygen supplementation. The document then reviews evidence and controversies around optimizing PEEP levels to reduce lung injury and improve outcomes in acute lung injury and acute respiratory distress syndrome patients.
Pulmonary function test and bronchial challenge test
Pulmonary function test and bronchial challenge testChulalongkorn Allergy and Clinical Immunology Research Group
Pulmonary function test and bronchial challenge test
Presented by Kullapornpas Benyajirapach, MD.
June28, 2019Ventilatory support
The document discusses various topics related to mechanical ventilation including:
1. Ventilation strategies for acute respiratory distress syndrome (ARDS) including low tidal volumes, optimal positive end-expiratory pressure, and prone positioning.
2. Ventilation modes and settings should be tailored to the individual patient's condition and aim to prevent ventilator-induced lung injury.
3. Non-invasive ventilation can be considered for certain patients with COPD or asthma to avoid intubation if criteria are met.
14 capnography part1 overview
This document provides an overview of capnography, which is a technology that objectively measures ventilation by detecting exhaled carbon dioxide. It can be used for both intubated and non-intubated patients to continuously monitor ventilation and the patient's ABCs. The document reviews the history of capnography, from its initial use in operating rooms to new portable technologies suitable for emergency medical services. It also outlines the clinical applications of capnography such as verifying endotracheal tube placement and monitoring treatment effectiveness.
CATALOGO PERFUMES
This document appears to be a catalog listing prices for various perfumes. The prices range from $2000 to $12,400 for different sizes of perfume bottles including 15ml, 30ml, 50ml, and 100ml. The most expensive perfume listed is $12,400 for a 100ml bottle while the cheapest is $2000 for an unspecified size.
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Ultrasound use in shock
Ultrasound can be useful in the evaluation and diagnosis of patients presenting in shock. Integrating bedside ultrasound allows for a more accurate initial diagnosis and earlier treatment. The RUSH protocol assesses the heart, IVC, pericardial space and lungs to help classify the type of shock. Ultrasound findings of a dilated and collapsing IVC along with evidence of free fluid suggest the patient has hypovolemic shock likely due to internal bleeding.
Weaning from mechanical Ventilation
Hippocrates first described endotracheal intubation in the 5th century BC. Mechanical ventilation progressed through the centuries with innovations like Paracelsus using bellows in 1530 and Vesalius recognizing artificial respiration through tracheostomy in dogs in the 16th century. The development of positive pressure ventilation in the 1950s helped greatly during polio epidemics. Key events included the iron lung in 1929 and intensive use of positive pressure ventilation in Scandinavia and the US in the 1950s. The document outlines the historical aspects and developments of mechanical ventilation from ancient times through the modern era.
aprv
APRV is a ventilation mode that applies CPAP at a high pressure for a prolonged period of time to recruit and maintain lung volume, followed by brief releases to a lower pressure to allow for exhalation and CO2 removal. It aims to preserve spontaneous breathing. APRV is indicated for ARDS management and postoperative atelectasis and has benefits like improved oxygenation and reduced sedation needs but risks include increased work of breathing and worsening of air leaks. Studies comparing APRV to other modes in ARDS patients have found similar outcomes but more research is still needed to determine its full utility.
Acute Respiratory Distress Syndrome
Acute respiratory distress syndrome (ARDS) is characterized by acute lung injury and hypoxemia caused by a profound inflammatory response and diffuse alveolar damage. ARDS has an incidence of 5-71 per 100,000 people and costs $5 billion annually to treat in the US. Standard treatment focuses on treating the underlying cause, maintaining adequate oxygen levels through ventilator support using lung-protective strategies, and considering approaches like prone positioning to improve oxygenation. While mortality was historically high, outcomes have improved with application of evidence-based protocols, though ARDS still carries significant morbidity and risk of long-term complications.
Transpulmonary driving pressure determined by a PEEP step
1) Transpulmonary pressure, the difference between airway opening and pleural space pressures, is the relevant pressure for the lung, but determining it requires measuring esophageal pressure, which is complicated.
2) A new simple method determines transpulmonary pressure using PEEP steps - by changing PEEP levels, one can measure the change in end-expiratory lung volume (EELV) and use it to calculate lung compliance and transpulmonary pressure without complex measurements.
3) This PEEP step method allows clinicians to monitor transpulmonary pressures at the bedside and optimize ventilation settings to prevent ventilator-induced lung injury, which is caused by high transpulmonary pressures.
Jet vent 2 8.2021.
Jet ventilation is a form of mechanical ventilation that uses very high respiratory rates and small tidal volumes delivered via a jet of gas. It can be used supraglottically or subglottically for procedures involving the airway. Key indications are subglottic and tracheal stenosis. The jet ventilator provides active insufflation of gas while exhalation is passive. Gas exchange occurs via mechanisms like laminar flow and Taylor dispersion. Precautions must be taken to ensure adequate ventilation and monitoring of end-tidal CO2. Complications can include barotrauma, pneumothorax, or difficulty ventilating.
Evolution of Boyle's Anaesthesia apparatus
The machine which is used to give general anaesthesia is generally called as Boyle's machine even though there are many other names for that machine.This presentation tries to trace the development of the Boyles machine from 1846.
Basics of mechanical ventilation
This document provides an overview of mechanical ventilation, including indications, modes, settings, and alarms. It discusses the different modes of ventilation such as controlled, assisted-control, SIMV. It explains various ventilation settings including tidal volume, respiratory rate, pressure and flow. It also describes the purpose and meaning of different ventilator alarms.
Mode of ventilation
This document discusses respiratory failure and various modes of mechanical ventilation. It begins by distinguishing between respiratory failure and respiratory insufficiency. It then covers initiating mechanical ventilation using either volume ventilation or pressure ventilation. Various modes are discussed including volume-targeted modes like control, assist, SIMV+PS. Pressure-targeted modes like pressure control ventilation and PSV are also covered. The document discusses the challenges of ventilating ARDS patients and how newer dual modes and closed-loop modes can help minimize ventilator-induced lung injury while maintaining lung recruitment and pressures. It also introduces APRV and bi-level ventilation as newer modes to apply PEEP above the lower inflection point.
Vortex Approach to Unexpected Difficult Airway
The document outlines a team-based approach for preventing and managing airway emergencies using a difficult airway algorithm. It discusses the need for such an algorithm given that past incidents have shown failures to properly execute basic techniques or abandon failed intubation attempts in a timely manner. The algorithm consists of Plan A which is the initial intubation plan, Plan B which is secondary intubation options if Plan A fails, Plan C which focuses on maintaining oxygenation if intubation continues to fail, and Plan D which are rescue techniques for "can't intubate, can't ventilate" situations involving interventions like cannula or surgical cricothyroidotomy. It provides step-by-step details for executing each plan.
HFOV - High Frequency Oscillatory Ventilation
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.
Ventilator strategies in ARDS
1) ARDS is characterized by hypoxemia, bilateral lung infiltrates, and respiratory failure not fully explained by cardiac failure. The Berlin definition classifies ARDS as mild, moderate, or severe based on oxygenation levels.
2) Management of ARDS focuses on treating underlying causes, preventing complications, and using ventilator strategies like low tidal volume ventilation to prevent ventilator-induced lung injury.
3) Other ventilator strategies discussed include prone positioning, neuromuscular blockade, recruitment maneuvers, and extracorporeal membrane oxygenation for severe cases, though evidence on benefits is mixed.
Mechanical ventilation sharath
1) The document discusses various aspects of mechanical ventilation including its history, classification, parameters, modes, and complications.
2) Key aspects covered include negative pressure ventilation devices like iron lungs, classification of ventilators based on pressure support, important parameters like compliance and resistance, and modes of ventilation including controlled, assisted, and spontaneous modes.
3) Complications of mechanical ventilation discussed are barotrauma, increased lung water, reduced cardiac output, and organ perfusion issues related to high airway pressures.
Difficult airway
This document discusses the assessment and management of difficult airways. It defines a difficult airway as one where adequate ventilation cannot be achieved with a mask or oxygen saturation cannot be maintained above 90%. It notes the prevalence of difficult airways is about 1 in 10,000 cases in general surgery and 1 in 300 in obstetrics. Basic airway evaluation involves examining the patient's history, neck, face, jaw movement, and oropharynx. The document outlines causes of difficult intubation related to both the anesthesiologist and patient factors. It emphasizes the importance of advance planning, having backup equipment and senior support available when anticipating a difficult airway. Various airway devices and techniques are presented for managing both anticipated and
Principles of icu ventilators
Mechanical ventilators are machines that assist or replace patient breathing. They have several key components, including an input power source, drive mechanism, control circuit, and ability to generate specific output waveforms. Ventilators are classified based on whether they use positive or negative pressure to support breathing. Positive pressure ventilators are now more commonly used and deliver gas by exerting pressure on the airway. They can control ventilation based on parameters like pressure, volume, flow, or time. Modern microprocessor-controlled ventilators provide closed-loop servo control to precisely match patient needs.
PEEP:Bring the Evidence to the Bedside
This document discusses the use of positive end-expiratory pressure (PEEP) in patients receiving mechanical ventilation. It describes a 19 year old female patient with immunosuppression and CMV pneumonia who requires intubation and mechanical ventilation. The goal of using PEEP in this patient is to decrease the risk of ventilator-induced lung injury while also aiming to increase oxygen levels and decrease the need for high oxygen supplementation. The document then reviews evidence and controversies around optimizing PEEP levels to reduce lung injury and improve outcomes in acute lung injury and acute respiratory distress syndrome patients.
Pulmonary function test and bronchial challenge test
Pulmonary function test and bronchial challenge testChulalongkorn Allergy and Clinical Immunology Research Group
Pulmonary function test and bronchial challenge test
Presented by Kullapornpas Benyajirapach, MD.
June28, 2019Ventilatory support
The document discusses various topics related to mechanical ventilation including:
1. Ventilation strategies for acute respiratory distress syndrome (ARDS) including low tidal volumes, optimal positive end-expiratory pressure, and prone positioning.
2. Ventilation modes and settings should be tailored to the individual patient's condition and aim to prevent ventilator-induced lung injury.
3. Non-invasive ventilation can be considered for certain patients with COPD or asthma to avoid intubation if criteria are met.
14 capnography part1 overview
This document provides an overview of capnography, which is a technology that objectively measures ventilation by detecting exhaled carbon dioxide. It can be used for both intubated and non-intubated patients to continuously monitor ventilation and the patient's ABCs. The document reviews the history of capnography, from its initial use in operating rooms to new portable technologies suitable for emergency medical services. It also outlines the clinical applications of capnography such as verifying endotracheal tube placement and monitoring treatment effectiveness.
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Transpulmonary driving pressure determined by a PEEP step
Transpulmonary driving pressure determined by a PEEP step
Pulmonary function test and bronchial challenge test
Pulmonary function test and bronchial challenge test
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CATALOGO PERFUMES
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Valved Holding Chambers V1
1) Valved holding chambers (VHCs) are devices used with pressurized metered dose inhalers (pMDIs) to improve drug delivery to the lungs. They hold the aerosol cloud to allow particles to evaporate to a smaller size before inhalation.
2) Guidelines from regulatory agencies like the EMEA and FDA provide recommendations for characterizing VHCs and assessing their impact on aerosol particle size and drug delivery. Studies evaluate factors like delay time between actuation and inhalation.
3) Key attributes of VHCs include their size selective function, impact of delay time, effect of electrostatic charge, and how the drug and VHC type
Pediatric intubation
This document provides guidance on pediatric intubation. It discusses indications for intubation in pediatric patients, how pediatric airways differ from adults, important considerations before intubation, equipment and medications needed, and techniques for performing intubation. Key differences in pediatric airways include a larger tongue, angled vocal cords, differently shaped epiglottis, and a funnel-shaped larynx. Important assessments before intubation include evaluating mouth opening, neck mobility, and airway anatomy. Common induction agents described are etomidate, propofol, ketamine, and fentanyl/versed. Succinylcholine, rocuronium, and cisatracurium are paralytic options. Case examples are provided
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人工急救甦醒球
- 1. 人工呼吸急救甦醒器介紹
- 11. 人工甦醒器基本構造 矽球體 / 橡膠球體 單向閥 氧氣儲氣閥 氧氣儲氣袋 早期單向閥：彈簧圓盤式、彈簧小球式、林狀式 新式單向閥：鴨嘴式、隔膜鴨嘴合併式、隔膜葉狀辦膜式 Y.J.Chang
- 14. 人工甦醒器的安全設計 -ASTM 兒童釋壓閥－ 自動提供調節肺部壓力，使其維持在 40+10cmH2O 以內 新生兒釋壓閥－ 自動提供調節肺部壓力，使其維持在 40+5cmH2O 以內 成人釋壓閥－ 可不用設定 Y.J.Chang
- 15. 人工甦醒器的安全設計 -ISO 新生兒壓力安全閥－ 自動提供調節肺部壓力，使其維持在 45cmH2O 以內 成人壓力安全閥－ 自動提供調節肺部壓力，使其維持在 60cmH2O 以內 Y.J.Chang
- 30. 人工甦醒器的問題及排除 Y.J.Chang 氧氣流量設定 15L/Min( 嬰兒或小孩更低 ) 修補破裂的儲氣袋 氧氣沒開或開太小 儲氣袋破裂 氧氣儲氣袋塌陷 氣道抽吸，或給予支氣管擴張劑 給藥改善肺或胸廓的順應性 降低每分鐘換氣量或治療原先的肺疾 清潔阻塞的進氣閥或更換甦醒器 氧氣流量設定 15L/Min( 嬰兒或小孩更低 ) 呼吸道阻力增加 肺或胸廓的順應性變差 高 AUTO PEEP 進氣閥阻塞 氧氣流量太大，造成阻力增加 球體不易壓 排除方法 原因 問題
- 31. 人工甦醒器的問題及排除 Y.J.Chang 每次呼吸都會發生 POP-OFF 氣道抽吸，或給予支氣管擴張劑 給藥改善肺或胸廓的順應性 降低每分鐘換氣量或治療原先的肺疾 擠小力一點 擠小力一點或調低氧氣流量 呼吸道阻力增加 肺或胸廓的順應性變差 高 AUTO PEEP 擠壓的容積太大 氧氣流量太大 氧氣流量設定 15L/Min( 嬰兒或小孩更低 ) 清潔阻塞的進氣閥或更換甦醒器 氧氣沒開或開太小 進氣閥阻塞 氧氣儲氣袋逐漸塌陷 排除方法 原因 問題