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.
Basic information on the Graphics displayed on the Ventilators. Prepared to educate about the graphics to train the professionals who work with Ventilators.
Basic information on the Graphics displayed on the Ventilators. Prepared to educate about the graphics to train the professionals who work with Ventilators.
Non-invasive ventilation (NIV) is the use of breathing support administered through a face mask or nasal mask. Learn more about NIV in this presentation by Dr Somnath Longani, consultant Anaesthesiologist & Intensivist, Midland Healthcare & Research Center, lucknow
https://midlandhealthcare.org/
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.
Non-invasive ventilation (NIV) is the use of breathing support administered through a face mask or nasal mask. Learn more about NIV in this presentation by Dr Somnath Longani, consultant Anaesthesiologist & Intensivist, Midland Healthcare & Research Center, lucknow
https://midlandhealthcare.org/
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.
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
There might be no safe ventilation. Much too often, all there is for us to measure at the bedside are nothing but global indicators of stress/strain, more or less refined. Heterogeneity at the alveolar level-inhomogeneities or stress raisers - render global parameters less useful than previously predicted. In fact, Mead had already stated it through his work on stress distribution at the alveolar level.
ECMO (VA ECMO) might be regarded as one other way of decatecholaminization (M.Singer). Stop stressing the already stressed heart. Unfortunately, fem-fem VA ECMO still needs inotropic support to lessen the LV distension. Levosimendan and IABP combined could help decrease the catecholamine usage in this context.
Presented by Dr Lluis Blanch at the Egyptian African Critical care Summit held at Cairo, Egypt.
The Egyptian African Critical care Summit is the leading Critical care and Emergency medicine medical conference in Egypt.
Presentation of Dr. Lluis Blanch at 8th Pulmonary Medicine Update Course, February 2008, Cairo, Egypt. Pulmonary Medicine Update Course is organized by Scribe : www.scribeofegypt.com
Lecture presented by Dr.Yasser Nassar at Pulmonary Critical care Egypt 2014, the leading medical educational event and exhibition for Intensive Care medicine in Egypt
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)
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- 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
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
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.
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.
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
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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!
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Ventilator Induced Lung Injury
1. 8th Pulmonary Medicine Update Course
The Egyptian Society of ICM & Trauma
Ventilator Induced Lung Injury:
from Barotrauma to Biotrauma
Lluis Blanch M.D.
Consultant, Critical Care Center, Hospital of Sabadell
Scientific Director, Corporacio Parc Tauli
University Institut Fundació Parc Taulí
Universitat Autónoma de Barcelona
Sabadell, Spain
lblanch@tauli.cat
Cairo, February 6 - 7, 2008
4. The concept of “Barotrauma”
Increased Microvascular Permeability in Dog Lungs
due to High Peak Airway Pressures
Parker JC et al. J Appl Physiol 1984;57:1809
5. The concept of “Biotrauma”
Mechanical Injury Leads to Inflammation
ARDS Baro-Volu-Atelectrauma
Surfactant Biotrauma
Depletion
Stress Failure
Shear Forces
TNFα
Overdistension
IL-1
IL-8
Cell Trigger Mechanism
6.
7. Injurious Ventilatory Strategies Increase Cytokines in
an isolated Rat Lung Model (Saline Injected Group)
Tremblay L et al. J Clin Invest 1997;99:944-952
9. Effect of Mechanical Ventilation Strategy on
Dissemination of Intratracheally Instilled
Escherichia coli in Dogs “second hit”
+ Blood Cultures
Group Overall 30 min.6 hours
Ptp 15, PEEP 3 0/6 0/6 0/6
Ptp 35, PEEP 3 5/6 5/6 2/4
Ptp 35, PEEP 10 1/6 1/6 1/6
Nahum A, et al Crit Care Med 1997; 25:1733-43.
10. VILI & Stress Distribution along the
Blood-Gas Barrier Results from a
Complex Interplay between
• Alveolar pressure
• Lung volume
• Surface tension
• Capillary pressure
• Flow through pulmonary vessels
• Rate of lung expansion
11.
12. High Capillary Pressure is More Injurious
at High Lung Volume Scanning
Transmission Electron Microscopy Electron Microscopy
Fu Z et al. J Appl Physiol 1992;73:123-133
13. Pulmonary Capillary in an Alveolar Wall Showing The
Three Principal Forces to which The Vessel Is Exposed
Increase in
Lung Inflation
Increase
in Pcap Stretch & Stress
The Capillary Wall
West JB & Mathieu-Costello O. Lancet 1992;340:762-767.
14. Perfusion (ml/min) Ptp (cmH2O)
Control 500 10
Low Flow 300 30
High Flow 900 30
Am J Respir Crit Care Med 1998; 157:1935-42
15. Prospective study designed to Systolic PAP
identify factors influencing
pathogenesis, severity and
prognosis of ARDS.
Patients: 586 (38 European ICUs)
Results:
- PaO2/FiO2 & Qs/Qt predicted
survival.
- High PAP and low SAP were
strong indicators of survival
(adverse prognostic significance).
16. 3
Weight Gain
(gm/gm lung)
1
* f: resp. rate
* P: PA pressure
0
High f Low f High f
Low P High P High P
Am J Respir Crit Care Med 2000; 161:463.
17.
18. Contributions of Vascular Flow & Pulmonary
Capillary Pressure to VILI
Study Design
Stabilization 15’ Pressure Controlled Ventilation 30’
Heart-Lung Block Measurements Measuremetns
Ischemic Time < 25 min
Pump Flow PAP LAP Pcap Paw PEEP
(ml/min) (mmHg) (mmHg) (mmHg) (cmH2O) (cmH2O)
↓Flow ↓Pcap 40 20 10 10 30 5
↑Flow ↑Pcap 500 35 10 20 30 5
↓Flow ↑Pcap 40 20 20 20 30 5
↑Flow ↓Pcap 500 35 5 10 30 5
19. Contributions of Vascular Flow & Pulmonary
Capillary Pressure to VILI
*† *†
% change in Cst
Vascular
*
*
failure was
observed
* †
ONLY in high
* †
flow groups
*† *†
20. Crit Care Med 2006;34:1106-1112
quot;%
quot;$
quot;
quot;
High Flow
& * †
Groups
%
$
'
Low Flow
Groups
! quot; quot;! ! #
Perfusion at high vascular flow promotes lung damage, edema, and
hemorrhage independent of the level of pulmonary capillary pressure
21. Effects of vascular flow and PEEP in a
multiple hit model of lung injury in isolated
perfused rabbit lung
To evaluate the protective role of PEEP in
lung injury development in two isolated and
perfused lung model of VILI:
High vascular flow model (one hit)
Oleic acid pre-injury and high vascular flow
model (two hit)
22. Effects of vascular flow and PEEP in a
multiple hit model of lung injury in isolated
perfused rabbit lung
• Experimental, prospective and acute study
• 30 Isolated perfused and ventilated lungs from New
Zealand rabbits ( 3.3 ± 0.5 kg)
• 6 Experimental groups (3 with and 3 without OA):
Group Flow PAP LAP Pcap
ml/min mmHg mmHg mmHg
Low Flow/Peep 5 40 20 10 12
High Flow/Peep 5 600 35 10 20
HighFlow/Peep15 600 35 10 20
23. Effects of vascular flow and PEEP in a
multiple hit model of lung injury in isolated
perfused rabbit lung
6 10
weight gain (g/g lung tissue)
†
*
weight gain (g/g lung tissue)
a
5
* + b
+
8
4
3
6
*
4 *
2
1 2
0 0
0 5 10 15 20 25 30 0 5 10 15 20 25 30
Time (minutes) Time (minutes)
! quot; # $% '
&' &(
! quot; # $% '
&' &)(
$ # $% '
&' &(
24. Effects of vascular flow and PEEP in a multiple hit model
of lung injury in isolated perfused rabbit lung
a
3
6
* +
Perivascular hemorrhage score
* + *†
Alveolar hemorrhage score
†
5 *
4 2
3
2 1
1
0 0
LFLP HFLP HFHP LFLP HFLP HFHP
8 b 4
+ +
Perivascular hemorrhage score
* * *
Alveolar hemorrhage score
*
7
6 3
5
4 2
3
2 1
1
0 0
LFLPOA HFLPOA HFHPOA LFLPOA HFLPOA HFHPOA
25. Factors Influencing Liquid Movement in
the Pulmonary Capillaries:
The Starling Equation
Qf = Kf {(Pc - Pis) - σ (πpl - πis)}
(π
Qf: net flow of fluid
Kf: capillary filtration coefficient
Pc: capillary hydrostatic pressure
Pis: hydrostatic pressure of the interstitial fluid
σ: reflection coefficient
πpl: oncotic pressure of the plasma
πis: oncotic pressure of the interstitial fluid