Year in Review Intensive Care Training Program Radboud University Medical Centre Nijmegen
|
|
- Winifred Harvey
- 5 years ago
- Views:
Transcription
1 Year in Review 2013 Intensive Care Training Program Radboud University Medical Centre Nijmegen
2 Contents ARDS Ventilator associated pneumonia Tracheostomy and endotracheal intubation Enteral feeding Fluid therapy Sepsis Cardiac arrest
3 Prone position in severe ARDS MC (27) RCT Severe ARDS and MV < 36 hrs with PF < 150 mmhg, FiO2 0.6 and PEEP 5 Tv 6 ml/kg PBW After inclusion stabilization period of hrs Guérin C. N Engl J Med 2013
4 Prone position in severe ARDS Prone for at least 16 consecutive hrs PEEP and FiO2 from table: Pplat < 30 and ph Clear criteria for stopping prone position Strategy followed for up to 28 days Proning as rescue in the supine group strictly controlled Guérin C. N Engl J Med 2013
5 Prone position in severe ARDS Supine (N = 229) Prone (N = 237) 90 P < P < P < , ,5 0 Mortality D28 Mortality D90 Extubation D90 Better oxygenation and less rescue therapy in prone group Main cause pneumonia - 4 ± 4 prone sessions Guérin C. N Engl J Med 2013
6 Very low TV ventilation MC (10) RCT Tv 3 ml/kg + ECCO2R (ila) versus Tv 6 ml/kg ARDS < 1 week AND Pplat > 25 using 6 ml/kg 24 h stabilization period with PEEP 12 before final inclusion Target PaO2 60 and ph 7.20 Bein T. Intensive Care Med 2013
7 No differences in ph en PaCO2 Bein T. Intensive Care Med 2013
8 Higher PEEP levels with 3mL/kg Bein T. Intensive Care Med 2013
9 Very low TV ventilation N = Tv 3 ml/kg 50 37,5 Tv 6 ml/kg P = P = P/F subgroup < ,5 0 VFD (D28) VFD (D60) 0 VFD (D28) VFD (D60) Mean duration of ila treatment 7.4 ± 4 D No differences in other outcome measures Lower IL-6 levels in first 48 hours Bein T. Intensive Care Med 2013
10 Statin therapy and VAP MC, placebo controlled RCT to determine statin therapy (60 mg) on outcome of VAP MV > 2 days and suspected VAP (CPIS 5) Planned enrollment 1002 patients (8% in 28 D mortality Stopping rule - absolute increase in mortapity of 2.7% in simvastatin group Papazian L. JAMA 2013;310:
11 Statin therapy and VAP Stopped for futility after 300 patients - 6% increase in mortality (p = 0.1) No other significant differences Papazian L. JAMA 2013;310:
12 Antibiotic resistance Aminoglycosides During SDD Polymyxin E/B Daneman N. Lancet Infect Dis 2013
13 Antibiotic resistance During SDD Fluoroquinolones Cephalosporins -3 d generation Median duration SDD 16 months Daneman N. Lancet Infect Dis 2013
14 Attributable mortality VAP Meta-analysis of individual patient data from randomised prevention studies Attributable mortality mainly results from longer stay in the ICU Melsen WG. Lancet 2013
15 Early vs late tracheostomy TracMan trial - MC (N = 72) RCT Patients on MV 4 D and expected to be ventilated at least another 7 D Tracheostomy 4 D versus 10 D Primary outcome 30 D mortality Young D. JAMA 2013
16 Early vs late tracheostomy N = Days > 10 Days 75 % Received tracheostomy Mortality 30 D Mortality 2 Y ICU LOS not significantly different between groups Young D. JAMA 2013
17 Difficult ICU intubation Prospective observational MC study (42) development and (18) validation All consecutive ICU patients with exclusion of pregnancy Difficult intubation: 3 laryngoscopic attempts or lasting > 10 minutes 1000 intubations for development and 400 for validation De Jong A. Am J Respir Crit Care Med 2013
18 Difficult intubation No problem 11,3% Development 88,7% 8% Difficult Factors Macocha score Mallampati score III/IV Obstructive sleep apnea syndrome Reduced mobility of cervical spine Limited mouth opening < 3 cm! Coma Severe hypoxemia (< 80%)! Non-anaesthesiologist Score 3 Points ! 1 1! 1 Validation PPV 36%, NPV 98%, AUC % De Jong A. Am J Respir Crit Care Med 2013
19 Difficult intubation % Difficult Intubation Macocha score De Jong A. Am J Respir Crit Care Med 2013
20 Difficult intubation % At least one complication Severe complication Sever hypoxemia Sever collaps Cardiac arrest Death Moderate complication Cardiac arrhythmia Esophageal intubation Agitation Aspiration Dental injury De Jong A. Am J Respir Crit Care Med 2013
21 Glutamine supplement MC RCT (40) with 2 2 design (glutamine and antioxidant supplementation for 28 D) Mechanical ventilation + organ failures Glutamine 0.35 mg/kg IBW Antioxidants: selenium, zinc, beta carotene, Vitamins E and C Heyland D. N Engl J Med 2013
22 Glutamine supplement Glutamine No glutamine Antioxidants No antioxidants 40 P = 0.05 P = ,4 27, ,8 28,8 Secondary outcomes Glutamine No glutamine P-value % 20 % 20 In-hospital mortality 37.2% 31% M mortality 43,7% 37,2% Mortality 28 D 0 Mortality 28 D Urea 13,4% 4% < No interaction between glutamine and antioxidants N = 1218 Heyland D. N Engl J Med 2013
23 Subgroup analysis Heyland D. N Engl J Med 2013
24 Heyland D. N Engl J Med 2013
25 Antioxidants Double edged sword Oxygen radicals essential for immune activation Jaine M. Am J Respir Crit Care Med 2013
26 CRISTAL trial MC, open label RCT colloids vs crystalloids in ICU patient with hypovolemic shock N = 2857 Stratification by case mix (sepsis, trauma and other hypovolemic shock) Primary outcome 28 D mortality Annane D. JAMA 2013;310:
27 CRISTAL trial Colloids Crystalloids! P-value 28 D mortality (%) D mortality (%)! RRT (%)! Statistically significant but clinically irrelevant decrease in MV and vasopressor days in colloids group Annane D. JAMA 2013;310:
28 CRISTAL trial Annane D. JAMA 2013;310:
29 Esmolol and septic shock Target heart rate bpm started 24 hrs after admission (hemodynamic stabilization) Esmolol group! Higher SVI Higher LVSWI Lower NE dose Less volume therapy Morelli A. JAMA 2013;310:
30 Cardiac arrest MC RCT comparing 33 0 versus 36 0 in OHCA (all rhythms) N = D follow-up Target temperature for 24 hours - in both groups temperature < C for 72 hrs Primary outcome: death at end of trial No baseline differences Nielsen N. N Engl J Med 2013
31 Nielsen N. N Engl J Med 2013
32 Outcome % Death at end of trial Death/CPC 3-5 Death/Modified Rankin 4-6 Death at 180 D Nielsen N. N Engl J Med 2013
33 Nielsen N. N Engl J Med 2013
ARDS Assisted ventilation and prone position. ICU Fellowship Training Radboudumc
ARDS Assisted ventilation and prone position ICU Fellowship Training Radboudumc Fig. 1 Physiological mechanisms controlling respiratory drive and clinical consequences of inappropriate respiratory drive
More informationOxygenation Failure. Increase FiO2. Titrate end-expiratory pressure. Adjust duty cycle to increase MAP. Patient Positioning. Inhaled Vasodilators
Oxygenation Failure Increase FiO2 Titrate end-expiratory pressure Adjust duty cycle to increase MAP Patient Positioning Inhaled Vasodilators Extracorporeal Circulation ARDS Radiology Increasing Intensity
More informationLandmark articles on ventilation
Landmark articles on ventilation Dr Shrikanth Srinivasan MD,DNB,FNB,EDIC Consultant, Critical Care Medicine Medanta, The Medicity ARDS AECC DEFINITION-1994 ALI Acute onset Bilateral chest infiltrates PCWP
More informationVentilatory Management of ARDS. Alexei Ortiz Milan; MD, MSc
Ventilatory Management of ARDS Alexei Ortiz Milan; MD, MSc 2017 Outline Ventilatory management of ARDS Protected Ventilatory Strategy Use of NMB Selection of PEEP Driving pressure Lung Recruitment Prone
More informationAcute Lung Injury/ARDS. Disclosures. Overview. Acute Respiratory Failure 5/30/2014. Research funding: NIH, UCSF CTSI, Glaxo Smith Kline
Disclosures Acute Respiratory Failure Carolyn S. Calfee, MD MAS UCSF Critical Care Medicine and Trauma CME May 30, 2014 Research funding: NIH, UCSF CTSI, Glaxo Smith Kline Medical advisory boards: Cerus
More informationOutcomes From Severe ARDS Managed Without ECMO. Roy Brower, MD Johns Hopkins University Critical Care Canada Forum Toronto November 1, 2016
Outcomes From Severe ARDS Managed Without ECMO Roy Brower, MD Johns Hopkins University Critical Care Canada Forum Toronto November 1, 2016 Severe ARDS Berlin Definition 2012 P:F ratio 100 mm Hg Prevalence:
More informationTracheal Intubation in ICU: Life saving or life threatening?
Tracheal Intubation in ICU: Life saving or life threatening? Prof. Sheila Nainan Myatra Department of Anaesthesia, Critical Care & Pain Tata Memorial Hospital Mumbai, India sheila150@hotmail.com Three
More informationARDS: an update 6 th March A. Hakeem Al Hashim, MD, FRCP SQUH
ARDS: an update 6 th March 2017 A. Hakeem Al Hashim, MD, FRCP SQUH 30M, previously healthy Hx: 1 week dry cough Gradually worsening SOB No travel Hx Case BP 130/70, HR 100/min ph 7.29 pco2 35 po2 50 HCO3
More informationApplication of Lung Protective Ventilation MUST Begin Immediately After Intubation
Conflict of Interest Disclosure Robert M Kacmarek Managing Severe Hypoxemia!" 9-28-17 FOCUS Bob Kacmarek PhD, RRT Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts I disclose
More informationNutrition. ICU Fellowship Training Radboudumc
Nutrition ICU Fellowship Training Radboudumc Critical Care MCQ s Nasogastric (NG) and nasojejunal (NJ) feeding tubes: A. Enteral nutrition is associated with a reduced risk of bacterial and toxin translocation.
More informationThe use of proning in the management of Acute Respiratory Distress Syndrome
Case 3 The use of proning in the management of Acute Respiratory Distress Syndrome Clinical Problem This expanded case summary has been chosen to explore the rationale and evidence behind the use of proning
More informationInhaled nitric oxide: clinical evidence for use in adults
Inhaled nitric oxide: clinical evidence for use in adults Neill Adhikari Critical Care Medicine Sunnybrook Health Sciences Centre and University of Toronto 31 October 2014 Conflict of interest Ikaria provided
More informationWeaning and extubation in PICU An evidence-based approach
Weaning and extubation in PICU An evidence-based approach Suchada Sritippayawan, MD. Div. Pulmonology & Crit Care Dept. Pediatrics Faculty of Medicine Chulalongkorn University Kanokporn Udomittipong, MD.
More informationFeeding the septic patient How and when? Masterclass ICU nurses
Feeding the septic patient How and when? Masterclass ICU nurses Case Male, 60 - No PMH - L 1.74 m and W 85 kg Pneumococcal pneumonia Stable hemodynamics - No AKI MV in prone position (PEEP 16 - FiO2 60%)
More informationBack to the Future: Updated Guidelines for Evaluation and Management of Adrenal Insufficiency in the Critically Ill
Back to the Future: Updated Guidelines for Evaluation and Management of Adrenal Insufficiency in the Critically Ill Joe Palumbo PGY-2 Critical Care Pharmacy Resident Buffalo General Medical Center Disclosures
More informationSurviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016
Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016 Mitchell M. Levy MD, MCCM Professor of Medicine Chief, Division of Pulmonary, Sleep, and Critical Care
More informationExclusion Criteria 1. Operator or supervisor feels specific intra- procedural laryngoscopy device will be required.
FELLOW Study Data Analysis Plan Direct Laryngoscopy vs Video Laryngoscopy Background Respiratory failure requiring endotracheal intubation occurs in as many as 40% of critically ill patients. Procedural
More informationWhen to start SPN in critically ill patients? Refereeravond IC
When to start SPN in critically ill patients? Refereeravond IC Introduction (1) Protein/calorie malnutrition is very frequent in critically ill patients Protein/calorie malnutrition is associated with
More informationSurgery Grand Rounds. Non-invasive Ventilation: A valuable tool. James Cromie, PGY 3 8/24/09
Surgery Grand Rounds Non-invasive Ventilation: A valuable tool James Cromie, PGY 3 8/24/09 History of mechanical ventilation 1930 s: use of iron lung 1940 s: First NIV system (Bellevue Hospital) 1950 s:
More informationNutrition and Sepsis
Nutrition and Sepsis Todd W. Rice, MD, MSc Associate Professor of Medicine Vanderbilt University 2017 DNS Symposium June 2, 2017 Case 55 y.o. male COPD, DM, HTN, presents with pneumonia and septic shock.
More informationWhat s New About Proning?
1 What s New About Proning? J. Brady Scott, MSc, RRT-ACCS, AE-C, FAARC Director of Clinical Education and Assistant Professor Department of Cardiopulmonary Sciences Division of Respiratory Care Rush University
More informationManagement of Severe ARDS: Current Canadian Practice
Management of Severe ARDS: Current Canadian Practice Erick Duan MD FRCPC Clinical Scholar, Department of Medicine, Division of Critical Care, McMaster University Intensivist, St. Joseph's Healthcare Hamilton
More informationSteroids for ARDS. Clinical Problem. Management
Steroids for ARDS James Beck Clinical Problem A 60 year old lady re-presented to ICU with respiratory failure. She had previously been admitted for fluid management and electrolyte correction having presented
More informationSepsis and septic shock Practical hemodynamic consequences. Intensive Care Training Program Radboud University Medical Centre Nijmegen
Sepsis and septic shock Practical hemodynamic consequences Intensive Care Training Program Radboud University Medical Centre Nijmegen Septic cardiomyopathy Present in > 50% and often masked by low vascular
More informationACUTE RESPIRATORY DISTRESS SYNDROME
ACUTE RESPIRATORY DISTRESS SYNDROME Angel Coz MD, FCCP, DCE Assistant Professor of Medicine UCSF Fresno November 4, 2017 No disclosures OBJECTIVES Identify current trends and risk factors of ARDS Describe
More informationARDS: The Evidence. Topics. New definition Breaths: Little or Big? Wet or Dry? Moving or Still? Upside down or Right side up?
ARDS: The Evidence Todd M Bull MD Professor of Medicine Division of Pulmonary Sciences and Critical Care Division of Cardiology Director Pulmonary Vascular Disease Center Director Center for Lungs and
More informationUpdate in Critical Care Medicine
Update in Critical Care Medicine Michael A. Gropper, MD, PhD Professor and Executive Vice Chair Department of Anesthesia and Perioperative Care Director, Critical Care Medicine UCSF Disclosure None Update
More informationOSCAR & OSCILLATE. & the Future of High Frequency Oscillatory Ventilation (HFOV)
& & the Future of High Frequency Oscillatory Ventilation (HFOV) www.philippelefevre.com What do we know already? Sud S et al. BMJ 2010 & Multi-centre randomised controlled trials of HFOV verses current
More informationECMO: a breakthrough in care for respiratory failure. PD Dr. Thomas Müller Regensburg no conflict of interest
ECMO: a breakthrough in care for respiratory failure? PD Dr. Thomas Müller Regensburg no conflict of interest 1 Overview Mortality of severe ARDS Indication for ECMO PaO 2 /FiO 2 Efficiency of ECMO: gas
More informationPAEDIATRIC RESPIRATORY FAILURE. Tang Swee Fong Department of Paediatrics University Kebangsaan Malaysia Medical Centre
PAEDIATRIC RESPIRATORY FAILURE Tang Swee Fong Department of Paediatrics University Kebangsaan Malaysia Medical Centre Outline of lecture Bronchiolitis Bronchopulmonary dysplasia Asthma ARDS Bronchiolitis
More informationECMO/ECCO 2 R in Acute Respiratory Failure
ECMO/ECCO 2 R in Acute Respiratory Failure Alain Combes, MD, PhD, Hôpital Pitié-Salpêtrière, AP-HP Inserm UMRS 1166, ican, Institute of Cardiometabolism and Nutrition Sorbonne Pierre et Marie Curie University,
More informationNIV in hypoxemic patients
NIV in hypoxemic patients Massimo Antonelli, MD Dept. of Intensive Care & Anesthesiology Università Cattolica del Sacro Cuore Rome - Italy Conflict of interest (research grants and consultations): Maquet
More informationVeno-Venous ECMO Support. Chris Cropsey, MD Sept. 21, 2015
Veno-Venous ECMO Support Chris Cropsey, MD Sept. 21, 2015 Objectives List indications and contraindications for ECMO Describe hemodynamics and oxygenation on ECMO Discuss evidence for ECMO outcomes Identify
More informationSepsis: Management ANUPOL PANITCHOTE, MD. Division of Critical Care Medicine Department of Medicine, Khon Kaen University, Thailand
Sepsis: Management ANUPOL PANITCHOTE, MD. Division of Critical Care Medicine Department of Medicine, Khon Kaen University, Thailand Vital signs Symptoms LAB BT > 38.3 or < 36 ๐ C HR > 90 bpm RR > 20 /min
More informationPro: Early use of VV ECMO for ARDS
Pro: Early use of VV ECMO for ARDS Kyle J. Rehder, MD, FCCP Associate Professor Division of Pediatric Critical Care Medicine Department of Pediatrics Duke Children s Hospital The ventilator is slowly killing
More informationSepsis is an important issue. Clinician s decision-making capability. Guideline recommendations
Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock: 2012 Clinicians decision-making capability Guideline recommendations Sepsis is an important issue 8.7%
More informationVentilator Associated Pneumonia. ICU Fellowship Training Radboudumc
Ventilator Associated Pneumonia ICU Fellowship Training Radboudumc Attributable mortality VAP Meta-analysis of individual patient data from randomized prevention studies Attributable mortality mainly results
More informationFacilitating EndotracheaL Intubation by Laryngoscopy technique and Apneic Oxygenation Within the Intensive Care Unit (FELLOW)
Facilitating EndotracheaL Intubation by Laryngoscopy technique and Apneic Oxygenation Within the Intensive Data Analysis Plan: Apneic Oxygenation vs. No Apneic Oxygenation Background Critically ill patients
More informationProne Position in ARDS
Prone Position in ARDS Rich Kallet MS RRT FAARC, FCCM Respiratory Care Services San Francisco General Hospital University of California, San Francisco, Case Study A 39 yo F admitted to SFGH TICU s/p hanging,
More informationTailored Volume Resuscitation in the Critically Ill is Achievable. Objectives. Clinical Case 2/16/2018
Tailored Volume Resuscitation in the Critically Ill is Achievable Heath E Latham, MD Associate Professor Fellowship Program Director Pulmonary and Critical Care Objectives Describe the goal of resuscitation
More informationSepsis and septic shock
Sepsis and septic shock Practical hemodynamic consequences Intensive Care Training Program Radboud University Medical Centre Nijmegen Septic cardiomyopathy Present in > 50% and often masked by low vascular
More informationCritical Care Medicine Update for Non-Intensivists 2015
27 March 2015 Boca Raton Critical Care Medicine Update for Non-Intensivists 2015 MARGARET M. JOHNSON, MD CHAIR, DIVISION OF PULMONARY MEDICINE MAYO CLINIC FLORIDA Critical Care Medicine Update for The
More informationPart 2 of park s Ventilator and ARDS slides for syllabus
Part 2 of park s Ventilator and ARDS slides for syllabus Early Neuromuscular Blockade Question 4 The early use of cis-atracurium in severe ARDS is: A. Contraindicated in patients with diabetes B. Associated
More informationARDS and Ventilators PG26 Update in Surgical Critical Care October 9, 2013
ARDS and Ventilators PG26 Update in Surgical Critical Care October 9, 2013 Pauline K. Park MD, FACS, FCCM University of Michigan School of Medicine Ann Arbor, MI OVERVIEW New Berlin definition of ARDS
More informationEFFECT OF EARLY VASOPRESSIN VS NOREPINEPHRINE ON KIDNEY FAILURE IN PATIENTS WITH SEPTIC SHOCK. Alexandria Rydz
EFFECT OF EARLY VASOPRESSIN VS NOREPINEPHRINE ON KIDNEY FAILURE IN PATIENTS WITH SEPTIC SHOCK Alexandria Rydz BACKGROUND- SEPSIS Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated
More informationDoes proning patients with refractory hypoxaemia improve mortality?
Does proning patients with refractory hypoxaemia improve mortality? Clinical problem and domain I selected this case because although this was the second patient we had proned in our unit within a week,
More informationAcute Liver Failure: Supporting Other Organs
Acute Liver Failure: Supporting Other Organs Michael A. Gropper, MD, PhD Professor of Anesthesia and Physiology Director, Critical Care Medicine University of California San Francisco Acute Liver Failure
More informationExperience with Low Flow ECCO2R device on a CRRT platform : CO2 removal
Experience with Low Flow ECCO2R device on a CRRT platform : CO2 removal Alain Combes, MD, PhD, Hôpital Pitié-Salpêtrière, AP-HP Inserm UMRS 1166, ican, Institute of Cardiometabolism and Nutrition Pierre
More informationDifficult Ventilation in ARDS Patients
Thank you for viewing this presentation. We would like to remind you that this material is the property of the author. It is provided to you by the ERS for your personal use only, as submitted by the author.
More informationUPDATE IN HOSPITAL MEDICINE
UPDATE IN HOSPITAL MEDICINE FLORIDA CHAPTER ACP MEETING 2016 Himangi Kaushal, M.D., F.A.C.P. Program Director Memorial Healthcare System Internal Medicine Residency DISCLOSURES None OBJECTIVES Review some
More informationACUTE RESPIRATORY DISTRESS SYNDROME (ARDS) Rv
ACUTE RESPIRATORY DISTRESS SYNDROME (ARDS) Rv.8.18.18 ACUTE RESPIRATORY DISTRESS SYNDROME (ARDS) SUDDEN PROGRESSIVE FORM OF ACUTE RESPIRATORY FAILURE ALVEOLAR CAPILLARY MEMBRANE BECOMES DAMAGED AND MORE
More informationSepsis overview. Dr. Tsang Hin Hung MBBS FHKCP FRCP
Sepsis overview Dr. Tsang Hin Hung MBBS FHKCP FRCP Epidemiology Sepsis, severe sepsis, septic shock Pathophysiology of sepsis Recent researches and advances From bench to bedside Sepsis bundle Severe sepsis
More informationARDS & TBI - Trading Off Ventilation Targets
ARDS & TBI - Trading Off Ventilation Targets Salvatore M. Maggiore, MD, PhD Rome, Italy smmaggiore@rm.unicatt.it Conflict of interest Principal Investigator: RINO trial o Nasal high-flow vs Venturi mask
More informationRounds in the ICU. Eran Segal, MD Director General ICU Sheba Medical Center
Rounds in the ICU Eran Segal, MD Director General ICU Sheba Medical Center Real Clinical cases (including our mistakes) Emphasis on hemodynamic monitoring Usually no single correct answer We will conduct
More informationOLB (Open Lung Biopsy) in ARDS
OLB (Open Lung Biopsy) in ARDS Claude GUERIN MD PhD Réanimation Médicale Hôpital de la Croix-Rousse Université de Lyon Lyon, France CCF Toronto October 28 th 2012 CCF 2012 1 Disclosure No conflict of interest
More informationProtective ventilation for ALL patients
Protective ventilation for ALL patients PAOLO PELOSI, MD, FERS Department of Surgical Sciences and Integrated Diagnostics (DISC), San Martino Policlinico Hospital IRCCS for Oncology, University of Genoa,
More informationHow to resuscitate the patient in early sepsis? A physiological approach. J.G. van der Hoeven, Nijmegen
How to resuscitate the patient in early sepsis? A physiological approach J.G. van der Hoeven, Nijmegen Disclosure interests speaker (potential) conflict of interest Potentially relevant relationships with
More informationProne Position in ARDS
Prone Position in ARDS Rich Kallet MS RRT FAARC, FCCM Respiratory Care Services Department of Anesthesia & Perioperative Care University of California, San Francisco, San Francisco General Hospital Case
More informationBest of Pulmonary Jennifer R. Hucks, MD University of South Carolina School of Medicine
Best of Pulmonary 2012-2013 Jennifer R. Hucks, MD University of South Carolina School of Medicine Topics ARDS- Berlin Definition Prone Positioning For ARDS Lung Protective Ventilation In Patients Without
More informationEffects of mechanical ventilation on organ function. Masterclass ICU nurses
Effects of mechanical ventilation on organ function Masterclass ICU nurses Case Male, 60 - No PMH - L 1.74 m and W 85 kg Pneumococcal pneumonia Stable hemodynamics - No AKI MV in prone position (PEEP 16
More informationBeyond the Golden Hour: Caring for the ICU Boarder
Beyond the Golden Hour: Caring for the ICU Boarder Kami M. Hu, MD Dept. of Emergency Medicine Dept. of Pulmonology & Critical Care University of Maryland SOM I have no relevant financial relationships
More informationLarge observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG-SAFE)
Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG-SAFE) John Laffey, Giacomo Bellani, Tai Pham, Eddy Fan, Antonio Pesenti on behalf of the LUNG SAFE Investigators
More informationProne ventilation revisited in H1N1 patients
International Journal of Advanced Multidisciplinary Research ISSN: 2393-8870 www.ijarm.com DOI: 10.22192/ijamr Volume 5, Issue 10-2018 Case Report DOI: http://dx.doi.org/10.22192/ijamr.2018.05.10.005 Prone
More informationARDS and treatment strategies
ARDS and treatment strategies Geoff Bellingan Medical Director University College Hospital ARDS: Definitions History of predisposing condition Refractory hypoxaemia of acute onset PaO 2 /FiO 2 ratio:
More informationA simple case of.. Acute severe asthma. MasterclassIC Schiermonnikoog 2017
A simple case of.. Acute severe asthma MasterclassIC Schiermonnikoog 2017 Case (1) Female, 27 - G1P0 (26 weeks) PMH - several admissions for severe acute asthma (no MV) Progressive dyspnea for 1 week Admitted
More informationCanadian Trauma Trials Collaborative. Occult Pneumothorax in Critical Care (OPTICC): Standardized Data Collection Sheet
Canadian Trauma Trials Collaborative STUDY CENTRE: Institution: City / Province: / Occult Pneumothorax in Critical Care (OPTICC): Standardized Sheet PATIENT DEMOGRAPHICS: First Name: Health record number
More information3/14/2017. Pediatric Sepsis: From Goal Directed Therapy to Protocolized Care. Objectives. Developmental Response to Sepsis
Pediatric Sepsis: From Goal Directed Therapy to Protocolized Care March 20, 2017 Reid WD Farris, MS MD Objectives Review the evolution & current state of the pediatric septic shock treatment guidelines
More informationCase discussion Acute severe asthma during pregnancy. J.G. van der Hoeven
Case discussion Acute severe asthma during pregnancy J.G. van der Hoeven Case (1) 32-year-old female - gravida 3 - para 2 Previous medical history - asthma Pregnant (33 w) Acute onset fever with wheezing
More informationINTELLiVENT -ASV insight. Alexandra Geiger CAS, Dr. Marc Wysocki, Head of Medical Research Hamilton Medical
INTELLiVENT -ASV insight Alexandra Geiger CAS, Dr. Marc Wysocki, Head of Medical Research Hamilton Medical First Automation of HAMILTON MEDICAL 1998 Adaptive Support Ventilation (ASV) ASV optimize VT and
More informationSupplementary Online Content 2
Supplementary Online Content 2 van Meenen DMP, van der Hoeven SM, Binnekade JM, et al. Effect of on demand vs routine nebulization of acetylcysteine with salbutamol on ventilator-free days in intensive
More informationEvidence-Based. Management of Severe Sepsis. What is the BP Target?
Evidence-Based Management of Severe Sepsis Michael A. Gropper, MD, PhD Professor and Vice Chair of Anesthesia Director, Critical Care Medicine Chair, Quality Improvment University of California San Francisco
More informationNew Surveillance Definitions for VAP
New Surveillance Definitions for VAP 2012 Critical Care Canada Forum Toronto Dr. John Muscedere Associate Professor of Medicine, Queen s University Kingston, Ontario Presenter Disclosure Dr. J. G. Muscedere
More informationCSIM annual meeting Acute respiratory failure. Dr. John Ronald, FRCPC Int Med, Resp, CCM. October 10, 2018
CSIM annual meeting - 2018 Acute respiratory failure Dr. John Ronald, FRCPC Int Med, Resp, CCM. October 10, 2018 NRGH affiliated with UBC medicine Disclosures None relevant to this presentation. Also no
More informationPost-Resuscitation Care. Prof. Wilhelm Behringer Center of Emergency Medicine University of Jena
Post-Resuscitation Care Prof. Wilhelm Behringer Center of Emergency Medicine University of Jena Conflict of interest Emcools Shareholder and founder, honoraria Zoll: honoraria Bard: honoraria, nephew works
More informationSub-category: Intensive Care for Respiratory Distress
Course n : Course 3 Title: RESPIRATORY PHYSIOLOGY, PHYSICS AND PATHOLOGY IN RELATION TO ANAESTHESIA AND INTENSIVE CARE Sub-category: Intensive Care for Respiratory Distress Topic: Acute Respiratory Distress
More informationYear in Review: Critical Care Medicine
Year in Review: Critical Care Medicine No disclosures Eric J. Seeley, M.D. Assistant Professor of Medicine Division of Pulmonary and Critical Care Medicine Why I Selected These Studies High quality studies
More informationTracheostomy practice in adults with acute respiratory failure
本檔僅供內部教學使用檔案內所使用之照片之版權仍屬於原期刊公開使用時, 須獲得原期刊之同意授權 Tracheostomy practice in adults with acute respiratory failure Bradley D. Freeman, MD, FACS; Peter E. Morris, MD, FCCP Crit Care Med 2012 Vol. 40, No. 10
More informationARF. 8 8 (PaO 2 / FIO 2 ) NPPV NPPV ( P = 0.37) NPPV NPPV. (PaO 2 / FIO 2 > 200 PaO 2 / FIO 2 NPPV > 100) (P = 0.02) NPPV ( NPPV P = 0.
Monica Rocco, MD; Donatella Dell'Utri, MD; Andrea Morelli, MD; Gustavo Spadetta, MD; Giorgio Conti, MD; Massimo Antonelli, MD; and Paolo Pietropaoli, MD (ARF) (NPPV) 19 ARF ( 8 8 3 ) NPPV 19 (PaO 2 / FIO
More informationPAPER DE LA VNI EN LA RETIRADA DE LA VENTILACIÓ INVASIVA I FRACÀS D EXTUBACIÓ
PAPER DE LA VNI EN LA RETIRADA DE LA VENTILACIÓ INVASIVA I FRACÀS D EXTUBACIÓ Dr. Miquel Ferrer UVIIR, Servei de Pneumologia, Hospital Clínic, IDIBAPS, CibeRes, Barcelona. E- mail: miferrer@clinic.ub.es
More informationCaring For the ICU Boarder. Kami M. Hu, MD Depts of Emergency & Internal Medicine University of Maryland SOM
Caring For the ICU Boarder Kami M. Hu, MD Depts of Emergency & Internal Medicine University of Maryland SOM I have no relevant financial relationships with the manufacturer(s) of any commercial product(s)and/or
More informationOptimize vent weaning and SBT outcomes. Identify underlying causes for SBT failures. Role SBT and weaning protocol have in respiratory care
Optimize vent weaning and SBT outcomes Identify underlying causes for SBT failures Role SBT and weaning protocol have in respiratory care Lower risk of developing complications Lower risk of VAP, other
More informationNothing to disclose 9/25/2017
Jessie O Neal, PharmD, BCCCP Critical Care Clinical Pharmacist University of New Mexico Hospital New Mexico Society of Health-System Pharmacists 2017 Balloon Fiesta Symposium Nothing to disclose 1 Explain
More informationSurviving Sepsis. Brian Woodcock MBChB MRCP FRCA FCCM
1 Surviving Sepsis Brian Woodcock MBChB MRCP FRCA FCCM 2 Disclosures No conflicts of interest 3 Sepsis Principles of management of septic shock in the operating room "Surviving Sepsis" guidelines 4 Add-on
More informationFrank Sebat, MD - June 29, 2006
Types of Shock Hypovolemic Shock Low blood volume decreasing cardiac output. AN INTEGRATED SYSTEM OF CARE FOR PATIENTS AT RISK SHOCK TEAM and RAPID RESPONSE TEAM Septic or Distributive Shock Decrease in
More information9/25/2017. Nothing to disclose
Nothing to disclose Jessie O Neal, PharmD, BCCCP Critical Care Clinical Pharmacist University of New Mexico Hospital New Mexico Society of Health-System Pharmacists 2017 Balloon Fiesta Symposium Explain
More information6-horas 24 horas Coleta de lactato Hemoculturas. Corticosteróides. Controle glicêmico. Fluidos/vasopressores. Otimização de SvO 2
Novas diretrizes da Surviving Sepsis Campaign 2012 o que foi atualizado? Os pacotes da sepse 6-horas 24 horas Coleta de lactato Hemoculturas Corticosteróides Antibióticos Proteína C ativdada Fluidos/vasopressores
More informationR2R: Severe sepsis/septic shock. Surat Tongyoo Critical care medicine Siriraj Hospital
R2R: Severe sepsis/septic shock Surat Tongyoo Critical care medicine Siriraj Hospital Diagnostic criteria ACCP/SCCM consensus conference 1991 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference
More informationDiagnosis and Management of Sepsis and Septic Shock. Martin D. Black MD Concord Pulmonary Medicine Concord, New Hampshire
Diagnosis and Management of Sepsis and Septic Shock Martin D. Black MD Concord Pulmonary Medicine Concord, New Hampshire Financial: none Disclosures Objectives: Identify physiologic principles of septic
More informationExtubation Failure & Delay in Brain-Injured Patients
Extubation Failure & Delay in Brain-Injured Patients Niall D. Ferguson, MD, FRCPC, MSc Director, Critical Care Medicine University Health Network & Mount Sinai Hospital Associate Professor of Medicine
More informationThe Use of Metabolic Resuscitation in Sepsis
The Use of Metabolic Resuscitation in Sepsis Jennifer M. Roth, PharmD, BCPS, BCCCP Critical Care Clinical Specialist - Surgical Trauma ICU Baylor University Medical Center Disclosures No conflicts of interest
More informationIcu-cpr PICTURE QUIZ march 2014
Department of surgery Icu-cpr PICTURE QUIZ march 2014 Prepared by Dr. Karam Kamal Younis Assistant professor and consultant surgeon Convener of the Department of Surgery College of Medicine University
More informationKingdom; 2 University of Cambridge, Cambridge, United Kingdom
P-111 TIMING OF TRACHEOSTOMY AND ASSOCIATED COMPLICATIONS IN CARDIOTHORACIC INTENSIVE CARE PATIENTS Zochios, Vasileios 1 ; Casey, Jessica 2 ; Vuylsteke, Alain 1 1 Cardiac Critical Care Unit, Papworth Hospital
More informationSteroids in ARDS: if, when, how much? John Fowler, MD, FACEP Dept. of Emergency Medicine Kent Hospital, İzmir, Türkiye
Steroids in ARDS: if, when, how much? John Fowler, MD, FACEP Dept. of Emergency Medicine Kent Hospital, İzmir, Türkiye Steroids in ARDS: conclusion Give low-dose steroids if indicated for another problem
More informationVentilator Associated Pneumonia. ICU Fellowship Training Radboudumc
Ventilator Associated Pneumonia ICU Fellowship Training Radboudumc Attributable mortality VAP Meta-analysis of individual patient data from randomized prevention studies Attributable mortality mainly results
More informationSurviving Sepsis Campaign Guidelines 2012 & Update for David E. Tannehill, DO Critical Care Medicine Mercy Hospital St.
Surviving Sepsis Campaign Guidelines 2012 & Update for 2015 David E. Tannehill, DO Critical Care Medicine Mercy Hospital St. Louis Be appropriately aggressive the longer one delays aggressive metabolic
More informationPost Arrest Ventilation/Oxygenation Management
Post Arrest Ventilation/Oxygenation Management Richard Branson MSc RRT Professor of Surgery University of Cincinnati Editor-In-Chief Respiratory Care 0 Presenter Disclosure Information Richard Branson
More informationFAILURE OF NONINVASIVE VENTILATION FOR DE NOVO ACUTE HYPOXEMIC RESPIRATORY FAILURE: ROLE OF TIDAL VOLUME
FAILURE OF NONINVASIVE VENTILATION FOR DE NOVO ACUTE HYPOXEMIC RESPIRATORY FAILURE: ROLE OF TIDAL VOLUME Guillaume CARTEAUX, Teresa MILLÁN-GUILARTE, Nicolas DE PROST, Keyvan RAZAZI, Shariq ABID, Arnaud
More informationThe Berlin Definition: Does it fix anything?
The Berlin Definition: Does it fix anything? Gordon D. Rubenfeld, MD MSc Professor of Medicine, University of Toronto Chief, Program in Trauma, Emergency, and Critical Care Sunnybrook Health Sciences Centre
More informationSepsis: Identification and Management in an Acute Care Setting
Sepsis: Identification and Management in an Acute Care Setting Dr. Barbara M. Mills DNP Director Rapid Response Team/ Code Resuscitation Stony Brook University Medical Center SEPSIS LECTURE NPA 2018 OBJECTIVES
More informationWet Lungs Dry lungs Impact on Outcome in ARDS. Charlie Phillips MD Division of PCCM OHSU 2009
Wet Lungs Dry lungs Impact on Outcome in ARDS Charlie Phillips MD Division of PCCM OHSU 2009 Today s talk Pathophysiology of ARDS The case for dry Targeting EVLW Disclosures Advisor for Pulsion Medical
More information