Post Arrest Ventilation/Oxygenation Management

Size: px
Start display at page:

Download "Post Arrest Ventilation/Oxygenation Management"

Transcription

1 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 MD Post Arrest Ventilation Management FINANCIAL DISCLOSURE: Grants/Research Support: Mallinckrodt, Ventec Life Systems, Aerogen, Philips, Speakers Bureau: Mallinckrodt UNLABELED/UNAPPROVED USES DISCLOSURE: None 1 1

2 2

3 Tremblay & Slutsky AJRCCM Lower Tidal Volume Ventilation for ALI and ARDS ARDS Network. N Engl J Med 2000; 342:1301 Randomized trial of conventional V T(11.8 *p <.01 ml/kg) vslow V T(6.2 ml/kg) ventilation in 861 Mortality patients with ALI Vent-free days Low TV Conventional * * Organ failure-free days * Barotrauma Percent of cases 3

4 The picture can't be displayed. Stopped early for futility no impact on outcome No safety concerns Improved gas exchange with higher PEEP improved compliance All patients ventilated with LPV 6 ml/kg/pbw N Engl J Med 2004;351:327 Pplat or PEEP (cm H 2 O) 6 ml/kg 6 ml/kg Nonrecruitable Injury > Benefit 6 ml/kg Recruitable ( Crs) Benefit > Injury Lower PEEP Higher PEEP 4

5 FIO PEEP no Assess lung recruitability PaO 2 /FIO 2 < 150 on 5 cm H 2 O PEEP Compliance or dead space with PEEP yes FIO PEEP Ramnath, Clin Chest Med 2006;27:601 Oxygenation & Ventilation following ROSC Mechanical ventilation Lung protection principles Oxygenation goals Ventilation goals 9 5

6 Hyperoxemia in Cardiac Patients Oxygen is often given in the absence of hypoxemia The vasoactive actions of oxygen are not well appreciated Once SpO 2 is 100% further increases in PaO 2 are not monitored Hyperoxemia in normoxicpatients may adversely effect outcome JAMA 2010;303:2165 6

7 JAMA 2010;303:2165 JAMA 2010;303:2165 7

8 8

9 9

10 19 10

11

12 Oxygen following Cardiac Arrest Supplemental Oxygen: 100% vs Titration Does the use of titrated oxygen during cardiac arrest, compared with the use of 100% oxygen, improve outcome (eg, ROSC, neurologically intact survival)? Consensus on Science There were no adult human studies. Two animal studies (LOE 5) suggested worse neurological outcomes compared with normoxic resuscitation. One animal study (LOE 5) 100% oxygen or 21% oxygen during resuscitation did not affect outcome. Treatment Recommendation There is insufficient evidence to support or refute the use of a titrated oxygen concentration or constant 21% oxygen compared with 100% oxygen during adult cardiac arrest. No change the current treatment algorithm (100% oxygen during cardiac arrest). Knowledge Gaps Prospective clinical trials may be warranted to explore constant (including room air) versus titrated oxygen resuscitation approaches during human adult cardiac arrest. Systematic Review Hyperoxiaand Coronary Blood Flow From 2,072 publications, 6 met criteria, 6 healthy and 61 with cardiac disease. High-concentration O2resulted in hyperoxia, PaO2 of 273 to 425 mm Hg. Hyperoxia caused a significant reduction in coronary blood flow (mean change 7.9% to 28.9%, n = 6 studies). Hyperoxia caused a significant increase in coronary vascular resistance (mean change 21.5% to 40.9%, n = 4 studies) and a significant reduction in myocardial oxygen consump6on (mean change 15.3% to 26.9%, n = 3 studies). Conclusions Hyperoxia from high-concentration oxygen therapy causes a marked reduction in coronary blood flow and myocardial oxygen consumption. These physiologic effects may have the potential to cause harm and are relevant to the use of high-concentration oxygen therapy in the treatment of cardiac and other disorders. (Farquhar H. Am Heart J 2009;158:371-7.) 12

13 Hyperoxemia and Coronary Blood Flow McNulty PH. Effects of supplemental oxygen administration on coronary blood flow in patients undergoing cardiac catheritization. Am J Physiol Heart Circ Physiol 2005;288:H

14 Background Oxygen is widely recommended for patients with myocardial infarction yet may do more harm than good. Systematic reviews have concluded that there was insufficient evidence to know whether oxygen reduced, increased or had no effect on the ischemia or infarct size. Selection criteria Randomized controlled trials of people with suspected or proven AMI, less than 24 hours after onset, in which the intervention was inhaled oxygen compared to air and regardless of co-therapies provided these were the same in both arms of the trial. Main results Three trials (387 patients) were included and 14 deaths occurred. The pooled RR of death was 2.88 (95% CI 0.88 to 9.39) in an intention-to-treat analysis and 3.03 (95% CI 0.93 to 9.83) in patients with confirmed AMI. While suggestive of harm, the small number of deaths recorded meant that this could be a chance occurrence. Conclusions There is no conclusive evidence from randomized controlled trials to support the routine use of inhaled oxygen in patients with acute AMI. A definitive randomized controlled trial is urgently required given the mismatch between trial evidence suggestive of possible harm from routine oxygen use and recommendations for its use in clinical practice guidelines. OXYGEN DOSE AFTER ROSC IN ADULTS Hypoxia vs. normoxia Avoid hypoxia in adults with ROSC after cardiac arrest in any setting (strong recommendation, very low quality evidence). Avoid hyperoxia in adults with ROSC after cardiac arrest in any setting (weak recommendation, very low quality evidence). Use 100% inspired oxygen until the arterial oxygen saturation or the partial pressure of arterial oxygen can be measured (weak recommendation, very low quality evidence)

15

16 30 Ventilation Target after ROSC No studies demonstrate better outcome with ventilation to a specific PaCO 2 in patients with ROSC. Suggest maintaining PaCO 2 within a normal physiological range as part of a post-rosc bundle of care (weak recommendation, very low quality evidence)

17 After restoration of circulation, routine hyperventilation leading to hypocapnia should be avoided in order to prevent additional cerebral ischemia. Hyperventilation is associated with increased intrathoracic pressure, diminished venous return and decreased cardiac output Treatment Recommendations No studies demonstrate better outcome with ventilation to a specific PaCO 2 in patients with ROSC. We suggest maintaining PaCO 2 within a normal physiological range as part of a post- ROSC bundle of care (weak recommendation, very low quality evidence). 17

18 Dallas 2015 Hospital registry study (IHCA/OHCA) 213 patients 1 outcome In-hospital mortality (survival) 2 outcome CPC 2 at discharge In multivariate analysis, hypocarbia was significantly associated with increased risk of in-hospital mortality (OR 2.522; 95% CI ). The mean PaCO 2 (hypercarbia) was significantly higher in survivors (5.2 kpa [ ]) compared to non-survivors (5.0 kpa [ ]), but the mean PaCO 2 was not associated with neurologic outcomes. Dallas 2015 Hospital registry study (IHCA/OHCA) 16,542 patients 1 outcome In-hospital mortality (survival) 2 outcome Survival to discharge home Patients with hypocapnia showed a trend toward greater mortality than those with normocapnia (OR 1.12 [95% CI ],p = 0.04). No difference for in-hospital mortality between patients with hypercapnia and those with normocapnia (OR 1.07, [95% CI ], p = 0.13). 18

19 Dallas 2015 Hospital registry study (OHCA) 409 patients 1 outcome CPC 2 at 12 months The mean 24 hours PaCO 2 level was an independent predictor of good outcome (OR 1.054; 95% CI ) With multivariate regression analysis, time spent in the PaCO 2 band higher than 6.0 kpa was associated with good outcome (OR 1.015; 95% CI ) No hypocapnia cohort Consensus on Science Statements! Hypocapnia! No studies have specifically randomised patients to ventilation to a specific PaCO 2 goal.! For the critical outcome of neurologically intact survival, two very low quality cohort studies {Roberts , Lee } with a total of 406 patients (downgraded for very serious concerns about risk of bias and imprecision) showed hypocapnia (<3.0 kpa & <4.7kPa respectively) was associated with a worse outcome.! For the critical outcome of death (or failure to be discharged home), one very low quality cohort study {Schneider } of 16,542 patients (downgraded for very serious concerns about risk of bias and imprecision) showed hypocapnia (<4.7kPa) was associated with a worse outcome. 19

20 Consensus on Science Statements! Hypercapnia! No studies have specifically randomised patients to ventilation to a specific PaCO2 goal.! For the critical outcome of neurologically intact survival, One very low quality cohort study {Roberts } with a total of 193 patients (downgraded for very serious concerns about risk of bias and imprecision) showed worse outcome in patients ventilated to hypercapnia (>PaCO 2 6.7kPa) One very low quality cohort study {Lee } with a total of 213 patients (downgraded for very serious concerns about risk of bias and imprecision) showed no difference in outcome for patients ventilated to hypercapnia (>PaCO 2 6.0kPa). One very low quality cohort study {Verhaasalo } with a total of 409 patients (downgraded for very serious concerns about risk of bias and imprecision) showed better outcome for patients ventilated to hypercapnia (PaCO kpa).! Hypercapnia Consensus on Science Statements! For the critical outcome of of death (or failure to be discharged home), One very low quality cohort study {Schneider 2013} with a total of 16,542 patients (downgraded for very serious concerns about risk of bias and imprecision) showed no difference in patients ventilated to hypercapnia (PaCO 2 >6.0kPa) One very low quality cohort study {Lee } with a total of 213 patients (downgraded for very serious concerns about risk of bias and imprecision) showed a higher mean PaCO 2 in survivors. 20

21 Treatment Recommendations Suggest maintaining PaCO 2 within a normal physiological range as part of a post-rosc bundle of care (weak recommendation, very low quality evidence). No studies demonstrate better outcome with ventilation to a specific PaCO 2 in patients with ROSC. Hypocarbia is associated with worse outcome and we suggest should be avoided where possible (moderate recommendation, very low quality evidence). The upper limit at which PaCO 2 becomes harmful is unknown, although mild hypercapnia may have some neuroprotective effect (weak recommendation, very low quality evidence). Hospital registry study (IHCA) 193 patients 1 outcome CPC 2 at discharge Hypocapnia (OR 2.43 (95% CI )) and hypercapnia (OR 2.20 (95% CI ) were independently associated with poor neurological function

22 Summary Principles of lung protection VT of 6-8 ml/kg and PEEP of 5 cm H 2 O Targets Avoid hypoxia first Avoid hyperoxia Target an SpO 2 of 94% Avoid hyperventilation Avoid hypoventilation Normocarbia mm Hg 42 22

Management of Post Cardiac Arrest Syndrome

Management of Post Cardiac Arrest Syndrome Management of Post Cardiac Arrest Syndrome Wilhelm Behringer Associated Professor of Emergency Medicine Medical University of Vienna, Austria Patients % What happens after ROSC? 35 30 25 20 15 10 5 ROSC

More information

Oxygen Toxicity Beyond Pulmonary Oxygen Toxicity

Oxygen Toxicity Beyond Pulmonary Oxygen Toxicity Oxygen Toxicity Beyond Pulmonary Oxygen Toxicity Rich Branson MSc RRT Professor of Surgery University of Cincinnati Disclosures American Association for Respiratory Care Bayer Ciel Medical Mallinckrodt

More information

Post-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 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 information

APRV Ventilation Mode

APRV Ventilation Mode APRV Ventilation Mode Airway Pressure Release Ventilation A Type of CPAP Continuous Positive Airway Pressure (CPAP) with an intermittent release phase. Patient cycles between two levels of CPAP higher

More information

Application of Lung Protective Ventilation MUST Begin Immediately After Intubation

Application 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 information

Stayin Alive: Pediatric Advanced Life Support (PALS) Updated Guidelines

Stayin Alive: Pediatric Advanced Life Support (PALS) Updated Guidelines Stayin Alive: Pediatric Advanced Life Support (PALS) Updated Guidelines Margaret Oates, PharmD, BCPPS Pediatric Critical Care Specialist GSHP Summer Meeting July 16, 2016 Disclosures I have nothing to

More information

OSCAR & OSCILLATE. & the Future of High Frequency Oscillatory Ventilation (HFOV)

OSCAR & 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 information

The new ARDS definitions: what does it mean?

The new ARDS definitions: what does it mean? The new ARDS definitions: what does it mean? Richard Beale 7 th September 2012 METHODS ESICM convened an international panel of experts, with representation of ATS and SCCM The objectives were to update

More information

The Association Between Oxygenation Thresholds and Mortality During Extracorporeal Life Support

The Association Between Oxygenation Thresholds and Mortality During Extracorporeal Life Support The Association Between Oxygenation Thresholds and Mortality During Extracorporeal Life Support Laveena Munshi, MD, MSc November 1, 2016 Critical Care Canada Forum Interdepartmental Division of Critical

More information

Post-Arrest Care: Beyond Hypothermia

Post-Arrest Care: Beyond Hypothermia Post-Arrest Care: Beyond Hypothermia Damon Scales MD PhD Department of Critical Care Medicine Sunnybrook Health Sciences Centre University of Toronto Disclosures CIHR Physicians Services Incorporated Main

More information

Thanks to Ben Taylor for his Grand Rounds talk which looks at the problems that may result from whacking on a bit of oxygen.

Thanks to Ben Taylor for his Grand Rounds talk which looks at the problems that may result from whacking on a bit of oxygen. EMERGENCY MEDICINE Liverpool Hospital The Weekly Probe 4 th July, 2012 Volume 15, Issue 20 THIS WEEK: 1. Hyperoxia and the perils of oxygen therapy 2. Next week s case 3. Joke of the Week Hyperoxia The

More information

Prepared by : Bayan Kaddourah RN,MHM. GICU Clinical Instructor

Prepared by : Bayan Kaddourah RN,MHM. GICU Clinical Instructor Mechanical Ventilation Prepared by : Bayan Kaddourah RN,MHM. GICU Clinical Instructor 1 Definition Is a supportive therapy to facilitate gas exchange. Most ventilatory support requires an artificial airway.

More information

ACLS/ACS Updates 2015

ACLS/ACS Updates 2015 ACLS/ACS Updates 2015 Advanced Cardiovascular Life Support by: Fareed Al Nozha, JBIM, ABIM, FKFSH&RC(Cardiology) Consultant Cardiologist Faculty, National CPR Committee, ACLS Program Head, SHA Dr Abdulhalim

More information

The relative importance or values of the main outcomes of interest: Outcome. Survival to Hospital Discharge

The relative importance or values of the main outcomes of interest: Outcome. Survival to Hospital Discharge Problem Is there a problem priority? Yes The existing evidence, though observational, indirect, imprecise, and thus very low quality, shows a consistent association between hypotension and adverse outcome.

More information

Oxygen:..Nothing is without poison.. the poison is in the dose..

Oxygen:..Nothing is without poison.. the poison is in the dose.. Interdepartmental Division of Critical Care Medicine Mount Sinai Hospital/University Health Network University of Toronto Toronto, Canada Oxygen:..Nothing is without poison.. the poison is in the dose..

More information

Outcomes 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 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 information

In-hospital Care of the Post-Cardiac Arrest Patient. David A. Pearson, MD, FACEP, FAAEM Associate Program Director Department of Emergency Medicine

In-hospital Care of the Post-Cardiac Arrest Patient. David A. Pearson, MD, FACEP, FAAEM Associate Program Director Department of Emergency Medicine In-hospital Care of the Post-Cardiac Arrest Patient David A. Pearson, MD, FACEP, FAAEM Associate Program Director Department of Emergency Medicine Disclosures I have no financial interest, arrangement,

More information

Science Behind CPR Update from Darrell Nelson, MD, FACEP Emergency Medicine Wake Forest University Health Sciences

Science Behind CPR Update from Darrell Nelson, MD, FACEP Emergency Medicine Wake Forest University Health Sciences Science Behind CPR Update from 2010 Darrell Nelson, MD, FACEP Emergency Medicine Wake Forest University Health Sciences FRAMING THE DISCUSSION NO ONE SURVIVES CARDIAC ARREST, EXCEPT ON TV Conflicts of

More information

Surviving 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 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 information

Analyzing Lung protective ventilation F Javier Belda MD, PhD Sº de Anestesiología y Reanimación. Hospital Clinico Universitario Valencia (Spain)

Analyzing Lung protective ventilation F Javier Belda MD, PhD Sº de Anestesiología y Reanimación. Hospital Clinico Universitario Valencia (Spain) Analyzing Lung protective ventilation F Javier Belda MD, PhD Sº de Anestesiología y Reanimación Hospital Clinico Universitario Valencia (Spain) ALI/ARDS Report of the American-European consensus conference

More information

INDEPENDENT LUNG VENTILATION

INDEPENDENT LUNG VENTILATION INDEPENDENT LUNG VENTILATION Giuseppe A. Marraro, MD Director Anaesthesia and Intensive Care Department Paediatric Intensive Care Unit Fatebenefratelli and Ophthalmiatric Hospital Milan, Italy gmarraro@picu.it

More information

Landmark articles on ventilation

Landmark 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 information

ARDS: The Evidence. Topics. New definition Breaths: Little or Big? Wet or Dry? Moving or Still? Upside down or Right side up?

ARDS: 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 information

1. When a patient fails to ventilate or oxygenate adequately, the problem is caused by pathophysiological factors such as hyperventilation.

1. When a patient fails to ventilate or oxygenate adequately, the problem is caused by pathophysiological factors such as hyperventilation. Chapter 1: Principles of Mechanical Ventilation TRUE/FALSE 1. When a patient fails to ventilate or oxygenate adequately, the problem is caused by pathophysiological factors such as hyperventilation. F

More information

ACUTE RESPIRATORY DISTRESS SYNDROME (ARDS) Rv

ACUTE 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 information

Cardiorespiratory Interactions:

Cardiorespiratory Interactions: Cardiorespiratory Interactions: The Heart - Lung Connection Jon N. Meliones, MD, MS, FCCM Professor of Pediatrics Duke University Medical Director PCVICU Optimizing CRI Cardiorespiratory Economics O2:

More information

Advanced airway placement (ETT vs SGA)

Advanced airway placement (ETT vs SGA) Advanced airway placement (ETT vs SGA) Among adults who are in cardiac arrest in any setting (P), does tracheal tube insertion as first advanced airway (I), compared with insertion of a supraglottic airway

More information

How to Improve Cardiac Arrest Survival in your Center

How to Improve Cardiac Arrest Survival in your Center How to Improve Cardiac Arrest Survival in your Center Ankur A. Doshi, MD FACEP Post Cardiac Arrest Service UPMC Presbyterian Department of Emergency Medicine University of Pittsburgh School of Medicine

More information

Science Behind Resuscitation. Vic Parwani, MD ED Medical Director CarolinaEast Health System August 6 th, 2013

Science Behind Resuscitation. Vic Parwani, MD ED Medical Director CarolinaEast Health System August 6 th, 2013 Science Behind Resuscitation Vic Parwani, MD ED Medical Director CarolinaEast Health System August 6 th, 2013 Conflict of Interest No Financial or Industrial Conflicts Slides: Drs. Nelson, Cole and Larabee

More information

A Bundle for Treatment after Cardiac Arrest: Protective Ventilation, Temperature Control and Stable Hemodynamics

A Bundle for Treatment after Cardiac Arrest: Protective Ventilation, Temperature Control and Stable Hemodynamics A Bundle for Treatment after Cardiac Arrest: Protective Ventilation, Temperature Control and Stable Hemodynamics PAOLO PELOSI, MD, FERS Department of Surgical Sciences and Integrated Diagnostics (DISC)

More information

POST-CARDIAC ARREST CARE: WHAT HAPPENS AFTER ROSC MATTERS! Emergency Nurses Association

POST-CARDIAC ARREST CARE: WHAT HAPPENS AFTER ROSC MATTERS! Emergency Nurses Association POST-CARDIAC ARREST CARE: WHAT HAPPENS AFTER ROSC MATTERS! Emergency Nurses Association - 2016 Nicole Kupchik MN, RN, CCNS, CCRN, PCCN, CMC Objectives Discuss the 2015 AHA Guideline Updates for Post- Arrest

More information

OXYGENATION AND ACID- BASE EVALUATION. Chapter 1

OXYGENATION AND ACID- BASE EVALUATION. Chapter 1 OXYGENATION AND ACID- BASE EVALUATION Chapter 1 MECHANICAL VENTILATION Used when patients are unable to sustain the level of ventilation necessary to maintain the gas exchange functions Artificial support

More information

Mechanical ventilation induced or exacerbated right ventricular failure

Mechanical ventilation induced or exacerbated right ventricular failure Mechanical ventilation induced or exacerbated right ventricular failure Toronto 2016 Jesse Hall MD Professor of Medicine, Anesthesia & Critical Care University of Chicago Faculty Disclosures Dr. Hall

More information

Post Cardiac Arrest Care 2015 American Heart Association Guideline Update for CPR and Emergency Cardiovascular Care

Post Cardiac Arrest Care 2015 American Heart Association Guideline Update for CPR and Emergency Cardiovascular Care Post Cardiac Arrest Care 2015 American Heart Association Guideline Update for CPR and Emergency Cardiovascular Care รศ.ดร.พญ.ต นหยง พ พานเมฆาภรณ ภาคว ชาว ส ญญ ว ทยา คณะแพทยศาสตร มหาว ทยาล ยเช ยงใหม System

More information

Oxygenation 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 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 information

Ventilatory Management of ARDS. Alexei Ortiz Milan; MD, MSc

Ventilatory 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 information

The ABC of CAB- Circulation, Airway, Breathing: PALS/Resuscitation Update

The ABC of CAB- Circulation, Airway, Breathing: PALS/Resuscitation Update The ABC of CAB- Circulation, Airway, Breathing: PALS/Resuscitation Update Jennifer K. Lee, MD Johns Hopkins University Dept. of Anesthesia, Division of Pediatric Anesthesia Disclosures I have research

More information

Management of refractory ARDS. Saurabh maji

Management of refractory ARDS. Saurabh maji Management of refractory ARDS Saurabh maji Refractory hypoxemia as PaO2/FIO2 is less than 100 mm Hg, inability to keep plateau pressure below 30 cm H2O despite a VT of 4 ml/kg development of barotrauma

More information

Resuscitation Science : Advancing Care for the Sickest Patients

Resuscitation Science : Advancing Care for the Sickest Patients Resuscitation Science : Advancing Care for the Sickest Patients William Hallinan University of Rochester What is resuscitation science? Simply the science of resuscitation : Pre arrest Arrest care Medical

More information

Post-resuscitation care for adults. Jerry Nolan Royal United Hospital Bath

Post-resuscitation care for adults. Jerry Nolan Royal United Hospital Bath Post-resuscitation care for adults Jerry Nolan Royal United Hospital Bath Post-resuscitation care for adults Titration of inspired oxygen concentration after ROSC Urgent coronary catheterisation and percutaneous

More information

The use of proning in the management of Acute Respiratory Distress Syndrome

The 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 information

NIV use in ED. Dr. Khalfan AL Amrani Emergency Resuscitation Symposium 2 nd May 2016 SQUH

NIV use in ED. Dr. Khalfan AL Amrani Emergency Resuscitation Symposium 2 nd May 2016 SQUH NIV use in ED Dr. Khalfan AL Amrani Emergency Resuscitation Symposium 2 nd May 2016 SQUH Outline History & Introduction Overview of NIV application Review of proven uses of NIV History of Ventilation 1940

More information

ACUTE RESPIRATORY DISTRESS SYNDROME

ACUTE 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 information

Cardiopulmonary Resuscitation in Adults

Cardiopulmonary Resuscitation in Adults Cardiopulmonary Resuscitation in Adults Fatma Özdemir, MD Emergency Deparment of Uludag University Faculty of Medicine OVERVIEW Introduction Pathophysiology BLS algorithm ALS algorithm Post resuscitation

More information

Disclosures. Overview. Cardiopulmonary Arrest: Quality Measures 5/29/2014. In-Hospital Cardiac Arrest: Measuring Effectiveness and Improving Outcomes

Disclosures. Overview. Cardiopulmonary Arrest: Quality Measures 5/29/2014. In-Hospital Cardiac Arrest: Measuring Effectiveness and Improving Outcomes Disclosures In-Hospital Cardiac Arrest: Measuring Effectiveness and Improving Outcomes Research support from UCOP CHQI award J. Matthew Aldrich, MD Anesthesia & Critical Care UCSF Overview Epidemiology

More information

Case discussion Acute severe asthma during pregnancy. J.G. van der Hoeven

Case 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 information

ARDS & TBI - Trading Off Ventilation Targets

ARDS & 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 information

Samphant Ponvilawan Bumrungrad International

Samphant Ponvilawan Bumrungrad International Samphant Ponvilawan Bumrungrad International Definitions Artificial circulation using VA ECMO as an alternative to ventilation and external cardiac massage Indications Out-of-Hospital Cardiac Arrest (OHCA)

More information

The GOLD Study. Goal of Open Lung Ventilation in Donors. Michael A. Matthay M.D. and Lorraine B. Ware, MD. Disclosures

The GOLD Study. Goal of Open Lung Ventilation in Donors. Michael A. Matthay M.D. and Lorraine B. Ware, MD. Disclosures The GOLD Study Goal of Open Lung Ventilation in Donors Michael A. Matthay M.D. and Lorraine B. Ware, MD Disclosures Research grants from the NHLBI, FDA & Industry - R37 HL51856 - R01 HL126176 - HL 110969

More information

PEEP recruitment maneuver

PEEP recruitment maneuver Robert M. Rodriguez, MD FAAEM Clinical Professor of Medicine and Emergency Medicine, UCSF Case 1: 40 yo Male restrained driver high speed MVA P 140, RR 40 labored, BP 100/70, O 2 sat 70 Chest wheeze, crackles

More information

Early Goal-Directed Therapy

Early Goal-Directed Therapy Early Goal-Directed Therapy Where do we stand? Jean-Daniel Chiche, MD PhD MICU & Dept of Host-Pathogen Interaction Hôpital Cochin & Institut Cochin, Paris-F Resuscitation targets in septic shock 1 The

More information

Capnography 101. James A Temple BA, NRP, CCP

Capnography 101. James A Temple BA, NRP, CCP Capnography 101 James A Temple BA, NRP, CCP Expected Outcomes 1. Gain a working knowledge of the physiology and science behind End-Tidal CO2. 2.Relate End-Tidal CO2 to ventilation, perfusion, and metabolism.

More information

THE USE OF HYPERINFLATION IN THE MANAGEMENT OF INTUBATED AND VENTILATED ADULT PATIENTS RECOMMENDATIONS

THE USE OF HYPERINFLATION IN THE MANAGEMENT OF INTUBATED AND VENTILATED ADULT PATIENTS RECOMMENDATIONS THE USE OF HYPERINFLATION IN THE MANAGEMENT OF INTUBATED AND VENTILATED ADULT PATIENTS RECOMMENDATIONS Recommendation 1 on website Hyperinflation (Ventilator or manual) might be included in the management

More information

Controversies in Chest Compressions & Airway Management During CPR. Bob Berg

Controversies in Chest Compressions & Airway Management During CPR. Bob Berg Controversies in Chest Compressions & Airway Management During CPR Bob Berg No Financial Conflicts of Interest Employment: University of Pennsylvania AHA Volunteer AHA GWTG-R & Systems of Care committees

More information

ARDS and Ventilators PG26 Update in Surgical Critical Care October 9, 2013

ARDS 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 information

Out-of-hospital Cardiac Arrest. Franz R. Eberli MD, FESC, FAHA Cardiology Triemli Hospital Zurich, Switzerland

Out-of-hospital Cardiac Arrest. Franz R. Eberli MD, FESC, FAHA Cardiology Triemli Hospital Zurich, Switzerland Out-of-hospital Cardiac Arrest Franz R. Eberli MD, FESC, FAHA Cardiology Triemli Hospital Zurich, Switzerland Conflict of Interest I have no conflict of interest to disclose regarding this presentation.

More information

Prehospital Post Arrest Care AHA Strive to Revive 2017 November 3, 2017

Prehospital Post Arrest Care AHA Strive to Revive 2017 November 3, 2017 Prehospital Post Arrest Care AHA Strive to Revive 2017 November 3, 2017 Jon Rittenberger, MD, MS Department of University of Pittsburgh Employers: Disclosures - Rittenberger University of Pittsburgh UPMC

More information

Neuromuscular Blockade in ARDS

Neuromuscular Blockade in ARDS Neuromuscular Blockade in ARDS Maureen O. Meade, MD, FRCPC Critical care consultant, Hamilton Health Sciences Professor of Medicine, McMaster University www.oscillatetrial.com Disclosures None Possible

More information

APPENDIX VI HFOV Quick Guide

APPENDIX VI HFOV Quick Guide APPENDIX VI HFOV Quick Guide Overall goal: Maintain PH in the target range at the minimum tidal volume. This is achieved by favoring higher frequencies over lower P (amplitude). This goal is also promoted

More information

Is the Statistical Deck Stacked in Observational Resuscitation Studies?

Is the Statistical Deck Stacked in Observational Resuscitation Studies? Is the Statistical Deck Stacked in Observational Resuscitation Studies? Michael Levy MD, FAEMS, FACEP, FACP Medical Director Anchorage Fire Department Medical Director State of Alaska Emergency Programs

More information

Post resuscitation care and role of urgent angiography after cardiac arrest. Georg Fuernau Luebeck

Post resuscitation care and role of urgent angiography after cardiac arrest. Georg Fuernau Luebeck Post resuscitation care and role of urgent angiography after cardiac arrest Georg Fuernau Luebeck The journey CPR and guidelines European Resuscitation Council American Heart Association International

More information

Post Cardiac Arrest Care. From : 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care

Post Cardiac Arrest Care. From : 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Post Cardiac Arrest Care From : 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Initial Objectives of Post cardiac Arrest Care Optimize cardiopulmonary

More information

Experience with Low Flow ECCO2R device on a CRRT platform : CO2 removal

Experience 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 information

ECMO/ECCO 2 R in Acute Respiratory Failure

ECMO/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 information

There is increasing recognition that systematic post cardiac

There is increasing recognition that systematic post cardiac Part 9: Post Cardiac Arrest Care 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Mary Ann Peberdy, Co-Chair*; Clifton W. Callaway, Co-Chair*;

More information

Lecture Notes. Chapter 2: Introduction to Respiratory Failure

Lecture Notes. Chapter 2: Introduction to Respiratory Failure Lecture Notes Chapter 2: Introduction to Respiratory Failure Objectives Define respiratory failure, ventilatory failure, and oxygenation failure List the causes of respiratory failure Describe the effects

More information

ARDS and Lung Protection

ARDS and Lung Protection ARDS and Lung Protection Kristina Sullivan, MD Associate Professor University of California, San Francisco Department of Anesthesia and Perioperative Care Division of Critical Care Medicine Overview Low

More information

Veno-Venous ECMO Support. Chris Cropsey, MD Sept. 21, 2015

Veno-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 information

Objectives. Trends in Resuscitation POST-CARDIAC ARREST CARE: WHAT S THE EVIDENCE?

Objectives. Trends in Resuscitation POST-CARDIAC ARREST CARE: WHAT S THE EVIDENCE? POST-CARDIAC ARREST CARE: WHAT S THE EVIDENCE? Nicole Kupchik RN, MN, CCNS, CCRN, PCCN, CMC Objectives Discuss the 2015 AHA Guideline Updates for Post- Arrest Care Discuss oxygenation & hemodynamic taregts

More information

NIV in Acute Respiratory Failure: Where we fail? Dr Shrikanth Srinivasan MD,DNB,FNB,EDIC Consultant, Critical Care Medicine Medanta, The Medicity

NIV in Acute Respiratory Failure: Where we fail? Dr Shrikanth Srinivasan MD,DNB,FNB,EDIC Consultant, Critical Care Medicine Medanta, The Medicity NIV in Acute Respiratory Failure: Where we fail? Dr Shrikanth Srinivasan MD,DNB,FNB,EDIC Consultant, Critical Care Medicine Medanta, The Medicity Use of NIV 1998-2010 50 45 40 35 30 25 20 15 10 5 0 1998

More information

Identification and Treatment of the Patient with Sleep Related Hypoventilation

Identification and Treatment of the Patient with Sleep Related Hypoventilation Identification and Treatment of the Patient with Sleep Related Hypoventilation Hillary Loomis-King, MD Pulmonary and Critical Care of NW MI Munson Sleep Disorders Center X Conflict of Interest Disclosures

More information

DECLARATION OF CONFLICT OF INTEREST. Research grants: Sanofi-Aventis

DECLARATION OF CONFLICT OF INTEREST. Research grants: Sanofi-Aventis DECLARATION OF CONFLICT OF INTEREST Research grants: Sanofi-Aventis Invasive management after cardiac arrest Nikolaos I Nikolaou FESC, FERC Athens, Greece Survival (%) Survival from Out of Hospital Cardiac

More information

FAILURE 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 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 information

SIMPLY Arterial Blood Gases Interpretation. Week 4 Dr William Dooley

SIMPLY Arterial Blood Gases Interpretation. Week 4 Dr William Dooley SIMPLY Arterial Blood Gases Interpretation Week 4 Dr William Dooley Plan Structure for interpretation 5-step approach Works for majority of cases Case scenarios Some common concerns A-a gradient BE Anion

More information

Head injuries. Severity of head injuries

Head injuries. Severity of head injuries Head injuries ED Teaching day 23 rd October Severity of head injuries Minor GCS 14-15 Must not have any of the following: Amnesia 10min Neurological sign or symptom Skull fracture (clinically or radiologically)

More information

Refractory cardiac arrest

Refractory cardiac arrest Refractory cardiac arrest Claudio Sandroni Dept. of Anaesthesiology and Intensive Care Catholic University School of Medicine Rome Italy IRC Scientific Committee Conflicts of interest None Cardiac arrest:

More information

Weaning from Mechanical Ventilation. Dr Azmin Huda Abdul Rahim

Weaning from Mechanical Ventilation. Dr Azmin Huda Abdul Rahim Weaning from Mechanical Ventilation Dr Azmin Huda Abdul Rahim Content Definition Classification Weaning criteria Weaning methods Criteria for extubation Introduction Weaning comprises 40% of the duration

More information

Acute Stroke Treatment: Mechanical Thrombectomy

Acute Stroke Treatment: Mechanical Thrombectomy Acute Stroke Treatment: Mechanical Thrombectomy Rudy Noppens Department of Anesthesiology & Perioperative Medicine CFPC CoI Templates: Slide 1 used in Faculty presentation only. Faculty/Presenter Disclosure

More information

The ALS Algorithm and Post Resuscitation Care

The ALS Algorithm and Post Resuscitation Care The ALS Algorithm and Post Resuscitation Care CET - Ballarat Health Services Valid from 1 st July 2018 to 30 th June 2020 2 Defibrillation Produces simultaneous mass depolarisation of myocardial cells

More information

The Art and Science of Weaning from Mechanical Ventilation

The Art and Science of Weaning from Mechanical Ventilation The Art and Science of Weaning from Mechanical Ventilation Shekhar T. Venkataraman M.D. Professor Departments of Critical Care Medicine and Pediatrics University of Pittsburgh School of Medicine Some definitions

More information

Does proning patients with refractory hypoxaemia improve mortality?

Does 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 information

Update in Critical Care Medicine

Update 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 information

Wet 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 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

CPR What Works, What Doesn t

CPR What Works, What Doesn t Resuscitation 2017 ECMO and ECLS April 1, 2017 Corey M. Slovis, M.D. Vanderbilt University Medical Center Metro Nashville Fire Department Nashville International Airport Nashville, TN Circulation 2013;128:417-35

More information

Disclosures. Pediatrician Financial: none Volunteer :

Disclosures. Pediatrician Financial: none Volunteer : Brain Resuscitation Neurocritical Care Monitoring & Therapies CCCF November 2, 2016 Anne-Marie Guerguerian Critical Care Medicine, The Hospital for Sick Children University of Toronto Disclosures Pediatrician

More information

ARDS: an update 6 th March A. Hakeem Al Hashim, MD, FRCP SQUH

ARDS: 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 information

INDICATIONS FOR RESPIRATORY ASSISTANCE A C U T E M E D I C I N E U N I T P - Y E A R M B B S 4

INDICATIONS FOR RESPIRATORY ASSISTANCE A C U T E M E D I C I N E U N I T P - Y E A R M B B S 4 INDICATIONS FOR RESPIRATORY ASSISTANCE A C U T E M E D I C I N E U N I T P - Y E A R M B B S 4 RESPIRATORY FAILURE Acute respiratory failure is defined by hypoxemia with or without hypercapnia. It is one

More information

No Excellence Without Evidence: The Therapeutic Use of Oxygen

No Excellence Without Evidence: The Therapeutic Use of Oxygen No Excellence Without Evidence: The Therapeutic Use of Oxygen Penelope S. Benedik PhD, CRNA, RRT Associate Professor of Clinical Nursing UTHealth Houston, Texas Oxygen is a DRUG Oxygen overuse is toxic

More information

PAEDIATRIC 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 PAEDIATRIC RESPIRATORY FAILURE Tang Swee Fong Department of Paediatrics University Kebangsaan Malaysia Medical Centre Outline of lecture Bronchiolitis Bronchopulmonary dysplasia Asthma ARDS Bronchiolitis

More information

Ventilator ECMO Interactions

Ventilator ECMO Interactions Ventilator ECMO Interactions Lorenzo Del Sorbo, MD CCCF Toronto, October 2 nd 2017 Disclosure Relevant relationships with commercial entities: none Potential for conflicts within this presentation: none

More information

Respiratory insufficiency in bariatric patients

Respiratory insufficiency in bariatric patients Respiratory insufficiency in bariatric patients Special considerations or just more of the same? Weaning and rehabilation conference 6th November 2015 Definition of obesity Underweight BMI< 18 Normal weight

More information

Emergency Cardiac Care Guidelines 2015

Emergency Cardiac Care Guidelines 2015 Emergency Cardiac Care Guidelines 2015 VACEP 2016 William Brady, MD University of Virginia Guidelines 2015 Basic Life Support & Advanced Cardiac Life Support Acute Coronary Syndrome Pediatric Advanced

More information

Supplementary Appendix

Supplementary Appendix Supplementary Appendix This appendix has been provided by the authors to give readers additional information about their work. Supplement to: Chan PS, Nallamothu BK, Krumholz HM, et al. Long-term outcomes

More information

Learning Objectives. 1. Indications versus contra-indications 2. CPAP versus NiVS 3. Clinical evidence

Learning Objectives. 1. Indications versus contra-indications 2. CPAP versus NiVS 3. Clinical evidence Learning Objectives 1. Indications versus contra-indications 2. CPAP versus NiVS 3. Clinical evidence Pre-hospital Non-invasive vventilatory support Marc Gillis, MD Imelda Bonheiden Our goal out there

More information

Year in Review Intensive Care Training Program Radboud University Medical Centre Nijmegen

Year in Review Intensive Care Training Program Radboud University Medical Centre Nijmegen Year in Review 2013 Intensive Care Training Program Radboud University Medical Centre Nijmegen Contents ARDS Ventilator associated pneumonia Tracheostomy and endotracheal intubation Enteral feeding Fluid

More information

Respiratory Depression and Considerations for Monitoring Following Ophthalmologic Surgery

Respiratory Depression and Considerations for Monitoring Following Ophthalmologic Surgery Respiratory Depression and Considerations for Monitoring Following Ophthalmologic Surgery Athir Morad, M.D. Division of Neurocritical care Departments of Anesthesiology/ Critical Care Medicine and Neurology

More information

SWISS SOCIETY OF NEONATOLOGY. Supercarbia in an infant with meconium aspiration syndrome

SWISS SOCIETY OF NEONATOLOGY. Supercarbia in an infant with meconium aspiration syndrome SWISS SOCIETY OF NEONATOLOGY Supercarbia in an infant with meconium aspiration syndrome January 2006 2 Wilhelm C, Frey B, Department of Intensive Care and Neonatology, University Children s Hospital Zurich,

More information

7/4/2015. diffuse lung injury resulting in noncardiogenic pulmonary edema due to increase in capillary permeability

7/4/2015. diffuse lung injury resulting in noncardiogenic pulmonary edema due to increase in capillary permeability Leanna R. Miller, RN, MN, CCRN-CMC, PCCN-CSC, CEN, CNRN, CMSRN, NP Education Specialist LRM Consulting Nashville, TN Objectives Identify the 5 criteria for the diagnosis of ARDS. Discuss the common etiologies

More information

Wanchai Wongkornrat Cardiovascular Thoracic Surgery Siriraj Hospital Mahidol University

Wanchai Wongkornrat Cardiovascular Thoracic Surgery Siriraj Hospital Mahidol University Wanchai Wongkornrat Cardiovascular Thoracic Surgery Siriraj Hospital Mahidol University Assess adequacy of ventilation and oxygenation Aids in establishing a diagnosis and severity of respiratory failure

More information

Post Resuscitation (ROSC) Care

Post Resuscitation (ROSC) Care Standard Operating Procedure 2.10 Post Resuscitation (ROSC) Care Position Responsible: Medical Director Approved: Clinical Governance Committee Related Documents: This document is the intellectual property

More information