Mechanical Ventilation Strategies in Anesthesia
|
|
- Camron Washington
- 6 years ago
- Views:
Transcription
1 Mechanical Ventilation Strategies in Anesthesia PAOLO PELOSI, MD, FERS Department of Surgical Sciences and Integrated Diagnostics (DISC), San Martino Policlinico Hospital IRCCS for Oncology, University of Genoa, Italy
2 Conflicts of interest I declare NO conflicts of interest
3 PROtective VEntilation NETWORK To perform Large multicenter clinical studies, randomized controlled trials, and meta analyses
4 Agenda Introduction Lung changes during anesthesia Postoperative pulmonary complications Rationale of protective ventilation Tidal volume PEEP Plateau pressure Driving pressure Recruitment FiO 2 PEEP post extubation Interactions between V T and PEEP Pplat - P RR Assisted ventilation during surgery Conclusions
5 ERAS Reccomendations No place for Intra-op Protective MV!
6
7 Anesthesiology Dec;125(6):
8 Agenda Introduction Lung changes during anesthesia Postoperative pulmonary complications Rationale of protective ventilation Tidal volume PEEP Plateau pressure Driving pressure Recruitment FiO 2 PEEP post extubation Interactions between V T and PEEP Pplat - P RR Assisted ventilation during surgery Conclusions
9 Atelectasis, Anesthesia and Post-Operative period Strandberg et al Acta Anaesthesiol Scand Feb;30(2): Awake Anesthesia, spontaneous breathing Anesthesia, and paralysis Spontaneous breathing 48 hrs postop
10 Atelectasis and General Anesthesia Brismar B. et al. Anesthesiology 1985 Apr;62(4):422-8 Lundquist H. et al. (1995) Acta Radiologica 36; Number of Patients (n = 109) 5 0 Atelectasis [% lung tissue]
11 Atelectasis and lung function in the postoperative period Lindberg P et al. Acta Anaesthesiol Scand 1992: 36:
12 Post-Op. Atelectasis: Myth or Reality? Güldner A. et al. Anesthesiology 2015 June 29 [Epub Ahead of Print]
13 Agenda Introduction Lung changes during anesthesia Postoperative pulmonary complications Rationale of protective ventilation Tidal volume PEEP Plateau pressure Driving pressure Recruitment FiO 2 PEEP post extubation Interactions between V T and PEEP Pplat - P RR Assisted ventilation during surgery Conclusions
14 Incidence of mortality and morbidity related to postoperative lung injury in patients who have undergone abdominal or thoracic surgery Serpa Neto A. et al. Lancet Respir Med Dec; 2(12): Mortality Pulmonary Complications ARISCAT 6.2% Periscope 8.0% Las Vegas 10.0% 1.4% 25.2% 39.4%
15 Epidemiology, Practice of Ventilation and Outcome for Patients at Increased Risk of PPCs (LAS VEGAS) an Observational Study in 29 Countries The LAS VEGAS Investigators - Eur J Anaesthesiol 2017; 34: ARISCAT<26 ARISCAT>= hospitals across 29 countries 9,864 patients Patients at increased risk %
16 Epidemiology, Practice of Ventilation and Outcome for Patients at Increased Risk of PPCs (LAS VEGAS) an Observational Study in 29 Countries The LAS VEGAS Investigators - Eur J Anaesthesiol 2017; 34:
17 To Predict the Risk of PPCs: ARISCAT Score Canet J. et al. for ARISCAT, Anesthesiology. 2010; 113(6): Mazo V. et al. Anesthesiology Aug;121(2): % (score 26-44) 54 % (score >45) risk to develop PPCs 11
18 Post-operative atelectasis and Post-operative SatO 2 Ball L, Bluth T, Guldner A et al (in preparation) sensitivity 92%, specificity 62%.
19 Post-operative atelectasis and Post-operative SatO 2 Ball L, Bluth T, Guldner A et al (in preparation) sensitivity 92%, specificity 62%.
20 PPCs & preoperative SpO 2 Mazo V. et al. Anesthesiology Aug;121(2): Canet J. et al. Eur J Anaesthesiol Jul;32(7): PPC and Preoperative SpO SpO2 5 0 <90% >90-92 >92-94 >94-96 >96-98 >98 %
21 The accuracy of postoperative, noninvasive Air-Test to diagnose atelectasis in healthy patients after surgery Ferrando C et al. BMJ Open 2017;7:e The presence of atelectasis was confirmed by CT scans in all patients (30/30) with positive and in 5 patients (17%) with negative Air-Test results Based on the Air-Test, postop atelectasis (CT>2%) was present in 36% of the patients
22 How to early recognize sepsis: qsofa? Singer M et al. JAMA. 2016;315(8): Seymour CW et al. JAMA. 2016;315(8): Quick SOFA (qsofa) In ED and ward settings 1) Respiratory rate 22 breaths/min 2) Altered mentation 3) Systolic blood pressure 100 mmhg 4) Sat O 2 in air < 94% THAM = Tachypnea, Hypotension, Altered Mentation - additional tests to evaluate organ function - prompt intervention - increased surveillance / transfer to ICU?
23 National Early Warning Score ( NEWS) To assess the acute-illness severity
24 Agenda Introduction Lung changes during anesthesia Postoperative pulmonary complications Rationale of protective ventilation Tidal volume PEEP Plateau pressure Driving pressure Recruitment FiO 2 PEEP post extubation Interactions between V T and PEEP Pplat - P RR Assisted ventilation during surgery Conclusions
25 Ann Transl Med 2016;4(1):17
26 Vidal Melo M.F., Eikermann M. Anesthesiology 2013; 118: Brismar B. et al. Anesthesiology Apr;62(4):422-8 Ball L et al. Minerva Anestesiol May 19. (Epub ahead of print) Duggan M, Kavanagh BP, Anesthesiology 2005; 102: Awake MV & ZEEP MV & PEEP
27 British Journal of Anaesthesia, 2016 Mar;116(3):438-9.
28 MV & Postoperative Respiratory Disorders Ball L. and Pelosi P. Minerva Anestesiol Mar;82(3):265-7 Ball L., Battaglini D, Pelosi P. Curr Opin Crit Care 2016, 22: Ball L et al. Minerva Anestesiol May 19. (Epub ahead of print)
29 Agenda Introduction Lung changes during anesthesia Postoperative pulmonary complications Rationale of protective ventilation Tidal volume PEEP Plateau pressure Driving pressure Recruitment FiO 2 PEEP post extubation Interactions between V T and PEEP Pplat - P RR Assisted ventilation during surgery Conclusions
30 Dose Response Relationship Between PPCs and V T during Surgery Serpa-Neto A. et al. Anesthesiology Jul;123(1):66-78 LOWER V T REDUCES PPCs (2,127 patients)
31 LAS VEGAS Practice of Ventilation in ORs Worldwide The LAS VEGAS Investigators - Eur J Anaesthesiol 2017; 34: international observational study 8,241 patients 8.1 [ ] ml/kg PBW V T > 8 ml/kg in 40% of patients
32 Agenda Introduction Lung changes during anesthesia Postoperative pulmonary complications Rationale of protective ventilation Tidal volume PEEP Plateau pressure Driving pressure Recruitment FiO 2 PEEP post extubation Interactions between V T and PEEP Pplat - P RR Assisted ventilation during surgery Conclusions
33 PEEP
34 Protective Mechanical Ventilation during Surgery: RCTs Futier E. et al. N Engl J Med 2013;369: PROVEnet investigators. The Lancet 2014; Aug 9;384: % 50 P = 0.84 Number of events (%) P< % Postoperative Pulmonary Complications (%) High V T /Low PEEP Group (n=200) Low V T /High PEEP Group (n=200) -V T ml/kg PBW PEEP 0 cmh 2 O -V T 6-8 ml/kg PBW PEEP 6-8 cmh 2 O RM 30 cmh 2 O 30 s every 30 min 0 PEEP/RM Group (n=445) no PEEP/RM Group (n=449) -V T 7 ml/kg PBW - PEEP =< 2 cmh 2 O -V T 7 ml/kg PBW - PEEP 12 cmh 2 O RM 30 cmh 2 O 3 times
35 Dose Response Relationship Between PPCs and PEEP during Surgery Serpa-Neto A. et al. Anesthesiology Jul;123(1):66-78 PEEP DOES NOT REDUCE PPCs (2,127 patients)
36 Intraoperative protective mechanical ventilation and risk of postoperative respiratory complications: hospital based registry study Ladha K et al. BMJ 2015;351:h3646 Postoperative Pulmonary Complications
37 Intraoperative Complications (%, n/n) The PROVE Network investigators. The Lancet 2014 Aug 9;384(9942): Higher PEEP N= 445 Lower PEEP N=449 P Rescue for 2 (11/442) 8 (34/445) < de saturation Hypotension 46 (205/441) 36 (162/449) Vasoactive drugs 62 (274/444) 51 (228/445) New arrhythmias 3 (12/442) 1 (5/445) 0 09 Organ perforation 1 (4/444) 1(4/444) 1
38 Respiratory System Mechanics During Low Versus High Positive End-Expiratory Pressure in Open Abdominal Surgery: A Substudy of PROVHILO RCT D Antini D et al. Anesth Analg Jun 19. (Epub Ahead of Print)
39 Ventilation with High or Low PEEP does not affect postop pulmonary functional tests (PROVHILO substudy) Treschan TA et al. Eur J Anaesthesiol Aug;34(8): Effects of PEEP: 2 cmh 2 O vs 12 cmh 2 O
40 Kinetics of plasma biomarkers for inflammation or lung injury in surgical patients with and without post operative pulmonary complications (PROVHILO substudy) Serpa-Neto A et al. Eur J Anaesthesiol Apr;34(4): PPCs vs no PPCs: INCREASED Lung injury biomarkers High PEEP vs Low PEEP: INCREASED Lung injury biomarkers open symbols, green box (no PPCs) closed symbols, red box (PPCs) open symbols, green box (low PEEP) closed symbols, red box (high PEEP)
41 Individualized PEEP in obese patients Nestler C et al Br J Anaesth 2017 (Epub Ahead of Print) Bariatric surgery, N = 50 patients V T = 8 ml/kg PBW PEEP = 5 cmh 2 O PEEP according to EIT (18.5 ± 5.6 cmh 2 O) before after before after intubation intraoperative extubation before after before after intubation intraoperative extubation
42 Individualized PEEP in obese patients Nestler C et al Br J Anaesth 2017 (Epub Ahead of Print) Bariatric surgery, N = 50 patients V T = 8 ml/kg PBW PEEP = 5 cmh 2 O PEEP according to EIT (18.5 ± 5.6 cmh 2 O) before after before after intubation intraoperative extubation before after before after intubation intraoperative extubation
43 SUBPHENOTYPES IN PATIENTS UNDERGOING GENERAL ANESTHESIA FOR OPEN ABDOMINAL SURGERY: An unbiased cluster analysis from the PROVHILO trial Serpa-Neto A et al. for the PROVE Network Investigators (submitted) Association between subphenotypes assignment and clinical outcomes Subphenotype 1 (n = 170) Subphenotype 2 (n = 40) Subphenotype 3 (n = 10) p value PPC 105 / 168 (62.5) 17 / 38 (44.7) 1 / 10 (10.0) Severe PPC 79 / 168 (47.0) 10 / 38 (26.3) 1 / 10 (10.0) EPC 101 / 168 (60.1) 21 / 38 (55.3) 1 / 10 (10.0) Hospital LOS in survivors, days 15 (11 28) 12 (9 18) 8 (8 14) In-hospital mortality 3 / 157 (1.9) 1 / 38 (2.6) 0 / 10 (0.0) 0.659
44 LAS VEGAS Practice of Ventilation in ORs Worldwide The LAS VEGAS Investigators - Eur J Anaesthesiol 2017; 34: international study 8,241 patients PEEP 4.0 [0 5] cm H 2 O PEEP 0 and 5 cm H 2 O most frequently used
45 Future RCTs on Intraoperative Ventilation PROBESE trial (obese patients): high vs. low PEEP, during lower V T ventilation PROTHOR trial (OLV): high vs. low PEEP, during lower V T ventilation
46 Rationale and study design for an individualized perioperative open lung ventilatory strategy (iprove): study protocol for a RCT Ferrando et al. Trials (2015) 16:193
47 Agenda Introduction Lung changes during anesthesia Postoperative pulmonary complications Rationale of protective ventilation Tidal volume PEEP Plateau pressure Driving pressure Recruitment FiO 2 PEEP post extubation Interactions between V T and PEEP Pplat - P RR Assisted ventilation during surgery Conclusions
48 Intraoperative protective mechanical ventilation and risk of postoperative respiratory complications: hospital based registry study Ladha K et al. BMJ 2015;351:h3646 Postoperative Pulmonary Complications
49 LAS VEGAS Practice of Ventilation in ORs Worldwide The LAS VEGAS Investigators - Eur J Anaesthesiol 2017; 34: international study 8,241 patients Pplat 15.5 [ ] cm H 2 O Ppeak 17.5 [ ] cm H 2 O Ppeak > 20 cm H 2 O (Pplat > 18 cmh 2 O) in 25-30% of patients
50 Agenda Introduction Lung changes during anesthesia Postoperative pulmonary complications Rationale of protective ventilation Tidal volume PEEP Plateau pressure Driving pressure Recruitment FiO 2 PEEP post extubation Interactions between V T and PEEP Pplat - P RR Assisted ventilation during surgery Conclusions
51 DRIVING PRESSURE: DEFINITION Marini JJ. Clinics in Chest Medicine: Recent Advances in MV Bluth T et al. Curr Opin Anaesthesiol Jun;29(3): Pressure ( cmh2o ) Pressure ( cmh2o ) P = Pplat,rs PEEP = VT/Cst = VT/EELV PA ΔP 0 Zero Flow Time Flow (L /sec) 0 VSET
52 Driving Pressure ( P,rs) & PPCs Neto AS et al. Lancet Respir Med Apr;4(4): HIGHER DRIVING PRESSURES INCREASE THE RISK OF PPCs patients from 15 RCTs P,rs > 12 cmh 2 O Higher risk of PPC S
53 Driving Pressure ( P,rs) & PPCs Ladha K et al. BMJ 2015;351:h3646 HIGHER DRIVING PRESSURES (> 12 cmh 2 O) INCREASE THE RISK OF PPCs patients from observational trial *Adjusting for patient body mass index, age, gender, ASA
54 LAS VEGAS Practice of Ventilation in ORs Worldwide The LAS VEGAS Investigators - Eur J Anaesthesiol 2017; 34: international study 8,241 patients P 12.0 [ ] cm H 2 O P > 12 cm H 2 O in 50% of patients
55 Agenda Introduction Lung changes during anesthesia Postoperative pulmonary complications Rationale of protective ventilation Tidal volume PEEP Plateau pressure Driving pressure Recruitment FiO 2 PEEP post extubation Interactions between V T and PEEP Pplat - P RR Assisted ventilation during surgery Conclusions
56 Recruitment maneuvre during anesthesia Reinius H et al. Anesthesiology 2009; 111: Güldner A. et al. Anesthesiology Sep;123(3):
57 Manual Recruitment with/without CPAP
58 Sustained Inflation Manoeuvre (single step)
59 Recruitment (multi-step) PEEP step increase 2 cmh 2 O Pinsp max 35 cmh 2 O PEEP 5 cmh 2 O P 8 cmh 2 O Resp/Passo n breaths at increasing PEEP PEEP max 20 cmh 2 O Resp@Max n breaths at PEEPmax
60 Lung recruitment and positive airway pressure before extubation does not improve oxygenation in the post-anaesthesia care unit: a RCT Lumb AB et al. British Journal of Anaesthesia 104 (5): (2010) PEEP 10 cmh2o + RM ( 40 cm H 2 O for 40 seconds)
61 LAS VEGAS Recruitment in obese patients Ball L et al for PROVEnet and LAS VEGAS-ESA investigators Routine Bag Squeezing RMs are associated with higher incidence of Unplanned O 2 and Severe PPCs morbidly obese patients No 1 Observed Events (%) * * * Unplanned O 2 Severe PPC 1 0 Not Recruited Routine Ventilator Routine Bag Squeezing Unplanned Ventilator Unplanned Bag Squeezing
62 Agenda Introduction Lung changes during anesthesia Postoperative pulmonary complications Rationale of protective ventilation Tidal volume PEEP Plateau pressure Driving pressure Recruitment FiO 2 PEEP post extubation Interactions between V T and PEEP Pplat - P RR Assisted ventilation during surgery Conclusions
63 Oxygen concentration and characteristics of progressive atelectasis formation during anaesthesia Edmark L et al. Acta Anaesthesiol Scand 2011; 55: 75 81
64 Post-operative atelectasis a randomised trial investigating a ventilatory strategy and low oxygenfraction during recovery Edmark L et al. Acta Anaesthesiol Scand 2014; 58: No significant effect of FiO 2 (with PEEP) before extubation
65 The effects of high perioperative inspiratory oxygen fraction for adult surgical patients Wetterslev J et al. Cochrane Database Syst Rev Jun 25;(6):CD No effects on surgical infections of higher or lower perioperative FiO 2 No effects on mortality of higher or lower perioperative FiO 2
66 Agenda Introduction Lung changes during anesthesia Postoperative pulmonary complications Rationale of protective ventilation Tidal volume PEEP Plateau pressure Driving pressure Recruitment FiO 2 PEEP post extubation Interactions between V T and PEEP Pplat - P RR Assisted ventilation during surgery Conclusions
67 Anesthesiology Sep;123(3):501-3
68 A ventilation strategy during general anaesthesia to reduce postoperative atelectasis Edmark L et al. Upsala Journal of Medical Sciences. 2014; 119: No significant effect of FiO 2 and PEEP before extubation No significant effect of FiO 2 and PEEP after extubation
69 Effect of early postextubation high-flow nasal cannula vs conventional oxygen therapy on hypoxemia in patients after major abdominal surgery (OPERA): a multicentre RCT Futier E et al. Intensive Care Med Dec;42(12): Edmark L et al. Ups J Med Sci 2014 Aug;119(3):242-50
70 Agenda Introduction Lung changes during anesthesia Postoperative pulmonary complications Rationale of protective ventilation Tidal volume PEEP Plateau pressure Driving pressure Recruitment FiO 2 PEEP post extubation Interactions between V T and PEEP Pplat - P RR Assisted ventilation during surgery Conclusions
71 Practice of Ventilation in ORs The LAS VEGAS Investigators - Eur J Anaesthesiol 2017; 34:
72 Agenda Introduction Lung changes during anesthesia Postoperative pulmonary complications Rationale of protective ventilation Tidal volume PEEP Plateau pressure Driving pressure Recruitment FiO 2 PEEP psot extubation Interactions between V T and PEEP Pplat - P RR Assisted ventilation during surgery Conclusions
73 Mechanical Ventilation Spontaneous Breathing
74
75 Smart Ventilation Control (SVC)
76 How does SVC operate? Course of a SVC session Adaptation Phase Ventilation Management Recovery Phase Controlled* * SVC is using the target ranges of Controlled during adaptation phase Intubation Extubation
77 What is Smart Ventilation Control? Main Idea Rethink Ventilation Ventilation goal RR, Pinsp, I:E, etco2, VT Select ventilation goal depending on procedure Check target ranges for tidal volume and etco2 Smart Ventilation Control will continuously monitor and adjust the ventilation
78 How does Smart Volume Control work? Ventilation Goals: Definition Ventilation Goal Controlled Explanation Applicable if no spontaneous breathing is desired Old World PC (BIPAP) 100 % Spont. Breathing Augmented Encourage SB Applicable if spontaneous breathing is OK, but should not be encouraged Applicable if spontaneous breathing is desired PC (BIPAP) + PS PS 0% Spon. Breathing Ventilation Goal Controlled Augmented Encourage SB
79 SVC A simple and patient oriented way to achieve spontaneous breathing
80 Smart Ventilation Control: User Interface Main Parameters Height: Needed for IBW as Smart Ventilation Control operates with VT in ml/kg Target Ranges: VT in ml/kg and etco2 Ranges predefined for normal patients. Need only to be adapted for special patients (e.g. COPD) Default settings can be chosen by hospital. There are different target ranges for each ventilation goal. Ventilation goal: main parameter to control the ventilation through whole procedure PEEP: The PEEP is the only parameter not adjusted by Smart Ventilation Control
81 Smart Ventilation Control: User Interface Main Parameters etco2 Waveform: In the standard etco2 waveform the target range for etco2 will be shown The range will always be shown if SVC is active
82 Agenda Introduction Lung changes during anesthesia Postoperative pulmonary complications Rationale of protective ventilation Tidal volume PEEP Plateau pressure Driving pressure Recruitment FiO 2 PEEP post extubation Interactions between V T and PEEP Pplat - P RR Assisted ventilation during surgery Conclusions
83 Permissive Atelectasis during General Anesthesia Pelosi P, Rocco PRM, de Abreu MG (Crit Care 2018 in press) Expiration Inspiration
84 The Funeral for Positive End-Expiratory Pressure better known as PEEP It was a dream for generations of anesthesiologists PEEP Rest in Peace
85 Conclusions Mechanical ventilation setting during surgery affects postoperative outcome (in patients at risk ) V T 6-8 ml/kg PBW/IBW PEEP 2-5 cmh 2 O w/o RM, but not yielding increased P PEEP higher than 5 cmh 2 O; - Surgery longer than 3 hours - Laparoscopy in Trendelenburg position - BMI equal or higher than 35 kg/m 2 Higher PEEP induces hemodynamic impairment and need of fluid overload Pplat < 16 cmh 2 O and P (Pplat-PEEP) < 13 cmh 2 O FiO 2 up to 80% does not affect post operative function Controlled mechanical ventilation is often unnecesssary and may be harmful: think about spontaneous breathing and servo-controlled systems!
86 Protective Mechanical Ventilation During Surgery To Improve Postoperative Outcome JUST DO IT!
Protective 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 informationAgenda. Mechanical Ventilation in Morbidly Obese Patients. Paolo Pelosi. ESPCOP, Ostend, Belgium Saturday, November 14, 2009.
Mechanical Ventilation in Morbidly Obese Patients t Paolo Pelosi Department of Ambient, Health and Safety University of Insubria - Varese, ITALY ppelosi@hotmail.com ESPCOP, Ostend, Belgium Saturday, November
More informationNoninvasive respiratory support:why is it working?
Noninvasive respiratory support:why is it working? Paolo Pelosi Department of Surgical Sciences and Integrated Diagnostics (DISC) IRCCS San Martino IST University of Genoa, Genoa, Italy ppelosi@hotmail.com
More informationRespiratory 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 informationEffect of peak inspiratory pressure on the development. of postoperative pulmonary complications.
Effect of peak inspiratory pressure on the development of postoperative pulmonary complications in mechanically ventilated adult surgical patients: a systematic review protocol Chelsa Wamsley Donald Missel
More informationICU Volume 14 - Issue 3 - Autumn Matrix
ICU Volume 14 - Issue 3 - Autumn 2014 - Matrix Prevention of Perioperative Complications: It Takes a Village to Raise a Child" Authors Yuda Sutherasan, MD Department of Surgical Sciences and Integrated
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 informationSub-Study. PRotective Ventilation with Higher versus Lower PEEP during General Anesthesia for Surgery in OBESE Patients
PRotective Ventilation with Higher versus Lower PEEP during General Anesthesia for Surgery in OBESE Patients The PROBESE Randomized Controlled Trial Preliminary evaluation of postural reduction of peripheral
More informationSleep Apnea and ifficulty in Extubation. Jean Louis BOURGAIN May 15, 2016
Sleep Apnea and ifficulty in Extubation Jean Louis BOURGAIN May 15, 2016 Introduction Repetitive collapse of the upper airway > sleep fragmentation, > hypoxemia, hypercapnia, > marked variations in intrathoracic
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 informationLung Recruitment Strategies in Anesthesia
Lung Recruitment Strategies in Anesthesia Intraoperative ventilatory management to prevent Post-operative Pulmonary Complications Kook-Hyun Lee, MD, PhD Department of Anesthesiology Seoul National University
More informationVentilation de l obèse: les 10 points clés
Ventilation de l obèse: les 10 points clés Samir JABER Department of Critical Care Medicine and Anesthesiology (DAR B) Saint Eloi University Hospital and Montpellier School of Medicine; INSERM U1046 University
More informationAPRV 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 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 informationBritish Journal of Anaesthesia 104 (5): (2010) doi: /bja/aeq080 Advance Access publication March 30, 2010
RESPIRATION AND THE AIRWAY Lung recruitment and positive airway pressure before extubation does not improve oxygenation in the post-anaesthesia care unit: a randomized clinical trial A. B. Lumb 1, S. J.
More informationRESEARCH PROTOCOL. OLV): study protocol for an international multicenter randomized controlled trial. Principal investigators:
RESEARCH PROTOCOL Rationale and study design for an Individualized PeriopeRative Open lung Ventilatory strategy in patients submitted to One Lung Ventilation (iprove- OLV): study protocol for an international
More informationPerioperative Lung Protective Ventilatory Management During Major Abdominal Surgery: a Hungarian Nationwide Survey
Online ahead-of-print. Page numbers NOT for citation purposes. RESEARCH ARTICLE Perioperative Lung Protective Ventilatory Management During Major Abdominal Surgery: a Hungarian Nationwide Survey Zoltán
More informationTracking lung recruitment and regional tidal volume at the bedside. Antonio Pesenti
Tracking lung recruitment and regional tidal volume at the bedside Antonio Pesenti Conflicts of Interest Maquet: Received research support and consultation fees Drager: Received research support and consultation
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 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 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: 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 informationARDS 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 informationAnalyzing 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 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 informationA 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 informationLAS VEGAS Case Report Form 1 Intra-Operative
LAS VEGAS Case Report Form 1 Intra-Operative Patient Informed Consent 1. Informed consent applicable: yes no (choose no if waived by local EC) 1.1 If applicable; was consent obtained? yes no 1.2 If yes,
More informationProtecting the Lungs
Protecting the Lungs PGA New York 12/07 Disclosures: Peter Slinger MD, FRCPC University of Toronto 58 y.o. Male, Chronic Gallstone Pancreatitis, Open Cholecystectomy 100 pack/year smoker Dyspnea > 1 block
More informationHigh Flow Humidification Therapy, Updates.
High Flow Humidification Therapy, Updates. Bernardo Selim, M.D. I have no relevant financial relationships to disclose. Assistant Professor, Pulmonary, Critical Care and Sleep Medicine, Mayo Clinic What
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 informationPEEP nuove indicazioni, stesse problematiche
PEEP nuove indicazioni, stesse problematiche Franco Valenza Department of Pathophysiology and Transplantation Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico Ossigenazione Clearance CO 2 Kats,
More informationWeaning 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 informationWhen is Anaesthesia & Ventilation a Worry?
Respiratory Function in Adult Congenital Heart Disease When is Anaesthesia & Ventilation a Worry? Bruce Cartwright Cardiac Anaesthesia Royal Prince Alfred Hospital University of Sydney OUTLINE Quantifying
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 informationA Comparative Study for the Lung Mechanics during One-Lung Ventilation in Thoracic Surgeries Using Two Different Modes of Mechanical Ventilation
Med. J. Cairo Univ., Vol. 85, No. 3, June: 967-972, 2017 www.medicaljournalofcairouniversity.net A Comparative Study for the Lung Mechanics during One-Lung Ventilation in Thoracic Surgeries Using Two Different
More informationOne Lung Ventilation in Obese patients
One Lung Ventilation in Obese patients YUSNI PUSPITA DEPARTEMEN ANESTESIOLOGI DAN TERAPI INTENSIF FAKULTAS KEDOKTERAN UNIVERSITAS SRIWIJAYA/RSMH PALEMBANG One Lung Ventilation Lung isolation techniques
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 informationChoosing the Appropriate Mode of PAP Therapy in the Perioperative Setting
Choosing the Appropriate Mode of PAP Therapy in the Perioperative Setting Lisa F. Wolfe MD Northwestern University Chicago, Illinois Choosing the Appropriate Mode of PAP Therapy in the Perioperative Setting
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 informationPerioperative use of high oxygen concentration
Perioperative use of high oxygen concentration F. Javier Belda MD, PhD, Professor of Anesthesiology Head of Department of Anesthesia and Critical Care Hospital Clinico Universitario, University of Valencia,
More informationWeaning: The key questions
Weaning from mechanical ventilation Weaning / Extubation failure: Is it a real problem in the PICU? Reported extubation failure rates in PICUs range from 4.1% to 19% Baisch SD, Wheeler WB, Kurachek SC,
More informationCPAP Reduces Hypoxemia After Cardiac Surgery (CRHACS Trial). A randomized controlled trial
CPAP Reduces Hypoxemia After Cardiac Surgery (CRHACS Trial). A randomized controlled trial Backgrounds Postoperative pulmonary complications are most frequent after cardiac surgery and lead to increased
More informationHow ARDS should be treated in 2017
How ARDS should be treated in 2017 2017, Ostrava Luciano Gattinoni, MD, FRCP Georg-August-Universität Göttingen Germany ARDS 1. Keep the patient alive respiration circulation 2. Cure the disease leading
More informationPREVENT COMPLICATIONS IN MAJOR SURGERY
PREVENT COMPLICATIONS IN MAJOR SURGERY Dept of Anesthesia and ICM (Prof. G. Della Rocca) Azienda Ospedaliero-Universitaria University of Udine. Udine, Italy CLINICAL TRIAL OF SURVIVORS CARDIORESPIRATORY
More informationOriginal Article Effects of prone position on lung function of patients undergoing mechanical ventilation under total intravenous anesthesia
Int J Clin Exp Med 2017;10(4):6769-6774 www.ijcem.com /ISSN:1940-5901/IJCEM0045140 Original Article Effects of prone position on lung function of patients undergoing mechanical ventilation under total
More informationManagement 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 informationComplications Respiratoires Postopératoires
XXème Journée de Réanimation de Picardie (JARP) Amiens, 15 Mars 2017 Complications Respiratoires Postopératoires Prévenir plutôt que guérir? Emmanuel FUTIER, MD, PhD Department of Anesthesiology and Critical
More informationDr. Yasser Fathi M.B.B.S, M.Sc, M.D. Anesthesia Consultant, Head of ICU King Saud Hospital, Unaizah
BY Dr. Yasser Fathi M.B.B.S, M.Sc, M.D Anesthesia Consultant, Head of ICU King Saud Hospital, Unaizah Objectives For Discussion Respiratory Physiology Pulmonary Graphics BIPAP Graphics Trouble Shootings
More informationLiterature List Electrical Impedance Tomography
Literature List Electrical Impedance Tomography 2017 Electrical Impedance Tomography (EIT) Literature List 2017 INDEX Writer Subject Publication Page Piraino T, Fan E Acute life-threatening hypoxemia during
More informationPatient-Ventilator Synchrony and Impact on Outcome
Variables Controlled during Mechanical Ventilation Patient-Ventilator Synchrony and Impact on Outcome 9-30-17 Cox Bob Kacmarek PhD, RRT Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
More informationNIV 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 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 informationPatient Asynchrony and Its Impact on Patient Outcome
Patient Asynchrony and Its Impact on Patient Outcome 5-14-18 CSRC Bob Kacmarek PhD, RRT Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts Conflict of Interest Disclosure Robert
More informationBiPAPS/TVAPSCPAPASV???? Lori Davis, B.Sc., R.C.P.T.(P), RPSGT
BiPAPS/TVAPSCPAPASV???? Lori Davis, B.Sc., R.C.P.T.(P), RPSGT Modes Continuous Positive Airway Pressure (CPAP): One set pressure which is the same on inspiration and expiration Auto-PAP (APAP) - Provides
More informationMechanical Ventilation Principles and Practices
Mechanical Ventilation Principles and Practices Dr LAU Chun Wing Arthur Department of Intensive Care Pamela Youde Nethersole Eastern Hospital 6 October 2009 In this lecture, you will learn Major concepts
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 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 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 informationPOLICY. Number: Title: APPLICATION OF NON INVASIVE VENTILATION FOR ACUTE RESPIRATORY FAILURE. Authorization
POLICY Number: 7311-60-024 Title: APPLICATION OF NON INVASIVE VENTILATION FOR ACUTE RESPIRATORY FAILURE Authorization [ ] President and CEO [ x ] Vice President, Finance and Corporate Services Source:
More informationARDS Management Protocol
ARDS Management Protocol February 2018 ARDS Criteria Onset Within 1 week of a known clinical insult or new or worsening respiratory symptoms Bilateral opacities not fully explained by effusions, lobar/lung
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 informationPrepared 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 informationMechanical Ventilation in COPD patients
Mechanical Ventilation in COPD patients Θεόδωρος Βασιλακόπουλος Καθηγητής Πνευμονολογίας-Εντατικής Θεραπείας Εθνικό & Καποδιστριακό Πανεπιστήμιο Αθηνών Νοσοκομείο «ο Ευαγγελισμός» Adjunct Professor, McGill
More information11/20/2015. Beyond CPAP. No relevant financial conflicts of interest. Kristie R Ross, M.D. November 12, Describe advanced ventilation options
Beyond CPAP Kristie R Ross, M.D. November 12, 2015 No relevant financial conflicts of interest Sponsored by The Warren Alpert Medical School of Brown University Describe advanced ventilation options Compare
More informationKeeping Patients Off the Vent: Bilevel, HFNC, Neither?
Keeping Patients Off the Vent: Bilevel, HFNC, Neither? Robert Kempainen, MD Pulmonary and Critical Care Medicine Hennepin County Medical Center University of Minnesota School of Medicine Objectives Summarize
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 informationNON-INVASIVE VENTILATION. Lijun Ding 23 Jan 2018
NON-INVASIVE VENTILATION Lijun Ding 23 Jan 2018 Learning objectives What is NIV The difference between CPAP and BiPAP The indication of the use of NIV Complication of NIV application Patient monitoring
More informationThe 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 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 informationDisclosures. Objectives. Defining Adult Obesity. Body Mass Index vs. Central Obesity 9/6/2017
Disclosures Why is the Morbidly Obese Patient at Increased Risk for Perioperative Morbidity? Lisa R. Farmer, MD Associate Professor No conflicts of interests concerning the content of this presentation
More informationDavid S. Warner, M.D., Editor. Intraoperative Protective Mechanical Ventilation for Prevention of Postoperative Pulmonary Complications
Review Article David S. Warner, M.D., Editor Intraoperative Protective Mechanical Ventilation for Prevention of Postoperative Pulmonary Complications A Comprehensive Review of the Role of Tidal Volume,
More informationNAVA. In Neonates. Howard Stein, M.D. Director Neonatology. Neurally Adjusted Ventilatory Assist. Toledo Children s Hospital Toledo, Ohio
NAVA Neurally Adjusted Ventilatory Assist In Neonates Howard Stein, M.D. Director Neonatology Toledo Children s Hospital Toledo, Ohio Disclaimers Dr Stein: Is discussing products made by Maquet Has no
More informationWhat is the next best step?
Noninvasive Ventilation William Janssen, M.D. Assistant Professor of Medicine National Jewish Health University of Colorado Denver Health Sciences Center What is the next best step? 65 year old female
More informationYear 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 information11 th Annual Congress Turkish Thoracic Society. Mechanical Ventilation in Acute Hypoxemic Respiratory Failure
11 th Annual Congress Turkish Thoracic Society Mechanical Ventilation in Acute Hypoxemic Respiratory Failure Lluis Blanch MD PhD Senior Critical Care Center Scientific Director Corporació Parc Taulí Universitat
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 informationCardiorespiratory Physiotherapy Tutoring Services 2017
VENTILATOR HYPERINFLATION ***This document is intended to be used as an information resource only it is not intended to be used as a policy document/practice guideline. Before incorporating the use of
More informationNew Modes and New Concepts In Mechanical Ventilation
New Modes and New Concepts In Mechanical Ventilation Prof Department of Anesthesia and Surgical Intensive Care Cairo University 1 2 New Ventilation Modes Dual Control Within-a-breath switches from PC to
More informationLung Injury and Protection in the Perioperative Period
J. Earl Wynands Lung Injury and Protection in the Perioperative Period Non-injured Lungs: Perioperative Experience (Surgeon) Injured Lungs: Anesthesiologist 78 y.o. Male, Chronic Gallstone Pancreatitis,
More informationMechanical Ventilation in COPD patients
Mechanical Ventilation in COPD patients Θεόδωρος Βασιλακόπουλος Καθηγητής Πνευμονολογίας-Εντατικής Θεραπείας Εθνικό & Καποδιστριακό Πανεπιστήμιο Αθηνών Νοσοκομείο «ο Ευαγγελισμός» Adjunct Professor, McGill
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 informationVentilator 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 informationThe Harvard community has made this article openly available. Please share how this access benefits you. Your story matters.
Protective intraoperative ventilation with higher versus lower levels of positive end-expiratory pressure in obese patients (PROBESE): study protocol for a randomized controlled trial The Harvard community
More informationAlveolar Recruitment Maneuvers and Noninvasive Positive Pressure Ventilation in Obese Patients: A Quality Improvement Project
The University of Southern Mississippi The Aquila Digital Community Doctoral Projects Fall 10-1-2018 Alveolar Recruitment Maneuvers and Noninvasive Positive Pressure Ventilation in Obese Patients: A Quality
More informationEvaluation of Low Tidal Volume During General Anesthesia in Prone Position on Respiratory Functions
Journal of Anesthesiology 2018; 6(1): 26-32 http://www.sciencepublishinggroup.com/j/ja doi: 10.11648/j.ja.20180601.15 ISSN: 2376-7766(Print); ISSN: 2376-7774(Online) Evaluation of Low Tidal Volume During
More informationQuickLung Breather Patient Settings
The QuickLung Breather is capable of simulating a spontaneously breathing patient in a variety of modes and patterns. In response to customer requests, we have compiled five common respiratory cases below.
More informationPostoperative pulmonary complications
British Journal of Anaesthesia, 118 (3): 317 34 (2017) doi: 10.1093/bja/aex002 Review Article Postoperative pulmonary complications A. Miskovic and A. B. Lumb* Department of Anaesthesia, St James s University
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 informationNon Invasive Ventilation In Preterm Infants. Manuel Sanchez Luna Hospital General Universitario Gregorio Marañón Complutense University Madrid
Non Invasive Ventilation In Preterm Infants Manuel Sanchez Luna Hospital General Universitario Gregorio Marañón Complutense University Madrid Summary Noninvasive ventilation begings in the delivery room
More informationDraft a protocol for a RCT for assessing the effectiveness of Alveolar Recruitment Maneuver During Cesarean Section in Improvement of Lung Compliance
Draft a protocol for a RCT for assessing the effectiveness of Alveolar Recruitment Maneuver During Cesarean Section in Improvement of Lung Compliance Diamanto Aretha Πρόγραμμα Μεταπτυχιακών Σπουδών ΜΕΘΟΔΟΛΟΓΙΑ
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 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 informationMechanical Ventilation 1. Shari McKeown, RRT Respiratory Services - VGH
Mechanical Ventilation 1 Shari McKeown, RRT Respiratory Services - VGH Objectives Describe indications for mcvent Describe types of breaths and modes of ventilation Describe compliance and resistance and
More informationIdentification 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 informationNew Modes to Enhance Synchrony & Dietrich Henzler MD, PhD, FRCPC Division of Critical Care
New Modes to Enhance Synchrony & Dietrich Henzler MD, PhD, FRCPC Division of Critical Care Disclosure Conflicts of Interest 2001-2011 Research Grants & Payments (cost reimbursements, speaker fees) Draeger
More informationPerioperative Use of Oxygen: What is the Right Amount?
Perioperative Use of Oxygen: What is the Right Amount? Walid Habre, MD, PhD Anesthesiological Investigations Unit & Pediatric Anesthesia Unit Geneva University Hospitals and University of Geneva www.walidhabre.org
More informationRole of Robotic Surgery in Endometrial Cancer: New Expensive Gadget or the Future?
Role of Robotic Surgery in Endometrial Cancer: New Expensive Gadget or the Future? Kathleen Yang, MD, FACOG Northwest Gynecologic Oncology Willamette Valley Cancer Institute Disclosure I have nothing to
More informationAVOIDING THE CRASH 3: RELAX, OPTIMAL POST-AIRWAY MANAGEMENT AVOIDING THE CRASH: OPTIMIZE YOUR PRE, PERI, AND POST AIRWAY MANAGEMENT
AVOIDING THE CRASH: OPTIMIZE YOUR PRE, PERI, AND POST AIRWAY MANAGEMENT Robert J. Vissers MD Chief, Emergency Medicine, Quality Chair, Legacy Emanuel Medical Center Adjunct Associate Professor, OHSU Portland,
More informationSupplementary Online Content
1 Supplementary Online Content Leme AC, Hajjar LA, Volpe MS, et al. Effect of intensive vs moderate alveolar recruitment strategies added to lung-protective ventilation on postoperative pulmonary complications:
More information