Archive for November, 2010

Ray RitzBA RRT FAARC

Beth Israel Deaconess Medical Center

Boston MA

Pleural Pressure Measurement Hypothesis

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Depending on the chest wall contribution to respiratory mechanics, a given PEEP level or plateau pressure may be adequate for one patient but potentially injurious for another…

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esophageal_balloon_manometry

Link

RCSW.org

Respiratory Care 2010 vol. 55 (2) pp. 162-74
Thus, the currently recommended strategy of setting

PEEP without regard to transpulmonary pressure is predicted to benefit some patients while

harming others. Recently the use of esophageal manometry to identify the optimal ventilator

settings, avoiding both under-inflation and over-inflation, was proposed. This method shows promise

but awaits larger clinical trials to assess its impact on clinical outcomes…..

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balloon

 

By Judy Rousseau

Oxygen
Definition
Physiology
Method
Indication for
Limitations
What FiO2 am I delivering anyways??
Standardizing Practice

Good PowerPoint on the uses of Low Flow O2 in neonates!

Nov 3-10 Low Flow O2 (PowerPoint)

Nov 3-10 Low Flow O2 (PDF version)

The Harper government’s recent decision to drop plans for a new round of cigarette-package warnings raised some eyebrows in the public-health world, to say the least. Canada had been a world-leader in requiring graphic alerts on tobacco labels, an idea since mimicked by numerous other countries.

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Read Canadian Medical Association Journal (CMAJ) response

CMAJ PDF

Methods

• In esophageal-pressure guided group, mechanical ventilation settings

determined by initial esophageal pressure measurements.

• Tidal volume set at 6ml per kg predicted body weight.

• PEEP set to achieve a transpulmonary pressure of 0-10cm H2O at end

expiration, according to a sliding scale based on PaO2 and FiO2 – see

figure 1.

• Also limited tidal volume to keep transpulmonary pressure <25cmH2O at

end-inspiration (limit rarely approached during study and tidal volume was

never reduced for this purpose)……..

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Mechanical Ventilation Guided by Esophageal Pressure in Acutex

GoogleDocs Link

All about Spirometry

All About link

Spirometry Calculator

A spirometer is a device to measure timed expired and inspired volumes, and hence indicate how quickly and effectively the lungs can be emptied and filled.

Spirometry can be used to screen for respiratory disease, diagnose obstructive airways disease and to monitor disease progression and rehabilitation/treatment gains. Vital capacity is a predictor of death from respiratory and cardiac disease and abnormal spirometry is associated with an increase in ‘all-cause’ mortality.1


The 2010 AHA Guidelines for CPR and ECC once again emphasize the need for high-quality CPR, including

• A compression rate of at least 100/min (a change from “approximately” 100/min)

• A compression depth of at least 2 inches (5 cm) in adults and a compression depth of at least one third of the anterior- posterior diameter of the chest in infants and children (approximately 1.5 inches [4 cm] in infants and 2 inches [5 cm] in children). Note that the range of 11?2 to 2 inches is no longer used for adults, and the absolute depth specified for children and infants is deeper than in previous versions of the AHA Guidelines for CPR and ECC.

Summary of Changes Guidelines 2010

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by Wava Truscott, PhD., director scientific affairs and clinical education, Kimberly-Clark Health Care


Why so critical?

2. Severe reduction in saliva results in the failed delivery…….

DNA studies have confirmed that up to 90% of ventilator-associated pneumonia (VAP) is caused by pathogens colonizing the mouth. Within hours of admission into the ICU, the oral physiology of the patient begins changing.

1. Saliva production decreases dramatically causing:

• gums, tongue and other oral tissues to become seriously dry (xerostomia)

• chapped lips, inflamed gums and oral lesions which provide protective havens within which pathogens can rapidly breed….

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