Understanding Rebreathing Kinetics
|
|
|
- Roger Merritt
- 5 years ago
- Views:
Transcription
1 Understanding Rebreathing Kinetics James H Philip, ME(E), MD, CCE Anesthesiologist and Director Bioengineering, Brigham and Women's Hospital Professor of Anaesthesia, Harvard Medical School Boston Massachusetts USA
2 Understanding Rebreathing Kinetics James H Philip, ME(E), MD, CCE Anesthesiologist and Director Bioengineering, Brigham and Women's Hospital Professor of Anaesthesia, Harvard Medical School Creator of Gas Man anesthesia kinetics simulation DISCLOSURE Gas Man and Med Man Simulations Inc. (MMSI) are a nonprofit charitable organization I receive no financial benefit from it
3 Optimal Volatile Agent Delivery Accurate Control of the Anesthetic State Anesthetize the Brain and Spinal Cord Get the Anesthetic Agent to the Effect Site Produce the correct anesthetic level Quickly Precisely Accurately Persistently And reverse this process rapidly
4 Electrical model explains inhalation kinetics P! DEL! P! =! P! P! I! A! E! P! VRG! F! MUS! F! FAT! P! DEL! F! FGF! F! VA! C! CKT! F! VRG! C! FRC! C! VRG! C! MUS! C! FAT! P = Partial Pressure or Tension (electrical V or E) F = Gas Flow = Conductance (electrical G = 1/R) C = Capacitance (electrical C) = Anesthetic flow (electrical current = I)
5 Electrical model explains inhalation kinetics P! DEL! P! =! P! P! I! A! E! P! VRG! F! FAT! This audience F! MUS! F! FGF! F! VA! F! VRG! P! DEL! probably C! C! CKT! FRC! could use this P = Partial Pressure or Tension (electrical V or E) F = Gas Flow = Conductance (electrical G = 1/R) C = Capacitance (electrical C) = Anesthetic flow (electrical current = I) C! VRG! C! MUS! C! FAT!
6 Our industrial colleagues used feedback control to overcome this complexity for users. Possible for USA soon,, as discussed at AAMI-FDA Summit 17 Sept 2014!
7 GE Aisys ET Control Agent, O 2 Draeger Zeus ET Agent, Insp O 2, TCI IV 2014 World Anesthesia Machines
8 A structure-behavior model shows this We and clinical colleagues might use Gas Man to understand what we do
9 GAS MAN physiologically-based model for inhalation kinetics Model was described by Kety in and is routinely used by Eger 2 and several in this room. Accurately predicts expired concentrations during induction and emergence 3. Flow-limited 4-compartment mammillary model plus breathing circuit 4. Each compartment has linear one-compartment mixing with anesthetic brought to it 4. Concentration effect makes the model no stationary and thereby nonlinear 4. Blood & tissue solubilities, gas & blood flows, compartment volumes are from literature 4. User selects patient size and can adjust Vaporizer, FGF, Ventilation, Cardiac Output 4. User can change body habitus adjusting Volumes and Flows of compartments like Fat and Muscle.4. The modified Euler Integration stabilizes model behavior under extreme settings like CO or VA = Learners can use and learn from Gas Man effectively without supervision 6. Researchers can explore subtle aspects of clinical anesthesia 7,8. 1 Kety, SS. Anesthesiology. 1950, 11, p Eger EI, Shafer SL Anesth Analg 2005, 101: (Tutorial). 3 Bouillon T, Shafer SL. Br J Anaesth 2000; 84: Philip JH Int J Clin Monit Comp 1986;3: Ji XB, Philip HM, Philip JH. Proc. STA Ann. Mtg Garfield JM, Paskin S, Philip JH. Med Educ 1989;23: Leeson S, Roberson R, Philip JH. Anesth Analg Hendrickx, DeWolf, Feldman, others in this room.
10 Mathematics Gas Man solves the simultaneous differential equations for multiple gases Used Euler s method of integration (Ver 1 & 2) New value = Old value + dp/dt * Δt Δt should be < 1/10 tau minimum Stiff integration problem adds complexity Several very different time constants (Lung = 0.5 minutes, Fat = 6 hours) Large Δt is OK late Small Δt is required early Ver 3 replaced Euler Integration with Exponential Integration 1 Some parameters change as a function of the the variables, thus nonlinear Any parameter can be changed during simulation, thus time-variant Gas Man is a nonlinear time-varying model 1. Ji XB, Philip HM, Philip JH. Gas Man overcomes stiff-integration oscillation using Exponential Integration. Proc. STA Ann. Mtg 1997.
11 (A) Wash-in 360 minutes = 6 hr. "15 minutes" (B) Wash-out "after breathing 1 MAC for 1 hr. " (C) Wash-out "after breathing 1 MAC for 2 h. " Gas Man model and math appear to be correct for induction and emergence" (D) Wash-out "after breathing 1 MAC for 4 h. " (E) Washout "after breathing 1 MAC for 12 h." Bouillon T, Shafer S. Editorial Hot air or full steam ahead? An empirical pharmacokinetic model of potent inhaled agents. Brit J. Anaes. 84: "
12 A structure-behavior model shows this Agent Level (Partial Pressure) Flow of carrier and agent
13 Compartments and Flows Tension = Partial Pressure D I Delivered Inspired A a Br arterial Alveolar Brain V Veins
14 Return Flows I A Inspired Alveolar V Veins Then agent returns
15 Flows link locations Flows link locations
16 Time, Uptake, and Delivered Quantity are shown Timing (L)! (L)! Uptake Delivered
17 The Model helps you Control Anesthetic Depth. Goal is VRG (Brain) = 1.0 MAC or some fraction or multiple JHP inference from Philip, Gas Man, 2008
18 A graph traces the behavior over time Alveolar response to step change in Delivered Concentration from a on-rebreathing circuit! Xe" " Des" " Sevo" " Iso" Alveolar Tension Curve" Show Alveolar over Delivered!
19 Alveolar and other tissue response to a step change in Delivered Concentration with high and low fresh gas flow!
20 8 L/min vs L/min Desflurane simulation!
21 Inspired response to a step change in Delivered!
22 Alveolar response to a step change in Delivered!
23 VRG response to a step change in Delivered "
24 Alveolar / Inspired for high flow and low fresh gas flow "
25 VRG / Alveolar for high flow and low fresh gas flow"
26 Low FGF " makes Inspired track Delivered poorly. But, if Inspired is well controlled despite the low FGF, other compartments be well controlled.!!! These curves are not identical because we are plotting the ratio of two responses.! If we had plotted the system transfer function or step response of the brain, they would have been identical!
27 Some of today s and most of tomorrow s! Anesthesia machines achieve agent control while using low fresh gas flow.! They do this using feedback control of measured expired agent.!
28 Case 1! Two recent examples where our clinical skills and low fresh gas flow failed us! Patient well-anesthetized on Desflurane-Air Oxygen! Drifted a little too deep over time! We tried negative bolus plus decreased infusion! Vaporizer off until ET reached desired! Vaporizer set to 1% less than before the negative bolus! Here is what it looked like!!
29 FGF 1 L/min limits ability to lighten anesthesua! GE Remote View"
30 FGF 1 L/min limits ability to lighten anesthesua! Zoom"
31 Computer Simulation shows and explains this!
32 ET control can avert some anesthetic overdoses" US Hospital! FGF 1 LPM! Des set to 10! I/E = 7% / 6%! Perfect case!!!
33 ET control can avert some anesthetic overdoses" US Hospital! FGF 1 LPM! Des set to 10! I/E = 7% / 6%! Perfect case!! Tubing caught and cut in CT Scan"!
34 Inadvertent overdose requiring pressors! Des I/E" 7/6" 15/9"
35 Computer Simulation shows this, and much of what we observe!
36 Wake Up!"
37 Inverted Alveolar Tension Curves (Emergence after infinite time anesthetic)! Iso" " Sevo" " Des" " Xe"
38 Brain Delay after ET Agent change! 2 6 minutes, for all agents in most patients! This is the Effect Site delay! Agent monitor and a timer let you see this! Use monitor s trend graph of ET Agent! ET three minutes ago is Brain level now! Compare this analysis to processed EEG Usually very close!
39 Brain delay from expired, on Gas Monitor and EEG Monitor" 0:00" 0:03" JHP Case"
40 Sevo brain delay 3 minutes!
41 Sevo Brain Close-up"
42 Simulate Sevoflurane VIMA and compare with ET monitor Agent Monitor! Gas Man"
43 Understanding Rebreathing Kinetics" Anyone can download Gas Man Student Edition free NAVAt attendees may download a 2 month Gas Man Professional Edition license from the meeting web site or get it from Gas Man table
44 Understanding Rebreathing Kinetics" Thank you" Anyone can download Gas Man Student Edition free NAVAt attendees may download a 2 month Gas Man Professional Edition license from the meeting web site
45 End"
Kinetics of Inhaled Anesthetic Agents
Kinetics of Inhaled Anesthetic Agents Copyright 1995-2011, James H Philip, all rights reserved. Dr. James Philip has performed funded research on Isoflurane, Sevoflurane, and Desflurane. He is often supported
VIMA. (Volatile Induction and Maintenance Anesthesia) How and Why. James H. Philip M.E.(E), M.D.
VIMA (Volatile Induction and Maintenance Anesthesia) How and Why James H. Philip M.E.(E), M.D. Copyright 1995-2007, James H Philip, all rights reserved VIMA (Volatile Induction and Maintenance Anesthesia)
New Anesthesia Delivery Systems What Do I Need to Know About My New Machine?
New Anesthesia Delivery Systems What Do I Need to Know About My New Machine? James H. Philip, MEE, MD, CCE Anesthesiologist and Director Bioengineering Department of Anesthesiology, Pain, and Peri-operative
What our equipment teaches us
What our equipment teaches us James H. Philip, ME(E), MD, CCE Brigham and Women s Hospital Anesthesiologist, Director of Anesthesia Clinical Bioengineering Professor of Anaesthesia, Harvard Medical School
How Technology Will Secure the Future of Inhalation Anesthesia. How Technology Will Secure the Future of Inhalation Anesthesia. Jan Hendrickx, MD, PhD
How Technology Will Secure the Future of Inhalation Anesthesia Jan Hendrickx, MD, PhD Staff Anesthesiologist, OLV Hospital, Aalst, Belgium Consulting Assistant Professor (alumni), Stanford University,
Anesthesia Delivery Systems What Do I Need to Know About My Machine? A Workshop James H. Philip, MEE, MD, CCE
Anesthesia Delivery Systems What Do I Need to Know About My Machine? A Workshop James H. Philip, MEE, MD, CCE Anesthesiologist and Director Bioengineering Department of Anesthesiology, Pain, and Peri-operative
Anesthesia Machine Intro
Anesthesia Machine Intro Brigham and Women s Hospital New Residents July 9, 2010 Copyright 2000-2010, James H Philip, all rights reserved ADS1 Ready JHP Anesthesia Machine Intro James H. Philip, MEE, MD,
Errors in Monitoring. BWH Clinical Conference 10/06/04. Copyright 2004, James H Philip, all rights reserved.
Errors in Monitoring BWH Clinical Conference 10/06/04 Copyright 2004, James H Philip, all rights reserved. Technology Block 2004 10/06/04 James Philip MD Low flow&closed circuit safety&danger 10/06/04
Materials and Methods
Anesthesiology 2002; 97:400 4 2002 American Society of Anesthesiologists, Inc. Lippincott Williams & Wilkins, Inc. Effect of N 2 O on Sevoflurane Vaporizer Settings during Minimal- and Low-flow Anesthesia
ROUTINE PREOXYGENATION
EDITORIAL ROUTINE PREOXYGENATION It is a fact of great clinical importance that the body oxygen stores are so small, and if replenishment ceases, they are normally insufficient to sustain life for more
Anes Machine Use and Pre-use Check - CA1 focus
Anes Machine Use and Pre-use Check - CA1 focus BWH Anesthesia Grand Rounds August 31, 2005 James H. Philip, MEE, MD, CCE Copyright 2000-2005, James H Philip, all rights reserved BWH Anesthesia Workspace
Historically, rebreathing anesthesia systems
ISSN 2466-488X (Online) doi:10.5937/sjait1608193h Revijalni članak/review article LOW FLOW ANESTHESIA Cristian Hönemann 1, Marie-Luise Rübsam 1 1 Klinikum Leer ggmbh, Klinik für Anästhesie und Intensivmedizin,
Hyperventilation delays clinical induction of desflurane
Anesth Pain Med 2010; 5: 216~221 Research Article Hyperventilation delays clinical induction of desflurane Department of Anesthesiology and Pain Medicine, Dongguk University Ilsan Hospital, Ilsan, *St.
Concentration and second-gas effects in the water analogue
British Journal of Anaesthesia 1998; 81: 837 843 CLINICAL INVESTIGATIONS Concentration and second-gas effects in the water analogue W. W. MAPLESON AND B. KORMAN Summary The water analogue provides a visual
GASEOUS HOMEOSTASIS AND THE CIRCLE SYSTEM
Br. J. Anaesth. (1986), 58, 1167-1180 GASEOUS HOMEOSTASIS AND THE CIRCLE SYSTEM Factors Influencing Anaesthetic Gas Exchange C. M. CONWAY When an inhaled anaesthetic agent is administered at a constant
Principles of Pharmacokinetics
Principles of Pharmacokinetics Ákos Csomós MD, PhD Professor, Head of Department Medical Centre, Hungarian Defence Force, Budapest Pharmacokinetics: Very basics How the organ affects the drug: 1) Absorption
PICU Resident Self-Study Tutorial The Basic Physics of Oxygen Transport. I was told that there would be no math!
Physiology of Oxygen Transport PICU Resident Self-Study Tutorial I was told that there would be no math! INTRODUCTION Christopher Carroll, MD Although cells rely on oxygen for aerobic metabolism and viability,
Comparison Of The Efficacy Of Two Low Fresh Gas Flow Techniques In Low Flow Anaesthesia
ISPUB.COM The Internet Journal of Anesthesiology Volume 7 Number 1 Comparison Of The Efficacy Of Two Low Fresh Gas Flow Techniques In Low Flow Anaesthesia S Kulandayan, L Ng, D Kamarudin Citation S Kulandayan,
Anesthesia Machines. Inhaled Anesthetic Agents
Anesthesia Machines Key Points Anesthesia Machines: - basic components of the generic machine understand how the gasses and agent-mixing part of the machine connects to the patient breathing circuit -
Effect of Fresh Gas Flow on Isoflurane Concentrations during Low-flow Anaesthesia
The Journal of International Medical Research 2005; 33: 513 519 Effect of Fresh Gas Flow on Isoflurane Concentrations during Low-flow Anaesthesia J-Y PARK 1, J-H KIM 2, W-Y KIM 2, M-S CHANG 2, J-Y KIM
Measurement of cardiac output by Alveolar gas exchange - Inert gas rebreathing
Measurement of cardiac output by Alveolar gas exchange - Inert gas rebreathing Carlo Capelli SS.MM. Università degli Studi di Verona Soluble Inert gas They dissolve and do not form bonds with haemoglobyn
AQAI SIS MODULES AND MODELS PAGE 1. AQAI Simulator Interface Software AQAI SIS
AQAI SIS MODULES AND MODELS PAGE 1 AQAI Simulator Interface Software AQAI SIS AQAI SIS MODULES AND MODELS PAGE 2 AQAI SIS CONTENTS: AQAI SIS General information AQAI SIS Models and Modules Combining SIS
Chapter 4: Ventilation Test Bank MULTIPLE CHOICE
Instant download and all chapters Test Bank Respiratory Care Anatomy and Physiology Foundations for Clinical Practice 3rd Edition Will Beachey https://testbanklab.com/download/test-bank-respiratory-care-anatomy-physiologyfoundations-clinical-practice-3rd-edition-will-beachey/
HYPERCAPNIC HYPERVENTILATION SPEEDS EMERGENCE FROM INHALED ANESTHESIA. Nishant A Gopalakrishnan
HYPERCAPNIC HYPERVENTILATION SPEEDS EMERGENCE FROM INHALED ANESTHESIA By Nishant A Gopalakrishnan A dissertation submitted to the faculty of The University of Utah in partial fulfillment of the requirements
1) Kety and others have attempted to predict
BY J. W. SEVERINGHAUS 2 (From the Department of Anesthesia, Hospital of the University of Pennsylvania, and Harrison Department of Surgical Research, University of Pennsylvania, Philadelphia, Pa.) (Submitted
Performance Redefined. Automatic Gas Control (AGC) FLOW-i Anesthesia Delivery System
Automatic Gas Control (AGC) FLOW-i Anesthesia Delivery System Performance Redefined This document is intended to provide information to an international audience outside of the US. 2 Critical Care FLOW-i
ALVEOLAR - BLOOD GAS EXCHANGE 1
ALVEOLAR - BLOOD GAS EXCHANGE 1 Summary: These notes examine the general means by which ventilation is regulated in terrestrial mammals. It then moves on to a discussion of what happens when someone over
Homecare Pneumology NEONATOLOGY ANAESTHESIA INTENSIVE CARE VENTILATION Step beyond the future
Homecare Pneumology NEONATOLOGY ANAESTHESIA INTENSIVE CARE VENTILATION Step beyond the future Sleep Diagnostics Service Patient Support The future starts now! For over 30 years, Heinen + Löwenstein has
Disclosures. The Pediatric Challenge. Topics for Discussion. Traditional Anesthesia Machine. Tidal Volume = mls/kg 2/13/14
2/13/14 Disclosures Optimal Ventilation of the Pediatric Patient in the OR Consulting Draeger Medical Jeffrey M. Feldman, MD, MSE Division Chief, General Anesthesia Dept. of Anesthesiology and Critical
Respiration. Figure 22: Schematic representation of the respiratory system
Respiration One of the seven characteristics of something which is living is respiration. Strictly speaking, respiration is the process that takes place at cellular level and is one of three different
GASEOUS HOMEOSTASIS AND THE CIRCLE SYSTEM Description of a Model
Br. J. Anaesth. (1986), 58, 330-336 GASEOUS HOMEOSTASIS AND THE CIRCLE SYSTEM Description of a Model C. M. CONWAY Models have been used widely in the study of the uptake, distribution and elimination of
MEDICAL EQUIPMENT IV MECHANICAL VENTILATORS. Prof. Yasser Mostafa Kadah
MEDICAL EQUIPMENT IV - 2013 MECHANICAL VENTILATORS Prof. Yasser Mostafa Kadah Mechanical Ventilator A ventilator is a machine, a system of related elements designed to alter, transmit, and direct energy
Lung Volumes and Capacities
Lung Volumes and Capacities Normally the volume of air entering the lungs during a single inspiration is approximately equal to the volume leaving on the subsequent expiration and is called the tidal volume.
Fabius will not compensate for Lung Compliance or Changes in lung compliance
Technology Topics 2007 James H Philip MEE, MD, CCE page 1 Technology Topics 2007 Full Text ANESTHESIA DELIVERY SYSTEMS (ADS) ADS Names and Brands BWH ADSs come from GE-Datex-Ohmeda and Draeger-Siemens
BleaseDatum Anesthesia Vaporizers PEACE OF MIND. Serving The HealthCare Industry
BleaseDatum Anesthesia Vaporizers PEACE OF MIND Serving The HealthCare Industry PEACE OF MIND While ventilation ensures that patients receive adequate oxygenation, reliable vaporization of inhaled anesthesia
A CO 2 Waveform Simulator For Evaluation and Testing of Respiratory Gas Analyzers
2011 ROCKY MOUNTAIN NASA SPACE GRANT CONSORTIUM 1 A CO 2 Waveform Simulator For Evaluation and Testing of Respiratory Gas Analyzers Christina Long, and Joseph Orr, Ph.D. Department of Bioengineering, University
Technology Topics 2017 James H Philip MEE, MD, CCE page 1
Technology Topics 2017 James H Philip MEE, MD, CCE page 1 Technology Topics 2017 Full Text ANESTHESIA DELIVERY SYSTEMS (ADS) ADS Names and Brands BWH ADSs come from GE-Datex-Ohmeda and Draeger-Siemens
QED-100 Clinical Brief
QED-100 Clinical Brief THE QED-100 WITH SPONTANEOUSLY BREATHING PATIENTS Author: Derek Sakata, MD Assistant Professor of Anesthesiology University of Utah Department of Anesthesiology QED-100 offers clinical
Respiratory Medicine. A-A Gradient & Alveolar Gas Equation Laboratory Diagnostics. Alveolar Gas Equation. See online here
Respiratory Medicine A-A Gradient & Alveolar Gas Equation Laboratory Diagnostics See online here Alveolar gas equation helps to calculate the partial pressure of oxygen in alveoli and A-a gradient is the
RESPIRATORY GAS EXCHANGE
RESPIRATORY GAS EXCHANGE Alveolar PO 2 = 105 mmhg; Pulmonary artery PO 2 = 40 mmhg PO 2 gradient across respiratory membrane 65 mmhg (105 mmhg 40 mmhg) Results in pulmonary vein PO 2 ~100 mmhg Partial
Experience the Flow. Streamlined workflow with the compact Flow-c
Experience the Flow Streamlined workflow with the compact Flow-c This document is intended to provide information to an international audience outside of the US. A smoother workflow for busy ORs Crowded
RC-178 a/a ratio. Better. PaO2 ACM than. a/a= PAO2. guessing!! Copyrights All rights reserved Louis M. Sinopoli
RC-178 a/a ratio Better a/a= PaO2 ACM than PAO2 guessing!! 1 A relative RC-178 a/a ratio way to judge the lungs ability to transport O2. Determine new FIO2 to achieve PaO 2 amount that got through the:
Draeger Fabius GS Pre-Use Check
Draeger Fabius GS Pre-Use Check James H Philip MEE, MD, CCE 2011 James H Philip All rights reserved Remember to enter Machine # Fabius GS front view Fabius GS pre-use checkout procedure Fabius GS pre-use
Monitoring, Ventilation & Capnography
Why do we need to monitor? Monitoring, Ventilation & Capnography Keith Simpson BVSc MRCVS MIET(Electronics) Torquay, Devon. Under anaesthesia animals no longer have the ability to adequately control their
UNIQUE CHARACTERISTICS OF THE PULMONARY CIRCULATION THE PULMONARY CIRCULATION MUST, AT ALL TIMES, ACCEPT THE ENTIRE CARDIAC OUTPUT
UNIQUE CHARACTERISTICS OF THE PULMONARY CIRCULATION THE PULMONARY CIRCULATION MUST, AT ALL TIMES, ACCEPT THE ENTIRE CARDIAC OUTPUT UNIQUE CHARACTERISTICS OF THE PULMONARY CIRCULATION THE PULMONARY CIRCULATION
New Generation System M, leading the World in the Non-Invasive Measurement of Critical Real-Time Parameters.
New Generation System M, leading the World in the Non-Invasive Measurement of Critical Real-Time Parameters. System M Spectrum Medicals total commitment to continuous product improvement is demonstrated
ADAPTIVE CONTROL OF LOW-FLOW ANAESTHESIA USING A MIXTURE OF ANAESTHETIC GASES. D. S. Coca, D. Coca and S.A. Billings
ADAPTIVE CNTRL F LW-FLW ANAESTHESIA USING A MIXTURE F ANAESTHETIC GASES D. S. Coca, D. Coca and S.A. Billings Department of Automatic Control & Systems Engineering, University of Sheffield, Mappin Street,
Completed downloadable Test Bank for Pilbeams Mechanical Ventilation Physiological and Clinical Applications 5th Edition by Cairo
Completed downloadable Test Bank for Pilbeams Mechanical Ventilation Physiological and Clinical Applications 5th Edition by Cairo Link full download: http://testbankcollection.com/download/pilbeams-mechanicalventilation-physiological-and-clinical-applications-5th-edition-test-bank-cairo
Anesthesiology Research and Scholarship. Follow this and additional works at:
University of New Mexico UNM Digital Repository Anesthesiology Research and Scholarship Anesthesiology 9-1-2013 Breathing Systems Janet Brierley Follow this and additional works at: https://digitalrepository.unm.edu/anesthesiology_pubs
The physiological functions of respiration and circulation. Mechanics. exercise 7. Respiratory Volumes. Objectives
exercise 7 Respiratory System Mechanics Objectives 1. To explain how the respiratory and circulatory systems work together to enable gas exchange among the lungs, blood, and body tissues 2. To define respiration,
Working version subject to Departmental approval. Drafted by Dr. Olympio and reviewed by clinical members of The Capital Equipment Committee
Wake Forest University Baptist Medical Center Department of Anesthesiology TECHNICIAN ABBREVIATED CHECKLIST OF RESPONSIBILITIES For Anesthesia Apparatus Checkout Specific to the Draeger APOLLO anesthesia
Guidelines on Monitoring in Anaesthesia
Page 1 of 8 Guidelines on Monitoring in Anaesthesia Version Effective Date 1 OCT 1992 2 FEB 2002 3 APR 2012 4 JUL 2013 5 MAY 2017 Document No. HKCA P1 v5 Prepared by College Guidelines Committee Endorsed
Initiation and Management of Airway Pressure Release Ventilation (APRV)
Initiation and Management of Airway Pressure Release Ventilation (APRV) Eric Kriner RRT Pulmonary Critical Care Clinical Specialist Pulmonary Services Department Medstar Washington Hospital Center Disclosures
Flow meter. bellow vaporizer. APL valve. Scavenging system
Introductory Lecture Series: The Anesthesia Machine PORNSIRI WANNADILOK Objectives Anesthesia Machine Ventilators Scavenging Systems System Checkout 1 Flow meter ventilator bellow vaporizer Corrugated
Unit II Problem 4 Physiology: Diffusion of Gases and Pulmonary Circulation
Unit II Problem 4 Physiology: Diffusion of Gases and Pulmonary Circulation - Physical principles of gases: Pressure of a gas is caused by the movement of its molecules against a surface (more concentration
GENERAL anesthesia is composed of four phases: induction,
0 ROCKY MOUNTAIN NASA SPACE GRANT CONSORTIUM A MODEL FOR ANESTHETIC WASHOUT DURING RECOVERY IN THE POST ANESTHESIA CARE UNIT Cameron Jacobson Department of Bioengineering, University of Utah, Salt Lake
Capnography in the Veterinary Technician Toolbox. Katie Pinner BS, LVT Bush Advanced Veterinary Imaging Richmond, VA
Capnography in the Veterinary Technician Toolbox Katie Pinner BS, LVT Bush Advanced Veterinary Imaging Richmond, VA What are Respiration and Ventilation? Respiration includes all those chemical and physical
THE ANAESTHETIC MACHINE THE NEXT GENERATION
Annual Queenstown Update in Anaesthesia, 2011 The Anaesthetic Machine The Next Generation THE ANAESTHETIC MACHINE THE NEXT GENERATION Dr Andrew Love North Shore Hospital, Auckland 41 In the last 10 to
MATHEMATICAL ASPECTS OF THE UPTAKE, DISTRIBUTION AND ELIMINATION OF INHALED GASES AND VAPOURS
Brit. J. Anaesth. (1964), 36,129 MATHEMATICAL ASPECTS OF THE UPTAKE, DISTRIBUTION AND ELIMINATION OF INHALED GASES AND VAPOURS BY W. W. MAPLESON Department of Anaesthetics, Welsh National School of Medicine,
Collin County Community College. Lung Physiology
Collin County Community College BIOL. 2402 Anatomy & Physiology WEEK 9 Respiratory System 1 Lung Physiology Factors affecting Ventillation 1. Airway resistance Flow = Δ P / R Most resistance is encountered
SIMULATION OF THE HUMAN LUNG. Noah D. Syroid, Volker E. Boehm, and Dwayne R. Westenskow
SMULATON OF THE HUMAN LUNG Noah D. Syroid, Volker E. Boehm, and Dwayne R. Westenskow Abstract A human lung simulator was implemented using a model based on the Fick principle. The simulator is designed
Section Two Diffusion of gases
Section Two Diffusion of gases Lecture 5: Partial pressure and the composition of gasses in air. Factors affecting diffusion of gases. Ventilation perfusion ratio effect on alveolar gas concentration.
BASIC PHYSICS APPLIED TO ANAESTHESIOLOGY
BASIC PHYSICS APPLIED TO ANAESTHESIOLOGY Dr.R.Selvakumar.M.D.D.A.DNB Professor of Anaesthesiology, K.A.P.Viswanatham Govt medical college, Trichy. The current practice of Anaesthesiology demands knowledge
Isocapnic hyperpnea (IH): fast-filtering foreign gases
Isocapnic hyperpnea (IH): fast-filtering foreign gases Joseph A. Fisher M.D. FRCP(C) Professor, Faculty of Medicine University of Toronto and Chief Scientist, Thornhill Research Inc. Aims: isocapnic hyperpnea
6 th Accredited Advanced Mechanical Ventilation Course for Anesthesiologists. Course Test Results for the accreditation of the acquired knowledge
6 th Accredited Advanced Mechanical Ventilation Course for Anesthesiologists Course Test Results for the accreditation of the acquired knowledge Q. Concerning the mechanics of the newborn s respiratory
Anesthesia. Midmark Animal Health Products
Anesthesia Midmark Animal Health Products The first and still the best. Safe, simple and controllable inhalation anesthesia Matrx anesthesia machines are the number one choice of veterinary professionals
Stikstofuitwas en Heliumdilutie. Eric Derom Universitair Ziekenhuis Gent
Stikstofuitwas en Heliumdilutie Eric Derom Universitair Ziekenhuis Gent Background Overview Helium-dilution technique Principle of Technique Equipment Procedure and Calculations Quality Control Nitrogen
Volumetric Gas Measurements Measurement Site Considerations
W H I T E P A P E R Volumetric Gas Measurements Measurement Site Considerations ABSTRACT For the measurement of gas exchange (such as carbon dioxide elimination), the choice of the gas and flow measurement
Public Assessment Report Scientific discussion. Lung test gas CO (He) AGA, 0.28%, inhalation gas, compressed (carbon monoxide, helium) SE/H/1154/01/MR
Public Assessment Report Scientific discussion Lung test gas CO (He) AGA, 0.28%, inhalation gas, compressed (carbon monoxide, helium) SE/H/1154/01/MR This module reflects the scientific discussion for
PHARMACOLOGY LABORATORY 2 PHARMACOKINETIC LABORATORY
PHARMACOLOGY LABORATORY 2 PHARMACOKINETIC LABORATORY OBJECTIVES: 1. Reinforce the different concepts of pharmacokinetics which were presented in lecture using computer simulation of one and multiple compartment
INTRODUCTION. Alterovitz G, Staelin DH, PhilipJH.Temporal patient state characterizationusingiterativeorderandnoise(ion)estimation:applications
TEMPORALPATIENTSTATECHARACTERIZATION USINGITERATIVEORDERANDNOISE(ION) ESTIMATION:APPLICATIONSTOANESTHESIA PATIENTMONITORING GilAlterovitz,SM, 1 DavidH.Staelin,ScD 1 and JamesH.Philip,ME(E),MD 2 Alterovitz
Simulation and prediction of uptake, distribution, and exhalation of organic
British Journal ofndustrial Medicine, 1974, 31, 45-52 Simulation and prediction of uptake, distribution, and exhalation of organic solvents VERA FSEROVA-BERGEROVA', KSHORE SNGHAL2 Department of Anesthesiology,
Let s talk about Capnography
Let s talk about Capnography This is one of a series of articles by Keith Simpson BVSc MRCVS MIET (Electronics) discussing the practical aspects of some common monitoring techniques. Capnometry is the
660 mm Hg (normal, 100 mm Hg, room air) Paco, (arterial Pc02) 36 mm Hg (normal, 40 mm Hg) % saturation 50% (normal, 95%-100%)
148 PHYSIOLOGY CASES AND PROBLEMS Case 26 Carbon Monoxide Poisoning Herman Neiswander is a 65-year-old retired landscape architect in northern Wisconsin. One cold January morning, he decided to warm his
DECOMPRESSION THEORY - NEO-HALDANE MODELS
DECOMPRESSION THEORY - NEO-HALDANE MODELS This section describes the Haldane or neo-haldane decompression theories. On each dive the divers body takes up inert gasses, like Nitrogen. After the dive the
Update on Thoracic Anesthesia: Perioperative Lung Protective Strategies in One- and Two-Lung Ventilation
Update on Thoracic Anesthesia: Perioperative Lung Protective Strategies in One- and Two-Lung Ventilation 2016 Dr. Alan Jay Schwartz: Hello. This is Alan Jay Schwartz, Editor-in-Chief of the American Society
ANESTHESIA VAPORIZER SERVICE RECOMMENDATIONS
ANESTHESIA VAPORIZER SERVICE RECOMMENDATIONS The anesthesia vaporizer is a critical component of your anesthetic machine. It is very important to ensure that the appropriate percentage of anesthetic agent
AN OVERVIEW OF RESPIRATION AND AN INTRODUCTION TO DIFFUSION AND SOLUBILITY OF GASES 1
AN OVERVIEW OF RESPIRATION AND AN INTRODUCTION TO DIFFUSION AND SOLUBILITY OF GASES 1 Summary: This set of notes gives an overview of respiration and then follows the overview with a detailed discussion
Principles of Mechanical Ventilation: A Graphics-Based Approach
Principles of Mechanical Ventilation: A Graphics-Based Approach Steven M. Donn, MD, FAAP Professor of Pediatrics Neonatal-Perinatal Medicine C.S. Mott Children s Hospital University of Michigan Health
Organis TestChest. Flight Simulator for Intensive Care Clinicians
Organis TestChest Flight Simulator for Intensive Care Clinicians Organis TestChest Critical Care challenges Training on ventilation modes with simulation is crucial for patient safety The equipment and
APNOEA AND PRE-OXYGENATION
APNOEA AND PRE-OXYGENATION Original article by Dr Andrew Biffen, Dr Richard Hughes Torbay Hospital, UK INTRODUCTION The purpose of pre-oxygenation is to increase physiological stores of oxygen in order
RESPIRATORY PHYSIOLOGY, PHYSICS AND PATHOLOGY IN RELATION TO ANAESTHESIA AND INTENSIVE CARE
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: Pulmonary Function and
Advanced Ventilator Modes. Shekhar T. Venkataraman M.D. Professor Critical Care Medicine and Pediatrics University of Pittsburgh School of Medicine
Advanced Ventilator Modes Shekhar T. Venkataraman M.D. Shekhar T. Venkataraman M.D. Professor Critical Care Medicine and Pediatrics University of Pittsburgh School of Medicine Advanced modes Pressure-Regulated
Some Clinical Aspects on the Blood Gas Physiology
Special Article* Some Clinical Aspects on the Blood Gas Physiology Hiroshi Sasamoto Professor and Chairman, Department of Medicine, School of Medicine Keio University, Shinjuku, Tokyo Recent trends on
APRV: Moving beyond ARDSnet
APRV: Moving beyond ARDSnet Matthew Lissauer, MD Associate Professor of Surgery Medical Director, Surgical Critical Care Rutgers, The State University of New Jersey What is APRV? APRV is different from
Pulmonary Circulation Linda Costanzo Ph.D.
Pulmonary Circulation Linda Costanzo Ph.D. OBJECTIVES: After studying this lecture, the student should understand: 1. The differences between pressures in the pulmonary and systemic circulations. 2. How
CHAPTER 3: The respiratory system
CHAPTER 3: The respiratory system Practice questions - text book pages 56-58 1) When the inspiratory muscles contract, which one of the following statements is true? a. the size of the thoracic cavity
Surgical Care at the District Hospital. EMERGENCY & ESSENTIAL SURGICAL CARE
Surgical Care at the District Hospital 1 15 Anesthetic Infrastructure and Supplies Key Points 2 15.1 Equipment & Supplies for Different Level Hospitals However well trained you are as an anaesthetist,
BleaseFocus Anesthesia System VERSATILE ANESTHESIA
BleaseFocus Anesthesia System VERSATILE ANESTHESIA VERSATILE ANESTHESIA Spacelabs Healthcare have over 60 years experience in anesthesia design and ventilator development. Coupled with extensive knowledge
VT900A + VAPOR. Technical data. One Solution. Auto-detection to Ensure Patient Safety. Key benefits and features
Technical data VT900A + VAPOR The Fluke Biomedical VT900A + VAPOR is designed to efficiently and reliably perform a full anesthesia machine PM, from ventilators to vaporizers. One Solution VT900A + VAPOR
2. State the volume of air remaining in the lungs after a normal breathing.
CLASS XI BIOLOGY Breathing And Exchange of Gases 1. Define vital capacity. What is its significance? Answer: Vital Capacity (VC): The maximum volume of air a person can breathe in after a forced expiration.
PROBLEM SET 8. SOLUTIONS April 15, 2004
Harvard-MIT Division of Health Sciences and Technology HST.542J: Quantitative Physiology: Organ Transport Systems Instructors: Roger Mark and Jose Venegas MASSACHUSETTS INSTITUTE OF TECHNOLOGY Departments
Neonatal Assisted Ventilation. Haresh Modi, M.D. Aspirus Wausau Hospital, Wausau, WI.
Neonatal Assisted Ventilation Haresh Modi, M.D. Aspirus Wausau Hospital, Wausau, WI. History of Assisted Ventilation Negative pressure : Spirophore developed in 1876 with manual device to create negative
Automated control of end-tidal inhalation anaesthetic concentration using the GE Aisys Carestation TM
British Journal of Anaesthesia Page 1 of 6 doi:.93/bja/aes464 Automated control of end-tidal inhalation anaesthetic concentration using the GE Aisys Carestation TM S. Singaravelu and P. Barclay* BJA Advance
Anesthesiologists work in remote locations both
TECHNICAL COMMUNICATIONS Oxygen Consumption with Mechanical Ventilation in a Field Anesthesia Machine Dale F. Szpisjak, MD*, Charles L. Lamb, MD, and Kenneth D. Klions, MD *Department of Anesthesiology,
Materials and Methods
Anesthesiology 2008; 108:381 7 Copyright 2008, the American Society of Anesthesiologists, Inc. Lippincott Williams & Wilkins, Inc. Magnitude of the Second Gas Effect on Arterial Sevoflurane Partial Pressure
Mechanical Ventilation. Which of the following is true regarding ventilation? Basics of Ventilation
Mechanical Ventilation Jeffrey L. Wilt, MD, FACP, FCCP Associate Professor of Medicine Michigan State University Associate Program Director MSU-Grand Rapids Internal Medicine Residency Which of the following
New A7 Anesthesia Workstation
New A7 Anesthesia Workstation Visible Precision Pls refer to user manual for manufacturer information BeneVision Central Monitoring System-210X285X12PX20150329 Since 2006 Mindray has successfully installed
Modeling Gas Dynamics in California Sea Lions
DISTRIBUTION STATEMENT A. Approved for public release; distribution is unlimited. Modeling Gas Dynamics in California Sea Lions Andreas Fahlman Department of Life Sciences Texas A&M University-Corpus Christi
TERMINOLOGY AND SYMBOLS USED LN RESPIRATORY PHYSIOLOGY. Assistant, Medical Unit, Middlesex Hospital, London, W.i
Brit. J. Anaesth. (1957), 29, 534 TERMINOLOGY AND SYMBOLS USED LN RESPIRATORY PHYSIOLOGY BY E. J. MORAN CAMPBELL Assistant, Medical Unit, Middlesex Hospital, London, W.i INTRODUCTION MANY anaesthetists