Review of literature
Monnet et al(1) published a review article on assessment of volume responsiveness in mechanically ventilated patients using heart and lung interactions. He explained that mechanical ventilation produces cyclic changes left ventricular stroke volume due to inspiration and expiration induced changes in LV preload. It denotes preload dependency of left ventricle indirectly right ventricle. He also describes various limitations of respiration variations in SV for predicting fluid responsiveness.
Guidet et al(2) conducted a study in sepsis patients to find haemodynamic efficacy and safety between 6%HES 130/0.4 vs 0.9% NaCl. He found that volume requirement was less with HES than NaCl in inial phase of fluid resuscitation and also the time required to reach haemodynamic stability was less with HES. There was no difference between AKIN and RIFLE criteria between two groups. There was also no difference in mortality upto 90days after resuscitation.
Christoph K Hofer et(3) al performed a study to find which system has better prediction of fluid responsiveness between FloTrac/Vigileo and PiCCO plus system, using stroke volume variation(SVV) as a predictor of fluid responsiveness. The study was performed in patients undergoing in elective cardiac surgery. He used a method to induce volume shift by changing body position from 30° head-up position to 30° head-down
Position. SVV was determined using radial Flotrac sensor and femoral PiCCO plus catheter. The decrease in SVV found using Flotrac and PiCCO plus were significant and also the correlation between found between the two SVVs were significant. He also found that SVV measured using FloTrac has lower threshold for prediction than the other.
Jan Be...
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...ilated. Through subcostal approach IVC diameter was measured at end inspiration(D max) and end expiration(D min) using echocardiography and distensibility index was calculated(dIVC=Dmax-Dmin/Dmin). Cardiac index(CI) measured using Doppler technique in pulmonary arterial trunk. Patients showing 15% increase in CI post volume infusion with 7ml/kg of plasma expanders were called as responders. A strong relation (r = 0.9) was observed between dIVC at baseline and the CI increase following blood volume expansion.
Stawiki SP(11) et al performed a study to compare the USG guided assessment of inferior vena cava collapsibility index (IVC-CI) and central venous pressure. He found an inverse relationship between CVP and IVC-CI. IVC-CI lesser than 25% is consistent with euvolemia or hypervolemia, while IVC-CI greater than 75% suggests intravascular volume depletion.
Epinephrine can be added to NE if needed to maintain acceptable BP, or substituted if necessary. Vasopressin (0.03 units/min) can be used as an adjunct to increase MAP,or to lower NE dose; it should not be used as a single agent. Dopamine can be used as an alternative to NE, but only in patients meeting criteria due to risk of arrhythmias; low dose dopamine not to be used for renal protection. Phenylephrine not recommended in most cases; can be utilized if NE leads to serious arrhythmias, CO is known to be high yet BP continues to be low, or as salvage therapy when MAP target is not achieved by other means. An arterial cath should be placed ASAP in patients who require vasopressors. Inotropes can be added to vasopressors or used alone, with a doubatmine trial of up to 20 mcg/kg/min as an option if myocardial dysfunction is suspected by elevated cardiac filling pressures and low CO, or if hypoperfusion is still evident although intravascular volume and MAP are at goal. Bicarbonate should not be used in patients with pH greater than or equal to
In this activity Effects of Arteriole Radius on Glomerular Filtration was recorded with valve opened and closed when blood pressure changed. When the one-way valve between the collecting duct and the urinary bladder was closed the filtrate pressure in Bowman’s capsule (was not directly measured) and the GFR pressure stayed the same and glomerular filtration decreased. Increasing the systemic blood pressure stayed the same when valve was closed and GFR was low when the valve was open.
Urine output is a time-honored measure of the patient’s effective blood volume (EBV) and a surrogate for tissue perfusion. Urine output is typically measured at one-hour intervals and expressed in milliliters per hour (ml/h). Because small volumes are difficult to measure, initial information becomes available only 20-30 minutes after catheter insertion by extrapolating to one full hour. This extrapolation can result in considerable over- or underestimation.
Fluid volume overload within the intervascular space can cause shortness of breath, fluid within the lungs, engorged neck veins, increased blood pressure and heart rate with a bounding pulse. As blood volume increases so will blood pressure and heart rate. Impaired gas exchange related to pulmonary congestion causes crackles within the lung fields. If oxygen saturation is low the nurse should supply supplemental oxygen. The nurse would raise head of the bed at least thirty degrees or higher to promote breathing and reduce cardiac pressure. Having the patient cough and breath deep can pop open alveoli to clear lung passages. Once the patient is comfortable and in safe position the nurse can call the doctor. The nurse should anticipate another dose of diuretics, such as furosemide. This treatment will decrease respiratory rate and blood pressure by reducing the amount of sodium and fluid within the body. Breath sounds will improve as crackles decrease. Maintaining appropriate fluid volume stabilizes blood pressure, cellular metabolism and proper nutrition gained or wastes lost. Supplemental oxygen if oxygen saturation is low and the nurse has already supplied the patient with oxygen. (Ignatavicius & Workman,
...c should be between 60-80 mmHg, heart rate should be within acceptable range of 60-110 beats/min, and central venous pressure should drop to the range of 0-6 cmH2O (Brown & Edwards, 2012; Rodgers, 2008; Swearingen, 2012). The patient’s pain score should be below 3-4 on a 0-10 pain rating scale, or absence of pain (Swearingen, 2012). The patient should be alert with no signs of agitation, and has good understanding of tension pneumothorax and interventions required (Swearingen, 2012).
Like with anything else, it is imperative to ensure a patent airway, adequate ventilation, good oxygenation, and adequate circulation. However, stroke patients have an increased risk of losing the ability to protect their own airway and subsequently aspirate. You can help protect the patient from aspirating by simply placing them in the semi-fowlers position. Now if severe vomiting becomes a factor and the airway is compromised, intubation may need to be used to protect the patient from any further aspiration. If either the tidal volume or rate becomes inadequate, quickly assist their ventilations at a rate of 10-12 breaths per minute. If assistance is needed with ventilations, its good practice to have your BVM hooked up to oxygen too because unless your patient is intubated at this point, some of the room air you pump into them is going to go into the stomach, making for less adequate oxygenation. Along with the ABC component, you’re going to establish IV access and apply the cardiac monitor to see what the heart is doing (Mistovich, 2008). Treating the symptoms is all you’re going to be able to do. As it was mentioned before, the only way to treat the underlying problem is to get the patient to the hospital as quickly as you
The nursing staff can answer the call immediately. The system provides up to 24 hours of PCA dosing history with corresponding time-based values from capnography and/or pulse oximetry monitoring. For proper implementation Physicians, nurses, pharmacists, and respiratory therapists worked together to develop policies and procedures, standardized PCA dosing forms, physician notification parameters, routine order sets for SpO2 and EtCO2monitoring, criteria for discontinuing monitoring and a reversal agent protocol. Patient and hospital staff knowledge about the process also played an key role in success of the therapy. It was ensured that Medical staff Education took place during staff orientation, annual competency assessments, and at the bedside. Well educated patients regarding the procedure are more likely to accept wearing the filter line and do very well with postoperative
Marini, J. (2013). Mechanical ventilation: past lessons and the near future. Critical Care (London, England), 17 Suppl 1S1. doi:10.1186/cc11499
If there is a driveline emerging from the abdomen, the paramedic should not cut, bend, or twist it since this is the direct connection to the power source to the pump. Ther pareamedic should begin his/her assessment with the routine steps of assessment; however, when the paramedic gets to step C, the process will change. Though some VAD’s produce a pulsating flow of blood throughout the body, a larger number of devices use a continuing flow creating a non-pulsating continuous flow. Therefore, these patients will not have a pulse when assessed in the conventional manner. Also, attempting to take a blood pressure reading with a manual cuff does not produce an audible
Shenkin H, Bezier H, & Bouzarth W. (1976). Restricted fluid intake: rational management of the neurosurgical patient. Journal of Neurosurgery, 45 (4), 432–36.
(PC - IRV) suggested for severe hypoxemia when high positive end expiratory pressure (PEEP) and high FiO2 have failed to improve oxygenation in (ALI / ARDS) (ega). The result is maintenance of numerous alveoli open and intrinsic Positive end expiratory pressure (PEEP), improving arterial oxygenation (Bates). (IRV ) with low (PEEP) levels during conventional ventilation, (IRV) is successful in improving Pao2, moderate PEEP levels that prevent recruitment, and when use high PEEP levels are required in severe ARDS, oxygenation is better preserved with conventional ventilation due to a lower shunt (Ferrando).The study’s by (Chaco): the three randomized trials compared pressure control ventilation (PCV) versus volume control ventilation (VCV) in a total of 1089 adults with (ALI / ARDS) from 43 intensive care unit (ICU).The method was they use (PC-IRV),equivalent pressure-controlled model compared with (VCV), we included parallel-group randomized controlled trials (RCTs) and quasi-RCTs irrespective of their language or publication status. Primary outcomes are 1- In-hospital mortality, including ICU mortality2- Mortality at 28 days. The result was 1-(PCV) probably reduces ICU mortality of (ALI / ARDS) compared with (VCV), 2- Risk of barotrauma may not differ between (PCV) and (VCV). There is some studies have shown
Mechanical ventilation is defined as using a device that is called a ventilator to provide positive pressure oxygen flow to a patient who have partially or fully lost the ability to breath on their own. Typically patients will require a ventilator for anesthesia during surgeries, or respiratory compromise due to trauma or some sort of illness. When people imagine a ventilated patient they constantly think of the unconscious person who sustained some sort of major trauma who are more than likely brain dead. However there are many patients that have lost the ability to breathe that are now regaining consciousness only to find they cannot breath on their own. This condition could be permanent or they could take some time to regain the ability to breathe on their own in a process called weaning.
...., & Jr, L. H. (1992). Release of vasoactive substances during cardiopulmonary bypass. Annals of Thoracic Surgery. doi:10.1016/0003-4975(92)90113-I-6
This reflection of vital signs will go into discussion about the strengths and weaknesses of each vital sign and the importance of each of them. Vital signs should be assessed many different times such as on admission to a health care facility, before and after something substantial has happened to the patient such as surgery and so forth (ref inter). I learned to assess blood pressure (BP), pulse (P), temperature (T) and respiration (R) and I will reflect and discuss which aspects were more difficult and ways to improve on them. While pulse, respiration and temperature were fairly easy to become skilled at, it was blood pressure which was a bit more difficult to understand.
The blood pressure of the patient on admission was 85/45 mmHg. Other vitals were, respiratory rate 25 /min, pulse rate 132/min, temperature 1010F and Oxygen saturation was 93% with face mask. An ECG does not show any specific changes except sinus tachycardia. As the patient deteriorate further transferred to the ICU. Resuscitation according to early goal directed therapy was