А это уже от РИТА - КР ФАР по периопреационному ведени пациентов с АГ. Имхо, рекомендации ФАР написаны вразумительнее. Видно, что не кардиологи писали)

Дорогие коллеги! Обещанный подарок вам от проф. Кузькова в его же собственный день рождения!)

Несложное для чтения, но редкое в практике. Пятничное. Доброкачественная метастатическая лейомиома матки в лёгких. Смотрите КТ- это не ковид и не альвеолярный лёгочный протеиноз. Гипоксемическая ДН тяжелой степени, ВПО, ИВЛ, трахеостома, отлучение через ВПО, выписка. Терапия антипрогестагенами.

А вот и статейка.

скажу сразу что РЕЕР 25 мы не ставили, но эффекта от РЕЕР до 18 тоже не было (как и должно быть) - АОР не изменился

Метаболограф компании «Тритон» (the ZISLIN metabolic module) вошел в состав аппарата ИВЛ компании “Lowenstein”. Наши поздравления разработчикам и особенно Алексею Владимировичу Чистякову! Это очень круто!

https://youtu.be/Mizq-h3gc0k

A New Global Definition of Acute Respiratory Distress Syndrome
?Full Publication of New ARDS Definition?
?Key changes from Berlin definition
?3 categories: Non-intubated, Intubated, resource-limited settings
?Inclusion of HFNO, SpO2/FiO2 & POCUS
What's new?
1⃣HFNO ≥30 L/m
2⃣SpO2/FiO2 ≤315 & SpO2 ≤97
3⃣Ultrasound diagnosis of bilateral opacities
4⃣Consideration for resource-limited settings
?

Full Publication dropped in
https://t.me/Respiratory_Care_Global/2201

Intraoperative Hypoxia / Desaturation / Cyanosis - Guidelines for Crises in Anaesthesia

Using these steps from start to end should identify any cause of unexpected hypoxia in theatre.
Avoid spending excessive time and attention on one aspect until you have run through the whole drill

❶ Adequate oxygen delivery
• Pause surgery if possible.
• Increase fresh gas flow AND give 100% oxygen AND check measured FiO2.
• Visual inspection of entire breathing system including valves and connections.
• Rapidly confirm reservoir bag moving OR ventilator bellows moving.
• If SpO2 low, is it accurate? Consider whether poor perfusion could be the problem.
❷ Airway
• Check position of airway device and listen for noise (including over larynx and stomach).
• Check capnogram shape compatible with patent airway.
• Confirm airway device is patent (consider passing suction catheter).
• Isolate patient from anaesthetic machine and breathing system (Box B).
• Once machine/breathing system problem excluded, consider whether airway device should be replaced or its type changed.
❸ Breathing
• Check chest symmetry, rate, breath sounds, SpO2, measured VTexp, ETCO2.
• Feel the airway pressure using reservoir bag and APL valve (Box C) <3 breaths.
• Consider potential causes and actions (Box D).
• Consider muscle relaxation to optimise ventilation.
❹ Circulation
• Check heart rate, rhythm, perfusion, recheck blood pressure.
• If circulation unstable, consider if this is secondary to hypoxia.
❺ Depth
• Ensure adequate depth of anaesthesia and analgesia.
❻ If not resolving call for help AND check arterial blood gas, 12-lead ECG, chest X-ray.

POTENTIAL CAUSES AND ACTIONS
• Hypoxia with increased airway pressure → 2-3
• Inadequate movement or expired volume: assist/increase ventilation.
• Asymmetrical chest expansion: exclude bronchial intubation/foreign body/pneumothorax.
• Consider potential actions: tracheal/bronchial suction; bronchodilator; PEEP; diuretic; bronchoscopy.
• Consider potential causes:
o Laryngospasm and stridor → 3-6
o Bronchospasm → 3-4
o Anaphylaxis → 3-1
o Circulatory embolism → 3-5
o Cardiac ischaemia (or infarction) → 3-12
o Cardiac tamponade → 3-9
o Sepsis → 3-14
o Malignant hyperthermia crisis → 3-8
o Aspiration, pulmonary oedema, congenital heart disease

Quick Reference Handbook - Guidelines for crises in anaesthesia
https://anaesthetists.org/Home/Resources-publications/Safety-alerts/Anaesthesia-emergencies/Quick-Reference-Handbook/PDF-version
#Hypoxia #Cyanosis #Anesthesiology #Intraoperative #Checklist #Diagnosis #Workup #Management #Workup #anesthesia

anaesthetists.org

Quick Reference Handbook (QRH) | The Association of Anaesthetists

The Association of Anaesthetists' Quick Reference Handbook (QRH) is a collection of guidelines for unexpected or uncommon anaesthesia-related emergencies.

aersol-guides-for-rts.pdf

For Respiratory Care Specialists