Mostrando entradas con la etiqueta Lung. Mostrar todas las entradas
Mostrando entradas con la etiqueta Lung. Mostrar todas las entradas

lunes, 13 de noviembre de 2017

Interacciones corazón-pulmón durante ventilación mecánica / Heart-lung interactions during mechanical ventilation.

Noviembre 13, 2017. No. 2901



Conceptos básicos de las interacciones corazón-pulmón durante la ventilación mecánica.
Los pacientes críticamente enfermos con la necesidad de ventilación mecánica muestran interacciones complejas entre la fisiología respiratoria y cardiovascular. Estas interacciones son importantes ya que pueden guiar las decisiones terapéuticas del médico y, posiblemente, afectar el resultado del paciente. El objetivo de la presente revisión es proporcionar al médico en ejercicio una visión general de los conceptos de las interacciones corazón-pulmón durante la ventilación mecánica. Resumimos la fisiología respiratoria y cardíaca básica durante la respiración espontánea y bajo ventilación mecánica. El foco principal está en la interacción entre la ventilación con presión positiva y sus efectos sobre la pre y poscarga del ventrículo derecho e izquierdo y la interdependencia ventricular. Además, discutimos diferentes modalidades para evaluar la capacidad de respuesta del volumen, como la variación de la presión del pulso. Nuestro objetivo es familiarizar al lector con los efectos secundarios cardiovasculares de la ventilación mecánica cuando experimenta problemas de destete o insuficiencia cardíaca derecha.
Basic concepts of heart-lung interactions during mechanical ventilation.
Swiss Med Wkly. 2017 Sep 25;147:w14491. doi: 10.4414/smw.2017.14491. eCollection 2017 Sep 25.
Abstract
Critically ill patients with the need for mechanical ventilation show complex interactions between respiratory and cardiovascular physiology. These interactions are important as they may guide the clinician's therapeutic decisions and, possibly, affect patient outcome. The aim of the present review is to provide the practicing physician with an overview of the concepts of heart-lung interactions during mechanical ventilation. We outline the basic cardiac and respiratory physiology during spontaneous breathing and under mechanical ventilation. The main focus is on the interaction between positive pressure ventilation and its effects on right and left ventricular pre- and afterload and ventricular interdependence. Further we discuss different modalities to assess volume responsiveness, such as pulse pressure variation. We aim to familiarise the reader with cardiovascular side effects of mechanical ventilation when experiencing weaning problems or right heart failure.

LI Congreso Mexicano de Anestesiología
Mérida Yucatán, Noviembre 21-25, 2017
International Anesthesia Research Society Annuals Meetings
USA
17h World Congress of Anaesthesiologists, WFSA
Prague, Czech Republic, Sep 6-11, 2020
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Anestesiología y Medicina del Dolor

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martes, 23 de mayo de 2017

Ultrasonido pulmonar / Lung ultrasound

Mayo 23, 2017. No. 2697







Ultrasonido pulmonar para anestesia regional y el especialista en dolor agudo.
Lung Ultrasound for the Regional Anesthesiologist and Acute Pain Specialist.
Reg Anesth Pain Med. 2017 May/Jun;42(3):289-298. doi: 10.1097/AAP.0000000000000583.
Abstract
In this article, we discuss the emerging role of lung point-of-care ultrasonography for regional anesthesiologists and pain management specialists. Lung ultrasonography is a well-established clinical tool that is used on a routine basis in emergency rooms and critical care units internationally to evaluate patients with respiratory distress; however, its benefits to the regional anesthesiologist and painspecialist are not as well known and are practiced less frequently. This review article covers the clinical evidence in support of lung point-of-care ultrasonography as a rapid and superior tool to traditional imaging modalities such as chest radiography and fluoroscopy. As anesthesiologists routinely perform nerve blocks that put patients at potential risk of complications such as pneumothorax or diaphragmatic paresis, it is important to understand how to use lung ultrasonography to evaluate for these conditions, as well as to differentiate between other potential causes of respiratory distress, such as interstitial syndrome and pleural effusions. This article describes the normal and pathological findings that can be used to quickly and confidently evaluate a patient for these conditions.
 ¿Puede la educación limitada del ultrasonido pulmonar ser realizada a estudiantes de medicina correctamente? Un estudio piloto
Can Limited Education of Lung Ultrasound Be Conducted to Medical Students Properly? A Pilot Study.
Lim JS1, Lee S1, Do HH1, Oh KH1.
Biomed Res Int. 2017;2017:8147075. doi: 10.1155/2017/8147075. Epub 2017 Mar 28.
Abstract
Objectives. Lung ultrasonography (LUS) is a useful examination to identify lung problems. Unfortunately, there are currently no LUS educational programs for medical students. We designed a brief LUS training course for medical students during the ED rotation. The purpose of training was improving cognitive and psychomotor learning domains, knowledge of ultrasound, knowledge of LUS, image acquisition, and image interpretation. Methods. Forty students in their fourth year of medical school were enrolled in this study. Student achievement was evaluated through examinations of cognitive and psychomotor skills. A survey was administered following the training. Results. The average test result was 42.1 ± 13.7 before training and 82.6 ± 10.7 after training. With respect to the assessment of LUS performance, the acceptable rates for right and left anterior chest wall scanning and right and left posterolateral scanning were 95%, 97.5%, 92.5%, and 100%, respectively. The students felt a high level of confidence in their ability to administer LUS to patients after training and they agreed that inclusion of LUS training in the medical school curriculum is necessary. Conclusion. This study showed that, among the medical students without ultrasound experience, limited LUS education to improve their knowledge, image acquisition, and interpretation ability was successful.





IX Foro Internacional de Medicina del Dolor y Paliativa
Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán
Ciudad de México, 8 al 10 de Junio
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lunes, 6 de marzo de 2017

Ultrasonido pulmonar en pediatría / Lung ultrasound in pediatric

Marzo 6, 2017. No. 2620



  



Uso rutinario del ultrasonido pulmonar en neonatos en terapia intensiva
Routine application of lung ultrasonography in the neonatal intensive care unit.
Medicine (Baltimore). 2017 Jan;96(2):e5826. doi: 10.1097/MD.0000000000005826.
Abstract
The aim of this study was to study the features of lung ultrasonography (LUS) in lung disease and to evaluate the usefulness of LUS in the neonatal intensive care unit (NICU).All of 3405 neonates included in this study underwent an LUS examination. Diagnoses were based on medical history, clinical manifestation, laboratory examination, and signs on chest radiography (CR) and/or computed tomography (CT). A single expert physician performed all LUS examinations.There were 2658 cases (78.9%) with lung disease and 747 cases (21.9%) without lung disease. The main signs of neonates with lung disease on LUS were as follows: absence of A-lines, pleural-line abnormalities, interstitial syndrome, lung consolidation, air bronchograms, pulmonary edema, and lung pulse. These abnormal signs were reduced or eliminated on LUS as patient conditions improved. There were 81 cases that could not be diagnosed as lung disease by CR but were discovered as pneumonia, respiratory distress syndrome (RDS), or transient tachypnea of newborn (TTN) on LUS. Likewise, 23 cases misdiagnosed as RDS by CR were diagnosed as TTN on LUS. Among 212 cases of long-term oxygen dependence (LTOD) that failed to yield signs of pulmonary edema and lung consolidation on CR, 103 cases showed abnormal signs on LUS. Among 747 cases without lung disease, B-lines of 713 neonates (95.4%) could be found within 3 days after birth, and 256 neonates (34.3%) could be observed from 3 days to 1 week after birth. B-lines of 19 cases could be detected from 1 to 2 weeks after birth. The longest time at which B-lines could still be observed was 19 days after birth.LUS has clinical value for the diagnosis of lung disease and the discrimination of causes of LTOP in premature infants, particularly for the diagnosis and identification of RDS and TTN. Moreover, LUS has additional advantages, including its lack of radiation exposure and its ability to noninvasively monitor treatment progress. Therefore, LUS should be routinely used in the NICU.

Ultrasonido pulmonar. Una herramienta útil en el diagnóstico y tratamiento de la bronquiolitis
Lung ultrasound: a useful tool in diagnosis and management of bronchiolitis.
BMC Pediatr. 2015 May 21;15:63. doi: 10.1186/s12887-015-0380-1.
Abstract
BACKGROUND: Clinical assessment is the gold standard for diagnosis of bronchiolitis. To date, only one study found LUS (Lung Ultrasound) to be a valuable tool in the diagnosis of bronchiolitis. Aim of this study is to evaluate the accuracy of lung ultrasonography in the diagnosis and management of bronchiolitis in infants. METHODS: This was an observational cohort study of infants admitted to our Pediatric Unit with suspected bronchiolitis. A physical examination and lung ultrasound scans were performed on each patient. Diagnosis and grading of bronchiolitis was assessed according to a clinical and a ultrasound score. An exploratory analysis was used to assess correspondence between the lung ultrasound findings and the clinical evaluation and to evaluate the inter-observer concordance between the two different sonographs. RESULTS: One hundred six infants were studied (average age 71 days). According to our clinical score, 74 infants had mild bronchiolitis, 30 had moderate bronchiolitis and two had severe bronchiolitis. 25 infants composed the control group. Agreement between the clinical and sonographic diagnosis was good (90.6%) with a statistically significant inter-observer ultrasound diagnosis concordance (89.6%). Lung ultrasound permits the identification of infants who are in need of supplementary oxygen with a specificity of 98.7%, a sensitivity of 96.6%, a positive predictive value of 96.6% and a negative predictive value of 98.7%. An aberrant ultrasound lung pattern in posterior chest area was collected in 86% of infants with bronchiolitis. In all patients clinical improvement at discharge was associated with disappearance of the previous LUS findings. Subpleural lung consolidation of 1 cm or more in the posterior area scan and a quantitative classification of interstitial syndrome based on intercostal spaces involved bilaterally, good correlate with bronchiolitis severity and oxygen use. CONCLUSIONS: The lung ultrasound findings strictly correlate with the clinical evaluations in infants with bronchiolitis and permit the identification of infants who are in need of supplementary oxygen with high specificity. Scans of the posterior area are more indicative in ascertaining the severity of bronchiolitis.
5to curso internacional Anestesiologia cardiotoracica_ vascular_ ecocardiografia y circulaci_n extracorporea.


Curso sobre Anestesia en Trasplantes, Cirugía abdominal, Plástica, Oftalmología y Otorrinolaringología.
Committee for European Education in Anaesthesiology (CEEA) 
y el Colegio de Anestesiólogos de León A.C.
Abril 7-9, 2017, León Guanajuato, México

Informes  (477) 716 06 16, kikinhedz@gmail.com
4° Congreso Internacional de Control Total de la Vía Aérea
Asociación Mexicana de Vía  Aérea Difícil, AC
Ciudad de México 21, 22 y 23 de Abril 2017
Informes: 
amvadmexico@gmail.com
Regional Anesthesiology and Acute Pain Medicine Meeting
April 6-8, 2017, San Francisco, California, USA
ASRA American Society of Regional Anesthesia and Pain Medicine
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