Hemodynamic And Cardiovascular Effects of Mechanical Ventilation
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- čas přidán 23. 07. 2024
- Intubating a patient and placing them on mechanical ventilation is often used as a lifesaving technique to support a patient while giving them time to heal. Mechanical ventilation though is not a "natural" process and has a number of significant effects on the hemodynamics/cardiovascular system of the patient. We discuss the most common hemodynamic changes that are critical to know when caring for these patients. Specifically, we will illustrate mechanical ventilation's effects on the right side of the heart (venous return/preload/afterload), pulmonary vasculature (alveolar and extra-alveolar pulmonary vascular resistance), and left side of the heart (preload/afterload). Check out the video to hear these concepts explained clearly!
**MECHANICAL VENTILATION SERIES**
Mechanical Ventilation - Comparing Volume Control to Pressure Control [Using Scalars]
• Mechanical Ventilation...
Mechanical Ventilation - Pressure Control Mode [Pressure, Flow, Volume Scalars]
• Mechanical Ventilation...
Mechanical Ventilation Settings - PEEP, FiO2, Respiratory Rate, Tidal Volume, Inspiratory Pressure
• Mechanical Ventilation...
Mechanical Ventilation - Volume Control Mode [Pressure, Flow, Volume Scalars]
• Mechanical Ventilation...
Ventilator Waveforms (Scalars) And Loops - Basic Concepts - Pressure, Flow, And Volume
• Ventilator Waveforms (...
Ventilator Dyssynchrony - Flow Starvation
• Ventilator Dyssynchron...
Ventilator Dyssynchrony - Double Triggering, Premature Cycling, Breath Stacking, Short Cycling
• Ventilator Dyssynchron...
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#mechanicalventilation #hemodynamics #intubation #medicaleducation #teaching
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Highlight Video!
Understanding The Venous Blood Gas (VBG): Components, Sampling Sites, Physiology, Converting To ABG.
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That brings me right back to my days of studying gas and fluid flow in pipes in Physics class 55yrs ago.
I'm glad you wrote the formula showing flow proportional to radius to the power of 4. That means a very small change in radius has a very large effect on flow. I worked out way back then that a change in tube radius from 6 units to 7 units doubles the flow. That's a much greater effect than you would guess at first glance. Thanks for the brain stimulating video.
Thanks for checking out the video and glad it was stimulating! Good old physics finds itself everywhere!
Respiratory therapist student here! Thanks for the video
Wonderful! Thanks for checking out the video and good luck as you continue on in your studies!
This is an awesome video
Very enlightening! I didn't know about the complexities that MV causes in relation to pressure changes for the heart/lungs. Makes me think about bringing back iron lungs to help expand the thoracic cavity to relieve some of those unnatural pressures upon inspiration. At least that where my mind went. :)
Thanks for the brilliant video ! im cardiac surgery masters student , whilst the high tidal volumes are increasing the total pulmonar vascular resistancce , does it mean that ICU can simply adjust mechanical ventilation settings to avoid the increase in right ventricle afterload , caused by high PVR. thanks again !
Just saw this video. Very helpful. Can you elaborate how positive pressure ventilation or PEEP decreases aortic transmural pressure. Thank you
Thanks for the kind words. This is a difficult concept and the exact details remain a touch elusive. We think the best way to understand it is by thinking about the intrathoracic aorta versus the extrathoracic aorta. PEEP increases intrathoracic pressure and as such the difference between the pressure in the thoracic space and the pressure inside the aorta decreases. This is in contrast to the negative inspiratory force required to take a spontaneous breath, which decreases the intrathoracic pressure and subsequently increases the difference in the pressure between the thoracic space and the pressure inside the aorta.
Now, if we pull in the extrathoracic aorta we can see that the extrathoracic aorta isn’t affected by PEEP changes. It’s pressure stays the same. When PEEP is applied though and the intrathoracic pressure increases and the transmural pressure then decreases, it is easier for blood to flow down the pressure gradient to the extrathoracic aorta. Compare this conceptually to when we take a spontaneous breath and create negative intrathoracic pressure that “pulls” on the aortic wall increasing the transmural pressure and thus there is less total force to “push” blood downstream into the extrathoracic aorta.
Does that make sense or did we just make it more confusing?
Thank you for this.
This is why mechanical ventilation is the treatment of last resort, it has an 80% mortality rate no matter how good of health a person is going into & being put on the process especially notwithstanding the caustic medically induced chemical cocktails ”Coma”.
Actually...the increase PVR initially increases the LV preload, and another effect of MV on the LV is that there is also a decrease in LV wall stress (not just aorta Compliance). Cheers
That is fair! There is that brief increase in LV preload as the pulmonary vasculature shifts it’s blood volume to the LV right after the PVR increases. Always appreciate the contributions!
Very nice review! In dark moments I wonder about bringing back a modern equivalent of the iron lung for advanced CoVid. We could use CPAP for hypoxia support and they could talk and eat?
Thanks for checking it out! It’s honestly an interesting consideration. It reminds me of some early pictures out of Italy I believe that essentially had patients upper torso/head in a bubble that provided both titratable FiO2 and positive pressure. Hadn’t heard of anything like that in the states
@@WhiteboardMedicine That is the cool European helmet CPAP...we need to get this variant here. More comfortable for the patient...saw a sad video with an Italian critical care doc. He said their health system couldn't afford oxygen for high flow so they used CPAP with their helmut systems...they had no negative pressure rooms, but their hospitals are old palaces, and " don't laugh at me, but we opened the windows and got good air flow. "
@@davidmbeckmann Yeah those looked much more comfortable than the often poorly tolerated BiPAP/CPAP masks! All sorts of creative (possible) solutions to limited resources in a time of need. Much cheaper than those negative pressure ventilation systems, to be sure...
Doctor, thousands of families have felt that loved ones on the Covid units were put on vents much to soon which eventually led to death. This is especially true if it was an older family member. Do you feel this rush to vent could have been avoided if not for the pandemic?
Money:
It’s all about filthy lucre sake which is why I got out of the medical mafia in the 1990s with a stellar education from UIC ‘83 Biology & Nutritive Sciences + an RD.
The ICU is one of the most lucrative units in a hospital which is why although usually only 10% of the overall capacity of a hospital?,it’s run between 85 and 90% constantly occupied rate.
ultimately ,what happens to cardiac output during mechanical ventilation please
That is a great question! Unfortunately, like many things in critical care medicine there isn’t a single straightforward answer. It is very much dependent on the state of the heart before going on mechanical ventilation (does the patient have heart failure?) as well as the current pathology they have. In some situations it can increase cardiac output and in other cases (probably the majority of cases) it can decrease cardiac output
Which program did you use to do this presentation? Congrats
Thanks for checking out the video! We use a fairly simple setup using a Wacom Tablet and Microsoft OneNote with Quickly screen capture!