ea apest epea '' ep ea ''

1
??e?a ??ap?e?st??? ??ep???e?a (?.?.) ep? ??e?a?
?.?. ????a ABGs
?a????t?? Ge?????? ?. ?pa?t?p?????
?a?ep?st?µ?a?? ??T G? ??? ??p??? 2007
2
???? ta ABGs s?efte?te

• Allens test for radial and ulnar artery
• Common errors of arterial blood sampling
• Air in sample PCO2?, pH?, PO2?
• Venous mixture PCO2?, pH?, PO2?
• Excess anticoagulant (dilution) PCO2?, pH?, PO2?
• Metabolic effects PCO2?, pH?, PO2?
• Simultaneous electrolytes panel

3
F?s????????? t?µ??

• pH 7.35-7.45
• pCO2 35-45 mm Hg
• HCO3 21-28 mEq/L
• pO2
• ??????e? 80-100 mm Hg
• ?e???? 60-70 mm Hg
• SaO2
• ??????e? gt 95
• ?e???? 40-90
• Base excess 2 mEq/L

4
S?µas?a

• pH 7.35 - 7.45
• ??t?? t?? ??e?ßas???? ?s????p?a? (s?????t??s?
  ???t?? ?d???????)
• pO2 60-90
• ??t?? t?? µe????? p?es?? t?? ???????? st?
  a?t???a?? a?µa
• pCO2 35-45
• ??t?? t?? µe????? p?es?? t?? d???e?d??? st?
  p??sµa, µ?t?? t?? ?at? ?ept?? ae??sµ??,
  ???µ??eta? ap? t?? ae??sµ?, a?a??? t?? ?at?stas?
  t?? a?ap?e?st???? pa?aµ?t??? t?? ??e?ßas????
  ?s????p?a?
• HCO3 22-26
• ??t?? t?? e?e??e??? d?tta???a????? st? a?µa
  a?a??? t?? µetaß????? ??e?ßas??? ?s????p?a p??
  ???µ??eta? ap? t??? ?ef????
• BE (-2) - (2)
• ?e???e? t?? p?s?t?ta t?? ????? ? t?? ß?s?? p??
  apa?te?ta? ??a ?a f?s????????p????e? t? pH
• O2Sat 96-100
• ?e???e? t? p?s?st? t?? a?µ?sfa?????? p?? e??a?
  desµe?µ??? µe t?? Hgb

5
The Key to Blood Gas Interpretation4 Equations,
3 Physiologic Processes

• Equation Physiologic Process
• 1) PaCO2 equation Alveolar ventilation
• 2) Alveolar gas equation Oxygenation
• 3) Oxygen content equation Oxygenation
• 4) Henderson-Hasselbalch equation Acid-base
  balance
• These 4 equations, crucial to understanding and
  interpreting arterial blood gas data.

6
PaCO2 equation PaCO2 reflects ratio of
metabolic CO2 production to alveolar ventilation

• VCO2 x 0.863 VCO2 CO2
  production
• PaCO2 ------------------ VA VE
  VD
• VA VE minute (total) ventilation
• VD dead space ventilation
  0.863 converts units to mm Hg
• Condition State of
• PaCO2 in blood alveolar ventilation
• gt45 mm Hg Hypercapnia Hypoventilation
• 35 - 45 mm Hg Eucapnia Normal
  ventilation
• lt35 mm Hg Hypocapnia Hyperventilation

7
Determinants of CO2 in the alveolus

• VA VE VD VT x f (1- VD/VT)
• PACO2 k x (VCO2/VA)
• Physiologic dead space anatomic dead space
  alveolar dead space
• ???s?s? t?? Bohr VD/VT PaCO2-PEO2/PaCO2

8
Alveolar Gas Equation

• Alveolar O2 dependent upon
• inspired O2
• alveolar CO2
• rates of O2 consumption and CO2 production

PAO2
PiO2 -
PACO2 / R
PaCO2 / R
9
P(A-a)O2

• P(A-a)O2 is the alveolar-arterial difference in
  partial pressure of oxygen. It is commonly
  called the A-a gradient, though it does not
  actually result from an O2 pressure gradient in
  the lungs. Instead, it results from
  gravity-related blood flow changes within the
  lungs (normal ventilation-perfusion imbalance).
• PAO2 is always calculated, based on FIO2, PaCO2
  and barometric pressure.
• PaO2 is always measured, on an arterial blood
  sample in a blood gas machine.
• Normal P(A-a)O2 ranges from _at_ 5 to 25 mm Hg
  breathing room air (it increases with age). A
  higher than normal P(A-a)O2 means the lungs are
  not transferring oxygen properly from alveoli
  into the pulmonary capillaries. Except for right
  to left cardiac shunts, an elevated P(A-a)O2
  signifies some sort of problem within the lungs.

10
Physiologic causes of low PaO2

• NON-RESPIRATORY P(A-a)O2Cardiac right to left
  shunt Increased
• Decreased PIO2 NormalLow mixed venous oxygen
  content Increased
• RESPIRATORYPulmonary right to left
  shunt IncreasedVentilation-perfusion
  imbalance IncreasedDiffusion barrier Increase
  dHypoventilation (increased PaCO2) Normal
• Unlikely to be clinically significant unless
  there is right to left shunting or
  ventilation-perfusion imbalance

11
Ventilation-Perfusion imbalance

• A normal amount of ventilation-perfusion (V-Q)
  imbalance accounts for the normal P(A-a)O2.
• By far the most common cause of low PaO2 is an
  abnormal degree of ventilation-perfusion
  imbalance within the hundreds of millions of
  alveolar-capillary units. Virtually all lung
  disease lowers PaO2 via V-Q imbalance, e.g.,
  asthma, pneumonia, atelectasis, pulmonary edema,
  COPD.
• Diffusion barrier is seldom a major cause of low
  PaO2 (it can lead to a low PaO2 during exercise).

12
SaO2 and oxygen content

• Tissues need a requisite amount of oxygen
  molecules for metabolism. Neither the PaO2 nor
  the SaO2 tells how much oxygen is in the blood.
  How much is provided by the oxygen content, CaO2
  (units ml O2/dl). CaO2 is calculated asCaO2
  quantity O2 bound quantity O2
  dissolved to hemoglobin in plasmaCaO2
  (Hb x 1.34 x SaO2) (.003 x PaO2)
• Hb hemoglobin in gm 1.34 ml O2 that can be
  bound to each gm of Hb SaO2 is percent
  saturation of hemoglobin with oxygen .003 is
  solubility coefficient of oxygen in plasma .003
  ml dissolved O2/mm Hg PO2.

13
Oxygenation

• Poor diffusion across alveolar membrane
• Small pressure gradient between PAO2 and PaO2
• Large alveolar area is required for gas transfer
• Hemoglobin carries the majority of oxygen in the
  blood

14
(No Transcript)
15
??µ?sfa????e? ?a? ?2
16
Oxygenation

• Ventilation and alveolar disease
• Ventilation??PAO2 ??PaO2 ?, combined PCO2?
• Alveolar disease
• Reduced alveolar area
• Thickened alveolar membrane
• V/Q mismatch
• Shunt

17
Henderson-Hasselbalch Equation

• CO2 H2O ? H2CO3 ? H HCO3-
• H K x CO2/HCO3-
• 24 PCO2/HCO3-
• pH 6.1 log (HCO3-/0.0301xPCO2)

18
??? ????µa?? pH µetaß??e? t?? d?ast????t?ta t???
19
Bicarbonate Buffering System
Metabolism Oral intake
Oral intake
Metabolism

• CO2 H2O ? H2CO3 ? H HCO3-

Kidney
Kidney Stomach
Lung
20
Determination of primary acid-base disorders
Respiratory alkalosis
Metabolic alkalsosis
7.6
pH
N
7.4
Metabolic acidosis
Respiratory acidosis
7.2
30
40
50
PCO2 (mmHg)
21

• ?a 6 ß?µata ??a t?? a????s? t?? ABG
• ???a? t? pH f?s?????????
• ???a? t? CO2 f?s?????????
• ???a? ta HCO3 f?s?????????
• ???a? t? CO2 ? ta HCO3 pa??????a µe t?? µetaß???
  t?? pH?
• ???a? t? CO2 ?a? ta HCO3 st?? a?t??et? ?ate????s?
  µe t?? µetaß??? t?? pH?
• ???a? t? pO2 ?a? t? SaO2 f?s?????????

22
???????µ??

• ???????µ?? a???????s?? a????s?? ae????
  a?t???a??? a?µat??.
• 1. pH ????s? ? a?????s?
• ????s? lt 7.35
• ??????s? gt 7.45

23
???????µ??

• 2. ?? t? pH e??a? pa????????, p??a e??a? ? a?t?a
  a?ap?e?st??? ? µetaß????? (?ef???)
• ?? ? paCO2 s?et??eta? µe t?? µetaß??? t?? pH,
  t?te t? p??ß??µa e??a? a?ap?e?st???
• ????s? ? ???? CO2
• ??????s? ? ?aµ??? CO2
• ?? ta HCO3- (ß?s? ? "alkali") s?et??eta? µe t?
  pa???????? pH, t?te t? p??ß??µa e??a? µetaß?????
• ??????s? ? ???? HCO3-
• ????s? ? ?aµ??? HCO3-

24
???????µ??

• 3. ???e? e??a? ?? t?µ?? t?? paCO2 ? HCO3- p?? ???
  s?et????ta? µe t? pH.
• ?? ?? t?µ?? e??a? f?s?????????, t?te de? ?p???e?
  a?t????p?st???? µ??a??sµ??
• ?? de? e??a? f?s????????? a??? t? pH pa?aµ??e?
  pa????????, t?te ?p???e? µe???? a?t????p?s?
• ?? e??a? f?s????????? ?a? t? pH f?s????????, t?te
  ?p???e? p????? a?t????p?s?

25
????s?
26
??????s?
27
?a???e? p?? p??pe? ?a ??µ?µaste

• ? PaCO2 ?at? 10 mmHg ? ? 1 meq/L HCO3P
• ? PaCO2 ?at? 10 mmHg ? ? 2 meq/L HCO3P

28
?a?ade??µata

• 28 et?? ???a??a, ?st????? d?ata?a??? pa?????
• ?a???s???eta? st? ??? ?a? pa?ap??e?ta? ??a
  d?sp???a
• ?????a ?pe?ae??sµ?? ?a? d?s???e?a?
• ABG
• pH 7.52
• paCO2 28 mmHg
• HCO3- 24 mEq/L
• pH gt 7.45 a?????s?
• paCO2 lt 35 ta??p???a, ap?ß??? d???e?d??? (???)
• HCO3- f?s????????.
• ??ap?e?st??? a?????s?

29
?a?ade??µata

• 80 et?? ??d?a?, ?st????? ???
• ??sp???a ?a? ???a???? ?????
• ABG
• pH 7.24paCO2 65 mmHgHCO3- 24mEq/L
• pH lt 7.35 ????s?
• paCO2 gt 45 a?epa???? ae??sµ?? (?p?ae??sµ??)
• HCO3- f?s???????? (de? ?p???e? a?t????p?s?)
• ??ap?e?st??? ????s?

30
?a?ade??µata

• ?f?ß?, µ???? ad??aµ?a t??
• ???ta se d?a?ta, ad??at?
• ABG
• pH 7.50paCO2 37HCO3- 20
• pH gt 7.45 a?????s?
• paCO2 e??a? f?s????????
• HCO3- lt 25 (?µet??, a???µ??? ???s? ?pa?t????)
• ?etaß????? a?????s?

31
?a?ade??µata

• 54 et?? ???a??a, ??s??????e?a?t?µe??? d?aß?t??
• ?d??aµ?a, ?a?t?a, ?µet??, d??a
• ABG
• pH 7.29
• paCO2 35 mmHg
• HCO3- 18 mEq/L
• pH lt 7.35 ????s?
• paCO2 f?s????????
• HCO3- lt 25
• ?etaß????? ????s?

St? ep?µe?? µ???µa ?a pa???s?ast??? ?? µe??t?? ???
32
S??d?asµ?? pe??ss?te??? t?? d?? d?ata?a???

• ??? (a?ap?e?st??? ????s?) ?a? ?????a ?e?ape?a µe
  d?????t??? (µetaß????? a?????s?) ?a? s?pt???
  shock (?a?a?t??? ????s?).
• ?ef???? a?ep???e?a (s??d?asµ?? ?pe?????a?µ????
  ?a? µe a???µ??? ??sµa a????t?? µetaß??????
  ????s??) ?a? ap??e?a ?ast????? pe??e??µ????
  (µetaß????? a?????s?) ?a? s?pt??? shock
  (a?ap?e?st??? a?????s? ???? ?pe?ae??sµ?? a?????
  ?a? µet? ?a?a?t??? ????s?).
• ?s?e??? ??T (a?ap?e?st??? ????s? ? a?????s?) ?a?
  ap??e?a ?ast????? pe??e??µ???? (µetaß?????
  a?????s?) ?a? d??????e? (?pe?????a?µ???
  µetaß????? ????s?) ?a? ?ef???? a?ep???e?a ?
  s?pt??? ? ????a?µ??? shock (µetaß????? ????s? µe
  a???µ??? ??sµa a????t??).

33
??e?a a?ap?e?st??? a?ep???e?a-???sµ??

• ? ???sµ??
• ?d??aµ?a d?at???s?? epa????? ???????s?? ?
  ae??sµ??, p?? a?apt?sseta? µ?sa se ??e? ? ?µ??e?
  

• ???t???a ???????s??
• PaO2 lt 50-55 mmHg ? SaO2 lt 85 se atµ?sfa?????
  a??a µe pa?µ??? ???µet??a? ?????
• ???t???a ae??sµ??
• PaCO2 gt 50 mmHg ? gt 10 mmHg a???s? se s?????s?
  µe t?? s?????( baseline) PaCO2

?? ???sµ?? d?ata?a??? PaO2 ?a? PaCO2 ????
e?d??a?d?a??? shunt ap? ?? ? de? e??a?
a?ap?e?st??? a?ep???e?a
34
?a?µ??? ???µet??
SaO2 lt 85

• A???ße?a 2 ??a Sat 70-100 ?a? 3 ??a
  Sat50-70
• Se ap?t?µ? pt?s? t?? Sat, ????? ap??t?s? 6 sec
  ??a a???d??t? a?t??? ?a? 24 sec ??a a???d??t?
  da?t????
• ?e? ep??e????ta? ap? t?? a?a?µ?a, t? f?t?sµ? ?a?
  t? p???? t?? ?st?? ?a? t? ???s? t?? d??µat??
• Ba?µ???µ???ta? a?t?µata ?a? d?a??t??? µ??µ?
• ?a???s?????? st?? ????? t??? t?? Sat, t?? a???µ?
  t?? sf??e?? ?a? t?? sf??e?? p????sµ???af???
• ??at??e?ta? se d??f??a µe????

35

• A line is drawn parallel to the alveolar phase of
  the EtCO2 waveform.
• A 2nd line corresponding to PaCO2 is drawn.

PaCO2
EtCO2
Phase I
Expired CO2
Volume CO2
Phase II
Exhaled Volume
36
X alveolar ventilation Y alveolar dead
space Z airway dead space
MValv X x RR
PaCO2
EtCO2
Y
q
Expired CO2
Z
X
Exhaled Volume
p
VD
VALV
Exhaled Tidal Volume
37
S??s? ae??sµ?? a?µ?t?s?? VA/Qc

• ? ae??sµ?? ?a? ? a?µ?t?s? de? e??a? ?µ??e?e??
• ?e????? ?a?? ae????µe?e? ???e??de? a?de???ta?
  pt??? DEAD SPACE
• ?e????? pt??? ae????µe?e? ???e??de? a?de???ta?
  ?a?? SHUNT
• Se ??p??e? pe?????? t?? p?e?µ??a ? a?ta??a?? t??
  ae???? e??a? µ????te?? ap? t?? optimal
• S?????? ?a?? ?a? ?a?? ae????µe?e? ???e??de?
  a?de???ta? ?a?? ?a? ?a?? a?t?st???a

38
F?s????????-?da????

• ??µ????? s??s? V/Q

39
?da???? a?ta??a??
40
????s? ?e???? ????? -Dead Space-
41
????s? t?? ?e???? ?????

• (Vd/Vt) V/Qgt1

42
????s? t?? ?e???? ?????F?s????????? ?e???? ?????

• (Vd/Vt) V/Qgt1

O2
CO2
43
Shunt-??d?p?e?µ????? d?af???

• ? e??s????p?s? t?? ???e??d???? ?a? t?? a?t???a???
  ?2 ?a d?ata?a??e? ap? t?? pe?????sµ? t??
  p??sßas?? t?? a?µat?? st?? ae????µe?e? ???e??de?
  
• ??t? s?µßa??e? epe?d? t? a?µa t?? ?? d?afe??e?
  ?a? de? pe??? ap? ?e?t???????? ???e??de?

44
Shunt ?a? ?p????? a??e??s?spas?
Q
45
Shunt ?a? ?p????? a??e??s?spas?
46
Shunt ??d?p?e?µ????? d?af???

• shunt V/Qlt1

O2
CO2
47
G?at? ? PaO2 e??a? µ????te?? ap? t?? PAO2 ?
PAO2
PiO2 -
PACO2 / R
PaCO2 / R
48
Hgb O2 Saturation
100 O2
200
400
600
PaO2 mm Hg
49
?a?? s??s? V/Q

• ?? Shunt e??a? t? ??a ???? t?? ?a??? s??s?? V/Q
  (V/Q? 0)
• S????te?? e??a? ? a??µ????e??? s??s? V/Q
• Se µe????? pe?????? V/Q gt 1
• Se µe????? pe?????? V/Q lt 1
• ? a??µ????e??? ae??sµ?? µp??e? ?a ?ata???e? se
  µe??s? t?s? t?? PaCO2 ?s? ?a? t?? PaO2

50
(No Transcript)
51
V/Q Matching
mixed venous blood
Tracheal air
52
?? te???? ap?t??esµa µet??e?!
53
?a?? s??s? V/Q
O2
CO2
SaO2 95
SvO2 70
SaO2 95
Mixed SaO2 88
CO2
SaO2 75
O2
54
?a?? s??s? V/Q? ??????s? ?2 s?????? a????e? t??
SaO2 a??????ta? t?? PAO2
100 O2
100 O2
SaO2 100
100 O2
SvO2 70
Mixed SaO2 95
SaO2 100
SaO2 90
55
??e?a a?ap?e?st??? a?ep???e?a st? ??T ????

• gt 60 t?? as?e??? t?? ??T e???s???ta? ?p?
  µ??a???? ?p?st????? t?? a?ap????
• ???et? s???? p????? ep?ßa?????ta? ?????
• ??e?a t?? PaO2 ? /?a? ??e?a t??
  PaCO2
• ??e?a ep? ??e?a?

• ARF develops within minutes or hours.

56
SatO2Hb/ PaO2/PETCO2
57
SatO2Hb/PaO2/PETCO2
58
(No Transcript)
59
Ppeak-Pplateau
60
?etaß??? t?? V/Q se µ?a ap?pe??a ape?e?????s??
ap? t? ??? -Weaning Trial
??p?? a?ap???? ta?e?a aßa???
??a?2
???a st? monitor?
Tobin MJ et al. Am Rev Respir Dis 1986 1341111.
61
??t?a ??? ep? ??? st? ??T?a? ??? µ???!!

• ?atast?se?? p?? µetaß????? t? VA
• ?atast?se?? p?? µetaß????? t? Q

62
?NEYMONIKH EMBO?H ?????S??S? ????S???????

• ????? ??S????
• ?s?e??? 17 et?? µetaf?????e st?? M.E.T µet? ap?
  12??? pa?aµ??? st? ?.?.?., ?p?? µetaf?????e µet?
  ap? a?afe??µe?? t???a?? at???µa.
• ??? CT ?/f?e? /???OS??S
• ????fa??? ?????? a?µ???a????? ???se?? st??
  pe????? t?? ?a??µ?? a??ste??, ???se?? se
  ?????te?? ep?ped? ap? t? ???aµ? pa?a???????
  a??ste??, ???se?? ???taf?ß?e?µat??? a??ste?? ?a?
  ß?e?µat??? ?µf?.
• ?st? ??ta?µa ???f?? ?a? p??s??a? ?????a? ??t????
  µe s???d? e?d?p?e???? a?µ?t?µa, ??ta?µa a??ste???
  ?s??a??? ???d??, ??ta?µa e????s?a? ap?f?s?? ?4,
  ??ta?µa a??ste??? ß?a??????? µe pa?e?t?p?s?.
• ???p? ???a?a ????? ?a??se??.
• CT t?e?? µ??e? µet? ?t? pa?ap??? µ????
  a?µ???a???? ???s? ???a?? a??ste??

63
5? ?µ??a ??s??e?a???f??d??? ap????esµ??FiO2
35?100

• ????a a?µat?? Ph7,40, PCO240mmHg, PO2 86mmHg,
  HCO323 (FiO2 100)
• ?.?. 120/80 mmHg (2??6? nor adrenaline)
• F?eß???µß??? ta???a?d?a (120 sf??e??/min), ?????
  ??e?t???a?d????af???? a?????se??
• ???et?? ??? 39C ap? 24????

64
?etaß???? t?? ae???? a?µat?? t?? ?µ??a t??
s?µß?µat??
FiO235
FiO2100
65
?etaß???? PaO2/FiO2 ?a? A-a gradient t?? ?µ??a
t?? s?µß?µat??
FiO235
FiO2100
66
??a???st???? s???e??

• ??e?µ????a?a?
• ?te?e?tas?a
• ?eta????s? t?a?e??s????a
• ??e?µ???a
• ??e?µ????? eµß???

67
??G?S??????? ???S?GG?S? ?/a ???a??? ??????
pa???????? e???µata ?
68
Spiral CT T??a???
69
????S? ??S ??????????S ??????S

• ?at? t?? ???d? ap? t?? ?.?.T.
• f?s???????? ?/a ???a???
• ?a?? a?ta??a?? ae????
• Ph 7,43, PaCO242, PaO2186, HCO327 µe ?????? ?2
  4lt/min.
• d?a??p? t?? µ????µ???a??? ?pa?????- a???? µe
  ???µa??????

70
? as?e??? µa? ...

• ?a???s?a?e t??? e??? p??d?a?es????? pa?????te?
• ??a?µa ?????
• ?at????s?-a????s?a
• ?p??s?a ???µß?p??f??a??? ???? a?µ???a??a? ??S
• ?a?et???asµ? µ???a?a? f??ßa?, ?p???e?d??? f??ßa?

71

• 261 patients
• the prevalence (up to 72 Hr post ICU admission)
  of DVTs was 2.7 (95 confidence interval
  1.15.5 7 pts)
• the incidence (gt72 Hr post ICU admission) was
  9.6 (95 confidence interval 6.313.8 25 pts)
  over the ICU stay
• VTE prophylaxis
• Ten patients had active bleeding (3.8)?
  ineligible for anticoagulant prophylaxis.
• Of the remaining 251 patients, 233 (92.8)
  received anticoagulants
• 205 (81.7) received subcutaneous unfractionated
  heparin for thromboprophylaxis,
• 17 (6.8) received intravenous unfractionated
  heparin for therapeutic anticoagulation,
• 10 (4.0) received subcutaneous low molecular
  weight heparin for acute coronary syndrome,
• and 1 (0.4) received warfarin.
• Other patients with contraindications to
  anticoagulants received antiembolic stockings
  with or without pneumatic compression devices (n
  18, 7.2).
• Three patients with DVT had PE (9.3).

D.Cook, M.Crowther, M.Meade, C.Rabbat
L.Griffith, D.Schiff, W. Geerts, G.Guyatt. Deep
venous thrombosis in medical-surgical critically
ill patientsPrevalence, incidence, and risk
factors. Crit Care Med 2005 3315651571
72
Prospective Evaluation of the Safety of
Enoxaparin Prophylaxis for VTEs in Patients With
Intracranial Hemorrhagic Injuries Arch Surg.
2002137696-702

• 1428 trauma pts were admitted during the 18-month
  study
• 1288 patients (90) were injured by blunt force
  mechanisms
• 177 of these (14) had a documented IHI on
  initial CT scan.
• Twenty-seven patients (15) with IHIs were
  excluded from the study owing to
• protocol violations (n8, 5),
• documented coagulopathy (n7, 4),
• age younger than 14 years (n5,3),
• surgeon reluctance to start anticoagulant therapy
  (n4, 2),
• discharge or death within 48 hours of hospital
  admission (n3, 2).
• 150 patients (85) with IHIs were enrolled in the
  study. First dose of enoxaparin within 26.511.5
  hours. Mortalitry 7, DVTs 2.
• There were 4 patients (3) with nonoperative
  splenic injuries, 4 (3) with nonoperative liver
  injuries, and 3 (2) with large retroperitoneal
  hematomas
• 34 patients CT progression of IHI (28 pre 6
  post enoxaparin. All 6 survived.)

73
?? st? ??T S??????S??

• 19 ?s?e?e?? t?? ??T ?a a?apt??e? DVT
• 19 ?s?e?e?? µe DVT ?p? ?e?ape?a ?a a?apt??e?
  ??
• 19 ?s?e?e?? µe ?? ?p? ?e?ape?a ?a pe???e?
• 37 Se 3 as?e?e?? µe ?? de? ?a ß?e?e? DVT
• 91 ?? ???µß?? p???????ta? ap? ta ??t? ???a
• ?ete??e???t???? ?? ?a? ?s?e?e?? µe ??? µp??e? ?a
  pa?????? T??µß?p??f??a?? 24 ??e? µet? t??
  ep?µßas? ? t?? ???
• ? p??f??a?? ?a? ? ?e?ape?a e?at?µ??e?eta?

74
?te?e?tas?a Prevalence of atelectasis in
mechanically ventilated patients before kinetic
therapy (7/2000- 6/2001 and after kinetic therapy
(7/ 2002 to 6/2003)
2
2.7
2.38
D.Chandy et al Impact of Kinetic Beds on the
Incidence of Atelectasis in Mechanically
Ventilated Patients American Journal of
Therapeutics 14, 259261 (2007)
75
?te?e?tas?a se as?e?? µe p??????a???? a?ep???e?a
???? s???? a?t????????? e???µata vs. µetaß????
PaO2
76
?te?e?tas?a
77
?te?e?tas?a ?a? ß?????s??p?s? st? ??T
M.E. Kreider,D.A. Lipson. Bronchoscopy for
Atelectasis in the ICU. A Case Report and Review
of the Literature CHEST 2003 124344350
78
Case Series of Insufflation Added to FOB
M.E. Kreider,D.A. Lipson. Bronchoscopy for
Atelectasis in the ICU. A Case Report and Review
of the Literature CHEST 2003 124344350
79
?te?e?tas?a ?a? ß?????s??p?s?
FRC increases, VC decreases. PAO2 decreases
during the procedure but returns to near normal
after the procedure.
Vt PAO2 fall during bronchoscopy but return to
near normal by 15 min post procedure.
M.E. Kreider,D.A. Lipson. Bronchoscopy for
Atelectasis in the ICU. A Case Report and Review
of the Literature CHEST 2003 124344350
80
?????st? ??eß?t?
Atelectasis Data
Comparison of resolution of atelectasis between
the control and test group.
S.Raoof, N.Chowdhrey, S.Raoof,M. Feuerman,
A.King, R.Sriraman, F. A. Khan. Effect of
Combined Kinetic Therapy and Percussion Therapy
on the Resolution of Atelectasis in Critically
Ill Patients CHEST 1999 11516581666
81
Comparison of oxygenation index between the
control and test group over a 2-week study period
S.Raoof, N.Chowdhrey, S.Raoof,M. Feuerman,
A.King, R.Sriraman, F. A. Khan. Effect of
Combined Kinetic Therapy and Percussion Therapy
on the Resolution of Atelectasis in Critically
Ill Patients CHEST 1999 11516581666
82
??e?µ????a?a? 2
Crude rate of pneumothorax (PTX ) and 95 CI
according to the month of the year.
Crude rate of pneumothorax (PTX ) and 95 CI
according to the week of the month.
N. T. Ayas et al Pneumothorax after insertion of
central venous catheters in the intensive care
unit association with month of year and week of
month Qual Saf Health Care 200716252255
83
?s?e??? ?p? ??? ???? ap?f?a??? a??te??? ae?a?????
?a? p?e?µ????a?a
84
??e?µ????a?a?
85
???e? ??t?t?te? ?s?e??? se T-piece
T-piece se A/C
AC se T-piece
PaO2
2 ??e? ?-piece
FiO2
PaCO2
?????S
86
???e? ??t?t?te? T-P trial se as?e?? µe S??,S?
(EF 18)
FiO2 50, CVP 10 mmHg
CVP 9
T/P
A/C
A/C
CVP 14
PaO2
T/P
T/P
A-aO2
PaCO2
87
???e? ??t?t?te? ????s? SS- Sp??d???des?a- ???
??a??p? ?atast???? ?s??????a µe a?ap?e?st??a
?????a?? a?ap???
??a??p? ?atast???? (µ?da????µ?, ?eµ?fe?ta????)
PaO2
?pa???a??? ?atast????
FiO2
?????S
88
???e? ??t?t?te? ?pa?ad?as?????s?
89
S?µp??asµa

• ?atast?se?? p?? ?d????? se ??? st? ??T
• ??e?µ????? eµß???
• ?te?e?tas?a
• ?p?d?as?????s?
• ??e?µ????a?a?
• ?s??????a
• ????µas?a ape?e?????s?? ap? t?? ???

???a??st? ??a t?? p??s??? sa?