CLINICAL MANAGEMENT OF LIFE-THREATENING HYPOXEMIA

Up Objectives Schedule Faculty

SCHEDULE

07:15 - 07:45 Registration

07:45 - 09:00 Pulmonary Physiology

Oxyhemoglobin dissociation curve
Oxygen delivery
Oxygen consumption
V/Q mismatch
Intrapulmonary shunt
Hypoxic pulmonary vasoconstriction
Mixed venous blood oxygenation
Influence of cardiac output on arterial oxygenation

 

09:00 - 09:15 Break

09:15 - 10:00 Causes of Hypoxemia

V/Q mismatch
    Cardiogenic pulmonary edema
    Sepsis
    Acute lung injury
    ARDS

Intrapulmonary shunt
    Acute lung injury
    ARDS

10:00 - 10:45 Bedside Monitoring in Severe Hypoxemia

Gas exchange
    PaO2/FIO2
    Shunt

Respiratory mechanics
    Plateau pressure
    Mean airway pressure
    Compliance

Hemodynamic and tissue oxygenation variables
    Cardiac output
    SvO2
    Blood lactate
    Pulmonary artery pressure

10:45 - 11:45 Lung Protective Ventilation

Initial ventilator settings
Issues related to FIO2

Refractory hypoxemia
    Role of mean airway pressure
        Inspiratory time
        PEEP

Setting PEEP
Pressure control ventilation

 

11:45 - 12:45 Lunch (on your own)

12:45 - 1:15 Acute Right Ventricular Dysfunction in the Ventilated ARDS Patient

Impact of plateau pressure, PEEP, and PaCO2 on RV function

RV function as an indicator of balance between alveolar recruitment and overdistension

Impact of RV dysfunction on prognosis

Auto-PEEP as a cause of increased RV afterload leading to dysfunction

Role of echocardiography

RV protective approach

1:15 - 2:00 Hemodynamic Monitoring in the Mechanically Ventilated Patient

Basic physiology of heart-lung interaction

Effect of ventilation on determinants of cardiac performance
    Preload
    Afterload
    Contractility

Monitoring parameters
    Blood pressure
    Significance of change in BP associated with change in ventilator settings

CVP
    Limitations in use of CVP as an indicator of preload/volume responsiveness
    Practical considerations regarding CVP in the ventilated patient

Cardiac output

SvO2/ScvO2

Relationship between intrapulmonary shunt, low CO, low SvO2/ScvO2 and arterial hypoxemia

Assessing preload responsiveness via respiratory variation in:
    CVP waveforms
    Arterial pressure waveforms

Using CVP/PAWP waveforms to evaluate respiratory function


2:00 - 2:15 Break

2:15 - 3:00 Prone Positioning

Mechanisms of improved oxygenation

Complications

Mortality benefits in more severely hypoxemic patients

Role in lung protection

3:00 - 3:45 Extracorporeal Membrane Oxygenation (ECMO)

Identification of candidates

Transfer to ECMO center

Complications

Outcomes

Research findings

 

 

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