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Discuss the roles of time, oxygen, and pressure in alveolar recruitment and V/Q matching.
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Explain the major differences in volume control ventilation and pressure control ventilation.
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Define and discuss the major modes of ventilation, from the bedside clinician’s perspective.
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| Identify the pressure waveforms consistent with volume control and pressure control, and explain the clinical relevance of this difference.
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Define PCV+ assist ventilation, emphasizing the feature which allows spontaneous breathing during mandatory ventilator breaths.
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Explain the concept of AutoflowTM in mechanical ventilation, including the clinical benefits.
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List the benefits of maintained spontaneous breathing during mechanical ventilation.
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| Discuss how acute lung injury and the associated hypoxemia,
hypercapnia, and mechanical ventilation worsen renal hemodynamics and function.
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Describe the interaction between the lungs and kidneys brought about by immune and inflammatory mediators during shock, trauma, and sepsis.
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Discuss therapeutic options for pathologic lung/kidney interaction, including fluid optimization and lung protective ventilation.
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Recognize diaphragmatic dysfunction as a primary cause of failure to wean from the ventilator.
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Identify mechanical ventilation as a cause of muscle fiber injury and atrophy within the diaphragm.
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Explain the importance of mechanical ventilation strategies that allow persistent diaphragmatic activation during mechanical ventilation.
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Discuss recent research findings regarding the use of recruitment maneuvers and higher levels of PEEP in treating hypoxemia in the most severe cases of
ARDS.
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Explain why the decrease in cardiac output that typically occurs during a recruitment maneuver invalidates the
PaO2 as a measure of lung recruitment.
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Discuss the use of spontaneous awakening trials followed by spontaneous breathing trials to improve patient outcomes related to ventilator weaning.
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List criteria to be used in identification of patients who should not undergo a spontaneous awakening trial for safety reasons.
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Discuss recent research findings related to weaning protocols which decrease post-traumatic stress disorder and improve 1-year survival rates.
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Discuss the impact of mechanical ventilation on hepato-splanchnic perfusion, abdominal organ function, and clinical outcome outcomes in critical illness.
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Discuss how routine nursing procedures and certain ventilator settings can cause repeated episodes of ischemia to the abdominal organs in the patient with limited cardiovascular reserves.
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Explain why modes which allow spontaneous breathing during mechanical ventilation can decrease the incidence of gut mucosal damage, mesenteric ischemia, and bacteremia in critically ill patients.
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Explore the value of brain tissue oxygen monitoring and cerebral blood flow monitoring when implementing a lung protective strategy in the acutely brain-injured patient.
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Identify the target values for PaCO2 in the patient with traumatic brain injury and developing acute lung injury.
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Discuss the pathological effects of hypoxemia in the brain-injured patient, including decreased cerebral oxygen delivery, cerebral vasodilatation, increased
ICP, and decreased CPP.
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| Discuss the clinical guidelines for using PEEP during ventilation of the acutely brain-injured
patient. |
