Основные положения · Jv = Lp S [ (Pc - Pi) – σd (7πc - πi) ] Jv –...

Основные положения

• Патофизиологические аспекты ОЛ

• Современная классификация ОЛ

• Особенности рентгенологической

картины при ОЛ

• Алгоритм лечебной программы

πc Кровеносный

сосуд

Интерстициальное

пространство

Воздухоносное

Закон Старлинга

Jv = Lp S [ (Pc - Pi) – σd (7πc - πi) ]

Jv – скорость транскапилярной фильтрации (cm3/sec)

Lp – гидродинамическое сопротивление мембран

S – площадь мембран

Pc – легочное капиллярное гидростатическое давление

Pi – интерстициальное гидростатическое давление

πc – онкотическое давление в капиляре

πi – онкотическое давление в интерстиции

πc Кровеносный сосуд

Вазодилататоры

π c Кровеносный

сосуд

Диуретики

СРАР

To show how to extract from the chest radiograph

important clinical information about central

hemodynamics in common clinical conditions

leading to right and/or left heart failure: ischemic

and valvular heart disease, primary and secondary

pulmonary hypertension, overhydration, renal

failure, ARDS.

Imaging of Cardiac Failure Specific Aims

Clinical information from the chest radiograph in

patients with right and/or left heart dysfunction

• Evaluation of body fluids balance in ICU patients

• Pulmonary hypertension (idiopathic or secondary to left

heart failure, COPD, pulmonary embolism, congenital heart

disease)

• Cardiogenic and noncardiogenic pulmonary edema

Radiographic features

to analyse and integrate

• Vascular pedicle and azygos vein

• Heart size and shape

• Pulmonary vessels

• Pulmonary edema

Vascular pedicle and azygos vein

• Pulmonary edema

• changes of circulating blood volume

• changes of central venous pressure

The vascular pedicle of the heart and the vena azygos. Radiology 1984

r = 0.98; p<0.001

Overhydration

При поступлении 3 дня спустя

The vascular pedicle of the heart and

the vena azygos. Radiology 1984

• Ely et al. Radiologic determination of intravascular volume status using portable, chest radiography.

Crit Care Med 2001 • Martin et al. Findings of the portable chest

radiograph correlate with fluid balance in critically ill patients. Chest 2002

• Ely and Haponik. Using the chest radiograph to

determine intravascular volume status. Chest 2002

Heart size and shape

• Pulmonary edema

• Right heart enlargement • Left heart enlargement

• Right + left heart enlargement

• Bulging of the main pulmonary artery

Idiopathic pulmonary hypertension

admission 1 day later 2 days later

ARDS after head and long bone trauma

Размеры сердца и его форма

поступление Через 2 часа 5 спустя

РСДСР у больного с кровоизлиянием

в мозг

Массивная эмболия a. pulmonalis

При поступлении После антикоагулянтов

Pulmonary vessels

• Pulmonary edema

Pulmonary vessels

• Pulmonary blood volume and its distribution

• Central/peripheral arteries ratio

• Vascular and perivascular changes

Pulmonary vessels

Acute renal failure

admission after dialysis

Pulmonary vessels

Intracardiac shunt

Pulmonary vessels

Intracardiac shunt

pO2 after 30 min of 100% O2 breathing: 151 mmHg

Pulmonary vessels

Left to right shunt

before after surgery

Pulmonary vessels

Eisenmerger’s syndrome

Pulmonary vessels

Pulmonary stenosis

Pulmonary vessels

Pulmonary embolism

admission after anticoagulation

Exacerbation of COPD

Pulmonary edema

Exacerbation of COPD

Классификация ОЛ

• Кардиогенный отек легких

• Некардиогенный отек

• Остро протекающий отек легких

• Нейрогенный отек легких

• Редкие формы отека легких

Pulmonary edema

• Etiology

• Severity

hydrostatic

injury (ARDS)

cardiogenic

overhydration

Pulmonary edema

Chest x-ray score

Pistolesi M, Giuntini C. Radiol Clin North Am 1978

Pulmonary edema

Interstitial edema (cardiogenic)

admission 2 weeks later

Pulmonary edema

Interstitial edema (cardiogenic)

Pulmonary edema

Congestive cardiomyopathy

Pulmonary edema

Alveolar edema (cardiogenic)

4 a.m. 9 a.m.

Pulmonary edema

Chronic ischemic heart failure

Pulmonary edema Chronic ischemic heart failure

Pulmonary edema

Chronic ischemic heart failure

Pulmonary edema

Mitral stenosis

Pulmonary edema

After mitral valve replacement

Pulmonary edema

ARDS after sepsis Acute myocardial infarction

Pulmonary edema

Alveolar edema (ARDS)

5 days later

Vascular pedicle and

azygos vein

Pulmonary vessels

Pulmonary edema

• Evaluation of body fluids balance

• Right and left heart failure

• Pulmonary hypertension

• Pulmonary embolism

• Evaluation of COPD

• Cardiogenic and noncardiogenic

pulmonary edema

“Seeing” is based on the information

content of the object, “perceiving” on the

information content of the observer.

The film reader with a knowledge of cardiopulmonary

pathophysiology is better able to determine why a

particular radiographic pattern occurs and therefore

to explain its functional significance.

Milne ENC, Pistolesi M. Reading the Chest Radiograph. A Physiologic Approach. St.Louis, Mosby-Year Books, 1993.

Основные положения · Jv = Lp S [ (Pc - Pi) – σd (7πc - πi) ] Jv –...

Documents

Transcript of Основные положения · Jv = Lp S [ (Pc - Pi) – σd (7πc - πi) ] Jv –...

Measurement of jVcb with 0 decays - arXivMeasurement of jVcbjwith B0 s!D s + decays LHCb collaborationy Abstract The element jV cbjof the Cabibbo{Kobayashi{Maskawa matrix is measured

ARDS & SEVERE HYPOXEMIAevaggelismos-hosp.gr/files/epistimoniki_enosi/02... · absence of Pneumothorax or ↑ Vt? ... [=Vt/Crs] LUNG: What do we need to avoid? • Hypoxemia • Ventilator-associated

Effect of driving pressure on mortality in ARDS patients during lung ...

Spesifikasi Sistem Respon - Universitas Negeri Yogyakartastaffnew.uny.ac.id/upload/132300110/pendidikan/Time...exponential decay frequency(σd) dan damped natural frequency ωd). Bab

]m¿-´n-]-{X-{]-h¿-ØIs Hm¿--°p-dn-pI · aq-cym-Sv am¸n-f FÂ.]n. kv-¡qÄ, Ip-¯p-]d-¼v t_mÀ-Uv kv-¡qÄ, sXm-¡n-e-§m-Sn l-bÀ sk-¡ï-dn kv-¡qÄ, ^m-dq-Jv tIm-tf-Pv F-¶n-h-S-§fnÂ

Human genetics 9 - FORTH-IMBB · Rosa26 x P (gene of interest)-Cre X-gal ... GCA GCA .KaMlépYElEç KUTTáPWV enÅa0TlK(jv AvTlŒrpot.pó (loxP at avTí6tTn t.popá ) EKtppaon: (a-rov

Influences of miR-155/NF-κB signaling pathway on ...MiR-155/NF-κB signaling pathway, ARDS in neona-tal pigs, Inflammatory factors, influences. Introduction Acute respiratory distress

B D Dˇ B D - arXiv · form factors [18{20], resulting in a value for jV cbjcompatible with the inclusive one [11,21,22]. Although the outcome refers to a single data set, the question

622816el - European Parliament · !"#$%%&'$()*+,- /p'33 .( /0$*1%1 23'433!" d/g s jisojho kzw qgie\jv^w fgkv]fo]fqj kv]^w syjzw \gv]fvwzwhol nvo kvl ]fvwzwh\l _ kiw misf]eokho ]ov

MicroRNA-615-3p promotes progression of neonatal ARDS · icro-615-3p promotes progression of neonatal S 4627 Isolation and Culture of MSCs Sprague Dawley rats (Model Animal Research

Small Divisors and the NLSE - University of Washingtonblwilson/MSRI9.4.pdfq >cq r for any p=q 2Q, q >0. Note: Diophantine numbers have full measure. Assuming is Diophantine, jv^(n)j.

1 - KROVNA KONSTRUKCIJA : OPTERE ĆENJE KROVNE KONSTRUKCIJE · σ = M / W σ = 12790 / 240 = 532,92 N / cm 2 σ < σd = 1000 N / cm 2 Usvajam rogove b / d = 10 / 12 . 1.2. ROŽNJA

Benzene, C6H6 σd mirror plane - University of Guelph · d mirror plane …cont’d NOTE: Some molecules have only σ d planes!! These are molecules in which there is an S 2n improper

Υψίσυχνος Αερισμός [High Frequency Oscillation (HFO)] · Targets ARDS • Gas Exchange • Lung but also RV PROTECTION . Traumatic Brain Injury (TBI) • Maintain

622816el - European Parliament · !"#$%%&'$()+,- /p'33 .( /0$1%1 23'433!" d/g s jisojho kzw qgie\jv^w fgkv]fo]fqj kv]^w syjzw \gv]fvwzwhol nvo kvl ]fvwzwh\l _ kiw misf]eokho ]ov