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F7AMBTANP - Equipment for Anesthesia and Critical Care

Code Completion Credits Range Language
F7AMBTANP Z,ZK 5 2P+2L English
Lecturer:
Jakub Ráfl, Karel Roubík (guarantor)
Tutor:
Václav Ort, Šimon Walzel
Supervisor:
Department of Biomedical Technology
Synopsis:

Basic concept or resuscitation. Importance of circulation, respiration, consciousness and internal environment, their control. Equipment overview, common requirements. Specific requirements for equipment at intensive care units (ICU) and departments of anaesthesia and critical care medicine (ACCM). Blood gases, their measurement and interpretation. Modelling of the fluidic systems, parameters and properties of the fluidic models. Principles and adverse effects of artificial lung ventilation (ALV). Conventional and unconventional lung ventilation, corresponding ventilators. Equipment for anaesthesia. Anaesthetic vaporisers, their thermodynamic principles. Humidification of ventilatory gases. Equipment for monitoring and support of blood circulation. Dilution methods. Bed-side monitors. Other diagnostic and therapeutic equipment at ICU and ACCM. Design of ICU and ACCM.

Requirements:

Assessment requirements:

Active lab attendance including pre-lab homework. All lab exercise assignments submitted by the following lab session.

Examination conditions:

The final exam is closed-book, made of a written test based on content of lectures and laboratory exercises including assigned individual study and home preparation. The final test score is included into the total course score if at least a half of the maximum points of the written test is reached.

The mid-term exam is closed-book, made of a written test based on content of lectures and laboratory exercises before the week of the exam (including assigned individual study and home preparation).

Grading according to the ECTS scale (100 points at most):

Mid-term exam: 20%

Final exam: 80%

Syllabus of lectures:

1. Basic concept or anaesthesia and resuscitation. Basic physiological parameters. Description of a patients status. Importance of circulation, respiration, consciousness and internal environment, their control.

2. Blood gases, their measurement and interpretation. Blood gas analysers.

3. Description of fluidic systems - circulation and ventilation. Mechanical parameters of the biological and technical fluidic systems. Modelling of the fluidic systems, parameters and properties of the fluidic models.

4. Extracorporeal life support (ECLS). Cardiopulmonary bypass. Extracorporeal membrane oxygenation (ECMO). Extracorporeal cardiopulmonary resuscitation (ECPR).

5. Cardiac output measurement. Dilution methods (thermodilution, LiDCO, PiCCO), impedance methods. Pulse oxymetry.

6. Principles and adverse effects of artificial lung ventilation (ALV). Conventional lung ventilation, conventional ventilators.

7. Unconventional methods of artificial lung ventilation. Unconventional ventilators.

8. Airway management. Non-invasive ventilation. Oxygen therapy. Home and long-term artificial lung ventilation.

9. Requirements for anesthetic devices. Anesthetic substances and thermodynamic principles of device operation. Anesthetic vaporizers.

10. Physical principles, construction and use of gas humidifier. Calculations of partial pressures in the organism, correction for humidity and measurement conditions. Calculations of oxygen transport in the organism.

11. Lung modeling, lung mechanics. Mathematical methods for determining the parameters of the respiratory system.

12. Monitoring of artificial lung ventilation: respiratory monitors, EtCO2 monitoring and interpretation of curves, indirect calorimetry and its limitations.

13. Monitoring of the brain and depth of anesthesia: BIS, simplified EEG monitoring, intracranial pressure and its monitoring, Monroe-Kelly doctrine, microdialysis.

14. Standardization and safety of devices for ICU. Comprehensive workplace equipment. Sources of medical gases, oxygen concentrators. Other diagnostic and therapeutic devices used in ICU.

Syllabus of tutorials:

1. Introduction to technology for ICU. Organization of exercises, completion of the course.

2. Experimental measurement of flow resistance.

3. Experimental measurement of compliance.

4. Electroacoustic analogy and its use.

5. Automated measurement of flow resistance.

6. Automated measurement of compliance.

7. Patient simulator; connection of ventilator and anesthetic device, monitoring of vital functions.

8. Measurement of CO2 ventilation efficiency from the lung model: tidal volume vs. frequency.

9. Measurement of dynamic lung hyperinflation in high-frequency oscillatory ventilation on laboratory models.

10. Pressure reduction valves - functions, properties and pressure stability.

11. Humidifiers - calculations and measurements of efficiency depending on minute ventilation

12. Experimental measurement of CO by thermodilution method.

13. Measurement of CO by Fick method.

14. Measurement of vessel impedance; Vasoscreen system.

Study Objective:

The aim of the subject is to give the students overview of the basic equipment of the intensive care units or departments of anaesthesia and critical care medicine. It involves life-supporting devices, especially for artificial lung ventilation, monitors of the patient's physiologic parameters, equipment for anaesthesia, etc.

Study materials:

Mandatory:

1. WEBSTER, John G., ed. Encyclopedia of Medical Devices and Instrumentation [online]. 2nd ed. Hoboken (NJ): John Wiley & Sons, 2006 [cit. 2016-10-25]. ISBN 9780471732877. DOI 10.1002/0471732877. Available from: http://onlinelibrary.wiley.com/book/10.1002/0471732877

2. MAGEE, Patrick. The physics, clinical measurement and equipment of anaesthetic practice for the FRCA. 2nd ed. Oxford: Oxford University Press, 2011. ISBN 978-0-19-959515-0.

3. CAIRO, Jimmy M. a Susan P. PILBEAM. Mechanical ventilation: physiological and clinical applications. 5th ed. St. Louis: Elsevier, 2012. ISBN 978-032-3072-076.

Recommended:

1. DAVIS, Paul D. a Gavin N. C. KENNY. Basic physics and measurement in anaesthesia. 5th ed. Edinburgh: Butterworth-Heinemann, 2003. ISBN 0-7506-4828-7.

Note:
The course is a part of the following study plans:
Downloads:

Lectures - link: 

Mechanical Ventilation Explained Clearly (1/5): https://www.youtube.com/watch?v=gk_Qf-JAL84

Mechanical Ventilation Explained Clearly (2/5): https://www.youtube.com/watch?v=K0maLgTzIto

Mechanical Ventilation Explained Clearly (3/5): https://www.youtube.com/watch?v=6Bdv7QhNNy4

Mechanical Ventilation Explained Clearly (4/5): https://www.youtube.com/watch?v=KHpJ21UWbhg

Mechanical Ventilation Explained Clearly (5/5): https://www.youtube.com/watch?v=Jx7oeJKzI9g&t=635s

High Frequency Ventilation: https://www.youtube.com/watch?v=O3YQBC9I-HY

The High Frequency Oscillatory Ventilator: https://www.youtube.com/watch?v=kGrXbJJ2QvA

ECMO: Educational Animation HD: https://www.youtube.com/watch?v=FiETnE4as5M

Introduction to Dual Circulations and Blood Mixing During Veno-Arterial ECMO: https://www.youtube.com/watch?v=zjFjRG2Kqkg

An introduction to Anaesthesia: https://www.youtube.com/watch?v=R3sOJc4imUs

Anesthesia Machine Fundamentals: https://www.youtube.com/watch?v=UX3lUZRiqXc