Cardiac and respiratory support 2017 [modo de compatibilidade]

1. Suporte Cardiorrespiratório no paciente pediátrico Antonio Souto Médico coordenador Unidade de Medicina Intensiva Pediátrica Unidade de Medicina Intensiva Neonatal Hospital Padre Albino Professor de Pediatria nível II Faculdades Integradas Padre Albino Catanduva / SP

2. UTI Pediátrica & Neonatal Hospital Padre Albino Dr. Antonio Souto acasouto@terra.com.br 2017

5. UTI Pediátrica & Neonatal Hospital Padre Albino Dr. Antonio Souto acasouto@terra.com.br 2017 Pediatric Advanced Life Support Simone Rugolotto, MD 2006

7. UTI Pediátrica & Neonatal Hospital Padre Albino Dr. Antonio Souto acasouto@terra.com.br 2017 “Wisdom”

8. UTI Pediátrica & Neonatal Hospital Padre Albino Transporte de Oxigênio X Dr. Antonio Souto acasouto@terra.com.br 2017 Hipóxia

14. UTI Pediátrica & Neonatal Hospital Padre Albino Transporte de oxigênio (DO2) TO2 = DC x CaO2 CaO2 = (1,36 x Hb x SaO2) + (0,003 x PaO2) Dr. Antonio Souto acasouto@terra.com.br 2017 DO2 = DC x [(1,36 x Hb x SaO2) + (0,003 x PaO2)]

16. Figure 1. FACTORS AFFECTING OXYGEN DELIVERY DO2 CaO2 Oxygenation Hgb A-a gradient DPG Acid-Base Balance Blockers Competitors Temperature Drugs Influenced By UTI Pediátrica & Neonatal Hospital Padre Albino CO SV HR Drugs Conduction System Ventricular Compliance EDV ESV Contractility CVP Venous Volume Venous Tone Afterload Blockers Temperature Competitors Drugs Autonomic Tone Metabolic Milieu Ions Acid Base Temperature Drugs Toxins Influenced By Influenced By Influenced By Dr. Antonio Souto acasouto@terra.com.br 2017

18. UTI Pediátrica & Neonatal Hospital Padre Albino Dr. Antonio Souto acasouto@terra.com.br 2017 Hipóxia

19. UTI Pediátrica & Neonatal Hospital Padre Albino Transporte de oxigênio inadequado Hipóxia DO2 = DC x [(1,36 x Hb x SaO2) + (0,003 x PaO2)] Dr. Antonio Souto acasouto@terra.com.br 2017 •Estagnante (DC) •Anêmica (Hb) •Hipoxêmica (SaO2) •Citopática (Mitocondrial)

20. UTI Pediátrica & Neonatal Hospital Padre Albino • Função normal das células • Processos bioquímicos e enzimáticos do metabolismo celular – Osmolaridade – Eletrólitos Dr. Antonio Souto acasouto@terra.com.br 2017 – Eletrólitos – Nutrientes – Temperatura – Oxigênio – Dióxido de carbono –Íon hidrogênio

21. UTI Pediátrica & Neonatal Hospital Padre Albino • pH 7.35-7.45 • Compatibilidade 6.8 - 8.0 • ___/______/___/______/___ 6.8 7.35 7.45 8.0 Dr. Antonio Souto acasouto@terra.com.br 2017

22. UTI Pediátrica & Neonatal Hospital Padre Albino Figure 1. FACTORS AFFECTING OXYGEN DELIVERY CaO2 Hgb A-a gradient “Wisdom” Dr. Antonio Souto acasouto@terra.com.br 2017 DO2 CaO2 CO SV HR Oxygenation A-a gradient DPG Acid-Base Balance Blockers Competitors Temperature Drugs Conduction System Ventricular Compliance EDV ESV Contractility CVP Venous Volume Venous Tone Afterload Blockers Temperature Competitors Drugs Autonomic Tone Metabolic Milieu Ions Acid Base Temperature Drugs Toxins Influenced By Influenced By Influenced By Influenced By “Wisdom” •Conhecimento •Ferramentas •Organização •Protocolo/Checklist

26. Figure 1. FACTORS AFFECTING OXYGEN DELIVERY DO2 CaO2 Oxygenation Hgb A-a gradient DPG Acid-Base Balance Blockers Competitors Temperature Drugs Influenced By UTI Pediátrica & Neonatal Hospital Padre Albino CO SV HR Drugs Conduction System Ventricular Compliance EDV ESV Contractility CVP Venous Volume Venous Tone Afterload Blockers Temperature Competitors Drugs Autonomic Tone Metabolic Milieu Ions Acid Base Temperature Drugs Toxins Influenced By Influenced By Influenced By Dr. Antonio Souto acasouto@terra.com.br 2017

28. UTI Pediátrica & Neonatal Hospital Padre Albino Hipóxia •Estagnante (DC) Transporte de oxigênio (DO2) Dr. Antonio Souto acasouto@terra.com.br 2017 •Anêmica (Hb) •Hipoxêmica (SaO2) •Citopática (Mitocondrial) INSUFICIÊNCIA RESPIRATÓRIA

29. UTI Pediátrica & Neonatal Hospital Padre Albino Trocas gasosas O2 / CO2 Dr. Antonio Souto acasouto@terra.com.br 2017

30. UTI Pediátrica & Neonatal Hospital Padre Albino Dr. Antonio Souto acasouto@terra.com.br 2017 Mecânica Promoção de fluxo Trabalho respiratório

37. UTI Pediátrica & Neonatal Hospital Padre Albino • Think in terms of oxygenation and ventilation • Think WHY (ie physiology) the patient is hypoxic/hypercarbic… Dr. Antonio Souto acasouto@terra.com.br 2017 is hypoxic/hypercarbic… • Remember to follow patients closely as they can deteriorate quickly

38. UTI Pediátrica & Neonatal Hospital Padre Albino Figure 1. FACTORS AFFECTING OXYGEN DELIVERY DO2 CaO2 Oxygenation Hgb A-a gradient DPG Acid-Base Balance Blockers Competitors Temperature Drugs Influenced By Dr. Antonio Souto acasouto@terra.com.br 2017 CO SV HR Drugs Conduction System Ventricular Compliance EDV ESV Contractility CVP Venous Volume Venous Tone Afterload Blockers Temperature Competitors Drugs Autonomic Tone Metabolic Milieu Ions Acid Base Temperature Drugs Toxins Influenced By Influenced By Influenced By

40. UTI Pediátrica & Neonatal Hospital Padre Albino Hipóxia •Estagnante (DC) •CHOQUE Transporte de oxigênio (DO2) Dr. Antonio Souto acasouto@terra.com.br 2017 •Anêmica (Hb) •Hipoxêmica (SaO2) •Citopática (Mitocondrial) •CHOQUE

50. UTI Pediátrica & Neonatal Hospital Padre Albino Carcillo et al. defined septic shock in pediatric patients Tachycardia (which may be absent in the hypothermic patient) with signs of decreased perfusion including decreased peripheral pulses compared with central pulses, altered Dr. Antonio Souto acasouto@terra.com.br 2017 pulses compared with central pulses, altered alertness, flash capillary refill or capillary refill >2 secs, mottled or cool extremities, or decreased urine output International pediatric sepsis consensus conference: Definitions for sepsis and organ dysfunction in pediatrics*

54. UTI Pediátrica & Neonatal Hospital Padre Albino Dr. Antonio Souto acasouto@terra.com.br 2017 20 ml/Kg a cada 5’ 60 ml/Kg em 15’

58. UTI Pediátrica & Neonatal Hospital Padre Albino Dr. Antonio Souto acasouto@terra.com.br 2017 Patient care is always our number one priority. (Hospital escola)

59. UTI Pediátrica & Neonatal Hospital Padre Albino Re-examine frequently Dr. Antonio Souto acasouto@terra.com.br 2017

60. UTI Pediátrica & Neonatal Hospital Padre Albino “Wisdom” Dr. Antonio Souto acasouto@terra.com.br 2017

61. UTI Pediátrica & Neonatal Hospital Padre Albino Obrigado!!! Dr. Antonio Souto acasouto@terra.com.br 2017

Cardiac and respiratory support 2017 [modo de compatibilidade]

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