Great content. Can you do video's on Swans and PA for new ICUs nurses. In depth analysis of what is in tail in the hemodynamic measuring. Fricking out pt etc.Thanks
I do have Swan/PA on the todo list. Also, I assume you are asking about Fick's Equation? I'll add that to the todo list. Finally I do have more info in the hemodynamics series, if that may be what you're looking for.
Great video! I was under the impression, however, that when the lungs expand they decrease intrathoracic pressure (not increase) because the thoracic cavity becomes expanded during inspiration.
I should have clarified this point more. I was referring to mechanically ventilated patients with positive pressure. This flips the hemodynamic response
@@ICUAdvantage As soon as I heard you say that, I knew it was because the majority of the patients you see are on a ventilator! Haha. Is it possible to add an annotation to clarify this?
Oh my god I just finished the pulmonary physiology and I know that we inhale the chest expands so that the pressure decreases to increase the venous return and do the inspiration and when the teacher I thank elsewhere said the opposite I was going to shout I thought I misunderstood things and I come to get the remark in comment telling me that maybe someone noticed and thank God I find your comment and I am reassured hahaha thank youuuuuuuu very much 😛😛😛😛
Great video, as always. I do have a question, though. You say that during inspiration, as the lungs expand, there's an increase in intrathoracic pressure and a decrease in venous return. Are you refering to the venous return to the right heart or the left heart? Because I recall that during inspiration, as intrapleural pressure decreased due to diaphragmatic movement, so did the intrathoracic pressure, and this would increase VR to the right heart, whilst pooling in the pulmonary circulation would promote decreased VR to the left heart, with resulting decreased SV.
You are correct for spontaneous breathing patients. I wasn't clear enough in this, but I was referring to mechanically ventilated patients. It is flipped.
17:15 be carefull with this...when critically Patient, better first time Just one leg!, see what happening...it is posible that the heart cann not support the volume sudenly from both legs and...u don't want to see what happening . Thanks for Video, great content.
Inspiration increases venous return. Then the right ventricule become sligly larger and pushes the septum towords the left ventricule. This is one of the reasons the filling volume in the left ventricule is decreased. The other one is that in inspiration as the pulmonary tissue becomes bigger, the venules become also bigger - they dilate so the blood stagnates so less blood is deliverd to left atrium-> left ventricule
if it is spontaneous breathing the negative intrathoracic pressure will increase preload. my guess is that his patients are almost always on the ventilator which causes a positive intrathoracic pressure during inspiration and decreases preload.
Pop Tudor, you are 100% correct, as Michael has pointed out, in spontaneously breathing patients. I should have clarified more that I was referring to mechanically ventilated patients. The positive pressure then flips this hemodynamic response to respiration.
Thank you sir. I had one question regarding your statement about lung expansion and intrathoracic pressure, sir isn’t the intrathoracic pressure inversely proportional to lung expansion?
Just watched about 2 hours straight of your fluid/pressors videos and I/m beyond happy with the vast amount of material explained so clearly. -Thank you!
This is GREAT content! I'm a new ICU nurse and we don't use the PLR method in our unit and I'm beginning to wonder why... Do you have references for your information? It would be great to present this to my management with EBP articles (especially the CVP vs fluid responsiveness chart). I'm a former engineer and so continuous improvement is in my blood. LOL
Thank you so much! Are you referring to it being in the Hemodynamics playlist? If so, it was suggested for it to be included there, which I kind of agreed with, so I included it :)
Great question. I should have been more clear that I was referring to mechanically ventilated lungs. In spontaneously breathing patients, its the opposite, as you are thinking.
Thank you for the great content. I learned so much, but I am still highly confused about the ultrasound subtopics such as IVC distensibility index. I’ll look those up. Ty again
Love this video came in handy. I’m MICU nurse and I did a fluid challenge on a pt last night with no response. However after watching your video I wonder if her lung compliance interfere with her results. Vent AC/PC peep 10. Hx of ARDS with poor lung compliance. Thank you for your content!
thanks so much for your effort to cut down this information and analysis everything. but how about the biomarkers? FEna & NGAL? I watched something about their relationship with fluid therapy but I didn't fully understand it.
Can you make a video on PICCO? Pulse Contour Cardiac Output? I heard it gives better status of Intravenous Fluids, was trying to read it but didn't understand that well
Can you use blood pressure as a stroke volume surrogate. For instance give a fluid bolus challenge and if there is an increase in sbp then pt will be a responder.
Hi... very useful content and the best presentation.. Can you make a video on emergency drugs used in critical conditions and how to manage emergencies ?
Great video! I would like to see more details. By details I mean numbers. What is the normal CVP value? Cause it can be very realtive patient to patient. How do I determine what's a normal value for my patient? Red like 10 sources about this and every one of them list different ranges. So confusing.
I do plan to cover those more in future lessons but I believe I do also cover CVP "norms" in the hemodynamics series I already have. To your point, I think there are many different sources and "thoughts" on what is a "normal" CVP. Clear as mud.
I used to work in a hospital where we used non-invasive CO monitors or NICOMs to perform an assessment of fluid status. from my experience it was helpful but intensivist at unit stated that NICOM is highly inaccurate as a measure of fluid status. can you elaborate on that?
As I covered in this lesson here, they all have their pitfalls and there really isn't a perfect measure of fluid status. Best to use multiple tools available and the situation to try and make a best determination.
Is that the PICCO or something like that? I think it may be. I may cover that in the future, but I have never personally used it. I did come across it though and it seems like it has good value from what I remember.
I think they are different, cmmiw PICCO is considered invasive procedure because it needs an arterial line while in ICON / non invasive electrical cardiometry you just attach the electrodes just like ECG. I haven't read further about the accuracy and precision in non invasive cardiometry though, but it measures almost similar features like PICCO, including Stroke volume, Stroke index and heart rate
i thought when the lungs expand (inspiration), the intra thoracic pressure decreases (during spontaneous breathing) and therefore, increases venous return to right atria?. im confused 😭😭 pls help
RN: hey Smitherson I think we should hold on the bolus, this would be liter number 5. Follow up Lactate was only 2.0 and their vitals are stable. Hospitalist: I SAID BOLUS THE PATIENT.
After being solder police cia and charged on bail now doctor i buy my medical kit all because of meth all my dreams was that i became police army ambulance cia agent any lazy to so i couldn’t even try now i just uniformed its ok feel different i don’t harras people’s but play with them now most people’s thin i in madic in army ur channel is helping o my god f*ck my English video finished bye I’ll video again
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Clinical Pharmacist here. Currently assigned in critical care. Thank you for this.
Sweet! You are very welcome and glad to hear you enjoyed it!
Love this channel! So happy I found a channel that explains these complicated subjects so clearly. Thank you!
Thank you Paul! That is literally my mission with this channel so really happy to hear it is received so well!
Amazing clearly explaining the fluid responsivenesses . Dynamic parameters should be integrated plus clinical assessment is also essential 👍🏻
Awesome video! One of my favorites you've ever done
Sweet! Glad to hear it man. Thanks!
Great content. Can you do video's on Swans and PA for new ICUs nurses. In depth analysis of what is in tail in the hemodynamic measuring. Fricking out pt etc.Thanks
I do have Swan/PA on the todo list. Also, I assume you are asking about Fick's Equation? I'll add that to the todo list. Finally I do have more info in the hemodynamics series, if that may be what you're looking for.
Great video! I was under the impression, however, that when the lungs expand they decrease intrathoracic pressure (not increase) because the thoracic cavity becomes expanded during inspiration.
it actually decrese intrathoracic pressure. In inspiration, the lungs become more negative
I should have clarified this point more. I was referring to mechanically ventilated patients with positive pressure. This flips the hemodynamic response
@@ICUAdvantage As soon as I heard you say that, I knew it was because the majority of the patients you see are on a ventilator! Haha. Is it possible to add an annotation to clarify this?
Oh my god I just finished the pulmonary physiology and I know that we inhale the chest expands so that the pressure decreases to increase the venous return and do the inspiration and when the teacher I thank elsewhere said the opposite I was going to shout I thought I misunderstood things and I come to get the remark in comment telling me that maybe someone noticed and thank God I find your comment and I am reassured hahaha thank youuuuuuuu very much 😛😛😛😛
Thank youuuuuuuu
Wow, well thank you so much for taking to time to leave one here. I really appreciate it and glad you enjoyed the video!
i love your videos, please do more and never stop, nobody explain so seriuosly and deep important topics
Really great to hear this! I will certainly keep making more!
excellent content, extremely organized, and your way of explaining is very clear. Thanks for the class
Thank you very much. Happy to hear you liked it!
This is very important ,you style of presentation is attractive
Great video, as always. I do have a question, though. You say that during inspiration, as the lungs expand, there's an increase in intrathoracic pressure and a decrease in venous return. Are you refering to the venous return to the right heart or the left heart? Because I recall that during inspiration, as intrapleural pressure decreased due to diaphragmatic movement, so did the intrathoracic pressure, and this would increase VR to the right heart, whilst pooling in the pulmonary circulation would promote decreased VR to the left heart, with resulting decreased SV.
You are correct for spontaneous breathing patients. I wasn't clear enough in this, but I was referring to mechanically ventilated patients. It is flipped.
@@ICUAdvantage Thank you for the clarity. I was wondering the same thing.
It's flipped in ppv?
For every crna interview I get, I have to come touch up on your vids. Thanks. Watched about 5-10 today.
Honestly best channel ever
Wow, thank you so much!
Its really a great channel
I am going though this fluid response videos and they are really useful
Thank you
17:15 be carefull with this...when critically Patient, better first time Just one leg!, see what happening...it is posible that the heart cann not support the volume sudenly from both legs and...u don't want to see what happening . Thanks for Video, great content.
Inspiration increases venous return. Then the right ventricule become sligly larger and pushes the septum towords the left ventricule. This is one of the reasons the filling volume in the left ventricule is decreased. The other one is that in inspiration as the pulmonary tissue becomes bigger, the venules become also bigger - they dilate so the blood stagnates so less blood is deliverd to left atrium-> left ventricule
if it is spontaneous breathing the negative intrathoracic pressure will increase preload. my guess is that his patients are almost always on the ventilator which causes a positive intrathoracic pressure during inspiration and decreases preload.
Pop Tudor, you are 100% correct, as Michael has pointed out, in spontaneously breathing patients.
I should have clarified more that I was referring to mechanically ventilated patients. The positive pressure then flips this hemodynamic response to respiration.
Omg you are a blessing to my profession. 👍🏽
Thank you sir. I had one question regarding your statement about lung expansion and intrathoracic pressure, sir isn’t the intrathoracic pressure inversely proportional to lung expansion?
Just watched about 2 hours straight of your fluid/pressors videos and I/m beyond happy with the vast amount of material explained so clearly. -Thank you!
Wow, thats so awesome Shane! Really happy to hear you liked it and found it presented well!
This is GREAT content! I'm a new ICU nurse and we don't use the PLR method in our unit and I'm beginning to wonder why... Do you have references for your information? It would be great to present this to my management with EBP articles (especially the CVP vs fluid responsiveness chart).
I'm a former engineer and so continuous improvement is in my blood. LOL
At my hospital, we routinely use the Baxter cheetah starling monitor. It incorporates PLR, and can be performed at the bedside by the RN.
Excellent lesson,kindly use 2 colours( black and white).
What a great piece of information you are providing us! 🙂
Really glad to hear this!
what do you think of the capillary fill time test to assess fluid response?
That intro got me so hyped up
Haha thats awesome. I do really love how it came out!
Appreciate your help and ability to break down complex and intricate topics. Thank you again 💓.
So glad to hear this Barbara! This is essentially the entire goal of making this channel and so happy to hear I am able to do just that! :)
This is an excellent presentation. Kindly try to leave a take-home message at the end of the presentation. Thanks again.
Thanks Jack. Any thoughts on what you are thinking as an example?
Great channel and content. Thank you so much.
Thanks for watching!
Thank u for helping us understand, but am still confused in on what situations do we use the mentioned measures?..
Thank you so much 💓
This vid is in the wrong playlist.. but incredible series as always. Stellar CC/ICU content!
Thank you so much! Are you referring to it being in the Hemodynamics playlist? If so, it was suggested for it to be included there, which I kind of agreed with, so I included it :)
@@ICUAdvantage ohhh okay. Mentioned because you have a separate playlist for fluids
@@simchakaplan7329 I could totally see how it would stand out in that playlist haha
Awesome...thanks for sharing knowledge..loom forward for more video....good job...
Happy to be able to help! I will certainly keep more coming!
10:55
You mentioned that lung expansion causes INCREASING in intrathoracic pressure and DECREASING in preload!
Shouldn't it be the opposite?
Great question. I should have been more clear that I was referring to mechanically ventilated lungs. In spontaneously breathing patients, its the opposite, as you are thinking.
Thanks a lot dear Doctor✌️✊🏽👍🏽
Glad you enjoyed it! Although I am an RN 😊
Thank you for the great content. I learned so much, but I am still highly confused about the ultrasound subtopics such as IVC distensibility index. I’ll look those up. Ty again
Somethings I talk about or mention could warrant entire videos for sure. Its never ending list of things to cover haha 😊
Love this video came in handy. I’m MICU nurse and I did a fluid challenge on a pt last night with no response. However after watching your video I wonder if her lung compliance interfere with her results. Vent AC/PC peep 10. Hx of ARDS with poor lung compliance. Thank you for your content!
thanks so much for your effort to cut down this information and analysis everything. but how about the biomarkers? FEna & NGAL? I watched something about their relationship with fluid therapy but I didn't fully understand it.
thank you
Youre welcome!
So as a medic, I don't have bedside US. So could I use the PP or HR as a surrogate for SV and CO in the PLR?
Can we use the passive leg raise test in childern to assess their fluid responsiveness.....has it been validated in peaditrics
You are brilliant. Thankyou
Wow, thank you! Too kind!
Thanks a lot !!!
Great video brother! Thank you as always!!
Thanks Tristian! Happy you enjoyed it.
Thank you so much!!!
Very very great video,, plz keep on
Can you make a video on PICCO? Pulse Contour Cardiac Output? I heard it gives better status of Intravenous Fluids, was trying to read it but didn't understand that well
I'll add it to the todo list! I've never personally used it but I've come across it several times.
I’m learning so much!
Yay!! Happy to hear this.
nice explanation
Thank you!
Wonderfull lesson! Thanks.
Glad you liked it!
Passive leg raise, u didn’t mention change in SBP only more invasive parameters like SV and CI. Any reason why?
The best measures to evaluate effectiveness were those that I mentioned, which did include a few noninvasive options of getting those measures.
Can you use blood pressure as a stroke volume surrogate. For instance give a fluid bolus challenge and if there is an increase in sbp then pt will be a responder.
You can use PPV or pulse pressure variation in the same way. The percentages are slightly different than SVV.
Uhhmmm I think you mistakenly interchanged the whole thing from 10:53 to 11:32 please?
Very good
Thank you!
Hi... very useful content and the best presentation.. Can you make a video on emergency drugs used in critical conditions and how to manage emergencies ?
Thank you and glad you liked it. I do have a whole series talking about ACLS and have some individual videos on ICU medications. Have you seen those?
@@ICUAdvantage No .. please can you link those
Thanks
Welcome
Great video! I would like to see more details. By details I mean numbers. What is the normal CVP value? Cause it can be very realtive patient to patient. How do I determine what's a normal value for my patient? Red like 10 sources about this and every one of them list different ranges. So confusing.
I do plan to cover those more in future lessons but I believe I do also cover CVP "norms" in the hemodynamics series I already have. To your point, I think there are many different sources and "thoughts" on what is a "normal" CVP. Clear as mud.
I used to work in a hospital where we used non-invasive CO monitors or NICOMs to perform an assessment of fluid status. from my experience it was helpful but intensivist at unit stated that NICOM is highly inaccurate as a measure of fluid status. can you elaborate on that?
As I covered in this lesson here, they all have their pitfalls and there really isn't a perfect measure of fluid status. Best to use multiple tools available and the situation to try and make a best determination.
Subbed! Great video.
Awesome, thank you! Welcome aboard!
How about non invasive cardiometer? Can u rely on it?
Is that the PICCO or something like that? I think it may be. I may cover that in the future, but I have never personally used it. I did come across it though and it seems like it has good value from what I remember.
I think they are different, cmmiw PICCO is considered invasive procedure because it needs an arterial line while in ICON / non invasive electrical cardiometry you just attach the electrodes just like ECG. I haven't read further about the accuracy and precision in non invasive cardiometry though, but it measures almost similar features like PICCO, including Stroke volume, Stroke index and heart rate
Very usefull
Thank you so much for this great lecture~
You are very welcome!
I would to see some case studies just to see the whole picture.
Will fluids increase sputum?
Vielen Dank
Thoughts on NICOM?
Not sure I know what that is??
I thought inspiration increases venous return?
For natural respirations, yes. Not for positive pressure ventilation though. Opposite is true.
My greetings from IRAQ
Hello Ahmed! What part of Iraq? I spent 15 months in Baghdad curtsey of the US Army. Rusafa if you are familiar.
i thought when the lungs expand (inspiration), the intra thoracic pressure decreases (during spontaneous breathing) and therefore, increases venous return to right atria?.
im confused 😭😭 pls help
oh i see, i spoke to early I guess? so this is applicable to patients with mech vent and peep
am i right? i wish theres someone to clarify this for me😢
@@adr5617
Hi u still here?
I want to talk with u about ths
I love u sir
Haha thank you!
This is awesome. Should be part of your hemodynamics series
Thank you! It would make a good addition to that!
Nice
Thank you!
2:21
Grwat bideo
Thank you!
RN: hey Smitherson I think we should hold on the bolus, this would be liter number 5. Follow up Lactate was only 2.0 and their vitals are stable.
Hospitalist: I SAID BOLUS THE PATIENT.
Probably normal saline 😬
After being solder police cia and charged on bail now doctor i buy my medical kit all because of meth all my dreams was that i became police army ambulance cia agent any lazy to so i couldn’t even try now i just uniformed its ok feel different i don’t harras people’s but play with them now most people’s thin i in madic in army ur channel is helping o my god f*ck my English video finished bye I’ll video again
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