Hello, doctor. Thanks for having this conference. Doctor, can I suggest? Can you explain more details on Prone CPR (CPR on a patient laying in the Prone Position)? Can you upload your very own Mannequin Simulation videos on how to administer Prone CPR and Posterior Defibrillation on an intubated cardiac arrest patient during prone position ventilation and spinal surgery?
th-cam.com/video/VN8p29iPX3k/w-d-xo.html th-cam.com/video/AL-ZKsCN_o0/w-d-xo.html dear Andrew u can try these 2 links , u may find them useful as of now we don't have our simulation video
So concise and great lecture by my beloved teacher and guru Dalim sir . Recent data suggest that prone positioning does not significantly alter perfusion. Carbon dioxide (CO₂) removal may be a more reliable predictor of patient outcomes than oxygenation, as a decrease in CO₂ reflects improved lung mechanics, better ventilation, reduced hyperinflation, and fewer areas of collapse. In the supine position, two factors-shape mismatch and gravity-work in the same direction, contributing to uneven ventilation. During prone positioning, these vectors oppose each other, resulting in more even distribution of ventilation. This leads to greater lung homogenization, as shown by an increase in the "decay distance"-the point from the top (ventral) to the bottom (dorsal) where lung aeration is reduced to 37%. In the prone position, this distance is extended, indicating a more uniform distribution of air across the lungs. Interestingly, some studies have shown that the total lung aeration does not significantly change with prone positioning. The overall average aeration and homogeneity factor (HF) remain roughly the same. However, it is the redistribution of ventilation with proning that plays the critical role, ensuring more homogenized aeration. This redistribution optimizes lung mechanics by reducing regional overdistension and collapse, thereby decreasing ventilator-induced lung injury (VILI). As a result, prone positioning makes the lungs more responsive to other interventions like PEEP, reduces the need for high FiO₂ and PEEP levels, and eventually decreases the risk of biotrauma. This cumulative effect is why proning is a powerful tool in managing acute respiratory failure and improving patient outcomes. The effect of recreation drainage cross contamination of healthy lung are also there . In ARDS with severe, resistant hypoxemia, achieving progress requires a combination of precise interventions. While proning is crucial, it must be integrated with lung protective ventilation, optimal PEEP, and careful fluid management. If proning is done without optimizing PEEP or adjusting the duration and timing of the maneuver, its effect will be limited. Additionally, identifying and addressing the underlying cause of ARDS is essential. The success of proning relies on the synergistic use of co-interventions, as no single maneuver will suffice on its own. When a patient is placed in the prone position, the compliance dynamics of the chest wall shift significantly. The ventral chest wall, which is more deformable in the supine position, becomes dependent, leading to a decrease in chest wall compliance. Meanwhile, the dorsal chest wall, now non-dependent, is naturally less deformable, preventing hyperinflation of non-dependent lung areas. This promotes more uniform ventilation distribution and improves lung homogenization, which is crucial for managing acute respiratory failure. While net effect on respiratory system compliance ie chest wall vs lung parenchyma will reflect in plateau pressures . Additionally, unpublished data suggest that placing a weight of 2 to 3 kg on the ventral chest wall in the supine position may further optimize lung mechanics. The added weight likely reduces the deformability of the ventral chest wall even more, limiting hyperinflation of the underlying lung tissue. This has been observed to increase tidal volumes and decrease plateau pressures, further enhancing the benefits of proning by ensuring better ventilation-perfusion matching and more efficient oxygenation.
Nice Dr Zahid However Co2 may increase - due to decrease in MV /CO and thus perfusion or decrease due to dead space decrease At times there is a variable change due to mix of factors Below is a nice article by prof guerin who did the proseva trial doi.org/10.1007%2Fs00134-020-06306-w
@@youngindiaintensivist7709 yes sir co2 can go in any direction depends upon the net difference in non dependent recruitment and dependant derecriutment… since better oxygenation isn’t translated into better survival necessarily while better pco2 after proning has better outcomes . Your dynamicity and great depth and understanding is a great treasure for all of us . Thank you sir will go through it …
pubmed.ncbi.nlm.nih.gov/31060091/ This is a masterpiece for basics and physiology Alongwith chapter from tobins book . pubmed.ncbi.nlm.nih.gov/24134414/ pubmed.ncbi.nlm.nih.gov/34825929/ www.ncbi.nlm.nih.gov/pmc/articles/PMC9995262/ Overall integrated and good one Will read one posted by you sir Thank you again
Thanks for amazing lectures free of cost, in times where many seniors are trying to monetize education ,every topic in garb of conference.
Our channel will always be free for all
Thank you sir for wonderful explanation
😊👍
Hello, doctor. Thanks for having this conference.
Doctor, can I suggest? Can you explain more details on Prone CPR (CPR on a patient laying in the Prone Position)? Can you upload your very own Mannequin Simulation videos on how to administer Prone CPR and Posterior Defibrillation on an intubated cardiac arrest patient during prone position ventilation and spinal surgery?
th-cam.com/video/VN8p29iPX3k/w-d-xo.html
th-cam.com/video/AL-ZKsCN_o0/w-d-xo.html
dear Andrew u can try these 2 links , u may find them useful
as of now we don't have our simulation video
for spinal injury pts, if spine is unstable then this is a contraindication to proning . if spine is stable then usual cpr
Can you share Powerpoint sir
Thank you sir
So concise and great lecture by my beloved teacher and guru Dalim sir .
Recent data suggest that prone positioning does not significantly alter perfusion. Carbon dioxide (CO₂) removal may be a more reliable predictor of patient outcomes than oxygenation, as a decrease in CO₂ reflects improved lung mechanics, better ventilation, reduced hyperinflation, and fewer areas of collapse.
In the supine position, two factors-shape mismatch and gravity-work in the same direction, contributing to uneven ventilation. During prone positioning, these vectors oppose each other, resulting in more even distribution of ventilation. This leads to greater lung homogenization, as shown by an increase in the "decay distance"-the point from the top (ventral) to the bottom (dorsal) where lung aeration is reduced to 37%. In the prone position, this distance is extended, indicating a more uniform distribution of air across the lungs.
Interestingly, some studies have shown that the total lung aeration does not significantly change with prone positioning. The overall average aeration and homogeneity factor (HF) remain roughly the same. However, it is the redistribution of ventilation with proning that plays the critical role, ensuring more homogenized aeration. This redistribution optimizes lung mechanics by reducing regional overdistension and collapse, thereby decreasing ventilator-induced lung injury (VILI).
As a result, prone positioning makes the lungs more responsive to other interventions like PEEP, reduces the need for high FiO₂ and PEEP levels, and eventually decreases the risk of biotrauma. This cumulative effect is why proning is a powerful tool in managing acute respiratory failure and improving patient outcomes.
The effect of recreation drainage cross contamination of healthy lung are also there .
In ARDS with severe, resistant hypoxemia, achieving progress requires a combination of precise interventions. While proning is crucial, it must be integrated with lung protective ventilation, optimal PEEP, and careful fluid management. If proning is done without optimizing PEEP or adjusting the duration and timing of the maneuver, its effect will be limited. Additionally, identifying and addressing the underlying cause of ARDS is essential. The success of proning relies on the synergistic use of co-interventions, as no single maneuver will suffice on its own.
When a patient is placed in the prone position, the compliance dynamics of the chest wall shift significantly. The ventral chest wall, which is more deformable in the supine position, becomes dependent, leading to a decrease in chest wall compliance. Meanwhile, the dorsal chest wall, now non-dependent, is naturally less deformable, preventing hyperinflation of non-dependent lung areas. This promotes more uniform ventilation distribution and improves lung homogenization, which is crucial for managing acute respiratory failure. While net effect on respiratory system compliance ie chest wall vs lung parenchyma will reflect in plateau pressures .
Additionally, unpublished data suggest that placing a weight of 2 to 3 kg on the ventral chest wall in the supine position may further optimize lung mechanics. The added weight likely reduces the deformability of the ventral chest wall even more, limiting hyperinflation of the underlying lung tissue. This has been observed to increase tidal volumes and decrease plateau pressures, further enhancing the benefits of proning by ensuring better ventilation-perfusion matching and more efficient oxygenation.
Nice Dr Zahid
However Co2 may increase - due to decrease in MV /CO and thus perfusion or decrease due to dead space decrease
At times there is a variable change due to mix of factors
Below is a nice article by prof guerin who did the proseva trial
doi.org/10.1007%2Fs00134-020-06306-w
@@youngindiaintensivist7709 yes sir co2 can go in any direction depends upon the net difference in non dependent recruitment and dependant derecriutment… since better oxygenation isn’t translated into better survival necessarily while better pco2 after proning has better outcomes . Your dynamicity and great depth and understanding is a great treasure for all of us .
Thank you sir will go through it …
@@zahidabdulmajeed1482 👍
pubmed.ncbi.nlm.nih.gov/31060091/
This is a masterpiece for basics and physiology Alongwith chapter from tobins book .
pubmed.ncbi.nlm.nih.gov/24134414/
pubmed.ncbi.nlm.nih.gov/34825929/
www.ncbi.nlm.nih.gov/pmc/articles/PMC9995262/
Overall integrated and good one
Will read one posted by you sir
Thank you again
Dr