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Step 1: evaluation of the utility of ABG, capillary blood gas and venous blood gas
Step 2: diagnosis of A-B disorders: Henderson-Hasselbalch equation and the relationship between partial pressure of oxygen (PO2), partial pressure of carbon dioxide (PCO2) and pH
Step 3: more on A-B disorders: importance of the D(A-a) difference, fraction of inspired oxygen (FiO2), the alveolar gas equation and measuring oxygen shunts
ABG analysis
Principles of measured and calculated ABG data
Physiology and pathophysiology of oxygenation, carbon dioxide removal and acid-base homeostasis
Assessment and appropriate use of ABG data during the diagnostic process
Calculation of secondary parameters such as the A-aO2 gradient, PaO2/FiO2 ratio and anion gap
Selection of appropriate treatment to correct ABG abnormalities
Seldinger technique for arterial line
Transpack assembly and its nuances
Interpretation of the invasive blood pressure curve
Pulmonary function testing to assess respiratory mechanics and gas exchange, including spirometry, flow-volume studies, lung volumes and diffusing capacity
Measurement principles of flow spirometry, body plethysmography, gas dilution methods and diffusion capacity including all measured (primary) and calculated (secondary) parameters
Different approaches to flexible bronchoscopy in spontaneously breathing patients and those on high-flow nasal therapy, non-invasive ventilation (NIV) and invasive mechanical ventilation (IMV)
Bronchoscopy
Goals of bronchoscopy (therapeutic/diagnostic)
Effects and side effects (risks and benefits) of bronchoscopy in secretion management (e.g. risk of atelectasis)
Indications for NIV during bronchoscopy
Monitoring requirements for the procedure
Appropriate setting for bronchoscopy according to the patient’s condition
Patient consent
Selection and application of appropriate topical and systemic medications for the procedure
Selection and mounting of appropriate interface that allows bronchoscopy during NIV
Selection and applying the appropriate ventilator settings to achieve optimal ventilator support and minimise the side effects of bronchoscopy
Set up of the monitoring equipment for bronchoscopy
Performance of bronchoscopy
Diagnostic bronchoscopy including airway examination and bronchoalveolar lavage
Indications, contraindications and risks of bronchoscopy and lavage
Principles of patient preparation for bronchoscopy and evaluation prior to bronchoscopy
Principles of sedation management during bronchoscopy
Airway anatomy
Bronchoscopy technique including biopsy and lavage equipment
Different routes to perform bronchoscopy (artificial airway, oral cavity, nasal cavity and during NIV)
Methods to treat endobronchial bleeding during bronchoscopy including the limitations of these measures
Management of sedation during bronchoscopy
Bronchoscopy (pass the upper airway and locate all accessible segmental ostia)
Mucosal biopsy
Bronchoalveolar lavage
Therapeutic bronchoscopy (through an artificial airway) to remove secretions
Indications, contraindications and risks of therapeutic bronchoscopy via an artificial airway
Ventilator management when bronchoscopy is performed during ventilation
Techniques to supply oxygen when bronchoscopy is performed during spontaneous breathing through an artificial airway
Therapeutic bronchoscopy through an artificial airway
Foreign body airway aspiration
Pathophysiology and complications of gross and silent aspiration
Indications for flexible or rigid bronchoscopy
Performance of flexible bronchoscopy and recognition of indications for rigid bronchoscopy
Physiological rationale and technical issues of non-invasive tools for secretion management and cough assist in spontaneously breathing and non-invasively supported patients
Non-disconnectable patients on invasive ventilation. Physiotherapy procedures using the mechanical respirator and online devices.
Use of devices to train inspiratory muscles
Positive expiratory pressure therapy: rationale and devices
The specific case of the patient on Extracorporeal Membrane Oxygenation (ECMO)
Early recognition and treatment of generalised or local hypoxia/hypoxaemia
Differentiation between oxygen saturation (SaO2) and pO2 in blood gas analysis (BGA)
Proactive attitude in early recognition and management
Practical skills: modes and principles of oxygen supplementation
Oxygen uptake and delivery
Indications and contraindications for oxygen therapy
Gas pressure and liquid oxygen systems as well as oxygen blenders
Different probe systems used to administer oxygen during spontaneous breathing, including their impact on FiO2
Oxygen humidification
Appropriate selection of an oxygen system, flow rate and FiO2
Appropriate selection of tests to monitor oxygen supplementation
Selection of appropriate patients for HFNO, excluding patients who require (non)invasive ventilation or low-flow oxygen
Current evidence for the use of high flow combined with NIV
Indications for HFNO in postextubation management, postoperative prophylactic or therapeutic treatment, in acute hypoxemic failure of lesional origin and in acute hypercapnic failure.
Hospital-acquired and opportunistic infections in critically ill patients
Most frequent infections acquired in the ICU, their predisposing factors including immunosuppression, their diagnostic criteria, the most frequent etiologic pathogens and recommended empiric treatment for each infection
Detection and diagnosis of these patients
Implementation of appropriate diagnostic methods
Appropriate selection of empiric treatment
Most frequent support measures in critically ill and immunosuppressed patients, including haemotherapy, antimicrobial treatment and life support measures such as mechanical ventilation, vasoactive drugs, renal replacement therapy and immunostimulation
Establishment of indications for each support measure and selection of the most appropriate measure in each clinical condition
National and international guidelines for treatment of ARF
Evaluation, performance, interpretation and reporting of BGA, O2 saturation, transcutaneous CO2 measurement, chest X-ray (imaging) and lung/chest wall mechanics
Hypoxemic respiratory failure including ARDS
Causes of hypoxemic ARF
Definition and classification of ARDS
Ventilator and tube-associated complications
Intubation-associated pneumonia (IAP)
Protective mechanical ventilation and VILI
Identification and management of hypoxemic ARF
Indications for NIV in patients with hypoxemic ARF
Risk assessment and management of NIV failure and indications for intubation
Intubation and IMV
Acute and chronic hypercapnic respiratory failure
Causes of respiratory failure
Principles of interpretation of BGA
National and international guidelines for treatment of acute and chronic hypercapnic respiratory failure
Indications for additional O2 treatment
Indications for long-term (home) mechanical ventilation
Management of patients with prolonged weaning
Non-IVM
Care for patients that are highly dependent on mechanical ventilation, e.g. those with a tracheostomy
Pleural diseases in patients with severe respiratory failure
Pathophysiology of restrictive thoracic/pleural diseases that cause severe respiratory failure
Various types of chest tubes and insertion techniques
Recognition of pleural diseases as a cause of severe respiratory failure
Performance of ultrasound examination of the pleural space
Interpretation of pleural pathology on chest X-rays
Chest tube insertion: technical issues must be considered to drain located effusions in some cases with organising parapneumonic pleural effusions
Interpretation of laboratory findings in patients with pleural effusion
Neuromuscular conditions associated with respiratory muscle weakness
Symptoms and signs of nocturnal hypoventilation and the probability of respiratory failure
Role of NIV versus invasive ventilation and cough augmentation (cough assist) techniques
Assessment of respiratory muscle strength (e.g. vital capacity)
Assessment of non-invasive respiratory muscle strength (e.g. mouth pressures and sniff inspiratory pressure)
Measurement of cough peak flow
Use of NIV
Clinical assessment of bulbar function
Causes, assessment and prognosis of coma
Principles of the assessment of coma severity (i.e. Glasgow coma scale)
Clinical assessment of coma
Differential diagnosis of coma
Indications for airway protection and mechanical ventilation
Guillain-Barré syndrome
Causes, subtypes, pathophysiology and natural history
Diagnostic methods and treatments (plasmapheresis and immunoglobulin)
Amyotrophic lateral sclerosis (ALS)
Different presentations of the motor neuron disease ALS: types (bulbar/non-bulbar), diagnosis (electromyography and nerve conduction studies) and natural history
Role of riluzole and symptom palliation
Respiratory muscle strength and bulbar function assessment
Careful handling of symptom palliation and discussion of advance directives
Myasthenia gravis
Pathophysiology of acquired myasthenia and congenital variants, diagnostic methods and therapies including anticholinesterases
Assessment of respiratory muscle strength
Myopathies and muscular dystrophies (Duchenne, etc.)
Understanding the classification of common myopathies (e.g. nemaline, Pompe disease and myotubular), muscular dystrophies (Duchenne and limb girdle) and neuropathies
Natural history of disorders such as cardiomyopathy in some conditions and the likelihood of respiratory failure
Assessment of respiratory muscle strength
Performance of sleep studies and NIV
Effective communication with patients and their families
Establish effective interactions with the multidisciplinary team of health professionals
Postoperative phrenic nerve dysfunction
Types of phrenic nerve dysfunction (nerve transection and paresis)
Predisposing surgical procedures
Natural history and clinical features
Assessment of respiratory muscle strength
Referral for phrenic nerve conduction studies
Principles of sedation
Diagnostic and therapeutic procedures for sedation and analgesia
Pharmacological basis of sedative agents
Indications for sedation and analgesia
Scores and scales for assessment of sedation in conscious and unconscious patients
Sedation and pain management including treatment of delirium and anxiety in critically ill patients using both pharmacologic and non-pharmacologic methods
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