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你有看過比賽或是電影中，運動員每次練完習都會跳到一桶大冰池裡嗎？
其實這個大冰池不光是幫他們降溫喔！
這可是大有學問的📖
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🧊冷水療（Cold Water Immersion,CWI），與冰敷都是很常被用來在運動員疲勞恢復使用
👇🏻功效作用：
1️⃣降低訓練中因肌肉撕裂所導致的延遲性肌肉痠痛（DOMS)
2️⃣誘發副交感神經活化，讓身體回到休息狀態
3️⃣水壓幫助周邊血液回流到中樞，增加心輸出量與中心靜脈壓（central venous pressure)
4️⃣提高肌肉痠痛的疼痛閾值
除了冷水療外，冷熱交替水療（Contrast Water Therapy,CMT)也是經常使用的方法之一。
#sportsyang
#workout
#sportsrecovery
#yang羊
#athletictrainer
#coach
#運動傷害
#姿勢矯正
#運動恢復
#運動按摩
#冷水療
#冰敷
#熱敷
ARDS 的血行動力學
Experts’ opinion on management of hemodynamics in ARDS patients: focus on the effects of mechanical ventilation
Acute respiratory distress syndrome (ARDS) is frequently associated with hemodynamic instability which appears as the main factor associated with mortality. Shock is driven by pulmonary hypertension, deleterious effects of mechanical ventilation (MV) on right ventricular (RV) function, and associated-sepsis. Hemodynamic effects of ventilation are due to changes in pleural pressure (Ppl) and changes in transpulmonary pressure (TP). TP affects RV afterload, whereas changes in Ppl affect venous return. Tidal forces and positive end-expiratory pressure (PEEP) increase pulmonary vascular resistance (PVR) in direct proportion to their effects on mean airway pressure (mPaw). The acutely injured lung has a reduced capacity to accommodate flowing blood and increases of blood flow accentuate fluid filtration. The dynamics of vascular pressure may contribute to ventilator-induced injury (VILI). In order to optimize perfusion, improve gas exchange, and minimize VILI risk, monitoring hemodynamics is important.
During passive ventilation pulse pressure variations are a predictor of fluid responsiveness when conditions to ensure its validity are observed, but may also reflect afterload effects of MV. Central venous pressure can be helpful to monitor the response of RV function to treatment. Echocardiography is suitable to visualize the RV and to detect acute cor pulmonale (ACP), which occurs in 20–25 % of cases. Inserting a pulmonary artery catheter may be useful to measure/calculate pulmonary artery pressure, pulmonary and systemic vascular resistance, and cardiac output. These last two indexes may be misleading, however, in cases of West zones 2 or 1 and tricuspid regurgitation associated with RV dilatation. Transpulmonary thermodilution may be useful to evaluate extravascular lung water and the pulmonary vascular permeability index. To ensure adequate intravascular volume is the first goal of hemodynamic support in patients with shock. The benefit and risk balance of fluid expansion has to be carefully evaluated since it may improve systemic perfusion but also may decrease ventilator-free days, increase pulmonary edema, and promote RV failure. ACP can be prevented or treated by applying RV protective MV (low driving pressure, limited hypercapnia, PEEP adapted to lung recruitability) and by prone positioning. In cases of shock that do not respond to intravascular fluid administration, norepinephrine infusion and vasodilators inhalation may improve RV function. Extracorporeal membrane oxygenation (ECMO) has the potential to be the cause of, as well as a remedy for, hemodynamic problems. Continuous thermodilution-based and pulse contour analysis-based cardiac output monitoring are not recommended in patients treated with ECMO, since the results are frequently inaccurate. Extracorporeal CO2 removal, which could have the capability to reduce hypercapnia/acidosis-induced ACP, cannot currently be recommended because of the lack of sufficient data.
http://bit.ly/1Xdb1Kv
Systematic review including re-analyses of 1148 individual data sets of central venous pressure as a predictor of fluid responsiveness
Most studies on fluid responsiveness reported mean/median CVP values in the intermediate range of 8–12 mmHg in both responders and non-responders. In our re-analyses of a large sample of individual patient data sets, lower CVP values (<8 mmHg) predicted fluid responsiveness and had some positive predictive value at 2 and 4 mmHg. Overall, the intermediate (8–12 mmHg) and higher (>12 mmHg) ranges of CVP values did not predict fluid responsiveness, though we found some negative predictive value using 14 and 16 mmHg as cut-off points. However, there were fewer data on higher CVP values, in particular >15 mmHg, resulting in less certain estimates of predictive values of higher CVP values. In any case, the predictive values, both positive and negative, were generally low for all the specific CVP values assessed in the range 0–20 mmHg.
http://bit.ly/1Y7M0VB
Human Physiology” is a free online course on Janux that is open to anyone. Learn more at http://janux.ou.edu.Created by the University of ... ... <看更多>
This is a video as part of the Stanford Medicine 25 showing how to approximate the central venous pressure using the arm in a patient with ... ... <看更多>
central venous pressure 在 "Interpreting Central Venous Pressure Waveforms" by James ... 的推薦與評價
Learn principles of central venous pressure monitoring, including how to interpret the segments of a central venous pressure waveform and ... ... <看更多>