Search results for: PEEP

Authors: Prabir Patel, Eugene Ming Han Lim

Abstract:

Introduction: Current literature shows that postoperative pulmonary complications following abdominal surgery may be reduced by using lower than conventional tidal volumes intraoperatively together with moderate levels of positive end expiratory pressure (PEEP). The recent studies demonstrated significant reduction demonstrated significant reduction in major complications in elective abdominal surgery through the use of lower tidal volumes (6-8 ml/kg predicted body weight), PEEP of 5 cmH20 and recruitment manoeuvres compared to higher ‘conventional’ volumes (10-12 mls/kg PBW) without lung recruitment. Our objective was to retrospectively audit current practice for patients undergoing major abdominal surgery in Sir Charles Gairdner Hospital. Methods: Patients over 18 undergoing elective general surgery lasting more than 3 hours and intubated during the duration of procedure were included in this audit. Data was collected over a 6 month period. Patients who had hepatic surgery, procedures necessitating one-lung ventilation, transplant surgery, documented history of pulmonary or intracranial hypertension were excluded. Results: 58 suitable patients were identified and notes were available for 54 patients. Key findings: Average peak airway pressure was 21cmH20 (+4), average peak airway pressure was less than 30 cmH20 in all patients, and less than 25 cmH20 in 80% of the cases. PEEP was used in 81% of the cases. Where PEEP was used, 75% used PEEP more than or equal to 5 cmH20. Average tidal volume per actual body weight was 7.1 ml/kg (+1.6). Average tidal volume per predicted body weight (PBW) was 8.8 ml/kg (+1.5). Average tidal volume was less than 10 ml/kg PBW in 90% of cases; 6-8 ml/kg PBW in 40% of the cases. There was no recorded use of recruitment manoeuvres in any cases. Conclusions: In the vast majority of patients undergoing prolonged abdominal surgery, a lung protective strategy using moderate levels of PEEP, peak airway pressures of less than 30 cmH20 and tidal volumes of less than 10 cmH20/kg PBW was utilised. A recent randomised control trial demonstrated benefit from utilising even lower volumes (6-8 mls/kg) based on findings in critical care patients, but this was compared to volumes of 10-12 ml/kg. Volumes of 6-8 ml/kg PBW were utilised in 40% of cases in this audit. Although theoretically beneficial, clinical benefit of lower volumes than what is currently practiced in this institution remains to be seen. The incidence of pulmonary complications was much lower than in the other cited studies and a larger data set would be required to investigate any benefit from lower tidal volume ventilation. The volumes used are comparable to results from published local and international data but PEEP utilisation was higher in this audit. Strategies that may potentially be implemented to ensure and maintain best practice include pre-operative recording of predicted body weight, adjustment of default ventilator settings and education/updates of current evidence.

Keywords: anaesthesia, intraoperative ventilation, PEEP, tidal volume

Procedia PDF Downloads 737

Authors: Mohammad Akram

Abstract:

The aim of this study is to improve classroom management while teaching especially ESL/EFL. At the same time, it has been discussed about the standard of the students through some surveys held in Jazan University in the month of February and March, 2013. The present research is a classroom action-oriented study. The subject of the study is mainly the students whose first language is not English at all. The study is prepared in one cycle that has planning, action, and reaction as well. Teachers of English as a second language/foreign language generally face numerous of unexpected problems while dealing with their students. To make the classes practical, meaningful, and easy like fun for the students is really a cumbersome task. It's a very practical move towards classroom ESL/EFL teaching if we want to apply anything new, I mean new policies, tactics, recent/smart teaching methodologies, we must peep into the hole of past because it will give us the best solution for the present strategies. We need to academically study the past of our students to make their present fruitful. Here, author wants to present a few important problematic issues like classroom management in the area of ESL/EFL while teaching ESL students. Impact these are suggestions to combat drawbacks of 'Classroom Teaching'. “Classroom management is to put into practice and a process through teaching and learning process”.

Keywords: global, teachers, perceptions, classroom, management, integrated, segregated, comprehension, productive

Procedia PDF Downloads 641

Authors: Saidalavi Kannattippadi

Abstract:

It is a culture based study on revealing how the indebtedness of the west belongs to the moral and scientific culture of Islam, even to such a way to be said there was no room for renaissance and the enlightment of the west without the active intervention of the Islamic culture in thoughts and activities of the European thinkers. The study focuses on the exact causes that led the west to the renaissance and goes through analyzing each of historical evidences for confirming the continuous cultural assimilations that occurred between east and west, through transmissions of knowledge, translations of unique treatises, study trips and so on. The west had deeply influenced by the thought and culture of Islam after having a long bitter experience from the blind rituals and customs introduced by the church and was expecting for a movement that can raise them upwards from the bankruptcy of morality and spirituality. The sequence of crusades and voyages of thinkers from west to eastern wards made the western people aware of the best culture ever found in the world as in name of Islam and they become ready to assimilate its notable cultural values and to borrow its cultural achievements. The west had two types of influences from the Islam; moral and scientific. the uprooting of untouchablitlity and racism from western society and their accepting the ideologies of equality and fraternity are moral influence and the innumerable inventions and discoveries found in modern science and technology are the scientific influences. Without the frantic efforts of Muslims in translating, modifying and commenting the science and philosophy of the Greek the west would not have even a chance to peep to the cultural values of the Greek. Here the Muslims are the guides and channels through which the west got educated and well cultured. The study also briefly sheds light on the cultural achievements of Muslims in material science, human science, etc.

Keywords: cultural assimilation, culture and civilization, indebtedness, Muslim world, west, translation, transmission

Procedia PDF Downloads 360