Pulmonology Critical care

Pulmonary Embolism Pulmonary embolism is obstruction of the pulmonary arterial circulation, usually by thrombus originating from the deep veins of the lower extremities or pelvis. Risk Factors—Virchow’s Triad  Mechanism Examples Venous stasis Immobilization, ICU stay Hypercoagulability Cancer, pregnancy Endothelial injury Surgery, trauma,Central venous Catheter Major Major surgery Trauma Malignancy Prior VTE Pregnancy/postpartum Moderate OCP use […]

ASTHMA EXACERBATION  Recommendations below are aligned primarily with the 2026 GINA Strategy Report, the current GINA reference available in 2026.  ADULT ASTHMA EXACERBATION — QUICK DOSE TABLE 1. WHAT IS AN ASTHMA EXACERBATION? An asthma exacerbation is an acute or subacute worsening of asthma symptoms and lung function compared with the patient’s usual state.Typical manifestations:

Prone Ventilation (Prone Positioning)  The landmark:PROSEVA Trial(2013)  Demonstrated significant mortality reduction in severe ARDS when: Used early Used for prolonged periods-at least 16 hours a day for 4-5 days on average (i.e. for ~ 70-75% of the time) Combined with lung-protective ventilation Since then, prone positioning became standard care for severe ARDS. Physiological Basis Why

Ventilator Settings  Trigger Trigger is the mechanism that initiates a ventilator breath. In simple words:”What tells the ventilator to start inspiration?” The trigger may be:Patient generated or Time generated Types of Trigger A. Time Trigger Ventilator starts breath according to set respiratory rate. Example:RR = 12/min so Breath every: 60/12 = 5 sec Ventilator triggers

Ventilator Asynchronies  Ventilator asynchrony refers to a mismatch between the patient’s neural respiratory drive and the ventilator’s delivered breath (trigger, flow, cycling, or mode). It leads to: ↑ Work of breathing (WOB) Patient discomfort Sedation escalation Delirium Prolonged mechanical ventilation Increased ICU stay Possibly increased mortalityAsynchrony is present in up to 20–40% of ventilated ICU

WEANING FROM MECHANICAL VENTILATION WHY WEANING IS IMPORTANT Complications of Delayed Weaning Ventilator-associated pneumonia (VAP) Diaphragmatic disuse atrophy (VIDD) ICU-acquired weakness (CIP/CIM) Increased ICU length of stay Higher mortality Increased sedation exposure Complications of Premature Weaning Reintubation Aspiration Hemodynamic instability Increased mortality (especially if reintubation within 48 hrs) CLASSIFICATION OF WEANING  1️⃣ Simple Weaning Successful

Acute Respiratory Distress Syndrome (ARDS)  ARDS (Acute Respiratory Distress Syndrome) is a diffuse inflammatory lung injury characterized by: Increased alveolar-capillary permeability Non-cardiogenic pulmonary edema Severe hypoxemia Reduced lung compliance Leading to acute respiratory failure requiring oxygen or ventilatory support.   Berlin Definition (2012) — Diagnostic Criteria Criterion Requirement Timing Within 1 week of clinical insult