Os autores que gostaria de agradecer a Anna Ciullo, M.D. pela sua assistência com desenvolvimento curricular e execução. Não havia nenhum financiamento externo para este relatório.

Todos os métodos descritos aqui foram encontrados para ser isentos de revisão pelo Conselho de revisão institucional de Summa.
1. dia 1 – avaliação pré-teste
<ol><li>Imprima listas de ação crítica, inquéritos à confiança de pré-teste, exames de múltipla escolha cognitiva de pré-teste.</li>
	<li>Coloque três simuladores humanos-paciente em leitos de UTI, com as seguintes denominações: síndrome respiratória aguda (Sara), atelectasia completa do pulmão secundário para muco obstruindo e pneumotórax. Conjunto de simuladores em quartos separados ou muito distante o suficiente que os alunos não será capazes de facilmente ouvir o outro simultaneamente executado sessões. Coloque simuladores em um espaço de aprendizagem dedicado.</li>
	<li>Entube os simuladores humanos-paciente. Não coloque o tubo endotraqueal na traqueia do simulador, mas sim através de um buraco na bochecha de interior do simulador que leva na parte de trás do pescoço do simulador.<ol>
<li>Conecte o tubo de papelão ondulado das vias respiratórias partir o simulador de pulmão para o tubo endotraqueal que agora está escondido por trás do pescoço do simulador. Uma vez conectado, o simulador de pulmão agora está funcional. Use um travesseiro para esconder esta conexão.</li>
	</ol>
</li>
	<li>Liga o simulador de pulmão. Escolha o estado patológico selecionado do menu na pasta Biblioteca do paciente. Inicie a patologia selecionada no simulador de pulmão.<ol>
<li>Conecte o ventilador mecânico para o tubo endotraqueal saindo da boca do simulador. Se o ventilador está ligado ao tubo endotraqueal antes de iniciar o programa de software de patologia pulmonar, o ventilador não funcionará corretamente.</li>
		<li>Conecte a respiração simuladores simuladores humanos-paciente. Conecte os simuladores humanos-paciente intubados ventiladores mecânicos.</li>
	</ol>
</li>
	<li>Coloque um monitor paciente simulado por cada simulador de paciente humano. Selecione o software sinal vital dentro do programa de simulador de pulmão. Escolha os sinais vitais iniciais apropriados para o início da apresentação de paciente simulado. Habilite o monitor de sinais vitais.</li>
	<li>Carregar os sinais vitais do paciente pré-selecionado, imagens de raio-x do tórax, eletrocardiogramas e medições de gás de sangue arterial para cada caso de paciente para cada respectivo monitor paciente (por exemplo, autoPEEP imagens são enviadas para o simulador de paciente-humanos designado como o paciente autoPEEP).</li>
	<li>Estabelecidos em cada estação, listas de verificação críticas ações para cada aluno onde quer que os membros do corpo docente observarão o caso. Isto pode ser por trás de um vidro unidirecional ou em uma mesa de cabeceira, mas a suficiente distância afastado que os aprendentes não será capazes de ler as listas de verificação. Atribua a um membro do corpo docente para cada estação.</li>
	<li>Tem cada aluno escolher um código de quatro dígitos de identificação para usar para inquéritos à confiança, exames cognitivos e listas de ação crítica. Os códigos podem ser utilizados para analisar os dados coletados de forma anônima. Os alunos podem escolher qualquer código de quatro dígitos que eles lembrarão consistentemente ao longo do currículo.</li>
	<li>Em um quarto separado, administre pesquisa de confiança do pré-teste de 5 minutos para os alunos. Após a sua conclusão, administre exames de múltipla escolha cognitiva de pré-teste de 25 minutos para os alunos.</li>
	<li>Tem relatório de alunos para uma estação, com um aluno presente em cada estação. Restantes alunos podem esperar em uma sala separada. Tenho alunos fornecer seu código de identificação de quatro dígitos para faculdade para sua lista de ação crítica.</li>
	<li>Tem faculdade ler a haste caso para aluno. Permitir que os alunos um máximo de dez minutos por estação de trabalho através de um cenário. Não administre feedback durante o caso. Na conclusão do cenário, demita os aprendentes para voltar ao seu quarto separado.</li>
	<li>Tem faculdade preencher listas de ação crítica para cada aluno após a conclusão de cada caso. Gire os alunos através de todas as estações individualmente até que todos os estudantes completaram todas as estações. Distribua leituras complementares para os alunos via papel ou e-mail.</li>
</ol>2. dia 2 – currículo e intervenção educativa
<ol><li>Configurar cinco estações com humanos-paciente simuladores, simuladores de respiração, ventiladores e monitores como descrito acima.</li>
	<li>Atribuir a cada estação, um dos seguintes tópicos: SDRA, atelectasias secundárias de muco, obstruindo, pneumotórax, alterou o estado mental secundário a overdose de drogas e hiperinflação dinâmica. Organize os alunos em grupos de duas ou três pessoas. Atribua a um membro do corpo docente para cada estação.</li>
	<li>Permitir que cada equipe 10 min para trabalhar através de um cenário. Faculdade de dar 35 min para fornecer feedback e cabeceira de instrução. Gire os aprendentes através das restantes quatro estações.</li>
</ol>3. dia 3 – pós-teste de avaliação
<ol><li>Imprima listas de ação crítica, inquéritos à confiança depois do teste, pós-testes cognitivos exames de múltipla escolha. Configurar três estações com humanos-paciente simuladores, simuladores de respiração, ventiladores e monitores como descrito acima. Atribuir a cada estação, um dos seguintes tópicos: SDRA, atelectasias secundárias de muco, obstruindo, pneumotórax.</li>
	<li>Carregar os sinais vitais, imagens de raio-x do tórax, eletrocardiogramas e medições de gás de sangue arterial para cada caso de paciente para cada respectivo monitor paciente (por exemplo, autoPEEP imagens são enviadas para o simulador de paciente humano designado como o autoPEEP paciente).</li>
	<li>Estabelecidos em cada estação, listas de verificação críticas ações para cada aluno. Atribua a um membro do corpo docente para cada estação. Administre a pesquisa de confiança do pós-teste de 5 minutos e 25 minutos depois do teste cognitivo exame de múltipla escolha.</li>
	<li>Tem relatório de alunos para uma estação, com um aluno presente em cada estação. Restantes alunos podem esperar em uma sala separada. Tenho alunos fornecer seu código de identificação de quatro dígitos para faculdade para sua lista de ação crítica.</li>
	<li>Tem faculdade ler a haste caso para aluno. Permitir que os alunos um máximo de dez minutos por estação de trabalho através de um cenário. Não administre feedback durante o caso. Na conclusão do cenário, demita os aprendentes para voltar ao seu quarto separado.</li>
	<li>Tem faculdade preencher listas de ação crítica para cada aluno após a conclusão de cada caso. Gire os alunos através de todas as estações individualmente até que todos os estudantes completaram todas as estações. Administre 10 minutos pós-currículo pesquisa para todos os estudantes.</li>
</ol>

<ol>
	<li>Slutsky, A. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=History+of+mechanical+ventilation.+From+vesalius+to+ventilator-induced+lung+injury.">History of mechanical ventilation. From vesalius to ventilator-induced lung injury.</a> Am J Respir Crit Care Med. 191 (10), 1106-1115 (2015).</li><li>Ahmed, N., Devitt, K. S., Keshet, I., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+Systematic+Review+of+the+Effects+of+Resident+Duty+Hour+Restrictions+in+Surgery.">A Systematic Review of the Effects of Resident Duty Hour Restrictions in Surgery.</a> Ann Surg. 259 (6), 1041-1053 (2014).</li><li>Ziv, A., Wolpe, P. R., Small, S. D., Glick, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Simulation-Based+Medical+Education:+An+Ethical+Imperative.">Simulation-Based Medical Education: An Ethical Imperative.</a> Acad Med. 78 (8), 783-788 (2003).</li><li>Duwat, A., Hubert, V., Deransy, R., Dupont, H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Difficult+airway+management:+assessment+of+knowledge+and+experience+in+anaesthesiology+residents.">Difficult airway management: assessment of knowledge and experience in anaesthesiology residents.</a> Ann Fr Anesth Reanim. 32 (40), 231-234 (2013).</li><li>Lee, M. O., Brown, L. L., Bender, J., Machan, J. T., Overly, F. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+medical+simulation-based+educational+intervention+for+emergency+medicine+residents+in+neonatal+resuscitation.">A medical simulation-based educational intervention for emergency medicine residents in neonatal resuscitation.</a> Acad Emerg Med. 19 (5), 577-585 (2012).</li><li>Barsuk, J. H., Cohen, E. R., Caprio, T., McGaghie, W. C., Simuni, T., Wayne, D. B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Simulation-based+education+with+mastery+learning+improves+residents'+lumbar+puncture+skills.">Simulation-based education with mastery learning improves residents' lumbar puncture skills.</a> Neurology. 79 (2), 132-137 (2012).</li><li>Barsuk, J. H., Cohen, E. R., Vozenilek, J. A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Simulation-based+education+with+mastery+learning+improves+paracentesis+skills.">Simulation-based education with mastery learning improves paracentesis skills.</a> J Grad Med Educ. 4 (1), 23-27 (2012).</li><li>Sohmer, B., Hudson, C., Hudson, J., Posner, G. D., Naik, V. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Transesophageal+echocardiography+simulation+is+an+effective+tool+in+teaching+psychomotor+skills+to+novice+echocardiographers.">Transesophageal echocardiography simulation is an effective tool in teaching psychomotor skills to novice echocardiographers.</a> Can J Anaesth. 61 (3), 235-241 (2014).</li><li>Sigounas, V. J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Evaluation+of+simulation-based+training+model+on+vascular+anastomotic+skills+for+surgical+residents.">Evaluation of simulation-based training model on vascular anastomotic skills for surgical residents.</a> Simul Healthc. 7 (6), 334-338 (2012).</li><li>Dawe, S. R., Windsor, J. A., Broeders, J. A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+systematic+review+of+surgical+skills+transfer+after+simulation-based+training:+laparoscopic+cholecystectomy+and+endoscopy.">A systematic review of surgical skills transfer after simulation-based training: laparoscopic cholecystectomy and endoscopy.</a> Ann Surg. 259 (2), 236-248 (2014).</li><li>Spadaro, S., Karbing, D. S., Fogagnolo, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Simulation+Training+for+Residents+Focused+on+Mechanical+Ventilation.">Simulation Training for Residents Focused on Mechanical Ventilation.</a> Simul Healthc. , (2017).</li><li>Yee, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Mechanical+Ventilation+Boot+Camp:+A+Simulation-Based+Pilot+Study.">Mechanical Ventilation Boot Camp: A Simulation-Based Pilot Study.</a> Crit Care Res Pract. 2016, (2016).</li><li>Ryoo, E. N., Ha, E. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+Importance+of+Debriefing+in+Simulation-Based+Learning:+Comparison+Between+Debriefing+and+No+Debriefing.">The Importance of Debriefing in Simulation-Based Learning: Comparison Between Debriefing and No Debriefing.</a> Comput Inform Nurs. 33 (12), 538-545 (2015).</li><li>Shinnick, M. A., Woo, M., Horwich, T. B., Steadman, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Debriefing:+The+Most+Important+Component+in+Simulation?.">Debriefing: The Most Important Component in Simulation?.</a> Clin Simul Nurs. 7 (3), e105-e111 (2011).</li></ol>

Os autores não têm nada para divulgar.

O boot camp é composto por três sessões separadas. Durante o primeiro dia, os alunos completar um pre-teste pesquisa de confiança e conhecimento médico testar antes de se submeter a um cenário de cinco minutos. Corpo docente avaliar os alunos usando ações críticas pré-determinada. Leaners são dadas leitura assíncrona para concluir antes do dia 2. O segundo dia é composto por fase de intervenção, onde grupos de 2-3 alunos trabalham através de cinco cenários diferentes. Faculdade são ao lado do cama para ...

Este acampamento foi desenvolvido para ensinar os moradores a gerenciar um paciente ventilado mecanicamente, bem como solucionar problemas de alarmes do ventilador. Gestão de nesta população de pacientes pode ser intimidante para o praticante iniciante que pode ter limitada experiência com pacientes criticamente enfermos. Ensinar princípios de cuidados críticos, ao lado do cama é dificultada por restrições de trabalho-hora nacional1,2e preocupações médico-legal3 nos Estados Unidos. Simulação é uma modalidade eficaz para desenvolver e aperfeiçoar as habilidades de cuidados críticos4,5, bem como procedimentos invasivos6,7,8,9,10 . Através da simulação, os alunos podem experimentar o que as consequências da sua tomada de decisão médica é sem colocar os pacientes em risco. Este currículo permite uma variedade de modalidades de aprendizagem diferentes, incluindo o ensino de cabeceira de um intensivista, exercícios de prática com um ventilador e leitura assíncrona suplementar.
Estudos anteriores mostraram aumento do conhecimento com a educação baseada em manequim de ventilação mecânica11,12. Spadaro et al 11 em comparação treinamento baseado em computador, com treinamento em manequim para residentes de Anestesiologia, passando por ensino baseado em simulação de ventilação mecânica. Os moradores que foram submetidos a treinamento em manequim tinham maior acção-chave e pontuações de avaliação global. Conforme observado na nossa anterior estudo12, os residentes de primeiro ano demonstraram melhoria do conhecimento, confiança e competência após a conclusão deste currículo de treinamento.
Como está escrito, este currículo três dias permite que educadores inicialmente avaliar o conhecimento de linha de base dos seus alunos no primeiro dia, bem como avaliar as alterações na competência, conhecimento e confiança após a conclusão do currículo no terceiro dia. Dias 1 e 3 são dedicados para a avaliação, enquanto o segundo dia é focado na cabeceira ensino por especialistas de conteúdo. Condições patológicas (síndrome respiratória aguda [Sara], atelectasia secundária a muco obstruindo e pneumotórax) foram utilizadas para a avaliação inicial e finais dias de testes, enquanto uma estação de alteração do estado mental foi adicionada durante o ensino dia de rever conceitos básicos de ventilador. Hiperinflação dinâmica também foi adicionada para o dia de ensino como para reforçar o ventilador diagnóstico e gestão, incluindo a sua consideração em pacientes com pressão alta do planalto. Educadores podem substituir as patologias como sentem-se adequada para suas necessidades de ensino.
Em preparação, faculdade de simulação realizada um dia do ensaio inicial para garantir que todos os educadores participantes estavam cientes de seus papéis e para garantir o equipamento estava funcionando adequadamente. Enquanto fazíamos faculdade de simulação para avaliação e crítica cuidados médicos para o ensino, educadores podem ajustar os papéis dos professores como recursos ditam. Execução deste acampamento requer um planejamento de logística preparatória. Os residentes de primeiro ano devem ser agendada protegido para garantir podem terminar todos os três dias do currículo. Intensivists será necessário agendar tempo fora com antecedência para participar em sessões de ensino de cabeceira. Equipamento de simulação tais como respiratórios, simuladores, ventiladores mecânicos e simuladores de humanos-paciente pode ter que ser comprado, alugado ou emprestado.

<table border="0" cellpadding="0" cellspacing="0" style="width:517px;" width="518">
	<tbody>
		<tr height="107">
			<td height="107" style="height:107px;width:71px;">Puritan Bennett 840 Ventilator</td>
			<td style="width:71px;">Medtronic</td>
			<td style="width:71px;">4-840120EMC-01</td>
			<td style="width:305px;">http://www.medtronic.com/covidien/en-us/products/acute-care-ventilation/puritan-bennett-pb840-ventilator.html</td>
		</tr>
		<tr height="107">
			<td height="107" style="height:107px;width:71px;">ASL 5000 Breathing Simulator&#160;</td>
			<td style="width:71px;">IngMar</td>
			<td style="width:71px;">31 00 117</td>
			<td>https://www.ingmarmed.com/</td>
		</tr>
		<tr height="43">
			<td height="43" style="height:43px;width:71px;">Smart Stat Basic&#160;</td>
			<td style="width:71px;">Simulaids</td>
			<td style="width:71px;">101-8002</td>
			<td>https://www.simulaids.com/product/101-8002</td>
		</tr>
	</tbody>
</table>

mechanical ventilation boot camp curriculum

Gestão médica dos pacientes ventilados mecanicamente é um desafio para provedores de principiante. Gestão incorrecta desta população pode levar a aumento da morbidade e mortalidade. Um campo de treinamento de três dias com base em simulação serve para fornecer instrução individual com um provedor de cuidados críticos. Estas intensivists podem dispensar personalizado feedback imediato como aprendentes se envolver na prática hands-on com um ventilador muito mecânico. Várias patologias podem ser revistas que não podem ser encontradas na prática clínica. Aprendentes podem visualizar as consequências imediatas de suas ações e pode solucionar problemas e fazer perguntas, tudo em um ambiente de aprendizagem seguro. Nós descrevemos o uso de simuladores de paciente humano ligado à respiração simuladores e ventiladores mecânicos. Executores de currículo potencial devem estar cientes do custo do equipamento e o tempo necessário para dedicar-se à execução de acampamento; no entanto, este treinamento interativo intensivo foi mostrado para aumentar a competência do provedor, conhecimento e confiança na gestão do ventilador. Este resumo de currículo fornece orientação sobre como executar um campo de treinamento baseado em simulação para treinar fornecedores sobre a gestão dos pacientes mecanicamente ventilados.

Conforme observado na Yee et al, residentes de primeiro ano que passou por este acampamento demonstraram de confiança, conhecimento e desempenho significativamente melhorado12. Conhecimento cognitivo, avaliados pelo pré e pós-intervenção testes de escolha múltipla, aumentados de uma pontuação média de 40,3% para 67,1%, com uma mudança média de Pontuação de +26.8% (Figura 1).
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Watch this Scientific Journal Video about Mechanical Ventilation Boot Camp Curriculum at JoVE.com

Mechanical Ventilation Boot Camp Curriculum

Este currículo descreve como executar um campo de treinamento baseado em simulação para ensinar os provedores gerenciar pacientes mecanicamente ventilados.

Ventilação mecânica Boot Camp currículo

Medical management of mechanically ventilated patients is challenging to novice providers. Incorrect management of this population may lead to increased ...

mechanical-ventilation-boot-camp-curriculum

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Unit 1

Fundamentals of Respiratory Care: Techniques and Management

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10.1K visualizações.  The Ohio State University. Este currículo descreve como executar um campo de treinamento baseado em simulação para ensinar os provedores gerenciar pacientes mecanicamente ventilados.

Vídeo: Mechanical Ventilation Boot Camp Curriculum

A Novel Rescue Technique for Difficult Intubation and Difficult Ventilation

We describe a novel non surgical technique to maintain oxygenation and ventilation in a case of difficult intubation and difficult ventilation, which works especially well with poor mask fit.
Can not intubate, can not ventilate" (CICV) is a potentially life threatening situation. In this video we present a simulation of the technique we used in a case of CICV where oxygenation and ventilation were maintained by inserting an endotracheal tube (ETT) nasally down to the level of the naso-pharynx while sealing the mouth and nares for successful positive pressure ventilation.
A 13 year old patient was taken to the operating room for incision and drainage of a neck abcess and direct laryngobronchoscopy. After preoxygenation, anesthesia was induced intravenously. Mask ventilation was found to be extremely difficult because of the swelling of the soft tissue. The face mask could not fit properly on the face due to significant facial swelling as well. A direct laryngoscopy was attempted with no visualization of the larynx. Oxygen saturation was difficult to maintain, with saturations falling to 80%. In order to oxygenate and ventilate the patient, an endotracheal tube was then inserted nasally after nasal spray with nasal decongestant and lubricant. The tube was pushed gently and blindly into the hypopharynx. The mouth and nose of the patient were sealed by hand and positive pressure ventilation was possible with 100% O2 with good oxygen saturation during that period of time. Once the patient was stable and well sedated, a rigid bronchoscope was introduced by the otolaryngologist showing extensive subglottic and epiglottic edema, and a mass effect from the abscess, contributing to the airway compromise. The airway was secured with an ETT tube by the otolaryngologist.This video will show a simulation of the technique on a patient undergoing general anesthesia for dental restorations.

We describe a technique to maintain oxygenation and ventilation using an endotracheal tube inserted nasally to the level of the naso-pharynx while sealing the mouth and nares for successful positive pressure ventilation.

A Técnica de Resgate Novel para intubação difícil e Ventilação Difícil

We describe a novel non surgical technique to maintain oxygenation and ventilation in a case of difficult intubation and difficult ventilation, which ...

Medicina

Pressure Controlled Ventilation to Induce Acute Lung Injury in Mice

Murine models are extensively used to investigate acute injuries of different organs systems (1-34). Acute lung injury (ALI), which occurs with prolonged mechanical ventilation, contributes to morbidity and mortality of critical illness, and studies on novel genetic or pharmacological targets are areas of intense investigation (1-3, 5, 8, 26, 30, 33-36). ALI is defined by the acute onset of the disease, which leads to non-cardiac pulmonary edema and subsequent impairment of pulmonary gas exchange (36). We have developed a murine model of ALI by using a pressure-controlled ventilation to induce ventilator-induced lung injury (2). For this purpose, C57BL/6 mice are anesthetized and a tracheotomy is performed followed by induction of ALI via mechanical ventilation. Mice are ventilated in a pressure-controlled setting with an inspiratory peak pressure of 45 mbar over 1 - 3 hours. As outcome parameters, pulmonary edema (wet-to-dry ratio), bronchoalveolar fluid albumin content, bronchoalveolar fluid and pulmonary tissue myeloperoxidase content and pulmonary gas exchange are assessed (2). Using this technique we could show that it sufficiently induces acute lung inflammation and can distinguish between different treatment groups or genotypes (1-3, 5). Therefore this technique may be helpful for researchers who pursue molecular mechanisms involved in ALI using a genetic approach in mice with gene-targeted deletion.

A murine model for ventilator induced lung injury is an important tool to study an acute lung injury in vivo. Here, we report an easy applicable in situ model for acute lung injury using high-pressure mechanical ventilation to induce acute failure of the lung.

Ventilação a pressão controlada para induzir lesão pulmonar aguda em ratos

Murine models are extensively used to investigate acute injuries of different organs systems (1-34). Acute lung injury (ALI), which occurs with prolonged ...

Myo-mechanical Analysis of Isolated Skeletal Muscle

To assess the in vivo effects of therapeutic interventions for the treatment of muscle disease 1,2,3, quantitative methods are needed that measure force generation and fatigability in treated muscle. We describe a detailed approach to evaluating myo-mechanical properties in freshly explanted hindlimb muscle from the mouse. We describe the atraumatic harvest of mouse extensor digitorum longus muscle, mounting the muscle in a muscle strip myograph (Model 820MS; Danish Myo Technology), and the measurement of maximal twitch and tetanic tension, contraction time, and half-relaxation time, using a square pulse stimulator (Model S48; Grass Technologies). Using these measurements, we demonstrate the calculation of specific twitch and tetanic tension normalized to muscle cross-sectional area, the twitch-to-tetanic tension ratio, the force-frequency relationship curve and the low frequency fatigue curve 4. This analysis provides a method for quantitative comparison between therapeutic interventions in mouse models of muscle disease 1,2,3,5, as well as comparison of the effects of genetic modification on muscle function 6,7,8,9.

To assess the in vivo effects of therapeutic interventions for muscle disease, methods are needed to quantitate force generation and fatigability in treated muscle. We detail an approach to evaluating myo-mechanical properties in explanted mouse hindlimb muscle. This analysis provides a robust approach to quantitating the effects of genetic modification on muscle function, as well as comparison of therapies in mouse models of muscle disease.

Myo-mecânico Análise do músculo esquelético isolado

To assess the in vivo effects of therapeutic interventions for the treatment of muscle disease 1,2,3, quantitative methods are needed that measure force ...

Repeated Measurement of Respiratory Muscle Activity and Ventilation in Mouse Models of Neuromuscular Disease

Accessory respiratory muscles help to maintain ventilation when diaphragm function is impaired. The following protocol describes a method for repeated measurements over weeks or months of accessory respiratory muscle activity while simultaneously measuring ventilation in a non-anesthetized, freely behaving mouse. The technique includes the surgical implantation of a radio transmitter and the insertion of electrode leads into the scalene and trapezius muscles to measure the electromyogram activity of these inspiratory muscles. Ventilation is measured by whole-body plethysmography, and animal movement is assessed by video and is synchronized with electromyogram activity. Measurements of muscle activity and ventilation in a mouse model of amyotrophic lateral sclerosis are presented to show how this tool can be used to investigate how respiratory muscle activity changes over time and to assess the impact of muscle activity on ventilation. The described methods can easily be adapted to measure the activity of other muscles or to assess accessory respiratory muscle activity in additional mouse models of disease or injury.

This paper introduces a method for repeated measurements of ventilation and respiratory muscle activity in a freely behaving amyotrophic lateral sclerosis (ALS) mouse model throughout disease progression with whole-body plethysmography and electromyography via an implanted telemetry device.

Medida repetida de actividade muscular respiratória e Ventilação no rato modelos de doença neuromuscular

Accessory respiratory muscles help to maintain ventilation when diaphragm function is impaired. The following protocol describes a method for repeated ...

Mechanical and Controlled PRP Injections in Patients Affected by Androgenetic Alopecia

23 patients (18 male and 5 female) aged 21-70 years who displayed male pattern hair loss (MPHL) in Stage 1 to Stage 5 as determined by the Norwood-Hamilton classification scale, and female pattern hair loss (FPHL) in Stage 1 to Stage 2 as determined by the Ludwig classification scale, were treated with non-activated autologous platelet-rich plasma (A-PRP). Autologous blood (55 mL) was harvested using sodium citrate as an anticoagulant. A-PRP (23 mL) was produced for all cases using a closed system according to the transfusion service protocol. Following centrifugation (260 x g for 10 min) the A-PRP was inserted in a laser light selector device, and after the centrifugation, 9 mL of A-PRP was collected.
The scalp of the patients affected by androgenetic alopecia (AGA) was divided into four areas (frontal, parietal, vertex, and occipital); local anesthesia was not performed. Interfollicular A-PRP injections (0.2 mL x cm2) were performed by controlled and mechanical injections scheduled at a depth of 5 mm using a medical injector gun. Treatment sessions were performed with a 30-day interval. For each patient, three treatment sessions were performed.
PRP was injected in the androgen-related areas of scalp affected by hair loss. Placebo (normal saline solution) was loaded in another syringe (10 mL) and injected on the adjacent side in a similar fashion.

This paper aims to describe the interfollicular autologous platelet-rich plasma injections (0.20 mL x cm2) in the scalp of 23 patients affected by androgenetic alopecia at a depth of 5 mm using a medical injector gun equipped with a 30 gauge needle, in three sessions.

Injeções de PRP mecânico e controlada em pacientes afetados por alopecia androgenética

23 patients (18 male and 5 female) aged 21-70 years who displayed male pattern hair loss (MPHL) in Stage 1 to Stage 5 as determined by the ...

Emergency Undocking in Robotic Surgery: A Simulation Curriculum

The following is a training platform to allow robotic surgeons to develop the skills necessary to lead an interprofessional team in emergency undocking of a robotic system. In traditional robotic training for surgeons, a brief web based overview of performing an emergency undocking is provided during initial introductory training to the robotics system. During such a process, there is no training in delineation of interdisciplinary roles for operating room (OR) personnel. The training presented here uses formative simulation and debriefing followed by a lecture. For the simulation, a modified gynecologic simulator is draped in a steep trendelenburg position consistent with most gynecologic laparoscopic surgery. The training torso is modified using tubing hooked to pressure bags of red food colored IV fluid used to simulate a catastrophic vessel injury on demand. Positioned throughout the operating room setting is an interprofessional team consisting of embedded standardized persons (ESPs) to fulfill the roles of a circulating nurse, scrub nurse, anesthesiologist, and bedside assist surgeon. Robotic surgeons are presented a case scenario necessitating emergency undocking, and given control of the robotic instruments. The scenario is terminated following either successful completion of an emergency undock, or at five minutes due to the emergent nature of the case. A debriefing session with hands on training of the steps to emergency undocking, necessary equipment, troubleshooting techniques, and operating room personnel roles follows the simulation. The learners are presented with a short lecture reemphasizing the material presented in the debriefing for their own self-study. This training results in improved time accessing the patient, improved knowledge, confidence, and completion of critical actions, and can be replicated in most institutions. All robotic surgeons should be able to demonstrate competence in this crucial intervention. A limitation of the curriculum is ability to access the in-situ environment for training purposes.

This training platform is designed to allow robotic surgeons to develop the skills necessary to lead an interprofessional team in emergency undocking of the robotic system. Training includes the utilization of the technology and equipment to perform an emergency undocking, as well as delineation of roles for such a scenario.

Desacoplamento de emergência em cirurgia robótica: um currículo de simulação

The following is a training platform to allow robotic surgeons to develop the skills necessary to lead an interprofessional team in emergency undocking of ...

Mechanical Micronization of Lipoaspirates for Regenerative Therapy

Stromal vascular fraction (SVF) has become a regenerative tool for various diseases; however, legislation strictly regulates the clinical application of cell products using collagenase. Here, we present a protocol to generate an injectable mixture of SVF cells and native extracellular matrix from adipose tissue by a purely mechanical process. Lipoaspirates are put into a centrifuge and spun at 1,200 x g for 3 min. The middle layer is collected and separated into two layers (high-density fat at the bottom and low-density fat on the top). The upper layer is directly emulsified by intersyringe shifting, at a rate of 20 mL/s for 6x to 8x. The emulsified fat is centrifuged at 2,000 x g for 3 min, and the sticky substance under the oil layer is collected and defined as the extracellular matrix (ECM)/SVF-gel. The oil on the top layer is collected. Approximately 5 mL of oil is added to 15 mL of high-density fat and emulsified by intersyringe shifting, at a rate of 20 mL/s for 6x to 8x. The emulsified fat is centrifuged at 2,000 x g for 3 min, and the sticky substance is also ECM/SVF-gel. After the transplantation of the ECM/SVF-gel into nude mice, the graft is harvested and assessed by histologic examination. The result shows that this product has the potential to regenerate into normal adipose tissue. This procedure is a simple, effective mechanical dissociation procedure to condense the SVF cells embedded in their natural supportive ECM for regenerative purposes.

Here, we present a protocol to obtain stromal vascular fraction from adipose tissue through a series of mechanical processes, which include emulsification and multiple centrifugations.

Micronização mecânica de Lipoaspirates para terapia regenerativa

Stromal vascular fraction (SVF) has become a regenerative tool for various diseases; however, legislation strictly regulates the clinical application of ...

Quantitative Mapping of Specific Ventilation in the Human Lung using Proton Magnetic Resonance Imaging and Oxygen as a Contrast Agent

Specific ventilation imaging (SVI) is a functional magnetic resonance imaging technique capable of quantifying specific ventilation &#8213; the ratio of the fresh gas entering a lung region divided by the region&#8217;s end-expiratory volume &#8213; in the human lung, using only inhaled oxygen as a contrast agent. Regional quantification of specific ventilation has the potential to help identify areas of pathologic lung function. Oxygen in solution in tissue shortens the tissue&#8217;s longitudinal relaxation time (T1), and thus a change in tissue oxygenation can be detected as a change in T1-weighted signal with an inversion recovery acquired image. Following an abrupt change between two concentrations of inspired oxygen, the rate at which lung tissue within a voxel equilibrates to a new steady-state reflects the rate at which resident gas is being replaced by inhaled gas. This rate is determined by specific ventilation. To elicit this sudden change in oxygenation, subjects alternately breathe 20-breath blocks of air (21% oxygen) and 100% oxygen while in the MRI scanner. A stepwise change in inspired oxygen fraction is achieved through use of a custom three-dimensional (3D)-printed flow bypass system with a manual switch during a short end-expiratory breath hold. To detect the corresponding change in T1, a global inversion pulse followed by a single shot fast spin echo sequence was used to acquire two-dimensional T1-weighted images in a 1.5&#160;T MRI scanner, using an eight-element torso coil. Both single slice and multi-slice imaging are possible, with slightly different imaging parameters. Quantification of specific ventilation is achieved by correlating the time-course of signal intensity for each lung voxel with a library of simulated responses to the air/oxygen stimulus. SVI estimations of specific ventilation heterogeneity have been validated against multiple breath washout and proved to accurately determine the heterogeneity of the specific ventilation distribution.

Specific ventilation imaging is a functional magnetic resonance imaging technique that allows for quantification of regional specific ventilation in the human lung, using inhaled oxygen as a contrast agent. Here, we present a protocol to collect and analyze specific ventilation imaging data.

Mapeamento quantitativo de ventilação específica no pulmão humano usando ressonância magnética de prótons e oxigênio como agente de contraste

Specific ventilation imaging (SVI) is a functional magnetic resonance imaging technique capable of quantifying specific ventilation &#8213; the ratio of ...

A Rat Carotid Artery Pressure-Controlled Segmental Balloon Injury with Periadventitial Therapeutic Application

Cardiovascular disease remains the leading cause of death and disability worldwide, in part due to atherosclerosis. Atherosclerotic plaque narrows the luminal surface area in arteries thereby reducing adequate blood flow to organs and distal tissues. Clinically, revascularization procedures such as balloon angioplasty with or without stent placement aim to restore blood flow. Although these procedures reestablish blood flow by reducing plaque burden, they damage the vessel wall, which initiates the arterial healing response. The prolonged healing response causes arterial restenosis, or re-narrowing, ultimately limiting the long-term success of these revascularization procedures. Therefore, preclinical animal models are integral for analyzing the pathophysiological mechanisms driving restenosis, and provide the opportunity to test novel therapeutic strategies. Murine models are cheaper and easier to operate on than large animal models. Balloon or wire injury are the two commonly accepted injury modalities used in murine models. Balloon injury models in particular mimic the clinical angioplasty procedure and cause adequate damage to the artery for the development of restenosis. Herein we describe the surgical details for performing and histologically analyzing the modified, pressure-controlled rat carotid artery balloon injury model. Additionally, this protocol highlights how local periadventitial application of therapeutics can be used to inhibit neointimal hyperplasia. Lastly, we present light sheet fluorescence microscopy as a novel approach for imaging and visualizing the arterial injury in three-dimensions.

The rat carotid artery balloon injury mimics the clinical angioplasty procedure performed to restore blood flow in atherosclerotic vessels. This model induces the arterial injury response by distending the arterial wall, and denuding the intimal layer of endothelial cells, ultimately causing remodeling and an intimal hyperplastic response.

Uma lesão de balão segmental controlada por pressão da artéria de rato com aplicação terapêutica periadventicional

Cardiovascular disease remains the leading cause of death and disability worldwide, in part due to atherosclerosis. Atherosclerotic plaque narrows the ...

Setup and Execution of the Rapid Cycle Deliberate Practice Death Notification Curriculum

Death notification is an important and challenging aspect of Emergency Medicine. An Emergency Medicine physician must deliver bad news, often sudden and unexpected, to patients and family members without any previous relationship. Unskilled death notification after unexpected events can lead to the development of pathologic grief and posttraumatic stress disorder. It is paramount for Emergency Medicine physicians to be trained in and practice death notification techniques. The GRIEV_ING curriculum provides a conceptual framework for death notification. The curriculum has demonstrated improvement in learners&#8217; confidence and competence when delivering bad news. Rapid Cycle Deliberate Practice is a simulation-based medical education technique that uses within the scenario debriefing. This technique uses the concepts of mastery learning and deliberate practice. It allows educators to pause a scenario, provide directed feedback, and then let learners continue the simulation scenario the &#8220;right way.&#8221; The purpose of this scholarly work is to describe how to apply the Rapid Cycle Deliberate Practice debriefing technique to the GRIEV_ING death notification curriculum to more effectively train learners in the delivery of bad news.

The goal is to demonstrate how to apply the rapid cycle deliberate practice debriefing technique to the GRIEV_ING death notification curriculum.

Configuração e execução do currículo de notificação de morte prática rápida

Death notification is an important and challenging aspect of Emergency Medicine. An Emergency Medicine physician must deliver bad news, often sudden and ...