Anaesthesiology intensive therapy
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Anaesthesiol Intensive Ther · Jan 2015
ReviewRole of permissive hypotension, hypertonic resuscitation and the global increased permeability syndrome in patients with severe hemorrhage: adjuncts to damage control resuscitation to prevent intra-abdominal hypertension.
Secondary intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are closely related to fluid resuscitation. IAH causes major deterioration of the cardiac function by affecting preload, contractility and afterload. The aim of this review is to discuss the different interactions between IAH, ACS and resuscitation, and to explore a new hypothesis with regard to damage control resuscitation, permissive hypotension and global increased permeability syndrome. ⋯ Novel markers like the capillary leak index, extravascular lung water and pulmonary permeability index may help the clinician in guiding appropriate fluid management. Capillary leak is an inflammatory condition with diverse triggers that results from a common pathway that includes ischaemia-reperfusion, toxic oxygen metabolite generation, cell wall and enzyme injury leading to a loss of capillary endothelial barrier function. Fluid overload should be avoided in this setting.
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Anaesthesiol Intensive Ther · Jan 2015
ReviewAssessment of regional ventilation in acute respiratory distress syndrome by electrical impedance tomography.
Mechanical ventilation in acute respiratory distress syndrome (ARDS) incurs a risk of ventilator-associated lung injury (VALI) from inhomogeneous conditions and different properties of dependent and non-dependent lung regions at risk of atelectasis and overdistension, respectively. Electrical impedance tomography (EIT) offers regional ventilation assessment to optimise treatment with mechanical ventilation. This article provides an overview of scientific literature on the application of impedance tomography in acute respiratory distress syndrome. It also presents the results of EIT studies in different clinical situations that may be of use in implementing impedance tomography for treating ARDS.
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Anaesthesiol Intensive Ther · Jan 2015
ReviewCardiac Ultrasonography in the critical care setting: a practical approach to asses cardiac function and preload for the "non-cardiologist".
Cardiac ultrasonography has become an indispensible tool in the management of hemodynamically unstable critically ill patients. Some consider it as the modern stethoscope. Echocardiography is non-invasive and safe while the modern portable devices allow to be used at the bedside in order to provide fast, specific and vital information regarding the hemodynamic status, as well as the function, structure and anatomy of the heart. ⋯ Echocardiography is also the perfect tool to evaluate right ventricular function with tricuspid annular plane systolic excursion (TAPSE), tissue Doppler imaging, together with inferior vena cava dimensions and systolic pulmonary artery pressure and right ventricular systolic pressure measurement. Finally, methods to assess fluid responsiveness with echocardiography are discussed with the inferior vena cava collapsibility index and the variation on left ventricle outflow tract peak velocity and velocity time integral. Cardiac ultrasonography is an indispensible tool for the critical care physician to assess cardiac preload, afterload and contractile function in hemodynamically unstable patients in order to fine-tune treatment with fluids, inotropes and/or vasopressors.
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Anaesthesiol Intensive Ther · Jan 2015
Apnea test in the determination of brain death in patients treated with extracorporeal membrane oxygenation (ECMO).
Extracorporeal Membrane Oxygenation (ECMO) is a well-established method of support in patients with severe respiratory and/or circulatory failure. Unfortunately, this invasive method of treatment is associated with a high risk of neurological complications including brain death. Proper diagnosis of brain death is crucial for the termination of futile medical care. ⋯ Hypercapnia achieved via this method should allow an apnea test to be conducted in the typical manner. In the case of profound desaturation and an inadequate increase in the arterial CO₂ concentration, the sweep gas flow rate may be increased to obtain the desired oxygenation level, and exogenous carbon dioxide may be added to achieve a target carbon dioxide level. Incorporation of an apnea test for ECMO patients is planned in the next edition of the Polish guidelines on the determination of brain death.
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Anaesthesiol Intensive Ther · Jan 2015
Non-invasive haemodynamic measurements with Nexfin predict the risk of hypotension following spinal anaesthesia.
Unfavourable circulatory system conditions have been observed in many patients with spinal anaesthesia. The most frequent symptoms include a decrease in blood pressure and, less frequently, bradycardia. The appearance of unfavourable consequences of spinal anaesthesia might be related to the initial status of the patient's circulatory system. The aim of this study was to establish the possibility of predicting unfavourable circulatory consequences (hypotension, bradycardia) following spinal anaesthesia, based on non-invasive haemodynamic assessment with a Nexfin device. ⋯ Nexfin-based non-invasive haemodynamic monitoring might be helpful in the identification of individuals with a high risk of hypotension following spinal blockade.