Anaesthesiology intensive therapy
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Anaesthesiol Intensive Ther · Jan 2015
ReviewFrom cardiac output to blood flow auto-regulation in shock.
Shock is defined as a state in which the circulation is unable to deliver sufficient oxygen to meet the demands of the tissues, resulting in cellular dysoxia and organ failure. In this process, the factors that govern the circulation at a haemodynamic level and oxygen delivery at a microcirculatory level play a major role. This manuscript aims to review the blood flow regulation from macro- and micro-haemodynamic point of view and to discuss new potential therapeutic approaches for cardiovascular instability in patients in cardiovascular shock. ⋯ All the levels of the circulatory system must be taken into account. Evaluation of microcirculation may help one to detect under-diagnosed shock, and together with classic haemodynamics, guide one towards the appropriate therapy. Restoration of classic haemodynamic parameters is essential but not sufficient to detect and treat patients in cardiovascular shock.
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Anaesthesiol Intensive Ther · Jan 2015
Awareness and knowledge of intra-abdominal hypertension and abdominal compartment syndrome: results of an international survey.
Surveys have demonstrated a lack of physician awareness of intra-abdominal hypertension and abdominal compartment syndrome (IAH/ACS) and wide variations in management of these conditions, with many intensive care units (ICUs) reporting that they do not measure intra-abdominal pressure (IAP). We sought to determine the association between publication of the 2006/2007 World Society of the Abdominal Compartment Syndrome (WSACS) Consensus Definitions and Guidelines and IAH/ACS clinical awareness and management. ⋯ This survey showed that although most responding clinicians claim to be familiar with IAH and ACS, knowledge of published consensus definitions, measurement techniques, and clinical management are inadequate.
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Anaesthesiol Intensive Ther · Jan 2015
Does epidural anaesthesia reduce the incidence of postoperative oxygen desaturation episodes in patients undergoing open abdominal aortic aneurysm repair?
Postoperative desaturation can lead to severe hypoxaemia and even tissue hypoxia, followed by cardiological and neurological complications. Opioid usage is the one of the most important risk factors of postoperative desaturation and hypoxemia. Epidural anaesthesia is recommended for vascular surgery for many reasons; the reduction or elimination of opioid doses is one reason. The aims of the study were to evaluate the incidence of desaturation episodes in patients after surgical procedures with abdominal aortic clamping, to determine whether the episodes in question lead to clinical symptoms of hypoxia and to determine whether epidural anaesthesia decreases the incidence of desaturation episodes. ⋯ Epidural anaesthesia did not protect against postoperative desaturation. Though oxygen therapy was used, desaturation was observed in approximately 90% of patients.
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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
Epidemiology of new-onset paroxysmal atrial fibrillation in the General Intensive Care Unit population and after discharge from ICU. A retrospective epidemiological study.
Evidence of various cardiac arrhythmias in septic patients has been demonstrated by multiple clinical reports and observations. Most cardiac arrhythmias in sepsis are new-onset and may be related to sepsis-induced myocardial dysfunction. We propose to investigate and analyze data of new-onset paroxysmal atrial fibrillation (AF) in a critically ill septic population. ⋯ In the present study we demonstrated no difference in morbidity and mortality rate in-ICU and after discharge between septic patients who had previous AF episodes and patients who had no previous past medical history of any cardiac arrhythmias.