Anaesthesiology intensive therapy
-
Anaesthesiol Intensive Ther · Jan 2015
Review Meta AnalysisAbdominal signs and symptoms in intensive care patients.
Abdominal problems, both as a primary reason for admission or developing as a part of multiple organ dysfunction syndrome during an ICU stay, are common in critically ill patients. The definitions, assessment, incidence and outcome of different abdominal signs, symptoms and syndromes are assessed in the current review. General abdominal signs and symptoms include abdominal pain and distension, as well as other signs assessed during the physical examination (e.g. palpation, percussion). ⋯ In conclusion, abdominal symptoms occur in half of patients in ICUs. Clinical evaluation, albeit largely subjective, remains the main bedside tool to detect abdominal problems and to assess GI function in the critically ill. IAP is a useful additional tool in the assessment of abdominal complications in ICUs.
-
Anaesthesiol Intensive Ther · Jan 2015
ReviewFluid therapy and perfusional considerations during resuscitation in critically ill patients with intra-abdominal hypertension.
Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are consistently associated with morbidity and mortality among the critically ill or injured. Thus, avoiding or potentially treating these conditions may improve patient outcomes. With the aim of improving the outcomes for patients with IAH/ACS, the World Society of the Abdominal Compartment Syndrome recently updated its clinical practice guidelines. ⋯ However, it is important to recognise that IAH either abolishes or increases threshold values for pulse pressure variation and stroke volume variation to predict fluid responsiveness, while the presence of IAH may also result in a false negative passive leg raising test. Correct fluid therapy and perfusional support during resuscitation form the cornerstone of medical management in patients with abdominal hypertension. Controlled studies determining whether the above medical interventions may improve outcomes among those with IAH/ACS are urgently required.
-
Labour is thought to be one of the most intense and painful experiences in a woman's life. Numerous studies using a Visual Analogue Scale invariably demonstrate that 20% of women in labour describe the pain as "unbearable" and 60% describe the pain as "very intense". Since the mid-1980s, continuous epidural analgesia during labour has been considered the gold standard of labour anaesthesia and is currently the most frequently used. ⋯ The drug that is nearest to ideal is remifentanil. The countries in which it is widely used as an alternative type of labour anaesthesia have developed practice standards or guidelines practice. Guidelines and alternatives to pethidine protocols for effective labour analgesia in Poland might be merited.
-
Anaesthesiol Intensive Ther · Jan 2015
ReviewCommon pitfalls and tips and tricks to get the most out of your transpulmonary thermodilution device: results of a survey and state-of-the-art review.
Haemodynamic monitoring with transpulmonary thermodilution (TPTD) is less invasive than a pulmonary artery catheter, and is increasingly used in the Intensive Care Unit and the Operating Room. Optimal treatment of the critically ill patient demands adequate, precise and continuous monitoring of clinical parameters. Little is known about staff knowledge of the basic principles and practical implementation of TPTD measurements at the bedside. The aims of this review are to: 1) present the results of a survey on the knowledge of TPTD measurement among 252 nurses and doctors; and 2) to focus on specific situations and common pitfalls in order to improve patient management in daily practice. ⋯ TPTD has gained its place in the haemodynamic monitoring field, but, as with any technique, its virtue is only fully appreciated with correct use and interpretation.
-
Anaesthesiol Intensive Ther · Jan 2015
ReviewIntra-abdominal hypertension and abdominal compartment syndrome in pancreatitis, paediatrics, and trauma.
Intra-abdominal hypertension (IAH) is an important contributor to early organ dysfunction among patients with trauma and sepsis. However, the impact of increased intra-abdominal pressure (IAP) among pediatric, pregnant, non-septic medical patients, and those with severe acute pancreatitis (SAP), obesity, and burns has been studied less extensively. The aim of this review is to outline the pathophysiologic implications and treatment options for IAH and abdominal compartment syndrome (ACS) for the above patient populations. ⋯ Patients at risk for IAH should be identified early during their treatment (with a low threshold to initiate IAP monitoring). Appropriate actions should be taken when IAP increases above 20 mm Hg, especially in patients developing difficulty with ventilation. Although on-operative measures should be instituted first, one should not hesitate to resort to surgical decompression if they fail.