Anaesthesiology intensive therapy
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Anaesthesiol Intensive Ther · Jan 2018
ReviewUltrasound assessment of gastric emptying and the risk of aspiration of gastric contents in the perioperative period.
The risk of aspiration of gastric contents in the perioperative period constitutes a serious clinical problem and it is connected with increased mortality. At present, the risk of aspiration is assessed only on the basis of an interview and information obtained from the patient. Such assessment is not always reliable while the concomitance of some additional factors influencing the delay of gastric emptying significantly decreases its sensitivity. Using bedside ultrasound imaging in an assessment of gastric contents is a method which supports an objective, simple and quick assessment of the risk of aspiration, helps one to optimise perioperative anaesthetic management, and should constitute a routine element of the perioperative patient assessment.
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Anaesthesiol Intensive Ther · Jan 2018
ReviewPoint-of-care gastrointestinal and urinary tract sonography in daily evaluation of gastrointestinal dysfunction in critically ill patients (GUTS Protocol).
There is currently a lack of universally accepted criteria for gastrointestinal (GI) failure or dysfunction in critical care. Moreover, the clinical assessment of intestinal function is notoriously difficult and thus often goes unrecognized, contributing to poor outcomes. A recent grading system has been proposed to define acute gastrointestinal injury (AGI) in conjunction with other organ function scores (e.g., SOFA). ⋯ Moreover, it is possible to examine the urinary tract and kidney function. Real-time ultrasound with the GUTS protocol is a simple, inexpensive, bedside imaging technique that can provide anatomical and functional information of the GI tract. Further studies are needed to investigate the utility of GUTS with other parameters, such as GI biomarkers, AGI class, and clinical outcomes.
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Anaesthesiol Intensive Ther · Jan 2018
ReviewICU delirium - a diagnostic and therapeutic challenge in the intensive care unit.
ICU delirium is a common medical problem occurring in patients admitted to the intensive care units (ICUs). Studies have shown that ICU delirium is associated with increased mortality, prolonged hospitalization, prolonged mechanical ventilation, costs and the occurrence of cognitive disoders after discharge from ICU. The tools available for ICU delirium screening and diagnosis are validated tests available for all members if the medical team (physicians, nurses, physiotherapists). ⋯ They have been implemented as Pain, Agitation, Delirium (PAD) Guidelines by the Society of Critical Care Medicine. Apart from monitoring, a strategy of prevention and treatment is recommended, based on non-pharmacological approach (restoration of senses, early mobilization, physiotherapy, improvement in sleep hygiene and family involvement) as well as pharmacological treatment (typical and atypical antipsychotics and dexmedetomidine). In this article, we present the risk factors of ICU delirium, available tools for monitoring, as well as options for prevention and treatment of delirium that can be used to improve care over critically ill patients.