Anaesthesiology intensive therapy
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Anaesthesiol Intensive Ther · Jan 2016
Safety of intensivist-led bedside decannulation of internal jugular bi-caval dual-lumen veno-venous extracorporeal membrane oxygenation cannulas and report of technique.
In the past decade, the rate and utilization of veno-venous extracorporeal membrane oxygenation (VV-ECMO) has increased dramatically. A single catheter technique has recently come into favour for providing VV-ECMO. Although it has been shown that intensivists can safely place these catheters, the safety of decannulation by intensivists has not been reported in the literature. ⋯ It is safe for intensivists to decannulate the Avalon Elite VV-ECMO cannula in the ICU using our purse-string suture technique. Performing these decannulations at the bedside compared to operating room may have positive clinical ramifications that include improved patient safety, timely patient care and reduced operating room costs.
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Anaesthesiol Intensive Ther · Jan 2016
Predictive value of the APACHE II, SAPS II, SOFA and GCS scoring systems in patients with severe purulent bacterial meningitis.
Scoring systems in critical care patients are essential for predicting of the patient outcome and evaluating the therapy. In this study, we determined the value of the Acute Physiology and Chronic Health Evaluation II (APACHE II), Simplified Acute Physiology Score II (SAPS II), Sequential Organ Failure Assessment (SOFA) and Glasgow Coma Scale (GCS) scoring systems in the prediction of mortality in adult patients admitted to the intensive care unit (ICU) with severe purulent bacterial meningitis. ⋯ For the prediction of mortality in a patient with severe purulent bacterial meningitis, SAPS II had the highest accuracy.
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Anaesthesiol Intensive Ther · Jan 2016
Case ReportsIntra-abdominal hypertension complicating pancreatitis-induced acute respiratory distress syndrome in three patients on extracorporeal membrane oxygenation.
Severe acute pancreatitis is associated with sever multiorgan failure from 15 to 50%, depending on the series. In some of these patients, conventional methods of ventilation and respiratory support will fail, demanding the use of extracorporeal membrane oxygenation (ECMO). Abdominal compartment syndrome is potentially harmful in this cohort of patients. We describe the successful treatment of three patients with severe acute pancreatitis who underwent respiratory ECMO and where intra abdominal pressure was monitored regularly. ⋯ Monitoring intraabdominal pressure is a valuable adjunct to decision making while caring for these high-risk critically ill patients.
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Anaesthesiol Intensive Ther · Jan 2016
Central venous pressure as an adjunct to flow-guided volume optimisation after induction of general anaesthesia.
Although the central venous pressure (CVP) is often used as a guide to volume status in major surgery and intensive care, fluid therapy should be guided by the response of the stroke volume (SV) to a fluid bolus. The present study evaluates whether the central venous pressure (CVP) can serve as an adjunct to decisions of whether or not fluid should be infused. ⋯ A low CVP suggests that the patient is lower on the Frank-Starling curve than indicated by SV as measured by FloTrac/Vigileo.
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Anaesthesiol Intensive Ther · Jan 2016
Anaesthetic perioperative management according to the ERAS protocol.
After many years of experience in surgery, a series of recommendations have been created by a group of European specialists to improve the quality of perioperative care and maximize postoperative outcomes. Early mobilization and oral feeding, preoperative oral intake of carbohydrate-rich fluids, proper fluid and pain management, intensive postoperative nausea and vomiting prophylaxis, and antimicrobial and thromboembolism prophylaxis are the interventions that may decrease surgery-induced metabolic stress and facilitate the return of bowel function and early discharge. The Enhanced Recovery After Surgery (ERAS) Society is the group that focuses on these perioperative issues. This paper aims to summarize the role of anaesthesiologists in the implementation of the ERAS protocol.