Anaesthesiology intensive therapy
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Anaesthesiol Intensive Ther · Jan 2015
ReviewHemodynamic monitoring: To calibrate or not to calibrate? Part 1 - Calibrated techniques.
Over recent decades, hemodynamic monitoring has evolved from basic cardiac output monitoring techniques to a broad variety of sophisticated monitoring devices with extra parameters. In order to reduce morbidity and mortality and optimize therapeutic strategies, different monitoring techniques can be used to guide fluid resuscitation and other medical management. Generally, they can be divided in calibrated and non-calibrated techniques. ⋯ However in complex situations or in patients not responding to fluid resuscitation alone, advanced hemodynamic monitoring is recommended with the use of calibrated techniques like transpulmonary thermodilution. Calibrated techniques are preferred in patients with severe shock and changing conditions of preload, afterload and contractility. The use of the pulmonary artery catheter should be reserved for patients with right ventricular failure in order to assess the effect of medical treatment.
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Anaesthesiol Intensive Ther · Jan 2015
Severe sepsis in intensive care units in Poland--a point prevalence study in 2012 and 2013.
Severe sepsis is associated with a high mortality rate, but the detailed epidemiology of sepsis is not well known in Polish hospitals. The aim of the study was to determine the prevalence and incidence of severe sepsis in Polish intensive care units (ICUs). ⋯ Severe sepsis was observed in one-fourth of patients treated in ICUs in Poland. However, the actual number of severe sepsis patients is at least 2 times higher because many patients with severe sepsis were treated outside accredited ICUs. Severe sepsis constitutes a major health problem in Poland.
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Anaesthesiol Intensive Ther · Jan 2015
Multicenter StudyResults of the severe sepsis registry in intensive care units in Poland from 2003-2009.
Severe sepsis remains the most common cause of death in intensive care units (ICUs) according to many epidemiological studies. There are no data in Poland on the extent of severe sepsis cases treated in ICUs. The aim of the study was to analyse the course and outcome of severe sepsis patients treated in Polish ICUs. ⋯ Patients with severe sepsis involved in the 7-year registry were critically ill in half of the cases because of intra-abdominal infections, and the majority of them had multi-organ dysfunction. The mortality of registered patients was high, but it significantly decreased during the observation time. Based on the results obtained from this voluntary registry, the authors conclude that mandated sepsis registries should be established in Polish hospitals to improve the strategy of diagnosing and managing this syndrome.
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Anaesthesiol Intensive Ther · Jan 2015
ReviewFluid therapy in critically ill patients: perspectives from the right heart.
As right heart function can affect outcome in the critically ill patient, a thorough understanding of factors determining right heart performance in health and disease is pivotal for the critical care physician. This review focuses on fluid therapy, which remains controversial in the setting of impending or overt right heart failure. ⋯ Following a general discussion of right heart function and failure, we specifically focus on important causes of right heart failure in the critically ill, i.e. sepsis induced myocardial dysfunction, the acute respiratory distress syndrome, acute pulmonary embolism and the effects of positive pressure ventilation. It is argued that fluid therapy should always be cautiously administered with the right heart in mind, which calls for close multimodal monitoring.
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Anaesthesiol Intensive Ther · Jan 2015
ReviewCritical care ultrasound in cardiac arrest. Technological requirements for performing the SESAME-protocol--a holistic approach.
The use of ultrasound has gained its place in critical care as part of our day-to-day monitoring tools. A better understanding of ultrasound techniques and recent publications including protocols for the lungs, the abdomen and the blood vessels has introduced ultrasound to the bedside of our ICU patients. However, we will prove in this paper that early machines, dating back more than 25 years, were perfectly able to do the job as compared to modern laptop machines with more features but few additional advantages. ⋯ Next comes the pericardium, to exclude pericardial tamponade. Finally, a transthoracic cardiac ultrasound is performed to check for other (cardiac) causes leading to cardiac arrest. The emphasis is on a holistic approach, where ultrasound can be seen as the modern stethoscope needed by clinicians to complete the full physiological examination of their critically ill unstable patients.