Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · May 2012
Review[Intraoperative ventilatory strategy in cardiac surgery: towards a multimodal approach].
Cardiac surgery with or without cardiopulmonary bypass (CPB) remains associated to respiratory morbidity. The underlying mechanisms are multiple. ⋯ The limitation of the inspired fraction, assisted ventilation controlled with low tidal volume, maintenance of ventilation during CPB and finally, a maneuver of vital capacity are the main components of respiratory management. Thus, to be fully effective, these strategies should be integrated into a multimodal approach starting from the induction and followed until ICU.
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Ann Fr Anesth Reanim · May 2012
Brachial cuff measurements of blood pressure during passive leg raising for fluid responsiveness prediction.
The passive leg raising maneuver (PLR) for fluid responsiveness testing relies on cardiac output (CO) measurements or invasive measurements of arterial pressure (AP) whereas the initial hemodynamic management during shock is often based solely on brachial cuff measurements. We assessed PLR-induced changes in noninvasive oscillometric readings to predict fluid responsiveness. ⋯ Regardless of CVP (i.e., during "blind PLR"), noninvasiveΔ(PLR)SAP more than 17% reliably identified fluid responders. During "CVP-guided PLR", in case of sufficient change in CVP, noninvasiveΔ(PLR)SAP performed better (cutoff of 9%). These findings, in sedated patients who had already undergone volume expansion and/or catecholamines, have to be verified during the early phase of circulatory failure (before an arterial line and/or a CO measuring device is placed).
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Ann Fr Anesth Reanim · May 2012
Case Reports[Acute negative pressure pulmonary edema: illustration from a unusual clinical case following a postoperative recurrent laryngeal nerve palsy].
Acute postoperative negative pressure pulmonary edema (NPPE) is a respiratory complication due to upper airway obstruction occurring most commonly in the postoperative period. Pathophysiologically, NPPE is explained by the abrupt generation of highly negative intrathoracic pressure that lead to fluid transudation from the pulmonary capillaries. This observation reports an unusual case of a young patient who has undergone total thyroidectomy for multinodular goiter. ⋯ This article stresses the importance of prevention of recurrent nerve palsy during thyroid surgery. It also highlights a little known respiratory complication: the NPPE. Understanding the pathophysiology of NPPE, rapid diagnosis and appropriate therapeutic measures could prevent its potential lethal consequences.