Annales françaises d'anesthèsie et de rèanimation
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One of the key challenges in perioperative care is to reduce postoperative morbidity and mortality. Patients who develop postoperative morbidity but survive to leave hospital have often reduced functional independence and long-term survival. Mechanical ventilation provides a specific example that may help us to shift thinking from treatment to prevention of postoperative complications. ⋯ Stimulated by previous findings in patients with acute respiratory distress syndrome, the use of lower tidal volume ventilation is becoming increasingly more common in the operating room. However, lowering tidal volume, though important, is only part of the overall multifaceted approach of lung protective mechanical ventilation. In this review, we aimed at providing the most recent and relevant clinical evidence regarding the use of mechanical ventilation in patients undergoing abdominal surgery.
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During the past few years, many manufacturers have developed a new generation anesthesia ventilators or anesthesia workstations with innovative technology and introduced so-called new ventilatory modes in the operating room. The aim of this article is to briefly explain how an anesthesia ventilator works, to describe the main differences between the technologies used, to describe the main criteria for evaluating technical and pneumatic performances and to list key elements not to be forgotten during the process of acquiring an anesthesia ventilator.
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Ann Fr Anesth Reanim · Jul 2014
ReviewExtracorporeal membrane oxygenation in adults for severe acute respiratory failure.
The purpose of this review is to examine the indications of extracorporeal membrane oxygenation (ECMO) for severe acute respiratory distress syndrome (ARDS). This technique of oxygenation has significantly increased worldwide with the H1N1 flu pandemic. ⋯ The enthusiasm for ECMO should not obscure the consideration for potential associated complications. Before widespread diffusion of ECMO, new trials should test the efficacy of early initiation or CO2 removal in addition to, or even as an alternative to mechanical ventilation for severe ARDS.
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Ann Fr Anesth Reanim · Jul 2014
ReviewInfluence of pain on postoperative ventilatory disturbances. Management and expected benefits.
Abdominal surgery induces postoperative ventilatory dysfunction related to a combination of reflex diaphragmatic inhibition, respiratory muscle injury and pain. The role of pain is difficult to isolate from other components. Thoracic epidural analgesia using local anesthetics is able to partially reverse the diaphragmatic dysfunction. ⋯ Regardless of the mechanisms, epidural analgesia has been shown to improve the postoperative ventilation and to prevent the occurrence of pulmonary complications. Pain relief, either by parenteral administration of opiate, and/or parietal blockade has been shown to improve the diaphragm motion and the overall respiratory status. All analgesic strategies may facilitate the implementation of postoperative physiotherapy which has a significant interest in preventing postoperative pulmonary complications.
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The incidents related to the medical devices are common during anesthesia and in intensive care unit. These incidents are rarely the cause of complications because monitoring detects them early; alternative scenarios allow bearing these problems. Although the incidence of these complications has much declined, these incidents are serious adverse events and at the origin of life-threatening complications. ⋯ Several actions are effective in preventing the occurrence of these incidents: the control before use, the continuation of the performance of the equipment, use based on the recommendations of the experts and manufacturers and appropriate training. This strategy is best applied by a clinical expert who has extensive technical knowledge. This expert is a key player for users learning and allows establishing and maintaining rules of use in collaboration with medical staff and biomedical engineers and manufacturers.