Resuscitation
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Many critically ill patients suffer pain which can produce by itself undesirable effects. Consequently, pain must be carefully prevented, or at least, treated early and effectively. ⋯ Computer-assisted intravenous "on demand" analgesia with Fentanyl can also be used. When pain coverage is required during transient events such as active physiotherapy or dressing changes, additional intravenous of a narcotic (1-2 mg morphine e.g.) or inhalation of nitrous oxide with oxygen are usually effective.
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Hyperlactatemia is frequently observed in critically ill patients. A correlation of blood lactate concentrations and outcome of patients has been proven in circulatory shock, circulatory arrest, acute myocardial infarction, acute hypnotic drug poisoning and severe pancreatitis. ⋯ In individual patients, hyperlactatemia is a useful indicator pointing to the severity of illness and to superimposed complications. Blood lactate is of considerable value for the metabolic monitoring of critically ill patients.
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Increase in total cardiac output can improve oxygen delivery to the cells. Although inotropic drugs increase primarily myocardial contractility, they can adversely affect cardiac preload and afterload. Moreover, they can dangerously increase myocardial oxygen requirements. The combined use of vasodilating agents, with fluid challenge represents a challenging but more efficient treatment of acute circulatory failure.
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HFPPV is not a jet technique, as it works without air entrainment. A low-compression ventilator, with a conventional rate of 20/min, provides efficient intrapulmonary gas mixing; however, with higher rates of 60-100/min the high inspiratory flow improves transfer/mixing of gas in the conducting airways. ⋯ It is important to note that enhanced gas mixing and improved gas distribution during HFPPV in acute respiratory failure patients are accomplished with lower mean airway pressure, thereby reducing barotrauma. In the future, versatile low-compression ventilators for volume-controlled IPPV and HFPPV will hopefully improve safety, efficiency and patient acceptance of mechanical ventilation in acute respiratory failure.