Medicina
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Review Comparative Study Historical Article
[Physiological aspects of cardiopulmonary resuscitation in adults].
This article reviews the physiology of cardiopulmonary resuscitation (CPR), monitoring and new devices for generating blood flow during CPR. Two controversial mechanisms of blood flow during chest compressions are described: the thoracic pump mechanism and cardiac pump mechanism. Also, new physiological aspects of blood flow, physiology of ventilation and gas transport during CPR are overviewed. ⋯ Electrocardiogram remains the most essential tool for diagnosis and monitoring of cardiac arrest. Monitoring of diastolic blood pressure, myocardial perfusion pressure and end-tidal CO2 are also useful. Other types of monitoring during cardiac arrests can provide information about effectiveness of CPR.
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Nosocomial pneumonia, especially ventilator-acquired pneumonia, has the greatest impact on patients' management in intensive care unit. Inappropriate initial antimicrobial treatment increases attributable and crude mortality from ventilator-acquired pneumonia. De-escalation therapy improves short-term survival of patients with ventilator-acquired pneumonia without increasing the emergence of resistant organisms.
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Comparative Study
Electrophysiology of small peripheral nerve fibers in man. A study using the cutaneous silent period.
Methods for assessing small peripheral nerve fiber function objectively are limited. The cutaneous silent period (CuSP), a transient suppression of electromyographic voluntary activity that follows painful stimuli, could serve as an objective functional measure of the A delta fibers. ⋯ The method for studying the CuSP is simple and well tolerated; it is useful to study A delta fibers in peripheral neuropathies and the central circuitry of this cutaneous nociceptive response in conditions affecting the spinal cord. Comparison of CuSP studies suggests the need for a standardization of the method.
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Pneumonia is the most frequently reported nosocomial infection in intensive care unit patients, predominantly in mechanically ventilated individuals. Most of the studies performed in intensive care unit settings reported the estimated 15-65% of ventilator-associated pneumonia, with high mortality rates. Ventilator-associated pneumonia results in prolonged hospitalization and increase in medical care costs. ⋯ Prevention of the ventilator-associated pneumonia by local multidisciplinary strategies may reduce mortality rates and is beneficiary both for the patients and the hospital system. The education of the nursing staff helps to decrease the occurrence of ventilator-associated pneumonia in intensive care unit setting. However, ventilator-associated pneumonia still remains a serious controversy-generating problem in intensive care unit.
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Review Comparative Study
[Severe pediatric head injury: is there any optimal solution?].
Traumatic brain injury in children is a worldwide problem. The incidence of trauma cases is increasing over the world, and in Lithuania it is several times higher than in the most developed European countries. The article reviews data about the most modern means of managing pediatric traumatic brain injury. ⋯ The role of intracranial pressure and cerebral perfusion pressure is crucial. Immediate management of intracranial pressure reduces mortality and improves outcomes. Techniques of intracranial pressure monitoring and management strategies of intracranial hypertension, their advantages and possible disadvantages are described.