Minerva anestesiologica
-
Minerva anestesiologica · Apr 2001
Multicenter StudyEvolution in the utilization of the mechanical ventilation in the critical care unit.
Use of mechanical ventilation has increased in recent years and constitutes a major therapeutic modality in the intensive care unit (ICU). In the recent years, changes in the ventilatory modes, in the ventilatory strategies and in the weaning from mechanical ventilation have occurred. We have compared the data obtained from the Spanish ICUs in studies that were carried out in three periods of the nineties, with the aim to test whether the aforementioned innovations have modified the clinical practice. ⋯ Concerning to weaning, over the course of the decade occurred an increase in use of pressure support ventilation and spontaneous breathing trial, being this method the most frequently used at the end of the decade. The performance of the tracheostomy has been lesser and earlier over the time. The results obtained suggest that findings from research on mechanical ventilation are incorporated into clinical practice at a very slow pace whereas the evidence obtained from the clinical trials about weaning has had a better reception.
-
Minerva anestesiologica · Apr 2001
Randomized Controlled Trial Clinical Trial[Control of postoperative pain in heart surgery. Comparison of analgesics].
Evaluation of the efficacy of three analgesic drugs (tramadol, ketorolac, and morphine) for the control of postoperative pain in cardiac surgery. ⋯ Tramadol in continuous infusion (dose 12 mg/h) proved to be effective for the control of postoperative pain after cardiac surgery. The proposed dose represents a good compromise between analgesic efficacy and interference with the vital functions of operated patients.
-
The pressure-volume curve of the respiratory system is a physiological method used for diagnotic purposes to describe the static mechanical properties of the respiratory system. A renewal of interest in the pressure-volume curve has recently appeared because of experimental evidence regarding the information conveyed by the curve, a better understanding of the pathophysiologic factors influencing its interpretation and the beneficial results of clinical trials based on the use of the pressure-volume curve for ventilatory management of acute respiratory distress syndrome. Thus, adapting ventilatory settings to individual characteristics of the patients in terms of respiratory mechanics may be an extremely important aspect for a better management of the most difficult to ventilate patients with acute lung injury. ⋯ The low-flow technique using ventilator technology has several potential advantages. It is hopeful to think that in the future the measurement of the P-V curve and the quantification of alveolar recruitment may be easily provided at the bedside and may help for the titration of the ventilatory settings in clinical practice. This review will focus briefly on the physiologic background, technique description, and recent advances concerning the interpretation of the P-V curve in the critically ill patients.
-
Clinical shock is a common problem of the critically ill patient. Assessment of the circulating volume is important to assure adequate oxygen supply to the tissues, and hypovolaemia must be treated promptly to avoid organ dysfunction. ⋯ Clinical signs are often late indicators and the monitoring of hemodynamic variables through cardiac catheterism can be misleading. The fluid challenge approach provides a useful diagnostic test of hypovolaemia, and a method for titrating the dose of fluid tailored to the individual's requirement.
-
Minerva anestesiologica · Apr 2001
ReviewPathophysiology and treatment of airway mucociliary clearance. A moving tale.
Airway hygiene depends largely on mucociliary clearance (MCC) which in turn depends upon the movement of viscoelastic mucus along the airway by the beating of the ciliary appendages of airway epithelial cells. Failure to keep the airways sterile by MCC results in a host inflammatory response to the persistent microorganisms which, if it becomes chronic, causes damage to the airway wall and upregulation of mucus production manifest clinically as bronchiectasis, sinusitis and otitis. There are three principal disorders of MCC. ⋯ Secondly, secondary ciliary dyskinesia due principally to microbial toxin-induced dysfunction of the energy pathways required for ciliary beating. Thirdly, abnormalities in the physicochemical properties of mucus, including reduced salt content/osmolality which results in it being unsuitable in quality for cilia to move it. Methods of rectifying this defect promise to restore MCC to normal and interfere in the vicious circle of inflammatory lung damage.