Minerva anestesiologica
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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.
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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.
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It is increasingly apparent that organ dysfunction in sepsis is caused, at least in part, by an acquired intrinsic derangement in cellular oxidative adenosine triphosphate (ATP) production. We have termed this phenomenon "cytopathic hypoxia". Although several different but mutually compatible mechanisms might account for the development of cytopathic hypoxia in sepsis, recent data from our laboratory point to activation of the nuclear enzyme, poly-ADP-ribosyl polymerase (PARP), as being the most important.
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Minerva anestesiologica · Apr 2001
Randomized Controlled Trial Clinical TrialAutomated protamine dose assay in heparin reversal management after cardiopulmonary by pass.
To evaluate the impact of automated Protamine Dose Assay (PDA) performed with Hemochron 8000 (International Technodyne Company, Edison, NJ) on the management of heparin reversal after cardiopulmonary bypass (CPB). PDA was compared with empirical protamine to heparin ratio with regard to calculation of the protamine dose, and the sensitivity of PDA and ACT to residual circulating heparin after protamine administration was investigated too. ⋯ PDA allowed us to administer a significantly lower amount of protamine. This can reduce incidence of adverse effects of over- and under-infusion of protamine. PDA also proved to be more sensitive than ACT in detecting residual circulating heparin after protamine administration.
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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.