Minerva anestesiologica
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During video assisted thoracoscopy (VAT) the lung should be well collapsed. When the separation of the lungs is strictly indicated, use of difficult tube, such as double lumen tube (DLT) or Univent tube cannot be avoided, despite the presence of a difficult airway. If a patient has a recognized difficult airway, awake intubation with fiberoptic bronchoscopy can be attempted with Univent tube, DLT or with single lumen tube (SLT). ⋯ The most important feature of the blocker is its flexible soft tip that allows to direct it in the desired bronchus. The blocker contains a lumen that allows suctioning of the lung to facilitate deflation, suctioning of secretion and insufflation of oxygen. In summary, the clinician should be able to master different methods of lung separation and make him/her self familiar with the available devices.
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The measurement of nursing workload first began in the 1970s, because of the need for determining severity of illness and cost-effectiveness in the intensive care unit. In the following decades, the need for more specific tools for assessing nursing workload brought to the development of scoring systems more focused on nursing activities. We will briefly review the scoring systems validated since 1974. ⋯ It describes 81% of the nursing time, compared to 43% of TISS 28. In conclusion, many scoring systems have been proposed to describe nursing workload, both directly (as with TOSS and PRN) or through severity and complexity of treatment (TISS, TISS 28, NAS and NEMS). These scores represent the instruments to assess the correct use of ICU resources.
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Minerva anestesiologica · May 2004
[Use of protein C concentrate in adult patients with severe sepsis and septic shock].
The aim of this study is to describe the first experiences on the use of protein C concentrate (PC) in adult patients with severe sepsis and septic shock and clinical contraindications to activated protein C (APC). On the basis of the effectiveness demonstrated by the activated form in sepsis and of the encouraging results expressed in literature of protein C concentrate (PC) mainly about meningococcus fulminating infections, we carried out an observational study on protein C concentrate (PC) with 28-day follow-up and a daily analysis of the hemato-chemical and clinical parameters. Particular attention was paid to the variations in the PC plasma levels, to the modifications of the coagulation system, to the SOFA score as well as to the safety under bleeding risk conditions. ⋯ In our small number of patients, protein C concentrate has proven to be safe and particularly useful in the control of the coagulopathy triggered and sustained by sepsis.