Minerva anestesiologica
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Minerva anestesiologica · Jan 2011
ReviewTime to wake up the patients in the ICU: a crazy idea or common sense?
With the first generation of ventilators, it was often necessary to sedate patients to avoid dyssynchrony between patient and ventilator. The standard treatment of patients in need of mechanical ventilation has therefore traditionally included sedation. Modern ventilators are able to simulate the patients breathing efforts to a higher degree, and therefore, deep sedation is no longer necessary. ⋯ Additionally, it has been shown that combining both a spontaneous breathing trial and a daily wake up trial reduced the mechanical ventilation time compared to a spontaneous breathing trial alone. We have recently shown in a randomized study that the use of no sedation, compared to the standard treatment with sedation and a daily wake up trial, reduced the time that patients required mechanical ventilation, the length of the patients' stay in the intensive care unit, and the total length of the hospital stay. All evidence indicates that the use of sedative drugs should be reduced, patients should be mobilized, and each patient's needs should be evaluated on a daily basis to optimize the care of each individual patient.
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Minerva anestesiologica · Jan 2011
ReviewLung recruitment maneuvers during acute respiratory distress syndrome: is it useful?
Although significant advances have been made in approaches to manage the acute respiratory distress syndrome (ARDS), reported overall mortality for ARDS is still high. Recruitment maneuvers (RM) have been recommended by some as potential adjuncts to lung protective ventilatory approaches in ARDS. ⋯ Specifically, the ability of RM to open the lung, the safety of RM, and their affect on outcome are addressed. Finally, a specific approach to performing RM with the use of a decremental PEEP trial is outlined.
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Minerva anestesiologica · Jan 2011
Comparative StudyThe influence of severe obesity on non-invasive ventilation (NIV) strategies and responses in patients with acute hypercapnic respiratory failure attacks in the ICU.
Obesity rates are increasing in the general population and are also prevalent in intensive care units (ICUs). Patients are sometimes admitted to ICUs for hypercapnic respiratory failure or cor pulmonale, but more often, they are admitted for pneumonia, excessive daytime sleepiness, heart failure, chronic obstructive pulmonary disease (COPD), asthma attacks or pulmonary embolism, and hypercapnic respiratory failure is coincidentally noticed during this period. The optimal noninvasive mechanical ventilation strategy is often not used during ICU treatment. The aim of this study was to assess the differences between non-invasive ventilation (NIV) strategies and the outcomes of obese and non-obese patients with acute hypercapnic respiratory failure. ⋯ These results suggest that improvement in hypercapnia in obese patients may require higher PEEP levels and longer times than that of non-obese patients during acute hypercapnic respiratory failure attack.
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Minerva anestesiologica · Jan 2011
Case ReportsLipid therapy for serotonin syndrome after intoxication with venlafaxine, lamotrigine and diazepam.
A 44-year-old woman developed coma and seizure activity after intentional ingestion of 200 mg diazepam, 20 g lamotrigine and 4.5 g venlafaxine. In our intensive care unit a distinct rigidity and hyperreflexia was observed. This status was not influenced by haemodialysis which was initiated directly after admission. ⋯ Eight hours after the start of haemodialysis a 150 mL (2.5 mL/kg) intravenous bolus of 20% lipid emulsion was given. Soon after administration of the lipid infusion the distinct rigidity and hyperreflexia disappeared. The further course was uneventful.
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Minerva anestesiologica · Jan 2011
Clinical TrialNon-invasive ventilation after cardiac surgery outside the Intensive Care Unit.
Non-invasive ventilation (NIV) can prevent or treat postoperative acute respiratory failure. NIV after discharge from the Intensive Care Unit (ICU) has never been described in the setting of cardiac surgery. ⋯ In our experience, postoperative NIV is feasible, safe and effective in treating postoperative acute respiratory failure when applied in the cardiac surgical ward, preserving intensive care unit beds for surgical activity. A respiratory therapy service managed the treatment in conjunction with ward nurses, while an anesthesiologist and a cardiologist served as consultants.