Minerva anestesiologica
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Minerva anestesiologica · Dec 2013
ReviewFungal Sepsis in the ICU: Are We Doing Better? - Trends in Incidence, Diagnosis, and Outcome.
Despite the availability of broad-spectrum antifungal agents, fungal sepsis remains an issue in Intensive Care Unit (ICU) patients. In terms of occurrence rates, the most important fungal infections are invasive candidiasis and invasive pulmonary aspergillosis. Early diagnosis is essential to optimize the chances of survival. ⋯ Given the problematic diagnosis of invasive aspergillosis no reliable trend data are available. Outcome following fungal sepsis remains cumbersome. Given the availability of potent antifungal agents any progress in survival is likely to come from a more timely diagnosis.
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Minerva anestesiologica · Dec 2013
Case ReportsMechanical and electrical equipment interference provokes a misleading Neurally Adjusted Ventilatory Assist (NAVA) EAdi signal. A technical note.
Neurally Adjusted Ventilatory Assist (NAVA) offers synchronized proportional pressure in accordance with the electrical activity of the diaphragm (EAdi). NAVA relies on the EAdi to trigger the respiratory cycle and then adjusts the ventilatory assist to the neural drive. The technique necessitates a catheter with bipolar microelectrodes positioned near the crural diaphragm where this signal can be captured. Capturing a reliable EAdi signal is a condition sine qua non for using NAVA as a mode of ventilation. The displayed signal represents the sum of the electrical activity of the muscle action potential of the diaphragm and is expressed in microvolts. ⋯ We illustrate that the detection and therefore interpretation of the EAdi signal during NAVA can be influenced by mechanical and electrical interference by other equipment used in the ICU or from endogenous leaking cardiac activity.