Minerva anestesiologica
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Minerva anestesiologica · Apr 2013
ReviewRecommendations for anesthesia and perioperative management of patients with neuromuscular disorders.
Patients with neuromuscular disorders are at high risk of intraoperative and postoperative complications. General anesthesia in these patients may exacerbate respiratory and cardiovascular failure due to a marked sensitivity to several anesthetic drugs. Moreover, succinylcholine and halogenated agents can trigger life-threatening reactions, such as malignant hyperthermia, rhabdomyolysis and severe hyperkalemia. ⋯ Anesthesia and perioperative management of patients with neuromuscular disorders are described in this article. To grade the strength of recommendations and the quality of evidence we adopted the GRADE approach. In case of low-quality evidence, these recommendations represent the collective opinion of the expert panel.
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Minerva anestesiologica · Apr 2013
ReviewPatient-ventilator dyssynchrony during assisted invasive mechanical ventilation.
Patient-ventilator dyssynchrony is common during mechanical ventilation. Dyssynchrony decreases comfort, prolongs mechanical ventilation and intensive care unit stays, and might lead to worse outcome. Dyssynchrony can occur during the triggering of the ventilator, the inspiration period after triggering, the transition from inspiration to expiration, and the expiratory phase. ⋯ To date, technological complexity has made it impossible to evaluate patient-ventilator synchrony throughout the course of mechanical ventilation. Studies have shown that a high index of dyssynchrony may increase the duration of mechanical ventilation. Better training, better ventilatory modes, and/or computerized systems that permit better synchronization of patients' demands and ventilator outputs are necessary to improve patient-ventilator synchrony.
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Fever is a common symptom in intensive care unit (ICU) patients and is caused by a wide variety of infectious and noninfectious disorders. The presence of fever often results in the act of diagnostic tests and procedures that considerably increase medical costs and expose the patient to inappropriate use of antibiotics which eventually results in antibiotic resistance. ⋯ Currently, managing ICU patients with fever should be towards a more restrictive approach than simply starting antibiotic therapy. This review summarizes the common causes of fever in ICU patients and outlines a clinical approach to the management of these patients.
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Fluid management is a crucial issue in patients with acute respiratory distress syndrome (ARDS). Assessment of preload responsiveness should help to define the best fluid strategy. Arterial pulse pressure variation (PPV), which represents the amplitude of the respiratory changes in arterial pulse pressure, is considered as a marker of preload responsiveness in patients mechanically ventilated and fully adapted to their ventilator. ⋯ Although a PPV >10-12% still keeps its good predictive value, a lower PPV (<10%) is far to guarantee fluid unresponsiveness since many false-negative cases can be encountered in this setting. Thus, performance of alternative preload responsiveness tests such as passive leg raising or end-expiratory occlusion tests, is necessary when low PPV values are measured. This review addresses the meaning of PPV, its conditions of use and its limits in ARDS patients.