Minerva anestesiologica
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Although weaning predictors have been extensively explored in weaning research, their use is currently under debate. From all the stages of mechanical ventilation, the measurements of weaning predictors have been considered by some authors as imperative in order to progress weaning and initiate a weaning trial. However, this practice is rejected by other authors who considered that these tests are not necessary to perform a weaning trial, based in a meta-analysis study from the American College of Chest Physicians. ⋯ In order to reduce weaning duration, weaning strategies must be performed earlier, when a failed weaning trial probably is poor tolerated and the use of f/VT could have a role. New applications of weaning predictors must be clarified in future research, in order to progress in weaning in the context of new studies. Weaning is still a challenging period during mechanical ventilation.
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Assays of cardiac troponin have become a cornerstone in the diagnosis of myocardial infarction across a broad range of clinical settings. In critically ill patients, cardiac troponin is detectable in the plasma in up to 60% of cases, and this incidence may increase further as assays become more sensitive. Troponin rises in critical care are commonly unrelated to pathology in the coronary arteries, but are frequently associated with conditions such as sepsis and respiratory failure. ⋯ Despite adding prognostic value, treatment for non-coronary troponin rises remains limited to management of the underlying cause, and restoration of a favourable balance between myocardial oxygen demand and supply. Conversely, troponin rises secondary to myocardial infarctions are amenable to the same interventions as in any other setting, albeit with additional diagnostic and therapeutic challenges. In this review, we will explore the utility of troponin as a biomarker in critical care, and we will outline a pragmatic management strategy for this patient population.
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Minerva anestesiologica · Sep 2012
Comparative Study Clinical TrialGood prognostic value of the intraoperative tissue Doppler-derived index E/e' after non-cardiac surgery.
The index E/e' derived from tissue Doppler imaging and pulsed Doppler is the ratio of the early transmitral flow velocity and the early mitral annular velocity and it correlates with left ventricular filling pressure. The purpose of this study was to investigate the relationship between intraoperative E/e' and postoperative cardiovascular complications and length of ICU and hospital stays after a non cardiac surgery. ⋯ This data suggests that the tissue Doppler index E/e' may be a useful indicator for predicting morbid events after non-cardiac surgery. Furthermore, patients with an elevated intraoperative E/e' may need more careful postoperative management.
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The experimental evidence that ventilator could injure lungs through the application of excessive end-inspiratory volumes and transpulmonary pressures has led to major changes in the clinical management of patients suffering from the acute respiratory distress syndrome (ARDS). The prevention of ventilator-induced lung injury has become one of the main goals of current ventilator strategies for patients with ARDS as well as for patients with normal lungs that require mechanical ventilation. ⋯ Considerable efforts have been made within the last decades to try to develop new ventilator strategies as well as pharmacological and mechanical measures in order to prevent VILI and further improve the outcome of ARDS patients. This review will strive to describe seminal experimental and clinical studies that aimed at preventing the development of VILI.
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Minerva anestesiologica · Sep 2012
Influence of different flow-triggering levels on the breathing effort of mechanically ventilated patients.
Although a sensitive flow triggering (FT) level is supposed to be associated with reduced breathing effort, the incidence of autotriggering (AT) is likely to be increased. The actual effects of various FT levels on the work of breathing and occurrence of AT in mechanically ventilated patients are unknown. We investigated the effects of different FT levels (1-8 L/min) on breathing effort and incidence of AT in mechanically ventilated patients under pressure support ventilation using a Puritan-Bennett 840 ventilator. ⋯ A higher FT level was associated with lower incidence of AT, but without a significant increase in breathing effort. A higher FT level may be more reasonable in mechanically ventilated patients with this particular ventilator.