Minerva anestesiologica
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Ultrasonographic scanning of the lung is gaining ever-growing recognition as a diagnostic and monitoring imaging technique. Its role in trauma assessment has already been established as an extension of the focused assessment of trauma with sonography for the diagnosis of pneumothorax. As more centers are discovering the advantages of ultrasound and conducting experimental and comparative studies, its use for diagnosing many other lung pathologies is becoming even more important. ⋯ Here, we review all possible applications of lung ultrasonography used thus far in Intensive Care Units, where a readily available and biologically non-invasive imaging technique may make the difference in diagnosis. In addition, we describe how the non-invasive nature of ultrasonography allows it to be used as a monitoring device of disease progression vs the healing process. We also provide a detailed explanation of the methods and materials necessary and a few indications towards unanswered questions in this field of research.
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Minerva anestesiologica · Sep 2009
Case ReportsRecurrent lung collapse due to unidentified phrenic nerve injury after cardiac surgery.
Partial or complete recurrent lung collapse after cardiac surgery is one cause of failure to wean from ventilator support, and frequently leads to multiple reintubations and prolonging intensive care unit and hospital stays. A 79-year-old female underwent uneventful coronary artery bypass surgery and was extubated on the first postoperative day (POD). On POD 2, a routine portable chest X-ray (CXR) revealed complete opacification of the left hemithorax. ⋯ The patient gradually became stronger, and as the airway edema subsided, she was able to be managed on the regular nursing floor with intermittent CPAP mask treatments and mucolytics. Although uncommon, one documented cause of failure to wean from mechanical ventilation is diaphragmatic dysfunction. This finding is often delayed because it requires a sniff test in an extubated patient to make the diagnosis.
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Minerva anestesiologica · Sep 2009
Editorial CommentInfection versus innate immunity in septic shock.
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Minerva anestesiologica · Jul 2009
ReviewNon-invasive ventilation outside the Intensive Care Unit for acute respiratory failure.
Non invasive ventilation (NIV) has been shown to be an effective therapy in selected patients with acute respiratory failure. Due to its benefit and relative ease of use, NIV is frequently used. ⋯ Choosing the right time and type of patient with acute respiratory failure to improve the chances of success with NIV requires an appropriate environment and monitoring. This review presents and discusses the currently available data regarding NIV success outside the intensive care unit, the optimal ventilatory strategy, possible solutions to the mechanical problems and the minimum monitoring required.