Minerva anestesiologica
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The authors briefly review the clinical applications of non-invasive ventilation (NIV) in patients with chronic obstructive pulmonary disease (COPD), mostly focusing on the application of NIV in the intensive care setting. After a short discussion of the main pathophysiologic aspects of NIV administration in patients with acute exacerbation of COPD, the most relevant clinical trials are shortly reviewed, particularly focussing on prospective randomised trials. NIV application is analysed both in its early administration, as a tool to prevent endotracheal intubation and its main complication, and as a technique alternative to endotracheal intubation in patients requiring mechanical ventilation. Finally, the main contraindications for NIV are reviewed and discussed.
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Minerva anestesiologica · Apr 2004
ReviewMicrovasculature in ventilator-induced lung injury: target or cause?
Clinicians managing acute lung injury must reconcile the competing objectives of ensuring adequate oxygen delivery and minimizing the adverse effects of ventilatory support. Judging from our experimental work, microvascular stresses appear to be a potent cofactor in the development of pulmonary edema as well as in the expression of lung damage resulting from an injurious pattern of ventilation. ⋯ Raising ventilation frequency may also have cost. Such observations imply that reducing the demands for blood flow and ventilation are important considerations in formulating a lung protective approach to mechanical ventilation of ARDS.
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Maintenance of adequate cardiac preload is of paramount importance in the treatment of patients undergoing major surgical surgery and in the critically ill setting. The end point is to maintain the organ perfusion through volume replacement and therapy to optimize cardiac output, oxygen deliver. ⋯ We briefly review the intra thoracic blood volume index as a preload index and the fluid responsiveness indexes, stroke volume variation and pulse pressure variation, available as novel parameters at the bed-side. The optimization of fluid balance and vasoactive drugs administration based on volumetric monitoring makes the transpulmonary indicator dilution technique a new option as an effective monitoring system where intravascular volume management is a primary objective.
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Minerva anestesiologica · Apr 2004
ReviewThe pulmonary artery catheter in critically ill patients. Does it change outcome?
Initially described more than 30 years ago, the Pulmonary Artery Catheter (PAC) technique was becoming more and more used in the following years. This hemodynamic monitoring device can be used according 2 different therapeutic attitudes. The first one strives to achieve supranormal hemodynamic values, particularly in terms of cardiac index and oxygen consumption. ⋯ Furthermore, because it is an invasive procedure, the safety of the PAC has been seriously questioned for several years. However, the recent study of Richard and coworkers clearly demonstrated that the use of PAC was not responsible for increased mortality in severely ill patients with circulatory shock and/or acute respiratory distress syndrome. The development of educational programs would allow to improve the quality of the collection and interpretation of hemodynamic parameters with the hope to enhance the efficiency of the PAC for the management of critically ill patients.
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Minerva anestesiologica · Apr 2004
Review[Cerebral oxygen consumption and ischemia in traumatic brain injury].
Clinical and experimental studies have shown a reduction of cerebral blood flow (CBF) and metabolic alterations following traumatic brain injury (TBI). The incidence of ischemia and the meaning of post-traumatic metabolic alterations are still unclear. ⋯ Cerebral ischemia occurs following TBI and should be defined based on CBF value and the metabolic needs of the brain. Global monitoring of cerebral oxygenation adequacy should be combined with regional monitoring. The meaning of high AJDO(2) values should be reconsidered: if they can highlights potential ischemia they are also showing a still living brain with a partially preserved oxygen extraction capability.