Minerva anestesiologica
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Brain injured patients have an increased risk of extracerebral organ failure, mainly pulmonary dysfunction. The prevalent cause of pulmonary failure is ventilator associated pneumonia (VAP) which increases morbidity and mortality. The respiratory dysfunction is mainly characterized by the presence of alveolar consolidation of the dependent lobes. ⋯ In conclusion, in brain injured patients 1) the respiratory mechanics is altered; 2) PEEP is uneffective to improve respiratory function in respiratory failure due to ventilator associated pneumonia. Further studies are warranted to better elucidate the pathophysiology and clinical management of respiratory dysfunction in brain injured patients.
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The new OxiMax Pulse Oximetry System includes the Nellcor N-595 Pulse Oximeter and a new line of OxiMax sensor. The main feature of this platform is the digital memory chip inserted within each OxiMax sensor that contains all the calibration and operating characteristics for that individual sensor. It allows an information exchange between the sensor and the monitor improving monitoring performance during difficult acquisition periods. We reviewed several studies showing that the more centrally placed forehead sensor can offer significant advantage over finger sensor when monitoring patient with low pulse perfusion, especially in situation where rapid detection of hypoxemia is critical.
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Minerva anestesiologica · Apr 2002
Guideline[The SIAARTI document in preparation: recommendations on admission and discharge from intensive care units and on limits of treatments in intensive care].
The document in progress is intended to help the health care professionals in bioethical decision-making process in ICU. It will be probably written as Recommendations because it is a conceptual framework for making decision about intensive care, consensually derived from an Ad Hoc Sub-Committee of SIAARTI Ethics Committee. ⋯ These guidelines do not relieve health care professionals involved from their personal responsibility for decisions and action taken in individual cases. These guidelines are in line with the general ethical principles for the care of critically ill patients as formulated, as examples, in the following declarations and deontological codes: Declaration of Helsinki, Ethical Principles in Intensive Care (World Federation of Society of Intensive and Critical Care Medicine), Italian Medical Association's Deontological Code (3/10/98), European Convention of Bioethics Oviedo and in many others international consensus statements and guidelines.
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Percutaneous radial artery catheterization for blood gas monitoring and continuous arterial pressure recording has become a common procedure in the management of patient undergoing cardiac surgery operations. Since radial artery pressure does not accurately reflect central aortic pressure, in the immediate post bypass period and in low cardiac output states, specially during catecholamine infusion, a long arterial line is necessary. The author has been using several techniques of central arterial cannulation from 1980 to 2002 in 6303 procedures using central radial artery, including 734 patients with Length of Stay (LOS) >96 h, and 1880 patients with Seldinger Technique, using polyurethane Arrow catheter 16 G 50 cm. The use of long radial catheter has been recently associated, for the control pulse analysis, with Picco technology successfully in 74 patients undergoing cardiac and vascular surgery operations, having no complication. The author referred on the clinical aspect connected with the use of central radial catheter with special emphasis on safety of the procedure. a) Large retrospective review on the use of long arterial catheter (6303), including prospective (50 patients) Trial of consecutive unrandomized patients. b) ⋯ Cardiac surgery end vascular department in a large over 1000 beds and 4 Hospitals Administration (the study has been limited to cardiac surgery unit).