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Anaesthesiology Intensive Therapy

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https://www.readbyqxmd.com/read/29165778/cardiac-ultrasound-a-true-haemodynamic-monitor
#1
Jan Poelaert, Manu L N G Malbrain
Cardiac ultrasound has been used in the critically ill for more than thirty years. The technology has made enormous progression with respect to image quality and quantity, various Doppler techniques, as well as connectivity, the transfer of data and offline calculations. Some consider cardiac ultrasound as the stethoscope of the Twenty-first century. The potential of eye-balling moving cardiac structures gives undeniable power to this diagnostic and monitoring tool. The main shortcoming is the discontinuous mode of monitoring and the fact that optimal information acquisition can only be obtained when one is well-trained and experienced...
November 22, 2017: Anaesthesiology Intensive Therapy
https://www.readbyqxmd.com/read/29165777/the-use-of-crystalloids-in-traumatic-brain-injury
#2
Wojciech Dąbrowski, Tom Woodcock, Ziemowit Rzecki, Manu L N G Malbrain
Fluid therapy is one of the most important treatments in patients with traumatic brain injury (TBI) as both hypo- and hypervolaemia can cause harm. The main goals of fluid therapy for patients with TBI are to optimize cerebral perfusion and to maintain adequate cerebral oxygenation. The avoidance of cerebral oedema is clearly essential. The current weight of evidence in the published literature suggests that albumin therapy is harmful and plasma substitutes have failed to demonstrate superiority over crystalloids solutions...
November 22, 2017: Anaesthesiology Intensive Therapy
https://www.readbyqxmd.com/read/29165776/model-driven-gas-exchange-monitoring-in-the-critically-ill
#3
Cosmin Ion Balan, Adrian View-Kim Wong
Understanding pulmonary gas exchange performance is a dynamic process which, depending on clinical context, exhibits different levels of complexity. Global tools such as tension-based indexes yield clinically crucial information under very specific conditions. Yet, accurate mechanistic insight can only originate in model-based tools. One-parameter models such as shunt or dead space are well established in clinical practice whilst two or three-parameter models have just been advanced and their role is yet to be delineated...
November 22, 2017: Anaesthesiology Intensive Therapy
https://www.readbyqxmd.com/read/29165775/re-operative-abdominal-predictive-score-a-prognostic-model-combining-acute-re-intervention-predictive-index-and-intra-abdominal-pressure
#4
Caridad de Dios Soler-Morejón, Tomás Ariel Lombardo-Vaillant, Teddy Osmín Tamargo-Barbeito, Robert Wise, Manu L N G Malbrain
BACKGROUND: The decision to re-operate after abdominal surgery is still difficult, especially in the setting of intra-abdominal sepsis. Mathematical models provide a good aid to both diagnosis and decision-making. METHODS: A prospective observational study was conducted with 300 patients consecutively admitted to the intensive care unit of an academic institution affiliated to Calixto García Medical Faculty following abdominal surgery from January 2008 to January 2010...
November 22, 2017: Anaesthesiology Intensive Therapy
https://www.readbyqxmd.com/read/29152710/the-black-box-revelation-monitoring-gastrointestinal-function
#5
Pieter-Jan Moonen, Annika Reintam Blaser, Joel Starkopf, Heleen M Oudemans-van Straaten, Jan Van der Mullen, Griet Vermeulen, Manu L N G Malbrain
The gastrointestinal tract comprises diverse functions. Despite recent developments in technology and science, there is no single and universal tool to monitor GI function in intensive care unit (ICU) patients. Clinical evaluation is complex and has a low sensitivity to diagnose pathological processes in the abdomen. We performed a MEDLINE and Pubmed search connecting abdominal assessment and critical care. Based on these findings we defined the following major categories of monitoring and diagnostic measures: clinical investigation; assessment of motility and digestive function; microbiome monitoring; perfusion monitoring; laboratory biomarkers and hormonal function; intra-abdominal pressure measurement; and imaging techniques...
November 20, 2017: Anaesthesiology Intensive Therapy
https://www.readbyqxmd.com/read/29152709/perioperative-gastrointestinal-problems-in-the-icu
#6
Annika Reintam Blaser, Joel Starkopf, Pieter-Jan Moonen, Manu L N G Malbrain, Heleen M Oudemans-van Straaten
Gastrointestinal (GI) problems after surgery are common and are not limited to patients undergoing abdominal surgery. GI function is complicated to monitor and is not included in organ dysfunction scores widely used in the ICUs. In most cases, it recovers after surgery, if systemic and local inflammation and perfusion improve, gut oedema resolves, and analgosedation is reduced. However, perioperative GI problems may have severe consequences and increase the risk of death if not recognized and managed in a timely manner...
November 20, 2017: Anaesthesiology Intensive Therapy
https://www.readbyqxmd.com/read/29151003/lung-ultrasound-in-the-critically-ill-luci-a-translational-discipline
#7
Daniel A Lichtenstein, Manu L N G Malbrain
In the early days of ultrasound, it was not a translational discipline. The heart was claimed by cardiologists, with others, such as gynaecologists, urologists and vascular surgeons claiming their part while the rest was given to radiologists. Only recently, ultrasound transgressed and crossed the usual borders between the different disciplines, such as emergency and critical care medicine. The advent of portable machines in the early 1980s, allowed the critical care physician to perform bedside ultrasound, and the development of whole body critical care ultrasound (CCUS) was born...
November 18, 2017: Anaesthesiology Intensive Therapy
https://www.readbyqxmd.com/read/29151002/management-of-arrhythmia-in-sepsis-and-septic-shock
#8
Martin Balik, Vojtech Matousek, Michal Maly, Tomas Brozek
The occurrence of supraventricular arrhythmias is associated with an unfavourable prognosis in septic shock. Available trials are difficult to apply in sepsis and septic shock patients due to included cohorts, control groups and because "one size does not fit all". The priorities in the critically ill are maintenance of a sinus rhythm and diastolic ventricular filling. The rate control modality should be reserved for chronic AF and in situations when a sinus rhythm is difficult to maintain due to extreme stress conditions resulting from a high dosage of vasoactive agents...
November 18, 2017: Anaesthesiology Intensive Therapy
https://www.readbyqxmd.com/read/29151001/intravenous-fluid-therapy-for-hospitalized-and-critically-ill-children-rationale-available-drugs-and-possible-side-effects
#9
Thomas Langer, Rosamaria Limuti, Concezione Tommasino, Niels van Regenmortel, Els L I M Duval, Pietro Caironi, Manu L N G Malbrain, Antonio Pesenti
Human beings are constituted mainly of water. In particular, children's total body water might reach 75-80% of their body weight, compared to 60-70% in adults. It is therefore not surprising, that children, especially hospitalized newborns and infants, are markedly prone to water and electrolyte imbalances. Parenteral fluid therapy is a cornerstone of medical treatment and is thus of exceptional relevance in this patient population. It is crucial to appreciate the fact that intravenous fluids are drugs with very different characteristics, different indications, contraindications and relevant side effects...
November 18, 2017: Anaesthesiology Intensive Therapy
https://www.readbyqxmd.com/read/29151000/implementing-clinical-practice-changes-in-critical-care-lessons-learned-in-a-national-collaborative-of-over-60-icu-teams
#10
Ruth Kleinpell, Jerry J Zimmerman
Improving care in the intensive care unit (ICU) is a global area of focus for clinicians worldwide. The complexity of the ICU environment, compounded by multiple patient comorbidities and high acuity levels, makes the ICU a unique and challenging area of clinical practice. The essence of quality improvement - designing and implementing strategies to enhance care - fit well with the ICU setting. However, implementing clinical change is challenging, regardless of the clinical setting. A national collaborative targeting ICU settings was initiated which provided a number of lessons learned regarding implementing quality of care initiatives in critical care...
November 18, 2017: Anaesthesiology Intensive Therapy
https://www.readbyqxmd.com/read/29150999/focus-on-focus-lack-of-coherence-between-systemic-and-microvascular-indices-of-edema-formation
#11
Birkitt Ten Tusscher, Corien Gudden, Suus van Vliet, Bob Smit, Can Ince, E Christiaan Boerma, Harm-Jan S de Grooth, Paul W G Elbers
BACKGROUND: Fluid therapy remains a cornerstone of therapy in shock states. However, fluid overloading ultimately results in edema formation which is related to excess morbidity and mortality. Handheld microscopes are now frequently used to study the sublingual microcirculation. As a corollary, these devices measure focal distance, or surface to capillary distance. Physiologically, this could represent a microvascular index of edema formation and could have the potential to guide fluid therapy...
November 18, 2017: Anaesthesiology Intensive Therapy
https://www.readbyqxmd.com/read/29150998/a-whiter-shade-of-pale-the-ongoing-challenge-of-haemorrhagic-shock
#12
David J J Muckart, Manu L N G Malbrain
No abstract text is available yet for this article.
November 18, 2017: Anaesthesiology Intensive Therapy
https://www.readbyqxmd.com/read/29150997/the-future-of-evidence-based-medicine-is-the-frog-still-boiling
#13
David J J Muckart, Manu L N G Malbrain
No abstract text is available yet for this article.
November 18, 2017: Anaesthesiology Intensive Therapy
https://www.readbyqxmd.com/read/29150996/the-sep-1-quality-mandate-may-be-harmful-how-to-drown-a-patient-with-30-ml-per-kg-fluid
#14
Paul E Marik, Manu L N G Malbrain
No abstract text is available yet for this article.
November 18, 2017: Anaesthesiology Intensive Therapy
https://www.readbyqxmd.com/read/29027658/pathological-drainage-of-the-right-superior-vena-cava-into-the-left-atrium-diagnosed-in-a-37-year-old-patient-in-postpartum-period-a-case-report
#15
Katarzyna Elżbieta Krysiak-Neneman, Karina Stefańska-Wronka, Jacek Galicki, Jolanta Miszczak-Śmiałek, Łukasz Matuszewski
No abstract text is available yet for this article.
October 13, 2017: Anaesthesiology Intensive Therapy
https://www.readbyqxmd.com/read/29027657/practical-issues-of-nutrition-during-continuous-renal-replacement-therapy
#16
Dariusz Onichimowski, Radosław Goraj, Rakesh Jalali, Jolanta Grabala, Ewa Mayzner-Zawadzka, Mirosław Czuczwar
Continuous renal replacement therapy (CRRT) in critically ill patients has significant impact on one's ability to provide efficient nutritional therapy. CRRT may help in the prevention of intestinal oedema and the maintenance of the proper function of the gastrointestinal tract by enabling strict control of the fluid balance. It facilitates early introduction of nutrition via the enteral route, as well as allowing for the composition of high-volume feeding mixtures. It is necessary to take into consideration that during CRRT, together with blood purification of toxic substances, nutritive elements are also eliminated to some extent (micro- and macronutrients)...
October 13, 2017: Anaesthesiology Intensive Therapy
https://www.readbyqxmd.com/read/29027656/pulmonary-complications-after-non-cardiac-surgeries-temporal-patterns-and-risk-factors
#17
Cássia Toledo, Flávio Eduardo Nácul, Marcos Freitas Knibel, Nilton Brandão Silva, Ederlon Rezende, Cintia Magalhães Carvalho Grion, Murillo Assunção, Fernando Gutierrez, Joelma Villafanha Gandolfi, Suzana Margareth Lobo
BACKGROUND: Postoperative complications are the primary determinants of survival following major surgery. We aimed to characterize the early perioperative risk factors for postoperative pulmonary complications (POPCs) in patients undergoing major non-cardiac surgeries. METHODS: This study utilized a multicenter prospective observational cohort design. Adult patients undergoing non-cardiac surgeries and admitted to 21 Brazilian ICUs were screened for inclusion in the study...
October 13, 2017: Anaesthesiology Intensive Therapy
https://www.readbyqxmd.com/read/29027655/determinants-of-immediate-failure-of-noninvasive-mechanical-ventilation-outside-the-intensive-care-unit
#18
Killen H Briones Claudett, Monica H Briones Claudett, Antonio M Esquinas, Michelle Grunauer Andrade
BACKGROUND: This study aimed to characterize which are the early determinants of immediate failure of the use of noninvasive mechanical ventilation (NIMV) outside the ICU. METHODS: This prospective study included patients who were admitted to the Military Hospital in Guayaquil, Ecuador. Each variable was analyzed independently by using a multiple logistic regression model toward establishing an association with the event. A P-value of < 0.05 was considered statistically significant...
October 13, 2017: Anaesthesiology Intensive Therapy
https://www.readbyqxmd.com/read/29027654/pharmacokinetic-drug-drug-interactions-in-the-intensive-care-unit-single-centre-experience-and-literature-review
#19
Piotr Łój, Aleksanda Olender, Weronika Ślęzak, Łukasz J Krzych
BACKGROUND: Drug-drug interactions constitute a serious health hazard in everyday clinical practice in critically ill patients. Drug-drug interactions may be pharmacokinetic or pharmacodynamic in their nature. We aimed to investigate the quantity and quality of possible drug-drug interactions, and their possible side effects in intensive care unit patients in a 12-month period. METHODS: This retrospective study covered data on pharmacological treatment of 43 consecutive patients (11 females, 32 males) aged 62 ± 15 years, hospitalized between January 2015 and February 2016...
October 13, 2017: Anaesthesiology Intensive Therapy
https://www.readbyqxmd.com/read/29027653/comparison-of-dexmedetomidine-and-fentanyl-to-prevent-haemodynamic-response-to-skull-pin-application-in-neurosurgery-double-blind-randomized-controlled-trial
#20
Cattleya Thongrong, Pannawat Sirikannarat, Pornthep Kasemsiri, Pichayen Duangthongphon
BACKGROUND: Skull pin application during craniotomy is a highly noxious stimulus. Therefore, the attenuated effect between dexmedetomidine and fentanyl was investigated. METHOD: A randomized, double-blind controlled trial included sixty patients, randomly allocated into groups A and B. After patients entered the operative room, blood pressure and heart rate were measured (T1). At 5 minutes after propofol induction (T2), group A received dexmedetomidine 1 µg kg⁻¹ whereas group B received normal saline...
October 13, 2017: Anaesthesiology Intensive Therapy
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