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Signa Vitae

A Journal In Intensive Care And Emergency Medicine

Month: October 2007 (Page 1 of 2)

Spontaneous breathing during anaesthesia: first, do no harm

Abstract

Controlled respiration and mechanical ventilation have long been part of anaesthetic practice. Modern surgery, anaesthetic techniques, and new agents require a reappraisal of this established habit. In many circumstances the adverse effects of mechanical ventilation can be avoided by the use of the laryngeal mask and allowing spontaneous ventilation. In addition to the more prominent advantages, such as less sore throat, reliable assessment of anaesthetic depth, and good recovery, there may be more subtle advantages such as improved cardiopulmonary interaction, better distribution of ventilation, and reduced mechanically induced lung damage. Some of these advantages may be also applied during mechanical ventilation, by allowing continued muscle activity or continuously varying the size of the tidal breaths.Mechanical ventilation is often unnecessary and may be harmful.

Key words: respiration, neuromuscular blockade, artificial respiration, pul-monary gas exchange

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Shwachman Diamond Syndrome: an emergency challenge

Abstract

Shwachman Diamond Syndrome is a rare congenital disorder characterized by pancreatic insufficiency, bone marrow dysfunction and skeletal abnormalities. No specific test is available for a definitive diagnosis for SDS. In the presence of clinical features of SDS, pancreatic insufficiency should be tested for or lipomatosis radiologically demonstrated. New directions might be found in genetic analysis. Sometimes, a life-threatening event may be the first clinical manifestation of the syndrome.

Keywords: lipomatosis, SDS, diag-nosis, children

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Clinical significance of intraabdominal pressure and abdominal perfusion pressure in patients with acute abdominal syndrome

Abstract

Elevated intraabdominal pressure (IAP) has been claimed to play a role in abdominal compartment syndrome. We assessed the correlation between the values of IAP, abdominal perfusion pressure (APP) and clinical scoring systems including SIRS, MODS and APACHE II and the patients’ survival rate in patients admitted to the ICU with acute abdomen due to ileus, intestinal perforation, peritonitis and trauma.
We measured IAP and APP in 50 surgical patients. In this study the IAP was measured in a non-invasive manner via urinary bladder pressure. The APP was calculated as the difference between mean arterial pressure and IAP values.
A significantly higher IAP was found in the non-survivors’ group in comparison with the survivors’ group. On the other hand, the APP inversely correlated with disease severity scores including SIRS, MODS and APACHE II, whereas IAP values did not show any correlation to these clinical parameters. These findings suggest that IAP and APP may be useful tools in the clinical evaluation of patients with acute abdomen.

Key words: intraabdominal pressure, abdominal perfusion pressure, acute abdominal syndrome

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Early complications of percutaneous tracheostomy using the Griggs method

Abstract

This article presents our observations and experiences with the Griggs method of percutaneous dilation tracheostomy (PTD). We performed 200 tracheostomies on neurosurgical and surgical patients who needed temporary ventilatory support and protection. Early complications were defined and registered. Frequency of early complications was 22,5 %. The majority of complications were minor and improved quickly. Therefore, PTD was shown to be a safe and appropriate technique for patients treated in the intensive care unit (ICU). Unfortunately, lack of standardization and defined criteria deprive the opportunity for good comparisons between the Griggs method and other PTD methods.

Key words: percutaneous trache-ostomy, Griggs method, early compli-cations, surgery, neurosurgery

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Hemorrhagic shock as a complication of anticoagulant therapy following the mitral valve replacement

Abstract

This report describes a case of the hemorrhagic shock in a patient on the anticoagulant therapy supplementing implanted mechanical prosthetic heart valve replacing the mitral valve. The association between hemorrhagic shock, mechanical prosthetic heart valve and anticoagulant therapy is briefly discussed.

Key words: hemorrhagic shock, mechanical prosthetic heart valve, anticoagulant therapy

 

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