Impact factor 0.175

Signa Vitae

A Journal In Intensive Care And Emergency Medicine

Category: Reviews (Page 1 of 16)

Do we need an individual approach to atrial fibrillation and adrenergic overload in the critically ill?

Abstract

Despite catecholamines being lifesaving drugs, they can also be harmful. Adrenergic overload is one of the major causes of supra- and ventricular arrhythmias, which induce haemodynamic instability of critically ill patients. In this paper we will focus on the pathophysiology of atrial fibrillation (AF), the importance of adrenergic overload for triggering AF, the importance of the autonomic nervous system and we will challenge the importance of decreasing adrenergic load with selective and non-selective β-blockers, which have different effects on the metabolism of the severely ill. We will also emphasize the importance of an individual approach due to pharmacogenetic differences in β-adrenergic signalling.

Key words: catecholamines, atrial fibrillation, beta-blockers, metabolism, resting energy expenditure

Read More

Pulmonary reperfusion injury

Abstract

Pulmonary reperfusion injury is a clinical syndrome with no single and recognized pathophysiologic mechanism. It is a major cause of morbidity and mortality following lung transplantation, cardiogenic shock, or cardiopulmonary bypass. The underlying mechanisms remain uncertain. Lung inflammatory injury induced by lipopolysaccharide, characterized by rapid sequestration of neutrophils in response to inflammatory chemokines and cytokines released in the lungs is an acceptable theory. Structural or functional impairment of surfactant has been noted in pulmonary reperfusion injury. The pathological changes may include bilateral pulmonary infiltrates, reduced lung compliance and worsening of gas exchange in the immediate posttransplant period. Recruitment maneuver and high positive end-expiratory pressure can relieve postoperative respiratory failure, especially in the patient with reperfusion pulmonary edema after pulmonary thromboendarterectomy. Pharmaceutical agents, including inhaled nitric oxide, soluble complement receptor type 1, prostaglandin E1 and exogenous surfactant, attenuate pulmonary reperfusion injury through distinct mechanisms. Extracorporeal membrane oxygenation and Novalung are temporary assistance in bridging to lung transplantation, stabilization of hemodynamics during transplantation and treatment of severe lung dysfunction and primary graft failure. Modulation of heme oxygenase-1 expression, ischemic conditioning and gene therapy are future directions for pulmonary reperfusion injury management.

Key words: cardiopulmonary bypass, pulmonary hypertension, respiratory insufficiency

Read More

The new types of child maltreatment: a public and social emergency no longer negligible

Abstract

Child abuse and neglect is a common problem that is potentially damaging to long-term physical and psychological health of children. As society and culture have progressively changed different configurations of child abuse and neglect have emerged. Few attention has been focused on these types of child maltreatment that represent the new emergency in this field. Pediatricians should be trained to play a major role in caring for and supporting the social and developmental well-being of children raised in variously conditions and in new types of problems. Pediatric care has been based on the increased awareness of the importance of meeting the psychosocial and developmental needs of children and of the role of families in promoting the health.

Keywords: Child abuse, neglect, emergency

Read More

How I use skeletal muscle Near Infrared Spectroscopy to non-invasively assess hemodynamic status of the critically ill

Abstract

The major goal of hemodynamic treatment is to reach adequate flow. Near infrared spectroscopy (NIRS) allows non-invasive assessment of skeletal muscle tissue oxygenation during rest and also during vascular occlusion test (VOT). VOT allows estimation of tissue oxygen extraction capability, which could be preserved (i.e. hypovolemic, obstructive and cardiogenic shock) or inappropriate (i.e. sepsis/septic shock). By using ultrasound to estimate cardiac output, arterial hemoglobin oxygen saturation, skeletal muscle NIRS, arterial lactate and hemoglobin, therapeutic goals in critically ill patients with preserved oxygen extraction capability can easily be targeted. Current controversies of NIRS technology and approach to patients with impaired oxygen extraction are discussed as well.

Key words: shock, skeletal muscle, near-infrared spectroscopy, critically ill

Read More

Assesment of hemodynamics by basic ultrasound

Abstract

Basic ultrasound can provide important information about the main parts of the circulatory system, the heart, and the main vessels. At the bedside, only by brief visual impression of the heart function and inferior vena cava diameter, and without any measurements, the attending physician can get important information which can influence the clinical opinion-making process and the management of the hemodynamically unstable patient. No less important is to obtain information about the lungs, particularly to estimate if extravascular lung water is present in excess or not. Ultrasound can help in the detection of the potentially reversible causes of hemodynamic instability or arrest and can guide the treatment. Examples are pneumothorax, cardiac tamponade, thromboembolism, the detection of blood in the pleural, pericardial or abdominal space after trauma and the detection and treatment of the source of the infection.

Key words: ultrasound, hemodynamic monitoring, shock

Read More

Page 1 of 16

© 2015. Signa Vitae. Except where otherwise noted, content on this site is licensed under a Creative Commons Attribution 4.0 International license.