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Signa Vitae

A Journal In Intensive Care And Emergency Medicine

Author: Signavitae (Page 1 of 79)

Well, here’s another nice mess you’ve gotten me into!

Abstract

Studies in the early 2000s suggested that the introduction of flow or cardiac output monitoring could improve outcome in major surgery, especially in high-risk patients. This led the National Institute of Health and Care Excellence (NICE) in the UK to issue guidance in 2011 recommending the use of the Deltex Cardio Q Doppler flow monitor in these patients both to improve outcome and also reduce costs. This advice was subsequently extended to include all “flow monitors” in 2012. However, recent systematic reviews and major randomized controlled trials have failed to confirm the benefits of adding “flow” to conventional monitoring in the perioperative period. This paper examines physiological and methodological reasons behind this failure and introduces an alternative management strategy in high risk patients which incorporates cardiac output monitoring alongside the additional monitoring of cortical suppression and cerebral and tissue oxygenation.

Key words: multi-modal monitoring, cardiac output monitoring, depth of anaesthesia monitoring, cerebral oxygenation,venodilation

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A case report of pulmonary vascular air embolism in elbw premature neonate

Introduction

Pulmonary vascular air embolism is a rare and almost fatal complication of positive pressure ventilation  in premature neonates with respiratory distress syndrome

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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

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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

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Are chest compression depths measured by the Resusci Anne SkillReporter and CPRmeter the same?

Abstract

Objective. We investigated whether data collected using the Resusci Anne SkillReporter were comparable with those collected using the CPRmeter (cardiopulmonary resuscitation meter -an accelerometer feedback device used to provide high-quality chest compressions).

Materials and Methods. Fifty continuous chest compressions were performed using a Resusci Anne SkillReporter and a CPRmeter under two conditions (Experiment 1: complete chest wall recoil; Experiment 2: incomplete chest wall recoil). The conditions were defined according to visual feedback signals provided by the CPRmeter. A single healthcare worker performed 20 repetitions under each experimental condition alternately. Chest compression data were collected and analyzed using the Laerdal PC SkillReporting System and QCPR Review software.

Results. The mean difference in chest compression depth between the Resusci Anne SkillReporter and CPRmeter was 6.7 ± 1.2 mm in Experiment 1 (95% CI: 6.1~7.3) and was significantly higher in Experiment 2 (17.3 ± 1.9 mm; 95% CI: 16.4~18.2; p < 0.001).

Conclusions. The chest compression depth measured by the Resusci Anne SkillReporter was significantly different from that of the CPRmeter. Cardiopulmonary resuscitation instructors, trainees, and researchers should be aware of this difference to ensure the most accurate interpretation of their training or experimental results.

Key words: cardiopulmonary resuscitation, manikins, feedback, education, training

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