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Signa Vitae

A Journal In Intensive Care And Emergency Medicine

Category: Volume 13 Number 1 (Page 1 of 4)

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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Informed Consent for Intravenous Contrast Administration in the Emergency Department: Understanding and satisfaction among patients using the video-assisted vs. traditional methods

Abstract

Background. Computed-tomography (CT) is increasingly performed among patients who visit an emergency department (ED), many of whom require the administration of intravenous contrast, to make an accurate diagnosis of their condition and offer prompt treatment. Though the safety profile of new intravenous contrast agents has improved, patients are still exposed to significant risk from potentially life-threatening reactions.

Materials and Methods. This is a prospective study. Subjects were patients over the age of 18, or their family representative, who visited the ED. Subjects were randomly assigned to either the original routine explanation for consent or the video-assisted explanation. Patients completed a questionnaire about contrast adverse effects and the proposed treatment.

Results. Mean values of the degree of understanding of informed consent were relatively higher in the video-assisted group. When assessing the proficiency of the informer, the score for understanding and satisfaction was higher in the attending staff informed group than the house staff informed group.

Conclusion. This study showed a higher level of understanding in the group that was provided information using visual aids, rather than in the traditional way. Also, a higher level of understanding and satisfaction was shown among those who were given explanations by an attending staff member.

The busy ED, due to factors such as overcrowding, is expected to see benefit from appropriately utilizing multimedia visual aids, and also from more experienced medical staff providing information.

Key words: informed consent, intravenous contrast, visual aids

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Comparison of haemodynamic parameters between the high and low spinal block in young healthy patients

Abstract

Background. For some surgical procedures a higher sensory block is needed. However, it is complicated by a higher incidence of hypotension, more bradycardia and nausea and a higher use of vasoactive drugs. In elderly and obstetric population complications have been attributed to the decrease in cardiac output and systemic vascular resistance, especially in a high block (above Th6). The aim of our study was to find the incidence of hypotension and bradycardia after a spinal anaesthesia in young, healthy patients. As young patients compensate more, we aimed to find the difference in haemodynamic variables between the group with a high and the group with a low spinal block and the underlying mechanisms of hypotension.

Methods. In a prospective, randomized study 44 American Society of Anaesthesiologists (ASA) 1 patients scheduled for knee arthroscopy under spinal anaesthesia were randomly distributed to a high (group H) and a low (group L) spinal block group. In a group H patients were placed into horizontal, whereas in a group L in 15-degree anti-Trendelenburg position immediately after the spinal block. Haemodynamic parameters were measured continuously noninvasively from 10 min before to 25 min after the spinal block using the CNAPTM device with the LiDCORapid monitor.

Results. The differences in haemodynamic parameters between the groups were not statistically significant at all measured times despite a significant difference in the spinal block level (18.5 vs 13.3 dermatomes above S5, p<0.001) and a significant difference in haemodynamic variables inside each group compared to the baseline value. With cardiac index (CI) as a dependent variable, a significant correlation between CI and stroke volume index (SVI) was found (β=0.849, p<0.001) and also between CI and heart rate (HR) (β=0.573, p<0.001). In group H the incidence of hypotension was 35%, whereas in group L it was 10%. The same difference was seen in the use of phenylephrine between the groups, however the difference was not significant.

Conclusion. In our study it was found that in young, healthy patients there are no significant differences in haemodynamic parameters and in incidence of hypotension between a high and low spinal block. Young, healthy patients compensate a decrease in systemic vascular resistance caused by the spinal anaesthesia with a compensatory increase in CI resulting from an increase in SVI and HR. However, a trend towards less hypotension, less bradycardia and less frequent phenylephrine use in a low spinal block was noted.

Key words: spinal anaesthesia, hyperbaric bupivacaine, haemodynamic parameters, cardiac output, hypotension

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