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Signa Vitae

A Journal In Intensive Care And Emergency Medicine

Tag: intensive care unit (Page 1 of 2)

Bronchoscopy during non-invasive ventilation in a patient with acute respiratory distress syndrome

Abstract

A 72-year-old man was transferred to our hospital for refractory severe acute respiratory syndrome. On arrival, he was intubated and mechanically ventilated. Furthermore, he required veno-venous extracorporeal membrane oxygenation. Two days later, he was extubated and supported with periods of non-invasive ventilation (NIV), with a new mask. Because of large amounts of bronchial secretions that he was not able to expectorate, flexible fiberoptic bronchoscopy (FFB) was performed to remove the secretions, without interrupting NIV support. During the procedure, the patient remained hemodynamically stable, breathing spontaneously and with just a mild reduction in oxygen saturation (SpO2) (97.9% vs. 96.8%). This case report highlights the possibility of performing upper endoscopic procedures, such as FFB, during non-invasive ventilation in patients in whom this respiratory support is required and its interruption may be harmful.

Key words: non-invasive ventilation, acute respiratory distress syndrome, flexible fiberoptic bronchoscopy, intensive care unit

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Current practice of hemodynamic monitoring with PiCCO in a single general surgical ICU in a university hospital – a short report

Abstract

Background: In recent years, there has been an overall trend toward using less invasive hemodynamic monitoring in surgical intensive care units. The pulse contour cardiac output monitor (PiCCO) is one of them.

Objectives: The aim of this study was to evaluate our practice of hemodynamic monitoring with PiCCO in the perioperative period.

Methods: A retrospective descriptive analysis was performed in a single general surgical intensive care unit (ICU) run by anesthesiologists for the years 2013-2016. We collected information about patients, ICU quality parameters and monitoring equipment available in the ICU. The primary endpoint was the incidence of PiCCO use.

Results: Out of 2972 patients admitted to the general surgical ICU in a 4-year period, besides basic monitoring with electrocardiography (ECG), pulse oximetry and blood pressure monitoring, more than half of the patients received central venous catheterization (55.1%), less than the half invasive arterial catheterization (44.1 %) and only a small proportion PiCCO (0.91%). No patient received a pulmonary arterial catheter. Mortality rate was 7.47 %.

Conclusion: The use of PiCCO in our ICU is far below reported in literature. In the majority of cases, our anesthesiologists make clinical decisions based on measurement of central venous and invasive arterial pressure.

Key words: hemodynamic monitoring, intensive care unit, general surgery

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Which parameters of ventricular function should be evaluated in the intensive care unit?

Abstract

Echocardiography is one of the most powerful diagnostic and monitoring tools available to the modern intensivist, providing the means to diagnose cardiac dysfunction, its underlying cause and suggest therapeutic interventions. Although seemingly simple, meaningful and clinically relevant evaluation of ventricular function is challenging, and standard measures frequently unhelpful. Although at present the widespread application of physiological echocardiography and advanced echocardiographic techniques within intensive care remains disappointingly limited, the huge potential for collaborative research between cardiologists and intensivists within this field is evident.

Key words: echocardiographic assessment, cardiac function, intensive care unit

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Inhalation sedation with the ‘Anaesthetic Conserving Device’ for patients in intensive care units: A literature review

Abstract

Background. The Anaesthetic Conserving Device is a modified heat and moisture exchanger that enables the application of inhalation sedation with existing ventilators in intensive care units. The following review describes the advantages of inhalation sedation using the Anaesthetic Conserving Device in comparison to standard intravenous sedation for patients in intensive care units and highlights the technical aspects of its functioning.

Methods. The literature search was limited to PubMed, Sage Journals and CINAHL databases, using the terms »anaesthetic conserving device«, »volatile anaesthetic reflection filter«, »AnaConDa« independently and in connection with the terms »sedation« and »intensive care unit«. Included are articles published up until December 2014.

Results. Use of inhalation sedation with the Anaesthetic Conserving Device enables faster transition to spontaneous breathing and a shorter awakening time than with intravenous sedation. Even short-term inhalation sedation of patients after open heart procedures has a cardioprotective effect and reduces troponin T values. Despite increased concentrations of inorganic fluoride in serum after sevoflurane exposure, no clinical studies to date have shown its nephrotoxic effect, even after long-term (48 h) sedation. The Anaesthetic Conserving Device is accurate in maintaining target values of volatile anaesthetics. However, increased dead space volume was found in several studies, exceeding the internal volume of the Anaesthetic Conserving Device.

Conclusion. Results to date show that inhalation sedation with the Anaesthetic Conserving Device may be an effective and safe alternative to existing protocols of intravenous sedation for patients requiring intensive treatment.

Key words: anaesthetic conserving device, inhalational sedation, intravenous sedation, intensive care unit

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Procalcitonin – potential, limitations and availability

Abstract

Bacterial infections and sepsis are major problems in critically ill patients. Timely diagnosis and therapy reduce morbidity and mortality. Many studies have included the investigation of various biomarkers whose elevated concentrations can indicate sepsis; among them, PCT proved to be most useful.

PCT is synthesized in the thyroid gland as a prohormone of calcitonin. In healthy individuals the PCT concentration is <0.1 ng/mL.

The advantage of the PCT is a high negative predictive value for the exclusion of sepsis, with the cut-off value of 0.5 ng/ml. A concentration between 2 and 10 ng/ml indicates strong sepsis, whereas a value ≥10 ng/ml is associated with septic shock. In addition to the diagnosis of sepsis, the measurement of PCT concentration is useful for the introduction and monitoring of antibiotic therapy, which is performed according to an algorithm based on the cut-off value for PCT.

Immunoassays are used to measure PCT concentrations in serum or plasma. It is possible to determine the concentration in whole blood by using point-of-care testing.

In pathological conditions that are not associated with sepsis, PCT is useful as a prognostic indicator of disease complications. Some studies suggest that PCT is a potential early indicator of acute coronary syndrome.

Key words: procalcitonin, bacterial infection, sepsis, intensive care unit

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