Anaesthesiology intensive therapy
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Anaesthesiol Intensive Ther · Jan 2019
ReviewThe Jehovah's Witness obstetric patient - a literature review.
The patient's right to refuse blood transfusion must be honoured in case of its clear expression. Some special pharmacologic and/or surgical procedures can be useful in a Jehovah Witness (JW) parturient. ⋯ Only a few hospitals have equipment for blood salvage, and alternative oxygen carriers have potentially lethal side effects. Findings suggest that obstetric facilities should develop special algo-rithms of management in the case of the JW obstetric patient, with written declaration of which elements of blood are not acceptable for the patient, early diagnosis and intensive treatment of anaemia in pregnancy, administration of antifibrinolytic agents before surgery, use of electric surgical tools to restore haemostasis, early detection and aggressive treatment of excessive blood loss and, last but not least, close cooperation between obstetricians and anaesthesiologists, including sharing the information about the patient's refusal of blood transfusion.
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Anaesthesiol Intensive Ther · Jan 2019
Clinical profile of patients with systemic autoimmune diseases treated in the intensive care unit who developed diffuse alveolar haemorrhage - an observational retrospective cohort study.
Patients with autoimmune diseases constitute a relatively low percentage of the intensive care unit (ICU) population but their prognosis is particularly poor, partially due to involvement of multiple organs as well as complications related to immunosuppressive treatment. Diffuse alveolar haemorrhage (DAH) is one of the most life-threatening presentations of autoimmune diseases, associated with worse outcomes. The aim of this study is to report about clinical factors associated with DAH in the ICU setting and to assess the survival in 5-year follow-up. ⋯ Patients who develop DAH in the course of autoimmune diseases and are treated in the ICU have a poor prognosis and often require advanced therapeutic measures.
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Anaesthesiol Intensive Ther · Jan 2019
Comparative StudyValidation of APACHE II and SAPS II scales at the intensive care unit along with assessment of SOFA scale at the admission as an isolated risk of death predictor.
Disease's severity classification systems are applied to measure the risk of death and to choose the best therapy for patients admitted to intensive care unit (ICU). The aim of the study was to verify risk of death calculated with APACHE II (Acute Physiology and Chronic Health Evaluation II), SAPS II (Simplified Acute Physiology Score II), SOFA (Sequential Organ Failure Assessment) and evaluate correlation between these scores. The usefulness of SOFA score as a sole scale also was assessed. ⋯ APACHE II and SAPS II scales have better discrimination, calibration and power to predict deaths on ICU than SOFA. Among these scales SOFA did not achieve expected results.
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Anaesthesiol Intensive Ther · Jan 2019
Awareness and knowledge of intra-abdominal hypertension and abdominal compartment syndrome: results of a repeat, international, cross-sectional survey.
Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are increasingly recognized as aetiologies of organ failure and mortality among a wide variety of patient populations. Since the first global survey in 2007, several surveys have been conducted. However, it remains unclear to what extent healthcare professionals in clinical practice are aware of the widely accepted definitions and recommendations proposed in the World Society of the Abdominal Compartment Syndrome (WSACS) guidelines and whether these recommendations are being applied clinically. ⋯ This survey shows an improvement in general awareness and knowledge regarding IAP, IAH and ACS, although the level of understanding and awareness of WSACS guidelines remains low. There appear to be some practice changes and greater awareness of the need to monitor abdominal pressures. Future initiatives should focus on education, identifying which patients should receive routine monitoring, and incorporation of IAH and ACS care into ICU bundles and protocols already in existence.