Anaesthesiology intensive therapy
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Anaesthesiol Intensive Ther · Jan 2015
Randomized Controlled TrialBalanced hydroxyethyl starch solution and hyperglycaemia in non diabetics - a prospective, randomized and controlled study.
There are very few studies that have examined the effect of hydroxyethyl starch (HES) solutions on blood glucose level. The study was aimed to compare the effects on blood glucose levels in patients undergoing lower limb surgeries under neuraxial block, receiving HES with those receiving 0.9% saline. ⋯ A balanced HES solution administered intravenously did not cause an increase in blood glucose concentrations compared to those who received 0.9% saline.
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Anaesthesiol Intensive Ther · Jan 2015
ReviewRight dose, right now: using big data to optimize antibiotic dosing in the critically ill.
Antibiotics save lives and are essential for the practice of intensive care medicine. Adequate antibiotic treatment is closely related to outcome. However this is challenging in the critically ill, as their pharmacokinetic profile is markedly altered. ⋯ At present, therapeutic drug monitoring may be of help, but has major disadvantages, remains unavailable for most antibiotics and has produced mixed results. We therefore propose the AutoKinetics concept, taking decision support for antibiotic dosing back to the bedside. By direct interaction with electronic patient records, this opens the way for the use of big data for providing the right dose at the right time in each patient.
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Anaesthesiol Intensive Ther · Jan 2015
ReviewFluid therapy in critically ill patients: perspectives from the right heart.
As right heart function can affect outcome in the critically ill patient, a thorough understanding of factors determining right heart performance in health and disease is pivotal for the critical care physician. This review focuses on fluid therapy, which remains controversial in the setting of impending or overt right heart failure. ⋯ Following a general discussion of right heart function and failure, we specifically focus on important causes of right heart failure in the critically ill, i.e. sepsis induced myocardial dysfunction, the acute respiratory distress syndrome, acute pulmonary embolism and the effects of positive pressure ventilation. It is argued that fluid therapy should always be cautiously administered with the right heart in mind, which calls for close multimodal monitoring.
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Anaesthesiol Intensive Ther · Jan 2015
ReviewCritical care ultrasound in cardiac arrest. Technological requirements for performing the SESAME-protocol--a holistic approach.
The use of ultrasound has gained its place in critical care as part of our day-to-day monitoring tools. A better understanding of ultrasound techniques and recent publications including protocols for the lungs, the abdomen and the blood vessels has introduced ultrasound to the bedside of our ICU patients. However, we will prove in this paper that early machines, dating back more than 25 years, were perfectly able to do the job as compared to modern laptop machines with more features but few additional advantages. ⋯ Next comes the pericardium, to exclude pericardial tamponade. Finally, a transthoracic cardiac ultrasound is performed to check for other (cardiac) causes leading to cardiac arrest. The emphasis is on a holistic approach, where ultrasound can be seen as the modern stethoscope needed by clinicians to complete the full physiological examination of their critically ill unstable patients.
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Anaesthesiol Intensive Ther · Jan 2015
ReviewAssessment of regional ventilation in acute respiratory distress syndrome by electrical impedance tomography.
Mechanical ventilation in acute respiratory distress syndrome (ARDS) incurs a risk of ventilator-associated lung injury (VALI) from inhomogeneous conditions and different properties of dependent and non-dependent lung regions at risk of atelectasis and overdistension, respectively. Electrical impedance tomography (EIT) offers regional ventilation assessment to optimise treatment with mechanical ventilation. This article provides an overview of scientific literature on the application of impedance tomography in acute respiratory distress syndrome. It also presents the results of EIT studies in different clinical situations that may be of use in implementing impedance tomography for treating ARDS.