Anaesthesiology intensive therapy
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Anaesthesiol Intensive Ther · Jan 2015
Apnea test in the determination of brain death in patients treated with extracorporeal membrane oxygenation (ECMO).
Extracorporeal Membrane Oxygenation (ECMO) is a well-established method of support in patients with severe respiratory and/or circulatory failure. Unfortunately, this invasive method of treatment is associated with a high risk of neurological complications including brain death. Proper diagnosis of brain death is crucial for the termination of futile medical care. ⋯ Hypercapnia achieved via this method should allow an apnea test to be conducted in the typical manner. In the case of profound desaturation and an inadequate increase in the arterial CO₂ concentration, the sweep gas flow rate may be increased to obtain the desired oxygenation level, and exogenous carbon dioxide may be added to achieve a target carbon dioxide level. Incorporation of an apnea test for ECMO patients is planned in the next edition of the Polish guidelines on the determination of brain death.
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Anaesthesiol Intensive Ther · Jan 2015
Ventilator-associated pneumonia monitoring according to the INICC project at one centre.
Pneumonia is a common complication of hospitalisation in severely ill patients who need mechanical ventilation. The aim of this study was to assess the usefulness of the International Nosocomial Infection Control Consortium programme for the surveillance of ventilator-associated pneumonia (VAP). ⋯ During the reported time span, the incidence of VAP was lower than in the INICC report (2007-2012), but it was tenfold higher than in the NHSN/CDC report (dated 2012). Because of the unchanged VAP level during the 2.5-year observation period, the root cause needs to be determined and action should be taken to resolve this issue.
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Anaesthesiol Intensive Ther · Jan 2015
Epidemiology of new-onset paroxysmal atrial fibrillation in the General Intensive Care Unit population and after discharge from ICU. A retrospective epidemiological study.
Evidence of various cardiac arrhythmias in septic patients has been demonstrated by multiple clinical reports and observations. Most cardiac arrhythmias in sepsis are new-onset and may be related to sepsis-induced myocardial dysfunction. We propose to investigate and analyze data of new-onset paroxysmal atrial fibrillation (AF) in a critically ill septic population. ⋯ In the present study we demonstrated no difference in morbidity and mortality rate in-ICU and after discharge between septic patients who had previous AF episodes and patients who had no previous past medical history of any cardiac arrhythmias.
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Anaesthesiol Intensive Ther · Jan 2015
Case ReportsApplication of V-A ECMO therapies for short-term mechanical circulatory support in patients with cardiogenic shock.
The aim of the study was to present our experience with short-term mechanical circulatory support by veno-arterial extracorporeal membrane oxygenation (V-A ECMO). A series of cases is described involving patients with symptoms of severe cardiogenic shock successfully treated with V-A ECMO. ⋯ The number of cases in which ECMO has been successfully applied in patients with cardiogenic shock and in deep hypothermia is increasingly high; therefore, it seems advisable to elaborate ECMO guidelines to be used in such situations. V-A ECMO is an effective and recognized method of treatment of patients in cardiogenic shock and deep hypothermia.
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Anaesthesiol Intensive Ther · Jan 2015
Non-invasive haemodynamic measurements with Nexfin predict the risk of hypotension following spinal anaesthesia.
Unfavourable circulatory system conditions have been observed in many patients with spinal anaesthesia. The most frequent symptoms include a decrease in blood pressure and, less frequently, bradycardia. The appearance of unfavourable consequences of spinal anaesthesia might be related to the initial status of the patient's circulatory system. The aim of this study was to establish the possibility of predicting unfavourable circulatory consequences (hypotension, bradycardia) following spinal anaesthesia, based on non-invasive haemodynamic assessment with a Nexfin device. ⋯ Nexfin-based non-invasive haemodynamic monitoring might be helpful in the identification of individuals with a high risk of hypotension following spinal blockade.