Anaesthesiology intensive therapy
-
Anaesthesiol Intensive Ther · Jan 2018
Randomized Controlled Trial Comparative StudyComparison of propofol-based versus volatile-based anaesthesia and postoperative sedation in cardiac surgical patients: a prospective, randomized, study.
Clinical trials have shown conflicting results regarding the use of volatile anaesthesia before or after an ischaemic insult in cardiac surgical patients and its effect on myocardial injury. This may be attributable to the failure of continuing volatile agents into the early postoperative period. We hypothesised that combined volatilebased anaesthesia and postoperative sedation would decrease the extent of myocardial injury after coronary artery bypass grafting (CABG) when compared with an intravenous, propofol-based approach. This study aimed to assess the feasibility of the perioperative protocol and investigate whether volatile anaesthesia provides cardioprotection in patients undergoing CABG. ⋯ The use of volatile-based anaesthesia and postoperative sedation did not confer any cardioprotection compared with propofol-based anaesthesia and sedation in patients who had good left ventricular function and were undergoing CABG.
-
Anaesthesiol Intensive Ther · Jan 2018
ReviewUltrasound assessment of gastric emptying and the risk of aspiration of gastric contents in the perioperative period.
The risk of aspiration of gastric contents in the perioperative period constitutes a serious clinical problem and it is connected with increased mortality. At present, the risk of aspiration is assessed only on the basis of an interview and information obtained from the patient. Such assessment is not always reliable while the concomitance of some additional factors influencing the delay of gastric emptying significantly decreases its sensitivity. Using bedside ultrasound imaging in an assessment of gastric contents is a method which supports an objective, simple and quick assessment of the risk of aspiration, helps one to optimise perioperative anaesthetic management, and should constitute a routine element of the perioperative patient assessment.
-
Anaesthesiol Intensive Ther · Jan 2018
Use of noninvasive mechanical ventilation with pressure support guaranteed with average volume in de novo hypoxaemic respiratory failure. A pilot study.
This study was designed to determine the results associated with the use of noninvasive mechanical ventilation (NIV) using the BiPAP S/T-AVAPS ventilation strategy in subjects with mild to moderate de novohypoxaemicrespiratory failure. ⋯ The BiPAP S/T-AVAPS ventilatory mode can be used in subjects with de novo hypoxaemic respiratory failure with special vigilance concerning exhaled tidal volumes and inspired pressure.
-
Anaesthesiol Intensive Ther · Jan 2018
Frailty is associated with an increased mortality among patients ≥ 80 years old treated in Polish ICUs
The increasing population of very old intensive care patients (VIPs) is a major challenge currently faced by clinicians and policymakers. Reliable indicators of VIPs' prognosis and purposefulness of their admission to the intensive care unit (ICU) are urgently needed. ⋯ Measuring frailty in critically ill older adults can facilitate making more informed clinical decisions and help avoid futile interventions.
-
Guidelines for infusion fluid therapy rarely take into account that adverse effects occur in a dose-dependent fashion. Adverse effects of crystalloid fluids are related to their preferential distribution to the interstitium of the subcutis, the gut, and the lungs. The gastrointestinal recovery time is prolonged by 2 days when more than 2 litres is administered. ⋯ Coagulopathy is aggravated by co-existing hypothermia. Although oedema can occur from both crystalloid and colloid fluids, these differ in pathophysiology. To balance fluid-induced adverse effects, this review suggests that a colloid fluid is indicated when the infused crystalloid volume exceeds 3-4 litres, plasma volume support is still needed, and the transfusion of blood products is not yet indicated.