Medicina intensiva
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Evaluate moment of extubation in maxillofacial post-operative patients admitted to an intensive care unit (ICU) and analyze early complications during their stay. ⋯ In our series, late extubation and the need for cervical lymph node extraction were independent risk factors for complications in ICU. Although early extubation may be hazardous in some cases in the first hours, we have no consistent data to maintain mechanical ventilation longer than needed to recover from the anesthesia.
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Tracheal intubation (TI) guided by fibrobronchoscopy (FB) is one of the essential techniques in the approach to the difficult airway (DAW). Few works have been published on the possible causes of TI failure with this procedure. This study aims to discover which factors could predict TI failure with FB. ⋯ TI guided by FB performed by bronchoscopist is successful in more than 90% of the cases with DAW. The skill and experience of the bronchoscopist is one of the primary determining factors of success of the procedure. Profound sedation may condition TI guided by FB failure.
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Second level therapeutic maneuvres for controlling intracranial hypertension (ICH) proposed by the European Brain Injury Consortium and the American Association of Neurological Surgeons include barbiturates, moderate hypothermia and decompressive craniectomy (DC). However, neither barbiturates nor hypothermia have been demonstrated to improve its outcome. DC could be a therapeutic option in the management of ICH without intracerebral masses. ⋯ However, to improve brain oxygenation (PtiO(2)), the probe must be placed in the healthy area of the most severely damaged cerebral hemisphere. What is the suggested surgical procedure? Frontal-subtemporal-parietal-occipital craniectomies, including enlargement of the dura by duroplasty. And finally, what are the current contraindications of DC? Glasgow Coma Scale score 3 points post-resuscitation states with dilated and arreactive pupils, age > 65 years old, ICH > 12 hours, persistent (a-yv)DO(2) < 3.2% or PtiO(2) < 10 mmHg maintained from the moment of admission.
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We present the case of a 64-year old woman with shock related to ischemic colitis associated with paradoxical embolism through a foramen ovale. Some utilities of transcranial Doppler ultra-sonography applied in this case that could have an usual interest in intensive and intermediate care are discussed. These include analysis of the regional distribution of cerebral blood flow, intracranial arterial continuous monitoring for detection of spontaneous microembolisms and injection of microbubbles to detect right to left shunts. The added value of using power M-mode Doppler in transcranial Doppler evaluations is highlighted.