Medicina
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Review Comparative Study
[Ventilator associated pneumonia: risk factors, diagnosis, treatment and prevention].
Treatment in the intensive care units has aggressive character. A lot of invasive diagnostic and treatment procedures are used in order to keep vital functions of the patients. Some complications are associated with treatment methods. ⋯ Antibiotic treatment should be chosen on the ground of clinical data, hospital epidemiologic situation and most common pathogens. Prevention of ventilator-associated pneumonia is based on improving basic hygiene and nursing quality. Ventilator-associated pneumonia morbidity could be reduced by identification of risk factors and risk prevention.
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Hyperglycemic hyperosmolar nonketotic syndrome and diabetic ketoacidosis are two of the most serious acute complications of diabetes. Hyperglycemic hyperosmolar nonketotic syndrome is found mostly in type 2 diabetic patients. It is characterized by extreme dehydration and neurologic symptoms, which are related directly to the degree of hyperosmolarity. ⋯ This article reviews data about precipitating factors, pathogenesis, carbohydrate, water and electrolyte metabolism in this hyperosmolar hyperglycemic state. The review discusses diagnostic procedures, laboratory evaluation, differential diagnosis and treatment: replacement of fluid and electrolytes, low-dose insulin therapy. A discussion of complications management of hyperosmolar hyperglycemia, mortality rate and prevention are included in this review.
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Hypothermia is defined as a core body temperature less than 35 degrees C (95 degrees F) and results from prolonged exposure to cold environment, drugs, and underlying pathologic conditions. Hypothermia is associated with marked depression of cerebral blood flow and oxygen requirement, reduced cardiac output, and decreased arterial pressure. Victims can appear to be clinically dead because of marked depression of brain and cardiovascular function, bet full resuscitation with intact neurological recovery is possible. ⋯ There are suggestions that the unofficial number of hypothermia--related deaths is substantially higher, particularity in the elderly. This article reviews the cause, pathogenesis, pathophysiology, clinical features, electrocardiographic manifestations of hypothermia, diagnosis, pre-hospital stabilization, hospital passive, active external, active core rewarming methods, other questions of treatment, and mortality of hypothermia. It is very important to remember, thar if a hypothermic victim is alive when rescued but dies during recovery treatment, and there is no other significant trauma or disease, this suggests that death may have resulted from either inappropriate or ineffective treatment, or no treatment at all.
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The article deals with the problems of perioperative management of patient with respiratory disease. The impact of general and regional anesthesia on respiratory system is discussed. Risk factors of perioperative respiratory complications are reviewed as well as general means for reducing them. Issues of anesthetic management of patients with bronchial asthma and chronic respiratory disease are discussed, putting stress on preoperative optimization of respiratory function, choice of anesthetic technique and postoperative pulmonary rehabilitation.
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The aim of the article is to review principles of thoracic anesthesia for pulmonary surgery. This article is divided into three sections. ⋯ Intraoperative period considerations are monitoring requirements, choice of anaesthesia and the indications for providing one-lung ventilation. Postoperative problems of immediate life-threatening complications, management of mechanical ventilation and control of pain are discussed in the third part.