Minerva anestesiologica
-
Minerva anestesiologica · Apr 2002
Principles, protocols and patients: the practical management of a limit in ICU.
The definition and management of a limit is a common but sometimes extremely complex problem in the Intensive Care Unit (ICU). Guidelines and consensus documents have been published in order to help clinicians. ⋯ In this sense, the practical management of a limit in ICU is usually run by a dual normativity: an external one, which derives from the cultural, moral and legal values of the society, and an internal one, which depends on the particular clinical and human situation, namely the values of everybody involved in (the patient, his/her relatives, the health staff) and the relationships among these people. The considerable freedom left for the decision by an open communication is a great and favourable potential which must be used in the interest of the patient's and of his/her family.
-
Brain injured patients have an increased risk of extracerebral organ failure, mainly pulmonary dysfunction. The prevalent cause of pulmonary failure is ventilator associated pneumonia (VAP) which increases morbidity and mortality. The respiratory dysfunction is mainly characterized by the presence of alveolar consolidation of the dependent lobes. ⋯ In conclusion, in brain injured patients 1) the respiratory mechanics is altered; 2) PEEP is uneffective to improve respiratory function in respiratory failure due to ventilator associated pneumonia. Further studies are warranted to better elucidate the pathophysiology and clinical management of respiratory dysfunction in brain injured patients.
-
The new OxiMax Pulse Oximetry System includes the Nellcor N-595 Pulse Oximeter and a new line of OxiMax sensor. The main feature of this platform is the digital memory chip inserted within each OxiMax sensor that contains all the calibration and operating characteristics for that individual sensor. It allows an information exchange between the sensor and the monitor improving monitoring performance during difficult acquisition periods. We reviewed several studies showing that the more centrally placed forehead sensor can offer significant advantage over finger sensor when monitoring patient with low pulse perfusion, especially in situation where rapid detection of hypoxemia is critical.
-
Minerva anestesiologica · Apr 2002
Guideline[The SIAARTI document in preparation: recommendations on admission and discharge from intensive care units and on limits of treatments in intensive care].
The document in progress is intended to help the health care professionals in bioethical decision-making process in ICU. It will be probably written as Recommendations because it is a conceptual framework for making decision about intensive care, consensually derived from an Ad Hoc Sub-Committee of SIAARTI Ethics Committee. ⋯ These guidelines do not relieve health care professionals involved from their personal responsibility for decisions and action taken in individual cases. These guidelines are in line with the general ethical principles for the care of critically ill patients as formulated, as examples, in the following declarations and deontological codes: Declaration of Helsinki, Ethical Principles in Intensive Care (World Federation of Society of Intensive and Critical Care Medicine), Italian Medical Association's Deontological Code (3/10/98), European Convention of Bioethics Oviedo and in many others international consensus statements and guidelines.