Minerva anestesiologica
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Initial Implementation of Mechanical Ventilation was focused on providing adequate oxygenation and relief of work of breathing. Over the last few decades it has become apparent that stretch-induced lung injury, associated with normocapnia or hypocapnia, is a real phenomenon. Attempts to reduce stretch-induced injury led to development of permissive hypercapnia in the neonatal population, and later to its acceptance as a standard of care in adult patients with ARDS. ⋯ It is now apparent that hypercapnia by itself can be protective. In addition, hypocapnia can be harmful. These observations led to the hypothesis of therapeutic hypercapnia, i.e., deliberate production of high CO2 as a goal in the care of critically ill patients.
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Adaptive Support Ventilation is a novel ventilation mode, a closed-loop control mode that may switch automatically from a PCV-like behaviour to an SIMV-like or PSV-like behaviour, according to the patient status. The operating principles are based on pressure-controlled SIMV with pressure levels and SIMV rate automatically adjusted according to measured lung mechanics at each breath. ⋯ In cardiac surgery tracheal extrubation was faster in ASV patients then in controls. In the early weaning phase of acute ventilatory insufficiency the need of resetting ventilator parameters was decreased, suggesting potential benefit for patient care.
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40% to 60% of children undergoing surgery under general anaesthesia develop anxiety in the preoperative period. Multiple factors contribute to the genesis of this disorder. Preoperative anxiety may complicate the induction of anaesthesia and can cause behavioural modifications in children even long after surgical procedures have been completed. ⋯ A preparation program, premedication and parental presence during induction of anaesthesia are valid tools for achieving this goal. We are herewith presenting a play preparation program carried out by play specialists and offered to all children prior to surgery. This approach proved effective in reducing preoperative anxiety in children and their mothers.
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In appropriately selected patients, NPPV decreases intubation rate, improves survival, and is cost-effective. Pressure support ventilation is commonly used successfully for NPPV. ⋯ A concern with portable pressure ventilators is the potential for rebreathing of carbon dioxide. Despite these issues, pressure support ventilation has been used successfully for noninvasive ventilation in thousands of patients with acute respiratory failure.
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Minerva anestesiologica · May 2002
Clinical TrialPumpless extracorporeal lung assist using an arterio-venous shunt. Applications and limitations.
We report the use of a pumpless extracorporeal lung assist (PECLA) in 70 patients with severe pulmonary failure of various causes. The device was used under rescue conditions in patients with preserved cardiac function. By establishing a shunt between femoral artery and vein using the arterio-venous pressure gradient as the driving force for the blood flow through the oxygenator, PECLA proved to be extremely effective in terms of oxygenation and carbon dioxide removal.