Minerva anestesiologica
-
Primary Acute Lung Injury (ALI) after lung resection (or "post-pneumonectomy pulmonary edema") is a rare form of acute respiratory failure characterized by dyspnea, hypoxemia, diffuse infiltrates on chest radiogram, and rapid evolution often unresponsive to therapy. ALI occurs almost exclusively following pneumonectomy, within 3 days from surgery and without a preceding cause. ⋯ There is no specific therapy. Suggested measures in the perioperative care include the meticulous maintenance of physiological stability, judicious fluid restriction, and the limitation of ventilatory volumes and pressures.
-
Minerva anestesiologica · Apr 2004
Review[Cerebral oxygen consumption and ischemia in traumatic brain injury].
Clinical and experimental studies have shown a reduction of cerebral blood flow (CBF) and metabolic alterations following traumatic brain injury (TBI). The incidence of ischemia and the meaning of post-traumatic metabolic alterations are still unclear. ⋯ Cerebral ischemia occurs following TBI and should be defined based on CBF value and the metabolic needs of the brain. Global monitoring of cerebral oxygenation adequacy should be combined with regional monitoring. The meaning of high AJDO(2) values should be reconsidered: if they can highlights potential ischemia they are also showing a still living brain with a partially preserved oxygen extraction capability.
-
Minerva anestesiologica · Apr 2004
ReviewMicrovasculature in ventilator-induced lung injury: target or cause?
Clinicians managing acute lung injury must reconcile the competing objectives of ensuring adequate oxygen delivery and minimizing the adverse effects of ventilatory support. Judging from our experimental work, microvascular stresses appear to be a potent cofactor in the development of pulmonary edema as well as in the expression of lung damage resulting from an injurious pattern of ventilation. ⋯ Raising ventilation frequency may also have cost. Such observations imply that reducing the demands for blood flow and ventilation are important considerations in formulating a lung protective approach to mechanical ventilation of ARDS.
-
Maintenance of adequate cardiac preload is of paramount importance in the treatment of patients undergoing major surgical surgery and in the critically ill setting. The end point is to maintain the organ perfusion through volume replacement and therapy to optimize cardiac output, oxygen deliver. ⋯ We briefly review the intra thoracic blood volume index as a preload index and the fluid responsiveness indexes, stroke volume variation and pulse pressure variation, available as novel parameters at the bed-side. The optimization of fluid balance and vasoactive drugs administration based on volumetric monitoring makes the transpulmonary indicator dilution technique a new option as an effective monitoring system where intravascular volume management is a primary objective.
-
Minerva anestesiologica · Apr 2004
Review[Non invasive mechanical ventilation in acute cardiogenic pulmonary edema: is it all done?].
The aim of the paper is to critically analyse the results obtained by recent literature concerning the most important aspects of application of Non Invasive Mechanical Ventilation for the treatment of Acute Cardiogenic Pulmonary Edema, and to elaborate a definition of what is, on the whole, widely accepted, focusing the attention on those issues which still remain unanswered and therefore require further studies. MEDLINE was searched and the bibliography of a selected group of articles was perused. The literature was analysed and the information gathered has proved to address the questions in a systematic way. ⋯ A good deal of favorable experimental evidence supports the use of non invasive ventilation in the acute pulmonary edema and guarantees safety when used in intensive care units. Very few trials have been carried out in order to explore application on severe pulmonary edema outside intensive care unit. A whole new world of old and new issues on patient selection criteria, ventilation times, type of ventilation and predictability of failure, could be discovered.