Minerva anestesiologica
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Minerva anestesiologica · Jan 2011
ReviewTime to wake up the patients in the ICU: a crazy idea or common sense?
With the first generation of ventilators, it was often necessary to sedate patients to avoid dyssynchrony between patient and ventilator. The standard treatment of patients in need of mechanical ventilation has therefore traditionally included sedation. Modern ventilators are able to simulate the patients breathing efforts to a higher degree, and therefore, deep sedation is no longer necessary. ⋯ Additionally, it has been shown that combining both a spontaneous breathing trial and a daily wake up trial reduced the mechanical ventilation time compared to a spontaneous breathing trial alone. We have recently shown in a randomized study that the use of no sedation, compared to the standard treatment with sedation and a daily wake up trial, reduced the time that patients required mechanical ventilation, the length of the patients' stay in the intensive care unit, and the total length of the hospital stay. All evidence indicates that the use of sedative drugs should be reduced, patients should be mobilized, and each patient's needs should be evaluated on a daily basis to optimize the care of each individual patient.
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Subarachnoid hemorrhage (SAH) remains a serious condition with high mortality and disability. In the past decades, there have been improvements in the techniques to secure aneurysms both surgical and endovascular techniques aimed at reducing the risk of future bleeding events. ⋯ Intracranial and extracranial complications following SAH are common and impact long-term outcomes. Intensive care management of patients with SAH offers the opportunity to reduce morbidity by reducing secondary insults and preventing complications.
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Minerva anestesiologica · Jan 2011
Randomized Controlled Trial Comparative StudyMacintosh and Glidescope® performance by Advanced Cardiac Life Support providers: a manikin study.
The aim of the present study was to assess whether the use of the Glidescope® would improve the success rates and the duration of intubation attempts during airway management when compared to direct laryngoscopy in Advanced Cardiac Life Support (ACLS) providers with no prior experience in videolaryngoscopy. ⋯ This study demonstrated that the Glidescope® videolaryngoscopy performed at least as well as conventional laryngoscopy in ACLS providers. Although simpler ventilation techniques should be applied first during critical airway management, this study suggests that, when intubation is needed, videolaryngoscopy cna be helpful.
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Minerva anestesiologica · Jan 2011
Comparative StudyThe influence of severe obesity on non-invasive ventilation (NIV) strategies and responses in patients with acute hypercapnic respiratory failure attacks in the ICU.
Obesity rates are increasing in the general population and are also prevalent in intensive care units (ICUs). Patients are sometimes admitted to ICUs for hypercapnic respiratory failure or cor pulmonale, but more often, they are admitted for pneumonia, excessive daytime sleepiness, heart failure, chronic obstructive pulmonary disease (COPD), asthma attacks or pulmonary embolism, and hypercapnic respiratory failure is coincidentally noticed during this period. The optimal noninvasive mechanical ventilation strategy is often not used during ICU treatment. The aim of this study was to assess the differences between non-invasive ventilation (NIV) strategies and the outcomes of obese and non-obese patients with acute hypercapnic respiratory failure. ⋯ These results suggest that improvement in hypercapnia in obese patients may require higher PEEP levels and longer times than that of non-obese patients during acute hypercapnic respiratory failure attack.
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Minerva anestesiologica · Jan 2011
The relationship between hospital volume and mortality following mechanical ventilation in the Intensive Care Unit.
A number of recent studies in North America and Europe have investigated the relationship between hospital volume and outcomes following mechanical ventilation in an Intensive Care Unit (ICU). All of these studies have revealed an association between worse outcomes and smaller-volume hospitals. This relationship has not been investigated recently in the UK. ⋯ There is no relationship between hospital volume and mortality following mechanical ventilation in the ICU. Further larger prospective studies are needed to confirm this apparent lack of a relationship between hospital volume and mortality following mechanical ventilation in ICUs in a network of hospitals in the UK.