Minerva anestesiologica
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Minerva anestesiologica · May 2013
Evaluation of acid-base status in brain dead donors and the impact of metabolic acidosis on organ retrieval.
Background: Pathophysiologic changes after brain death can lead to acid-base disturbances. The primary aim of this study was to clarify the acid-base state and its source in brain dead donors using Stewart's approach. Additionally, we investigated whether the presence of metabolic acidosis affected the number of organs retrieved from donors. ⋯ Although more organs were retrieved from the donors without metabolic acidosis than those with metabolic acidosis (P=0.012), serum albumin level (P=0.010) and donor age (P<0.001), rather than metabolic acid-base disturbances, significantly correlated with the number of organs retrieved in multivariate regression analysis. Conclusion: Most brain dead donors exhibited metabolic acid-base disturbances. However, rather than metabolic acidosis, serum albumin level and donor age were well correlated with the number of organs retrieved.
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Survival of critically ill patients is frequently associated with significant functional impairment and reduced health-related quality of life. Early physiotherapy of acute respiratory distress syndrome (ARDS) patients has recently been identified as an important therapeutical tool and has become an important evidence-based component in the management of these patients. Nevertheless, availability and quality of physiotherapy performed in intensive care units (ICUs) is often inadequate. ⋯ The assessment and evidence-based treatment of these patients should include prevention and reduction of adverse consequences of immobilization and weaning failure. A variety of modalities of early physiotherapy in ICU are suggested by clinical research and should be applied according to the stage of disease, comorbidities, and patient's level of cooperation. Early ICU physiotherapy is an interdisciplinary team activity, involving physical therapists, occupational therapists, nurses and medical staff.
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Minerva anestesiologica · May 2013
Editorial CommentEndotracheal cuffs and microaspiration. No guarantees.