Minerva anestesiologica
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During the cyclic changes in intrathoracic pressure, changes in stroke volume characterize the state at which both ventricles are preload dependant. Determining stoke volume variations may thus help to predict fluid responsiveness in mechanically ventilated patients. Selected review of the articles having investigated the stroke volume variations in critically ill patients. ⋯ However, these index are sensitive to tidal volume. During mechanical ventilation with low tidal volumes, the ventilatory-induced changes in preload may be too small to generate changes in stroke volume, even in preload dependant patients. Stroke volume variations can be useful to detect fluid responsiveness in mechanically ventilated patients.
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Fever is one of the most aspecific marker of disease, it is considered a protective host defense response and it is the result of a reset of the hypothalamic thermostat. Fever is a common problem in ICU patients and it is associated with infective and non infective causes. Fever presenting in ICU should always be a source of concern and the first and immediate priority is to determine its clinical significance.
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The aim of hemodynamic monitoring in intensive care is to recognize derangements in physiologic variables, which herald the progression toward organ failure. Traditionally the term "vital signs" refers to heart rate, arterial pressure, respiratory rate and body temperature monitoring. Continuous monitoring of vital signs, is advocated, since trends are more significant than single measurements, and is still a cornerstone, in the hemodynamic evaluation of a critically ill patient. Nevertheless, the spectrum of hemodynamic derangements that can arise during intensive care unit stay is very large and often additional information, beside the vital signs, are needed to evaluate correctly the individual patient.
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Ventilator associated pneumonia (VAP) is a nosocomial lower respiratory tract infection that ensues in critically ill patients undergoing mechanical ventilation. The reported incidence of VAP varies between 9% and 68% with a mortality ranging between 33% and 71%. ⋯ Prompt recognition and treatment of established VAP has also been demostrated to affect outcome. Therefore, the knowledge of risk factors associated with the development of VAP and the implementation of strategies to prevent, diagnose and treat VAP are mainstems in the nursing of mechanically ventilated patients.
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ICU nurses hold an important role in the management of septic patients underlining with their ability to recognize SIRS that is the first step in the proinflammatory and procoagulant cascade following an infection. Early and timely approach to organ dysfunction can indeed modify the damages due to hypoperfusion. The ability to recognize organ dysfunction using different monitoring devices available should be part of the nursing attitudes.