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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Even moderate temperature elevations soon acute cerebral damage may markedly worsen initial brain injury. These effects may justify aggressive antipyretic treatment in neurosurgical intensive care unit (NICU). On the basis of a literature survey, it is observed that fever is extraordinarily common in the neurosurgical intensive care unit during the acute phase of subarachnoid hemorrhage, stroke, and traumatic brain injury. ⋯ Some of the more common and innovative methods to control body temperature in order to mitigate the detrimental effects of pyrexia following acute neurological injury are explored. Maintenance of normothermia appears to be a desirable therapeutic goal in managing the patients with damaged or at-risk brain tissue. However, it has not been established conclusively that the benefits of antipyretic therapy outweigh its risks and that despite a sound physiologic argument for controlling fever in the brain-injured patient, there is no evidence that doing so will improve their outcome.
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The detection of tissue hypoxia and its correction is one of the aim of the hemodynamic monitoring. Classical hemodynamic variable often fail to achieve this goal. Lactate measurements may be a good indicator of tissue hypoxia. ⋯ Whatever its origin, blood lactate levels have a strong predictive value. The interpretation of blood lactate levels is difficult. Nevertheless, monitoring blood lactate levels can be useful to detect tissue hypoxia and to monitor the effects of therapy.
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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.