Minerva anestesiologica
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Minerva anestesiologica · Apr 2001
Randomized Controlled Trial Comparative Study Clinical TrialEnd tidal carbon dioxide monitoring in spontaneously breathing, nonintubated patients. A clinical comparison between conventional sidestream and microstream capnometers.
To evaluate the end tidal carbon dioxide estimation in nonintubated, spontaneously breathing patients using either conventional sidestream or microstream capnometers. ⋯ The microstream capnometer provides a more accurate end tidal CO2 partial pressure measurement in nonintubated, spontaneously breathing patients than conventional sidestream capnometers, allowing for adequate monitoring of the respiratory function in nonintubated patients.
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Quality of recovery after anesthesia and surgery is an important dimension of the patient's experience and may be related to the quality of anesthesia care. Quality of recovery is also related to patient satisfaction. We have developed and validated a quality of recovery (QoR) score. ⋯ Patient satisfaction is associated with higher QoR Scores. The measurement of quality of recovery is an important aspect of a quality anaesthetic practice. The QoR Score can be incorporated into routine practice and this should improve patient care and resultant levels of satisfaction.
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Minerva anestesiologica · Apr 2001
Review Randomized Controlled Trial Clinical TrialPathophysiology of prone positioning in the healthy lung and in ALI/ARDS.
Prone position was initially introduced in healthy anesthetized and paralyzed subjects for surgical specific reasons. Then, it was used during acute respiratory failure to improve gas exchange. The interest on prone position during ALI/ARDS progressively increased, even if the mechanisms leading to a respiratory improvement are not yet completely understood. ⋯ The proportion of responders increased to 85% after 6 hours of prone positioning. The incidence of maneuver-related complications and severe and life-threatening complications was extremely rare. The overall mortality at ICU discharge was 51% and the ICU stay was similar in survivors and non survivors (17.8 +/- 11.6 vs 17.8 +/- 11.4 days).
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Clinical shock is a common problem of the critically ill patient. Assessment of the circulating volume is important to assure adequate oxygen supply to the tissues, and hypovolaemia must be treated promptly to avoid organ dysfunction. ⋯ Clinical signs are often late indicators and the monitoring of hemodynamic variables through cardiac catheterism can be misleading. The fluid challenge approach provides a useful diagnostic test of hypovolaemia, and a method for titrating the dose of fluid tailored to the individual's requirement.
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Minerva anestesiologica · Apr 2001
Multicenter StudyEvolution in the utilization of the mechanical ventilation in the critical care unit.
Use of mechanical ventilation has increased in recent years and constitutes a major therapeutic modality in the intensive care unit (ICU). In the recent years, changes in the ventilatory modes, in the ventilatory strategies and in the weaning from mechanical ventilation have occurred. We have compared the data obtained from the Spanish ICUs in studies that were carried out in three periods of the nineties, with the aim to test whether the aforementioned innovations have modified the clinical practice. ⋯ Concerning to weaning, over the course of the decade occurred an increase in use of pressure support ventilation and spontaneous breathing trial, being this method the most frequently used at the end of the decade. The performance of the tracheostomy has been lesser and earlier over the time. The results obtained suggest that findings from research on mechanical ventilation are incorporated into clinical practice at a very slow pace whereas the evidence obtained from the clinical trials about weaning has had a better reception.