Revue médicale suisse
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Revue médicale suisse · Dec 2009
[Evaluation of practical skills in echocardiography for intensivists].
In 2009, the Critical Care NetWork of the American College of Chest Physicians (ACCP) in partnership with La Société de réanimation de langue française (SRLF) selected a panel of experts to characterize competence in critical care ultrasonography (CCUS) and suggest a consensus statement on competence in CCUS. CCUS may be divided into general CCUS (thoracic, abdominal, and vascular), and echocardiography (basic and advanced). ⋯ They, also, defined a reasonable minimum standard statement to serve as a guide for the intensivist in achieving proficiency in the field. The present article focuses on the consensus statement concerning the evaluation of the competences (basic level) in critical care echocardiography.
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Prognosis after severe traumatic brain injury (TBI) is determined by the severity of initial injury and secondary cerebral damage. The main determinants of secondary cerebral damage are brain ischemia and oedema. ⋯ A standardised approach based on prevention and treatment of secondary cerebral damage is the only effective therapeutic strategy of severe TBI. We review the classification, pathophysiology and treatment of secondary cerebral damage after severe TBI and discuss the management of intracranial hypertension, cerebral perfusion pressure and brain ischemia.
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Occidental countries are affected by a demographic ageing. The growing number of elderlies in the intensive care units (ICU) reflects this phenomenon. ⋯ Tools to improve the ability to estimate prognosis during the triage process or during an ICU stay are necessary. Currently no prediction model can decide about the ICU admission or about the treatment to provide to elderly patients without the opinion of an ICU specialist.
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Specialized and multidisciplinary care is needed for patients with amyotrophic lateral sclerosis (ALS). Respiratory failure secondary to respiratory muscle dysfunction, ineffective cough, weight loss and progressive loss of autonomy should always be sought and explored. ⋯ Patients should be informed clearly as to the nature and evolution of ALS, and as to the potential benefits and disadvantages associated with each treatment modality in order to be involved in therapeutic decisions. This evidence-based review focuses on respiratory care of patients with ALS.
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Medical use of chronic opioids has recently increased in Switzerland. Even though their effect on daytime vigilance tends to disappear after some time, 70% of chronic opioid users will suffer from sleep disordered breathing. ⋯ More sophisticated ventilatory modes such as bilevel ventilation with backup respiratory rate or adaptive servoventilation are often required. Older patients with concomitant COPD or obstructive sleep apnea are at higher risk of developing nocturnal breathing disorders.