Best practice & research. Clinical anaesthesiology
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Best Pract Res Clin Anaesthesiol · Sep 2008
ReviewVentilator-associated pneumonia: problems with diagnosis and therapy.
The diagnosis of ventilator-associated pneumonia, VAP, is problematic because of a lack of objective tools that are utilized to make an assessment of bacterial-induced lung injury in a heterogeneous group of hosts. Clinical symptoms and signs are used to identify patients that may have a "lung infection". However, the symptoms and signs can be produced by a myriad of other conditions. ⋯ Exploratory molecular studies utilizing clone libraries and molecular arrays for microbial identification document the inability of culture-based techniques to even identify all the microbes involved in VAP. These molecular studies also offer evidence that oral flora present in the lungs of patients with VAP, suggesting aspiration of oral secretions and/or biofilms on endotracheal tubes, supply the bacteria for VAP. Much more investigation is needed to determine the optimal timing of antibiotic treatment and which diagnostic molecular methods can be utilized in the ICU.
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Best Pract Res Clin Anaesthesiol · Sep 2008
ReviewBioterrorism and the anaesthesiologist's perspective.
The use of non-conventional agents aimed at causing panic and terror among civilians has a long history. There have been uninterrupted threats and the use of biological and chemical weaponry from the time of early tribal conflicts to the Iran-Iraq war. ⋯ This chapter reviews the main chemical and biological agents possibly obtainable by individuals and groups, and the anaesthesiologist's tasks during the resultant non-conventional multi-casualty scenarios. It briefly illustrates the chemical and biological pathological effects of the various intoxicants on the human body, and describes modes of protection and the currently available treatment, based on both military and civilian materials and on the authors' own experience derived from specially designed drills.
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Best Pract Res Clin Anaesthesiol · Jun 2008
ReviewArginine vasopressin in the treatment of vasodilatory septic shock.
Vasodilatory septic shock is characterized by profound vasodilation of the peripheral circulation, relative refractoriness to catecholamines and a relative deficiency of the posterior pituitary hormone, vasopressin. Arginine vasopressin is effective in restoring vascular tone in vasodilatory septic shock and may be associated with decreased mortality in less severe septic shock as well as improved mortality and decreased renal failure in septic shock patients at risk for renal failure.
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Best Pract Res Clin Anaesthesiol · Jun 2008
ReviewRole of arginine vasopressin in the setting of cardiopulmonary resuscitation.
Arginine vasopressin (AVP) constitutes an integral part of the neuroendocrine stress response during cardiac arrest. A strong correlation between endogenous AVP secretion and outcome from cardiac arrest has led to a number of experimental studies indicating a survival benefit of AVP compared to epinephrine. ⋯ Although current data suggest that both epinephrine and AVP are equally effective to restore spontaneous circulation in out-of-hospital cardiac arrest, benefits of AVP in specific patient groups, e.g. those with asystolic cardiac arrest, have been shown. The latest international guidelines recommend AVP as an alternative vasopressor drug which may replace the first or second dosage of epinephrine in the treatment of pulseless arrest If the combined use of AVP and epinephrine is superior to epinephrine alone in terms of improved hospital admission and discharge rates this needs to be re-confirmed by the results of an ongoing multicenter trial.