Articles: postoperative.
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Curr Opin Crit Care · Aug 2014
ReviewPerioperative haemodynamic management: is echocardiography the right tool?
This review analyses the application of perioperative echocardiography as an important tool in the management of haemodynamic impairment. ⋯ Echocardiography has recently gained popularity among anaesthesiologists and intensive care practitioners because it provides a pathophysiological picture of haemodynamic impairment, allowing a more detailed understanding of the static or dynamic parameters on which clinicians usually rely when making decisions.
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Randomized Controlled Trial
The effect of intra-operative passive movement therapy on non-surgical site pain after breast reconstructive surgery: a preliminary study.
Pain distant to an operative site is under-reported but sometimes more severe than pain from the surgical site. Intra-operative passive movement could possibly reduce this pain. This preliminary study was designed to assess the practicalities of conducting a randomised controlled trial of this therapy in anaesthetised patients. ⋯ Forty-two patients undergoing breast reconstruction were randomly assigned to receive either intra-operative passive movement or standard care. Twenty-four hours after surgery, median (IQR [range]) morphine consumption was 33 (11-42 [0-176]) mg in the passive movement group compared with 74 (15-118 [0-238]) mg with standard care (p = 0.126), while participants reported median (IQR [range]) visual analogue scores in areas distant from the surgical site of 0 (0-4 [0-34]) mm in the passive movement group compared with 10 (2-30 [0-57]) mm in those receiving standard care (p = 0.002). A full trial of intra-operative passive movement therapy to reduce postoperative is feasible and warranted.
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Semin Respir Crit Care Med · Aug 2014
ReviewNoninvasive Ventilation for Patients with Hypoxemic Acute Respiratory Failure.
Noninvasive ventilation (NIV) has an established efficacy to improve gas exchange and reduce the work of breathing in patients with hypoxemic acute respiratory failure. The clinical efficacy in terms of meaningful outcome is less clear and depends very much on patient selection and assessment of the risks of the technique. The potential risks include an insufficient reduction of the oxygen consumption of the respiratory muscles in case of shock, an excessive increase in tidal volume in case of lung injury, and a risk of delayed or emergent intubation. ⋯ In all cases, there is both a time window and a severity window for NIV to work, after which delaying endotracheal intubation may worsen outcome. The preventive use of NIV seems promising in this setting but needs more research. An emerging interesting new option is the use of high flow humidified oxygen, which seems to be intermediate between oxygen alone and NIV.
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Persistent postsurgical pain after amputation is common and has a number of proposed risk factors. We describe the management of a patient with persistent pain after a below-the-knee amputation. We used a combination of general, peripheral, and neuraxial anesthesia techniques to control postoperative phantom limb and stump pain in a patient at high risk for developing chronic pain. With preemptive management and mechanism-directed therapies, adequate preoperative and postoperative pain control were achieved in attempts to reduce the risk of chronic phantom limb pain.
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Curr Opin Crit Care · Aug 2014
ReviewPulmonary complications in patients receiving a solid-organ transplant.
Major improvements in perioperative care and immunobiology have not abated the risk for severe pulmonary complications after solid-organ transplantation. The aim of this study is to update information on infectious and noninfectious pulmonary complications after solid-organ transplantation, addressing epidemiology, risk factors, diagnostic workup, and management. ⋯ Pulmonary complications after solid-organ transplantation, and particularly infections, are able to compromise the extremely good results of the transplant procedures. Solid-organ transplantation recipients challenge the ICU physician with unique aspects of their post-transplant course, adding, in an already critical patient, the immunosuppressed state and the quality of the functional recovery of the graft.