1,721,555 research outputs found
Should we use early less invasive hemodynamic monitoring in unstable ICU patients?
Full text linkIn the previous issue of Critical Care, Takala and colleagues presented the results of a multicenter study to investigate whether the early presence of less invasive hemodynamic monitoring improves outcome in patients admitted with hemodynamic instability to the intensive care unit. The authors' results suggest that it makes no difference. We discuss these findings and compare them to the literature on early goal-directed therapy in which monitors are used early but with a protocol
Valutare il risparmio energetico dell’automazione integrata delle utility
No full textL’illuminazione costituisce una delle voci più consistenti tra i consumi elettrici, specialmente nel terziario dove rappresenta più del 40% del totale. Ciò significa che un risparmio sull’illuminazione comporta un miglioramento della prestazione energetica dell’edificio e di conseguenza una riduzione sostanziale della bolletta elettrica.
Per limitare i consumi dell’illuminazione, a parità di qualità luminosa, è possibile agire su due fronti:
- si può ottimizzare l’efficienza luminosa dell’impianto,
- si può ottimizzare il controllo.
Il primo conduce ad un risparmio poiché, con un impianto efficiente, è possibile garantire lo stesso illuminamento con una minore potenza elettrica impegnata, il secondo permette di ridurre gli sprechi poiché le lampade vengono utilizzate solo nella misura strettamente necessaria
Goal-directed haemodynamic therapy during elective total hip arthroplasty under regional anaesthesia.
No full textINTRODUCTION: Total hip replacement is one of the most commonly performed major orthopaedic operations. Goal-directed therapy (GDT) using haemodynamic monitoring has previously demonstrated outcome benefits in high-risk surgical patients under general anaesthesia. GDT has never been formally assessed during regional anaesthesia.
METHODS: Patients undergoing total hip replacement while under regional anaesthesia were randomised to either the control group (CTRL) or the protocol group (GDT). Patients in the GDT group, in addition to standard monitoring, were connected to the FloTrac sensor/Vigileo monitor haemodynamic monitoring system, and a GDT protocol was used to maximise the stroke volume and target the oxygen delivery index to > 600 mL/minute/m2.
RESULTS: Patients randomised to the GDT group were given a greater volume of intravenous fluids during the intraoperative period (means ± standard deviation (SD): 6,032 ± 1,388 mL vs. 2,635 ± 346 mL; P < 0.0001), and more of the GDT patients received dobutamine (0 of 20 CTRL patients vs. 11 of 20 GDT patients; P < 0.0003). The GDT patients also received more blood transfused during the intraoperative period (means ± SD: 595 ± 316 mL vs. 0 ± 0 mL; P < 0.0001), although the CTRL group received greater volumes of blood replacement postoperatively (CTRL patients 658 ± 68 mL vs. GDT patients 198 ± 292 mL; P < 0.001). Overall blood consumption (intraoperatively and postoperatively) was not different between the two groups. There were an increased number of complications in the CTRL group (20 of 20 CTRL patients (100%) vs. 16 of 20 GDT patients (80%); P = 0.05). These outcomes were predominantly due to a difference in minor complications (20 of 20 CTRL patients (100%) vs. 15 of 20 GDT patients (75%); P = 0.047).
CONCLUSIONS: GDT applied during regional anaesthesia in patients undergoing elective total hip replacement changes intraoperative fluid management and may improve patient outcomes by decreasing postoperative complications. Larger trials are required to confirm our findings
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