1,060 research outputs found
Intra‐abdominal pressure as an ignored parameter in the pathophysiology of preeclampsia
No full textMalbrain, MLNG (corresponding author), Univ Hosp Brussels UZB, Intens Care Unit, Jette, Belgium.
[email protected]
Ventilation in patients with intra-abdominal hypertension: what every critical care physician needs to know
No full textAbstract The incidence of intra-abdominal hypertension (IAH) is high and still underappreciated by critical care physicians throughout the world. One in four to one in three patients will have IAH on admission, while one out of two will develop IAH within the first week of Intensive Care Unit stay. IAH is associated with high morbidity and mortality. Although considerable progress has been made over the past decades, some important questions remain regarding the optimal ventilation management in patients with IAH. An important first step is to measure intra-abdominal pressure (IAP). If IAH (IAP > 12 mmHg) is present, medical therapies should be initiated to reduce IAP as small reductions in intra-abdominal volume can significantly reduce IAP and airway pressures. Protective lung ventilation with low tidal volumes in patients with respiratory failure and IAH is important. Abdominal-thoracic pressure transmission is around 50%. In patients with IAH, higher positive end-expiratory pressure (PEEP) levels are often required to avoid alveolar collapse but the optimal PEEP in these patients is still unknown. During recruitment manoeuvres, higher opening pressures may be required while closely monitoring oxygenation and the haemodynamic response. During lung-protective ventilation, whilst keeping driving pressures within safe limits, higher plateau pressures than normally considered might be acceptable. Monitoring of the respiratory function and adapting the ventilatory settings during anaesthesia and critical care are of great importance. This review will focus on how to deal with the respiratory derangements in critically ill patients with IAH
Compartment Syndrome
No full textComprehensively addressing the topic of the compartment syndrome, this book covers all aspects of this painful and complex condition, ranging from the history to the pathophysiology and treatment in the various body compartments affected by the syndrome, as well as the short- and long-term outcomes. With an up-to-date literature review and the innovative content written by international opinion leaders, it offers all involved in the management of such complicated patients a much-needed source of reference. Discussing compartment syndrome in everyday practice, this book is of interest to surgeons, practicing physicians, anesthesiologists and nurses
Is it feasible to measure intra-abdominal pressure using a balloon-tipped rectal catheter? Results of a validation study
No full textAbstractThe gold standard to measure intra-abdominal pressure (IAP) is intra-vesical measurement via the urinary bladder. However, this technique is restricted in ambulatory settings because of the risk of iatrogenic urinary tract infections. Rectal IAP measurements (IAPrect) may overcome these limitations, but requires validation. This validation study compares the IAPrect technique against gold standard intra-vesical IAP measurements (IAPves). IAPrect using an air-filled balloon catheter and IAPves using Foley Manometer Low Volume were measured simultaneously in sedated and ventilated patients. Measurements were performed twice in different positions (supine and HOB 45° elevated head of bed) and with an external abdominal pressure belt. Sixteen patients were included. Seven were not eligible for analysis due to unreliable IAPrect values. IAPrect was significantly higher than IAPves for all body positions (p < 0.01) and the correlation between IAPves and IAPrect was poor and not significant in each position (p ≥ 0.25, R2 < 0.6, Lin’s CCC < 0.8, bias − 8.1 mmHg and precision of 5.6 mmHg with large limits of agreement between − 19 to 2.9 mmHg, high percentage error 67.3%, and low concordance 86.2%). Repeatability of IAPrect was not reliable (R = 0.539, p = 0.315). For both techniques, measurements with the external abdominal pressure belt were significantly higher compared to those without (p < 0.03). IAPrect has important shortcomings making IAP estimation using a rectal catheter unfeasible because the numbers cannot be trusted nor validated.</jats:p
What is appropriate care? A qualitative study into the perceptions of healthcare professionals in Flemish university hospital intensive care units
No full textAim: This study examines when healthcare professionals consider intensive care as appropriate care.
Background: Despite attempts to conceptualize appropriate care in prior research, there is a lack of insight into its meaning and implementation in practice. This is an important issue because healthcare professionals as well as patients and relatives report inappropriate care in the intensive care unit (ICU) on a regular basis.
Methods: A qualitative study was designed, based on principles of grounded theory. Seventeen semi-structured interviews were conducted with nurses, doctors and doctors in training from three Flemish university hospitals. Analyses followed the Quagol method; insights were gained by means of the constant comparative method.
Results: Healthcare professionals described appropriate care as socially sustainable care, high-quality care, patient-oriented care, dignified care and meaningful care. They considered it important that care is not only proportional to the expected survival and quality of life of the patient and in line with the patient's or relatives’ wishes, but also that the pursuit of the care goals is proportional to the patient's suffering.
Although healthcare professionals indicated the same elements of appropriate care, they were defined and interpreted in individual and therefore different ways. This diversity lies at the basis of fields of tension and frustrations among healthcare professionals.
Conclusion: Appropriate care is defined and interpreted in individual and therefore different ways. In order to decide which type of care is appropriate for a specific patient, a process of open and constructive communication in a team is recommended
Meditsiinidoktor Annika Reintam
No full text5. septembril 2008 kaitses Tartu Ülikooli arstiteaduskonna nõukogus doktorikraadi
Annika Reintam. Töö „Gastrointestinaalne puudulikkus intensiivravi haigetel“ valmis Tartu Ülikooli anestesioloogia ja intensiivravi kliinikus, juhendajateks olid prof Joel Starkopf ja külalisprofessor Hartmut Kern. Oponeeris dr Manu Malbrain Antverpeni Ülikoolist
Abdominal Contributions to Cardiorenal Dysfunction in Congestive Heart Failure
No full textCurrent pathophysiological models of congestive heart failure unsatisfactorily explain the detrimental link between congestion and cardiorenal function. Abdominal congestion (i.e., splanchnic venous and interstitial congestion) manifests in a substantial number of patients with advanced congestive heart failure, yet is poorly defined. Compromised capacitance function of the splanchnic vasculature and deficient abdominal lymph flow resulting in interstitial edema might both be implied in the occurrence of increased cardiac filling pressures and renal dysfunction. Indeed, increased intra-abdominal pressure, as an extreme marker of abdominal congestion, is correlated with renal dysfunction in advanced congestive heart failure. Intriguing findings provide preliminary evidence that alterations in the liver and spleen contribute to systemic congestion in heart failure. Finally, gut-derived hormones might influence sodium homeostasis, whereas entrance of bowel toxins into the circulatory system, as a result of impaired intestinal barrier function secondary to congestion, might further depress cardiac as well as renal function. Those toxins are mainly produced by micro-organisms in the gut lumen, with presumably important alterations in advanced heart failure, especially when renal function is depressed. Therefore, in this state-of-the-art review, we explore the crosstalk between the abdomen, heart, and kidneys in congestive heart failure. This might offer new diagnostic opportunities as well as treatment strategies to achieve decongestion in heart failure, especially when abdominal congestion is present. Among those currently under investigation are paracentesis, ultrafiltration, peritoneal dialysis, oral sodium binders, vasodilator therapy, renal sympathetic denervation and agents targeting the gut microbiota. (J Am Coll Cardiol 2013;62:485-95) (C) 2013 by the American College of Cardiology Foundatio
Struktur dan Fungsi Hasehawaka Manu Kakae pada Masyarakat Tetun Fehan, Desa Forek Modok
No full textIn this research, the author wants to find our structure and function in Hasehawaka Manu Kakae in Tetun Fehan society in Forekmodok village. This research aims at describing structure and function in Hasehawaka Manu Kakae. Method used in this research was qualitative descriptive by using observation, interview with recording and note technique. The result shows that structure and function in Hasehawaka Manu Kakae consist of diction, line, couplet, voice that consists of rhyme, rhythm an other voice such as euphony and cacophony, and language style. Besides, function found in Hasehawaka Manu Kakae consists of social, educative and cultural functions
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