1,721,655 research outputs found
Predictive scores for postoperative pulmonary complications: Time to move towards clinical practice
No full textUltrasound and bronchoscopic guided percutaneous dilatational tracheostomy: friends for life!
No full text
Positive end-expiratory pressure and recruitment maneuvers in obese patients: Should we chase oxygenation?
No full textLung CT scan
No full textAbstract: In the last 20 years, the use of computed tomography (CT) to evaluate thoracic diseases has rapidly gained
popularity and CT has become firmly established as an important research and diagnostic modality. In particular, CT has
played an important role in improving our knowledge about the pathophysiology of the adult respiratory distress
syndrome (ARDS) and in determining the morphological and functional relationships of different therapeutic options
commonly used in the clinical management of this syndrome. CT scan may provide: 1) accurate measurement of the
impact of mechanical ventilation on hyperaeration and reaeration/recruitment, being the most objective technique
currently available to set mechanical ventilation and identifying patients for extracorporeal lung support; 2) the amount of lung edema, associated with the severity of the alveolar capillary barrier lesion and the risk of mortality; 3) clinical
information in patients with a sudden and unexplained deterioration of the clinical status or the lack of expected
improvement as well as to follow the evolution with time. We recommend to perform: 1) one single whole lung CT scan
at end-expiration at PEEP 5 cmH2O, to evaluate the distribution of aeration and to compute the amount of lung weight; 2) only three lung CT slices, taken at the lung apex, hilum, and basis, at PEEP = 5 cmH2O and at Pplat = 45 cmH2O, to
assess of lung recruitability; 3) a CT scan as early as possible after onset of ARDS (if clinical characteristics persist for
more than 24 hours) and repeat it after 1 week if no clinical improvement is observed; 4) a CT scan in presence of any
clinical deterioration not explained by conventional diagnostic tools. We suggest considering the measurement of
extravascular lung water and end-expiratory lung volume by non radiological techniques and lung ultrasound if CT scan
cannot be done
FG-4497: a new target for acute respiratory distress syndrome?
No full textThe morbidity and mortality rates associated with acute respiratory distress syndrome (ARDS) remain high and the development of new therapeutic strategies is urgently required. Some pharmacological treatments, proposed or under evaluation for ARDS, seek to protect the endothelium and consequently mitigate fluid extravasation into the alveolar space. FG-4497 is a new compound which acts as a prolyl hydroxylase domain 2 inhibitor and mimics hypoxia in the activation of hypoxia-inducible factor-2α signaling, decreasing VE-cadherin phosphorylation and thus promoting integrity of adherens junctions. In this special report, we discuss the pharmacological characteristics of FG-4497, its effect on lung parenchyma and other organs and future perspectives in ARDS. In short, FG-4497 may be considered a novel pharmacological option targeting endothelial cell repair in lung diseases such as ARDS. Further experimental and clinical studies are warranted to better understand the mechanisms of action of FG-4497 in different types of lung injury
Traumatic brain injury and translational research: pharmacological and nonpharmacological perspectives
No full textPostoperative complications of patients undergoing cardiac surgery
No full textPurpose of review
Cardiac surgery is at high risk for the development of postoperative complications involving cardiovascular and respiratory system, as well as kidneys and central nervous system. The aim of this review is to provide an overview on the most recent findings concerning the type and incidence of different complications after cardiac surgery and to summarize the current recommendations.
Recent findings
Despite an improvement of surgical and anaesthesia techniques that resulted in a significant decrease in mortality, postoperative complications play a major role in affecting morbidity, mortality, length of hospital stay and patients' quality of life. The most recent evidence suggests that fluid and inotropes administration should be targeted to maintain a cardiac index above 3 l/min/m(2) throughout the perioperative period. Volatile anaesthesia and mechanical ventilation with low tidal volumes, low driving pressure and moderate-low positive end-expiratory pressure should be preferred. Preoperative steroids could reduce postoperative atrial fibrillation, whereas no drug has shown to effectively prevent kidney injury.
Summary
Cardiac surgery is still at high risk for postoperative complications. The optimal type of anaesthesia, protective mechanical ventilation during and after surgery as well as haemodynamic management with vasoactive and inotropic drugs is still to be determined
- …
