1,721,230 research outputs found
“I feel how you feel”: reflections about empathy in the relationship between ICU physicians and relatives
No full textIs smaller high enough? Another piece in the puzzle of stress, strain, size, and systems
No full textExtracorporeal lung-supporting procedures open the possibility of staying within widely accepted margins of 'protective' mechanical ventilation (tidal volume of less than 6 mL per kg of predicted ideal body weight and plateau pressure of less than 30 cm H(2)O) in most any case of respiratory failure or even of further reducing ventilator settings while still providing adequate gas exchange. There is evidence that, at least in some patients, a further reduction in tidal volumes might be beneficial. Extracorporeal procedures to support the lungs have undergone tremendous technical developments, thus reducing the procedure-related risks. However, what is true for ventilator settings should also be true for extracorporeal procedures: studies will have to demonstrate a convincing risk-benefit ratio. In addition, a simple reduction of the tidal volume will certainly not be the right answer. If extracorporeal support largely influences gas exchange, the 'optimal' tidal volume/positive end-expiratory pressure ratio keeping stress and strain low and avoiding alveolar derecruitment will still have to be individually defined
Bridge or Abyss: Extracorporeal Membrane Oxygenation for Acute Respiratory Failure in Interstitial Lung Disease
No full textF ifty Y ears of R esearch in ARDS Why Is Acute Respiratory Distress Syndrome So Important for Critical Care?
No full text
Forced-air warming: technology, physical background and practical aspects
No full textPurpose of review There is an ever-increasing number of forced-air warming devices available in the market. However, there is also a paucity of studies that have investigated the physical background of these devices, making it difficult to find the most suitable ones. Recent findings Heat flow produced by power units depends on the air temperature at the nozzle and the airflow. The heat transfer from the blanket to the body surface depends on the heat exchange coefficient, the temperature gradient between the blanket and the body surface and the area that is covered. Additionally, the homogeneity of heat distribution inside the blanket is very important. The lower the temperature difference between the highest and the lowest blanket temperature, the better the performance of the blanket. Summary The efficacy of a forced-air warming system is mainly determined by the design of the blankets. A good forced-air warming blanket can easily be detected by measuring the temperature difference between the highest blanket temperature and the lowest blanket temperature. This temperature difference should be as low as possible. Because of the limited efficacy of forced-air warming systems to prevent hypothermia, patients must be prewarmed for 30-60 min even if a forced-air warming system is used during the operation. During the operation, the largest blanket that is possible for the operation should be used
Review
No full textPostoperative bleeding might become a serious problem in the management of cardiac surgical patients, with marked medical and economic impact. In these life-threatening situations, massive haemorrhage represents frequently a combination of surgical and coagulopathic bleeding. Surgical bleeding results from a definite source at the operation site and can be corrected using surgical standard techniques. Acute coagulopathies, in contrast, result from impaired thrombin formation, and require optimized therapeutical strategies. Effective pharmacological treatment will be complicated by the presence of ventricular assist devices (VAD), which necessarily imply effective anticoagulation. In episodes of uncontrolled coagulopathic bleeding, the application of recombinant activated factor VII (rFVIIa) as a effective haemostatic agent has become more and more popular. However, only very few data are available on its use in patients with VAD in place. We researched the PubMed-database for case reports about the use of rFVIIa in patients with VAD and summarized them. In addition, we report a case from our hospital. In all cases cessation of bleeding without any thrombembolic complications could be achieved. In cases of uncontrollable, non-surgical bleeding rFVIIa seems to be a therapeutical option even for patients with VAD
Breathing and Ventilation during Extracorporeal Membrane Oxygenation: How to Find the Balance between Rest and Load
No full text
- …
