195 research outputs found
Fluid resuscitation in trauma patients : what should we know?
No full textPURPOSE OF REVIEW: Fluid resuscitation in trauma patients could reduce organ failure, until blood components are available and hemorrhage is controlled. However, the ideal fluid resuscitation strategy in trauma patients remains a debated topic. Different types of trauma can require different types of fluids and different volume of infusion. RECENT FINDINGS: There are few randomized controlled trials investigating the efficacy of fluids in trauma patients. There is no evidence that any type of fluids can improve short-term and long-term outcome in these patients. The main clinical evidence emphasizes that a restrictive fluid resuscitation before surgery improves outcome in patients with penetrating trauma. Fluid management of blunt trauma patients, in particular with coexisting brain injury, remains unclear. SUMMARY: In order to focus on the state of the art about this topic, we review the current literature and guidelines. Recent studies have underlined that the correct fluid resuscitation strategy can depend on the type of trauma condition: penetrating, blunt, brain injury or a combination of them. Of course, further studies are needed to investigate the impact of a specific fluid strategy on different type and severity of trauma
β-blockers in critically ill patients : from physiology to clinical evidence
No full textThis article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2015 and co-published as a series in Critical Care. Other articles in the series can be found online at http://ccforum.com/series/annualupdate2015. Further information about the Annual Update in Intensive Care and Emergency Medicine is available from http://www.springer.com/series/8901
Toward lung protective ventilation during general anesthesia : a new challenge = Hacia la ventilación de protección pulmonar durante la anestesia general. Un nuevo desafío
No full textUpdate on lung imaging to select ventilatory management in ARDS patients
No full textThe lung imaging techniques have always been a crucial component for the pathophysiological knowledge and management of the Acute Respiratory Distress Syndrome (ARDS). Recently, the current ARDS definition has been update also clarifying the role of lung imaging in order to optimize the agreement between intensivists and radiologists and to make the clinical use of the definition easier. In this chapter we will focus on the diagnostic assessment, clinical management, technical and clinical limitations of chest X-ray, computed tomography, lung ultrasound, positron emission tomography, electrical impedance tomography and finally magnetic resonance for ARDS management
Esophageal pressure monitoring in ARDS
No full textAcute respiratory distress syndrome (ARDS) remains a disease with high mortality rates despite recent therapeutic advances [1]. Although mechanical ventilation can be lifesaving, inappropriate use of the ventilator can itself promote lung injury. It could be useful to know the mechanics characteristics of the respiratory system in order to be able to set a protective ventilation strategy, because ARDS is a syndrome with marked clinical variability. The assessment of respiratory mechanics is important in mechanically ventilated patients because acute respiratory failure is most often the consequence of severe abnormalities in the mechanical properties of the respiratory system, including its lung and chest wall components [2]. Despite possible technical artifacts, recording of the esophageal pressure (Pes) provides the opportunity of estimating pleural pressure (PPl), to partition the mechanics and better understand the underlying pulmonary injury
Noninvasive ventilation in chest trauma: Systematic review and meta-analysis
No full textPurpose: Single studies of Noninvasive Ventilation (NIV) in the management of acute respiratory failure in chest trauma patients have produced controversial findings. The aim of this study is to critically review the literature to investigate whether NIV reduces mortality, intubation rate, length of stay and complications in patients with chest trauma, compared to standard therapy. Methods: We performed a systematic review and meta-analysis of randomized controlled trials, prospective and retrospective observational studies, by searching PubMed, EMBASE and bibliographies of articles retrieved. We screened for relevance studies that enrolled adults with chest trauma who developed mild to severe acute respiratory failure and were treated with NIV. We included studies reporting at least one clinical outcome of interest to perform a meta-analysis. Results: Ten studies (368 patients) met the inclusion criteria and were included for the meta-analysis. Five studies (219 patients) reported mortality and results were quite homogeneous across studies, with a summary relative risk for patients treated with NIV compared with standard care (oxygen therapy and invasive mechanical ventilation) of 0.26 (95 % confidence interval 0.09-0.71, p = 0.003). There was no advantage in mortality of continuous positive airway pressure over noninvasive pressure support ventilation. NIV significantly increased arterial oxygenation and was associated with a significant reduction in intubation rate, in the incidence of overall complications and infections. Conclusions: These results suggest that NIV could be useful in the management of acute respiratory failure due to chest trauma. © 2013 Springer-Verlag Berlin Heidelberg and ESICM
Maxillofacial trauma in the emergency department : pearls and pitfalls in airway management
No full textMaxillofacial trauma poses a challenge for the anesthesiologist because injuries can often compromise the patient's airways. Airway maintenance is the first step in the American College of Surgeons Advance Trauma Life Support (ATLS®) protocol. However, clinical dilemmas may arise about the best way to manage a potentially life-threatening injury. There are no recommendations about the best time to intubate, the warning signs for deciding to intubate, or which device should be used when difficulty is expected. In this context the ATLS® approach is important but not sufficient. It is also necessary to recognize and be able to manage specific problems in this scenario where clinical priorities may be conflicting, may suddenly change or may be hidden. This clinical review discusses the complexity of this scenario, providing an overview of the conditions at greatest risk for airway obstruction and the options for airway management, on the basis of the recent literature. Clinicians must recognize the milestones and pitfalls of this topic in order to adopt a systematic approach for airway management, to identify specific characteristics associated with it, and to establish the utility of different instruments for airway management
Sodium bicarbonate in different critically ill conditions : from physiology to clinical practice
No full textBackground:Pain management is important for ensuring early mobilization after hip arthroplasty; however, the optimal components remain controversial. Recently, the quadratus lumborum block has been proposed as an analgesic option. The current study tested the hypothesis that the posterior quadratus lumborum block combined with multimodal analgesia decreases morphine consumption after hip arthroplasty.Methods:This study was a prospective, randomized, double-blind, placebo-controlled trial. Before general anesthesia, 100 participating patients scheduled for elective total hip arthroplasty were randomly allocated to receive a 30-ml injection posterior to the quadratus lumborum muscle with either 0.33% ropivacaine (n = 50) or normal saline (n = 50). For all patients, multimodal analgesia included systematic administration of acetaminophen, ketoprofen, and a morphine intravenous patient-controlled analgesia. The primary outcome was total intravenous morphine consumption in the first 24 h. Secondary outcomes recorded intraoperative sufentanil consumption; morphine consumption in the postanesthesia care unit; pain scores at extubation and at 2, 6, 12, and 24 h; motor blockade; time to first standing and ambulation; hospital length of stay; and adverse events.Results:There was no significant difference in the 24-h total morphine consumption (ropivacaine group, median [interquartile range], 13 [7 to 21] versus saline group, 16 [9 to 21] mg; median difference, -1.5; 95% CI, -5 to 2; P = 0.337). Pain scores were not different between the groups (beta = -0.4; 95% CI, -0.9 to 0.2; P = 0.199). There was no statistical difference between the two groups in intraoperative sufentanil consumption, morphine consumption in the postanesthesia care unit, motor blockade, times to first standing (median difference, 0.83 h; 95% CI, -1.7 to 3.4; P = 0.690) and ambulation (median difference, -1.85 h; 95% CI, -4.5 to 0.8; P = 0.173), hospital length of stay, and adverse events.Conclusions:After elective hip arthroplasty, neither morphine consumption nor pain scores were reduced by the addition of a posterior quadratus lumborum block to a multimodal analgesia regimen
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