1,721,014 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
Full text linkThis 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 textMaxillofacial 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
What’s next after ARDS : Long-term outcomes
No full textARDS is a life-threatening organ failure due to several pulmonary and extrapulmonary injuries with an incidence between 5 and 60 cases/100,000 persons/y. Patients with ARDS have non-cardiogenic pulmonary edema and dyspnea often requiring invasive mechanical ventilation and intensive care admission. Although the short-term mortality rate has significantly decreased in the last decade, mainly due to the widespread application of lung-protective ventilation and better general support, long-term outcomes are still unsatisfactory. Besides simply evaluating the outcome at hospital discharge, several recent studies have assessed the health-related quality of life, neuropsychological disability, radiological findings, and pulmonary dysfunction up to 5 y. This paper reviews the literature regarding the long-term outcomes in patients with ARDS
Old and new strategies to preserve the lung before transplantation
No full textSummary - Transplantation is considered a valuable option in the treatment of end-stage lung disease. However, organs
from multi-organ donors available for transplantation are far fewer than the number of potential recipients, so that as
many as 15 to 20% of them die while on a waitlist.
Over the years a number of ways have been explored to overcome the discrepancy between the need and the availability of
organs, including the use of lung allocation scores and the implementation of standardized donor management protocols.
In the last decade several authors have extended lung donor criteria to increase the pool of organs, unfortunately with
controversial results. Recently, the feasibility and safety of transplanting high-risk donor lungs that have undergone ex-vivo
lung perfusion (EVLP) have been successfully documented. EVLP allows donor lungs to be evaluated before transplantation
when function is doubtful and injured donor lungs can be repaired, thus increasing the number of organs available
for transplantation.
Although EVLP has opened a new era in lung transplantation, conventional strategies to preserve the lung before transplantation
still maintain their importance in the process of organ donation and significantly contribute to the final outcome
of transplantation.
The purpose of this review is to summarize old and new strategies to preserve the lung before transplantation
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
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
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