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Zapata L, Gómez-López R, Llanos-Jorge C, Duerto J, Martin-Villen L. Cardiogenic shock as a health issue. Physiology, classification, and detection. Med Intensiva 2024; 48:282-295. [PMID: 38458914 DOI: 10.1016/j.medine.2023.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 12/27/2023] [Indexed: 03/10/2024]
Abstract
Cardiogenic shock (CS) is a heterogeneous syndrome with high mortality and a growing incidence. It is characterized by an imbalance between the tissue oxygen demands and the capacity of the cardiovascular system to meet these demands, due to acute cardiac dysfunction. Historically, acute coronary syndromes have been the primary cause of CS. However, non-ischemic cases have seen a rise in incidence. The pathophysiology involves ischemic damage of the myocardium and a sympathetic, renin-angiotensin-aldosterone system and inflammatory response, perpetuating the situation of tissue hypoperfusion and ultimately leading to multiorgan dysfunction. The characterization of CS patients through a triaxial assessment and the widespread use of the Society for Cardiovascular Angiography and Interventions (SCAI) scale has allowed standardization of the severity stratification of CS; this, coupled with early detection and the "hub and spoke" approach, could contribute to improving the prognosis of these patients.
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Affiliation(s)
- Luis Zapata
- Servicio de Medicina Intensiva, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Rocío Gómez-López
- Servicio de Medicina Intensiva, Hospital Álvaro Cunqueiro, Vigo, Spain
| | - Celina Llanos-Jorge
- Servicio de Medicina Intensiva, Complejo Hospitalario Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, Spain
| | - Jorge Duerto
- Servicio de Medicina Intensiva, Hospital Clínico Universitario San Carlos, Madrid, Spain
| | - Luis Martin-Villen
- Servicio de Medicina Intensiva, Hospital Universitario Virgen del Rocío, Seville, Spain
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2
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Ochagavía A, Fraile V, Zapata L. Introduction to the update series: update in intensive care medicine: ultrasound in the critically ill patient. Clinical applications. Med Intensiva 2023; 47:526-528. [PMID: 37634919 DOI: 10.1016/j.medine.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 08/04/2023] [Indexed: 08/29/2023]
Affiliation(s)
- Ana Ochagavía
- Servicio de Medicina Intensiva, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat (Barcelona). Spain.
| | - Virginia Fraile
- Servicio de Medicina Intensiva, Hospital Universitario Río Hortega. Valladolid. Spain.
| | - Lluis Zapata
- Servicio de Medicina Intensiva, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona. Spain.
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3
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Rababa M, Al-Sabbah S. The use of islamic spiritual care practices among critically ill adult patients: A systematic review. Heliyon 2023; 9:e13862. [PMID: 36915488 PMCID: PMC10006532 DOI: 10.1016/j.heliyon.2023.e13862] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 01/14/2023] [Accepted: 02/14/2023] [Indexed: 02/22/2023] Open
Abstract
Spiritual care is essential to the healthcare plans of critically ill patients and their families. However, spiritual care remains neglected and requires healthcare institutions and providers' attention to be incorporated into healthcare management plans, especially for critically ill Muslim patients and their families. To date, no review has been conducted to discuss spiritual care in adult critical care Muslim patients. Spiritual care and Holy Quran recitation have been reported to be practical non-pharmacological interventions for critically ill Muslim patients. However, there is a need for Islamic healthcare institutions and providers to pay further attention to including spiritual care in the healthcare management plans of their patients. Also, future research is recommended to test the effectiveness of incorporating spiritual care in the healthcare plans of critical care patients.
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Affiliation(s)
- Mohammad Rababa
- Adult Health Nursing Department, Faculty of Nursing, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Shatha Al-Sabbah
- Adult Health Nursing Department, Faculty of Nursing, Jordan University of Science and Technology, Irbid, 22110, Jordan
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4
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Cardozo Júnior LCM, Lemos GSD, Besen BAMP. Fluid responsiveness assessment using inferior vena cava collapsibility among spontaneously breathing patients: Systematic review and meta-analysis. Med Intensiva 2023; 47:90-98. [PMID: 36272909 DOI: 10.1016/j.medine.2021.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 12/28/2021] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To synthesize the evidence about diagnostic accuracy of inferior vena cava collapsibility (IVCc) in prediction of fluid responsiveness among spontaneously breathing patients. DESIGN Systematic review of diagnostic accuracy studies. SETTING Intensive care units or emergency departments. PATIENTS AND PARTICIPANTS spontaneously breathing patients with indication for fluid bolus administration. INTERVENTIONS A search was conducted in MEDLINE and EMBASE. We included studies assessing IVCc accuracy for fluid responsiveness assessment with a standard method for cardiac output measure as index test. MAIN VARIABLES OF INTEREST General information (year, setting, cutoffs, standard method), sensitivity, specificity, and area under the receiving operator characteristics curve (AUROC). Risk of bias was assessed with QUADAS 2 tool. We obtained the pooled sensitivity, specificity and summary ROC curve, with estimated confidence intervals from a bivariate model. We also calculated positive and negative likelihood ratios and developed a Fagon nomogram. RESULTS Eight studies were included with 497 patients. Overall, the studies presented a high risk of bias. IVCc sensitivity was 63% (95% CI - 46-78%) and specificity 83% (95% CI - 76-87%). Despite moderate accuracy of IVCc (SROC 0.83, 95% CI - 0.80-0.86), post-test probability of being fluid responsive based on a 50% pre-test probability led to considerable misclassification. CONCLUSIONS IVCc had moderate accuracy for fluid responsiveness assessment in spontaneously breathing patients and should not be used in isolation for this purpose.
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Affiliation(s)
- L C M Cardozo Júnior
- Medical ICU, Disciplina de Emergências Clínicas, Departamento de Clínica Médica, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
| | - G S D Lemos
- Medical ICU, Disciplina de Emergências Clínicas, Departamento de Clínica Médica, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil; ICU, Hospital São Paulo, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - B A M P Besen
- Medical ICU, Disciplina de Emergências Clínicas, Departamento de Clínica Médica, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil; ICU, Hospital A.C. Camargo Cancer Center, São Paulo, SP, Brazil
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5
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Pérez Vela JL, Llanos Jorge C, Duerto Álvarez J, Jiménez Rivera JJ. Clinical management of postcardiotomy shock in adults. Med Intensiva 2022; 46:312-325. [PMID: 35570187 DOI: 10.1016/j.medine.2022.04.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 08/14/2021] [Accepted: 08/21/2021] [Indexed: 06/15/2023]
Abstract
Postcardiotomy cardiogenic shock represents the most serious expression of low cardiac output syndrome after cardiac surgery. Although infrequent, it is a relevant condition due to its specific and complex pathophysiology and important morbidity-mortality. The diagnosis requires a high index of suspicion and multimodal hemodynamic monitoring, where echocardiography and the pulmonary arterial catheter play a main role. Early and multidisciplinary management should focus on the management of postoperative or mechanical complications and the optimization of determinants of cardiac output through fluid therapy or diuretic treatments, inotropic drugs and vasopressors/vasodilators and, in the absence of a response, early mechanical circulatory support. The aim of this paper is to review and update the pathophysiology, diagnosis and management of postcardiotomy cardiogenic shock.
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Affiliation(s)
- J L Pérez Vela
- Servicio de Medicina Intensiva, Hospital Universitario Doce de Octubre, Madrid, Spain.
| | - C Llanos Jorge
- Servicio de Medicina Intensiva, Hospital Quirónsalud Tenerife, Santa Cruz de Tenerife, Spain
| | - J Duerto Álvarez
- Servicio de Medicina Intensiva, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - J J Jiménez Rivera
- Servicio de Medicina Intensiva, Complejo Hospitalario Universitario de Canarias, San Cristóbal de La Laguna, Santa Cruz de Tenerife, Spain
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Caballer A, Nogales S, Gruartmoner G, Mesquida J. Monitorización hemodinámica en la sepsis y el shock séptico. Med Intensiva 2022. [DOI: 10.1016/j.medin.2022.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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7
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Zaky S, Fathelbab HK, Elbadry M, El-Raey F, Abd-Elsalam SM, Makhlouf HA, Makhlouf NA, Metwally MA, Ali-Eldin F, Hasan AA, Alboraie M, Yousef AM, Shata HM, Eid A, Asem N, Khalaf A, Elnady MA, Elbahnasawy M, Abdelaziz A, Shaltout SW, Elshemy EE, Wahdan A, Hegazi MS, Abdel Baki A, Hassany M. Egyptian Consensus on the Role of Lung Ultrasonography During the Coronavirus Disease 2019 Pandemic. Infect Drug Resist 2022; 15:1995-2013. [PMID: 36176457 PMCID: PMC9513721 DOI: 10.2147/idr.s353283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 03/28/2022] [Indexed: 12/05/2022] Open
Abstract
Background & Aims Coronavirus disease 2019 (COVID-19) is a global health problem, presenting with symptoms ranging from mild nonspecific symptoms to serious pneumonia. Early screening techniques are essential in the diagnosis and assessment of disease progression. This consensus was designed to clarify the role of lung ultrasonography versus other imaging modalities in the COVID-19 pandemic. Methods A multidisciplinary team consisting of experts from different specialties (ie, pulmonary diseases, infectious diseases, intensive care unit and emergency medicine, radiology, and public health) who deal with patients with COVID-19 from different geographical areas was classified into task groups to review the literatures from different databases and generate 10 statements. The final consensus statements were based on expert physically panelists’ discussion held in Cairo July 2021 followed by electric voting for each statement. Results The statements were electronically voted to be either “agree,” “not agree,” or “neutral.” For a statement to be accepted to the consensus, it should have 80% agreement. Conclusion Lung ultrasonography is a rapid and useful tool, which can be performed at bedside and overcomes computed tomography limitations, for screening and monitoring patients with COVID-19 with an accepted accuracy rate.
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Affiliation(s)
- Samy Zaky
- Department of Hepatogastroenterology and Infectious Diseases; Al-Azhar University, Cairo, Egypt
| | | | - Mohamed Elbadry
- Department of Endemic Medicine, Helwan University, Cairo, Egypt
| | - Fathiya El-Raey
- Department of Hepatogastroenterology and Infectious Diseases Al-Azhar University, Damietta, Egypt
| | - Sherief M Abd-Elsalam
- Department of Tropical Medicine, Tanta University, Tanta, Egypt
- Correspondence: Sherief M Abd-Elsalam, Department of Tropical Medicine, Tanta University, Tanta, Egypt, Tel +201063319696, Email
| | | | - Nahed A Makhlouf
- Department of Tropical Medicine and Gastroenterology, Assiut University, Assiut, Egypt
| | - Mohamed A Metwally
- Department of Hepatology, Gastroenterology, and Infectious Diseases, Benha University, Benha, Egypt
| | - Fatma Ali-Eldin
- Department of Tropical medicine; Ain Shams University, Cairo, Egypt
| | | | - Mohamed Alboraie
- Department of Internal Medicine; Al-Azhar University, Cairo, Egypt
| | - Ahmed M Yousef
- Department of Community and Industrial Medicine, Damietta, Al-Azhar University, Damietta, Egypt
| | - Hanan M Shata
- Department of Chest Medicine; Mansoura University, Mansoura, Egypt
| | - Alshaimaa Eid
- Department of Hepatogastroenterology and Infectious Diseases; Al-Azhar University, Cairo, Egypt
| | - Noha Asem
- Department of Public Health and Community Medicine, Cairo University and Ministry of Health and Population, Cairo, Egypt
| | - Asmaa Khalaf
- Department of Radiology, Minia University, Minia, Egypt
| | - Mohamed A Elnady
- Department of Pulmonary Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed Elbahnasawy
- Department of Emergency Medicine and Traumatology, Tanta University, Tanta, Egypt
| | - Ahmed Abdelaziz
- Department of Hepatogastroenterology and Infectious Diseases Al-Azhar University, Damietta, Egypt
| | - Shaker W Shaltout
- Department of Tropical Medicine, Port Said University, Port Said, Egypt
| | - Eman E Elshemy
- Department of Hepatogastroenterology and Infectious Diseases; Al-Azhar University, Cairo, Egypt
| | - Atef Wahdan
- Department of Chest Diseases, Damietta, Al-Azhar University, Damietta, Egypt
| | - Mohamed S Hegazi
- Department of Hepatogastroenterology and Infectious Diseases Al-Azhar University, Damietta, Egypt
| | - Amin Abdel Baki
- Department Hepatology, Gastroenterology and Infectious diseases National Hepatology and Tropical Medicine Research Institute NHTMRI, Cairo, Egypt
| | - Mohamed Hassany
- Department Hepatology, Gastroenterology and Infectious diseases National Hepatology and Tropical Medicine Research Institute NHTMRI, Cairo, Egypt
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Caballer A, Nogales S, Gruartmoner G, Mesquida J. [Haemodynamic monitoring in sepsis and septic shock]. Med Intensiva 2022; 46 Suppl 1:38-48. [PMID: 38341259 DOI: 10.1016/j.medine.2022.02.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 02/23/2022] [Accepted: 02/26/2022] [Indexed: 02/12/2024]
Abstract
Cardiovascular disturbances associated with sepsis cause hypoperfusion situations, which will negatively impact these patients' prognosis. The aim of haemodynamic monitoring is to guide the detection and correction of this hypoperfusion, and assist in decision making in optimising oxygen transport to tissues, primarily by manipulating cardiac output. This review seeks to summarise the different parameters of haemodynamic monitoring, the objectives of resuscitation, the physiological parameters, and the tools available to us for appropriate cardiac output manipulation.
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Affiliation(s)
- Alba Caballer
- Àrea de Crítics, Hospital Universitari Parc Taulí, Sabadell, Barcelona, España.
| | - Sara Nogales
- Àrea de Crítics, Hospital Universitari Parc Taulí, Sabadell, Barcelona, España
| | - Guillem Gruartmoner
- Àrea de Crítics, Hospital Universitari Parc Taulí, Sabadell, Barcelona, España
| | - Jaume Mesquida
- Àrea de Crítics, Hospital Universitari Parc Taulí, Sabadell, Barcelona, España
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Fluid responsiveness assessment using inferior vena cava collapsibility among spontaneously breathing patients: Systematic review and meta-analysis. Med Intensiva 2022. [DOI: 10.1016/j.medin.2021.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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10
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Pérez Vela J, Llanos Jorge C, Duerto Álvarez J, Jiménez Rivera J. Manejo clínico del shock poscardiotomía en pacientes adultos. Med Intensiva 2021. [DOI: 10.1016/j.medin.2021.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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11
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Jiménez Rivera JJ, Llanos Jorge C, López Gude MJ, Pérez Vela JL. Perioperative management in cardiovascular surgery. Med Intensiva 2020; 45:175-183. [PMID: 33358388 DOI: 10.1016/j.medin.2020.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 10/29/2020] [Indexed: 12/21/2022]
Abstract
Cardio-surgical patient care requires a comprehensive and multidisciplinary approach to develop strategies to improve patient safety and outcomes. In the preoperative period, prophylaxis for frequent postoperative complications, such as de novo atrial fibrillation or bleeding, and prehabilitation based on exercise training, respiratory physiotherapy and nutritional and cognitive therapy, especially in fragile patients, stand out. There have been great advances, during the intraoperative phase, such as minimally invasive surgery, improved myocardial preservation, enhanced systemic perfusion and brain protection during extracorporeal circulation, or implementation of Safe Surgery protocols. Postoperative care should include goal-directed hemodynamic theraphy, a correct approach to coagulation disorders, and a multimodal analgesic protocol to facilitate early extubation and mobilization. Finally, optimal management of postoperative complications is key, including arrhythmias, vasoplegia, bleeding, and myocardial stunning that can lead to low cardiac output syndrome or, in extreme cases, cardiogenic shock. This global approach and the high degree of complexity require highly specialised units where intensive care specialists add value and are key to obtain more effective and efficient clinical results.
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Affiliation(s)
- J J Jiménez Rivera
- Servicio de Medicina Intensiva, Hospital Universitario de Canarias, La Laguna, España.
| | - C Llanos Jorge
- Servicio de Medicina Intensiva, Hospital Quirón salud Tenerife, Santa Cruz de Tenerife, España
| | - M J López Gude
- Servicio de Cirugía Cardiovascular, Hospital Universitario Doce de Octubre, Madrid, España
| | - J L Pérez Vela
- Servicio de Medicina Intensiva, Hospital Universitario Doce de Octubre, Madrid, España
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Lactate and lactate clearance in critically burned patients: usefulness and limitations as a resuscitation guide and as a prognostic factor. Burns 2020; 46:1839-1847. [PMID: 32653255 DOI: 10.1016/j.burns.2020.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 05/30/2020] [Accepted: 06/08/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Lactate levels to guide resuscitation in critically burned patients are controversial. The purpose of our study was to determine whether absolute lactate values or lower lactate clearance predict mortality, and whether these are useful tools in the resuscitation phase. METHODS We conducted a prospective, unicentric, observational study of a cohort of 214 burn patients admitted in the Burn Intensive Care Unit. We collected demographic and laboratory data, complications, absolute lactate levels and lactate clearance every 8 h since admission to 72 h. In critical patients we monitored hemodynamic parameters with transpulmonary thermodilution. We used Student's t-test or nonparametric tests, mixed models and Pearson and Spearman methods, Fisher's exact and chi-squared test. RESULTS Of the 214 patients, 76.6% were male, mean age were 46 ± 15 years and 23.0 ± 19.5% of Total Basal Surface Area (TBSA) burned. Initial mean absolute levels of lactate were 2.02 ± 1.62 mmol/L in survivors vs. 4.05 ± 3.90 mmol/L in nonsurvivors. Initial elevated lactate levels increased mortality (p < .001), length of ICU stay, mechanical ventilation and shock. In the subgroup of burned TBSA < 20%, lowering the lactate cut-off point from 2.0 to 1.8 mmol/L improved the mortality prediction (OR:9.3). We found no relationship between lactate clearance in the first 24 h and mortality. In more severe patients (> 20% TBSA burned and initial lactate levels > 2), a good correlation was found between lactate and cardiac index; but not with intrathoracic blood volume index (ITBVI). Patients with low ITBVI preload (< 600 mL/m2) did not show significant differences in lactate clearance compared with those with ITBVI > 600. CONCLUSIONS Initial elevated lactate levels are a factor of poor prognosis and the cut-off point that best predicts mortality should be adjusted in the patients with TBSA burned < 20%. The global clearance of lactate in the first 24 h, unlike what occurs in other injuries, does not correlate with mortality. Monitoring lactate can ensure adequate peripheral perfusion during resuscitation with lower than normal fluid preload values.
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[Ultrasound in the management of the critically ill patient with SARS-CoV-2 infection (COVID-19): narrative review]. Med Intensiva 2020; 44:551-565. [PMID: 32527471 PMCID: PMC7198178 DOI: 10.1016/j.medin.2020.04.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 04/28/2020] [Indexed: 12/15/2022]
Abstract
La infección por SARS-CoV-2 (COVID-19) se caracteriza por producir en las formas graves, un cuadro de insuficiencia respiratoria que puede evolucionar hacia neumonía y síndrome de distrés respiratorio agudo (SDRA), presentar complicaciones como fenómenos trombóticos y disfunción cardiaca, lo que motiva el ingreso en la Unidad de Cuidados Intensivos (UCI). La ecografía, convertida en una herramienta de uso habitual en la UCI, puede ser muy útil durante la pandemia por COVID-19 ya que la información obtenida por el clínico puede ser interpretada e integrada en la valoración global durante la exploración del paciente. Este documento describe algunas de sus aplicaciones, adaptadas al paciente crítico con COVID-19, con el objetivo de proporcionar una guía a los médicos responsables. Alguna de sus aplicaciones desde el ingreso en la UCI incluyen: confirmar la correcta posición del tubo endotraqueal, facilitar la inserción segura de las vías e identificar complicaciones y fenómenos trombóticos. Además, la ecografía pleuropulmonar puede ser una alternativa diagnóstica válida que permite evaluar el grado de afectación pulmonar, mediante el análisis de patrones ecográficos específicos, la identificación de derrame pleural y barotrauma. La ecocardiografía proporciona información acerca de la afectación cardiaca, detección del cor pulmonale y estados de shock.
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Índice de cardioplejía infundida: una nueva herramienta en la protección miocárdica. Un estudio de cohortes. Med Intensiva 2019; 43:337-345. [DOI: 10.1016/j.medin.2018.03.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 03/06/2018] [Accepted: 03/27/2018] [Indexed: 01/01/2023]
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Hernández-Hernández G, Reynoso-García J. Cuidado de enfermería postoperación de Tromboendarterectomia Pulmonar Bilateral. Estudio de caso fundamentado en los principios de Henderson. ENFERMERÍA UNIVERSITARIA 2019. [DOI: 10.22201/eneo.23958421e.2019.3.710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introducción: La tromboembolia pulmonar (TEP) es un padecimiento que se presenta con frecuencia de manera silenciosa, el 50 % o más de los casos no se diagnostica. Se define como la oclusión total o parcial de la circulación pulmonar, ocasionada por un coágulo sanguíneo proveniente de la circulación venosa sistémica, incluidas las cavidades derechas y que, de acuerdo a su magnitud, puede o no originar síntomas. Está considerada como una urgencia cardiovascular y constituye una de las principales causas de morbimortalidad en pacientes hospitalizados. Objetivo: Desarrollar un Estudio de caso basado en el Proceso de Atención de Enfermería en la persona postoperada de Tromboendarterectomía Pulmonar Bilateral en Unidad de cuidados intensivos postquirúrgica de un Instituto Nacional de Tercer Nivel de la Ciudad de México. Método: Estudio de caso basado en las etapas del proceso enfermero, se utilizó una Guía de valoración de las 14 necesidades de Virginia Henderson, jerarquización de Diagnósticos enfermeros, se ofreció una atención integral enfocada en cuidados especializados para cubrir las necesidades más afectadas en la persona. Conclusiones: La aplicación del proceso de atención enfermero con base en la valoración de las 14 necesidades de Virginia Henderson, identificó que las necesidades más afectadas fueron; Oxigenación/Circulación y Evitar peligros, con la jerarquización se determinó que es imprescindible el conocimiento de enfermería en intervenciones especificas en el proceso postoperatorio de Tromboendarterectomía como: la detección del riesgo de alteraciones del ritmo cardiaco, valoración e intervenciones en insuficiencia respiratoria aguda, la propensión a eventos trombóticos secundarios a afección genética, para el logro de la recuperación de la salud de manera exitosa.
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Fernández-Mondéjar E, Fuset-Cabanes MP, Grau-Carmona T, López-Sánchez M, Peñuelas Ó, Pérez-Vela JL, Pérez-Villares JM, Rubio-Muñoz JJ, Solla-Buceta M. The use of ECMO in ICU. Recommendations of the Spanish Society of Critical Care Medicine and Coronary Units. Med Intensiva 2018; 43:108-120. [PMID: 30482406 DOI: 10.1016/j.medin.2018.09.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 09/26/2018] [Accepted: 09/30/2018] [Indexed: 02/07/2023]
Abstract
The use of extracorporeal membrane oxygenation systems has increased significantly in recent years; given this reality, the Spanish Society of Critical Intensive Care Medicine and Coronary Units (SEMICYUC) has decided to draw up a series of recommendations that serve as a framework for the use of this technique in intensive care units. The three most frequent areas of extracorporeal membrane oxygenation systems use in our setting are: as a cardiocirculatory support, as a respiratory support and for the maintenance of the abdominal organs in donors. The SEMICYUC appointed a series of experts belonging to the three working groups involved (Cardiological Intensive Care and CPR, Acute Respiratory Failure and Transplant work group) that, after reviewing the existing literature until March 2018, developed a series of recommendations. These recommendations were posted on the SEMICYUC website to receive suggestions from the intensivists and finally approved by the Scientific Committee of the Society. The recommendations, based on current knowledge, are about which patients may be candidates for the technique, when to start it and the necessary infrastructure conditions of the hospital centers or, the conditions for transfer to centers with experience. Although from a physiopathological point of view, there are clear arguments for the use of extracorporeal membrane oxygenation systems, the current scientific evidence is weak, so studies are needed that define more precisely which patients benefit most from the technique and when they should start.
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Affiliation(s)
- E Fernández-Mondéjar
- Servicio de Medicina Intensiva, Hospital Universitario Virgen de las Nieves, Granada, España; Instituto de Investigación Biosanitaria IBS, Granada, España.
| | - M P Fuset-Cabanes
- Servicio de Medicina Intensiva, Hospital Universitari i Politècnic La Fe, Valencia, España
| | - T Grau-Carmona
- Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, España
| | - M López-Sánchez
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - Ó Peñuelas
- Servicio de Medicina Intensiva, Hospital Universitario de Getafe, Getafe, Madrid, España; CIBER de Enfermedades Respiratorias, CIBERES, Madrid, España
| | - J L Pérez-Vela
- Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, España
| | - J M Pérez-Villares
- Servicio de Medicina Intensiva, Hospital Universitario Virgen de las Nieves, Granada, España; Instituto de Investigación Biosanitaria IBS, Granada, España
| | - J J Rubio-Muñoz
- Servicio de Medicina Intensiva, Hospital Universitario Puerta de Hierro, Madrid, España
| | - M Solla-Buceta
- Servicio de Medicina Intensiva, Complejo Hospitalario Universitario, La Coruña, España
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González de Molina Ortiz FJ, Gordo Vidal F, Estella García A, Morrondo Valdeolmillos P, Fernández Ortega JF, Caballero López J, Pérez Villares PV, Ballesteros Sanz MA, de Haro López C, Sanchez-Izquierdo Riera JA, Serrano Lázaro A, Fuset Cabanes MP, Terceros Almanza LJ, Nuvials Casals X, Baldirà Martínez de Irujo J. "Do not do" recommendations of the working groups of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC) for the management of critically ill patients. Med Intensiva 2018; 42:425-443. [PMID: 29789183 DOI: 10.1016/j.medin.2018.04.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 03/24/2018] [Accepted: 04/02/2018] [Indexed: 02/06/2023]
Abstract
The project "Commitment to Quality of Scientific Societies", promoted since 2013 by the Spanish Ministry of Health, seeks to reduce unnecessary health interventions that have not proven effective, have little or doubtful effectiveness, or are not cost-effective. The objective is to establish the "do not do" recommendations for the management of critically ill patients. A panel of experts from the 13 working groups (WGs) of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC) was selected and nominated by virtue of clinical expertise and/or scientific experience to carry out the recommendations. Available scientific literature in the management of adult critically ill patients from 2000 to 2017 was extracted. The clinical evidence was discussed and summarized by the experts in the course of consensus finding of each WG, and was finally approved by the WGs after an extensive internal review process carried out during the first semester of 2017. A total of 65 recommendations were developed, of which 5 corresponded to each of the 13 WGs. These recommendations are based on the opinion of experts and scientific knowledge, and aim to reduce those treatments or procedures that do not add value to the care process; avoid the exposure of critical patients to potential risks; and improve the adequacy of health resources.
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Affiliation(s)
- F J González de Molina Ortiz
- Servicio de Medicina Intensiva, Hospital Universitario Mutua Terrassa, Barcelona, España; Servicio de Medicina Intensiva, Hospital Universitario Quirón Dexeus, Barcelona, España.
| | - F Gordo Vidal
- Servicio de Medicina Intensiva, Hospital Universitario del Henares, Coslada, Madrid, España
| | - A Estella García
- Servicio de Medicina Intensiva, Hospital del SAS de Jerez, Jerez, Cádiz, España
| | - P Morrondo Valdeolmillos
- Servicio de Medicina Intensiva, Hospital Universitario Donostia, San Sebastián, Guipúzcoa, España
| | - J F Fernández Ortega
- Servicio de Medicina Intensiva, Complejo Hospitalario Carlos Haya, Málaga, España
| | - J Caballero López
- Servicio de Medicina Intensiva, Hospital Universitario Arnau de Vilanova, Lleida, España
| | - P V Pérez Villares
- Servicio de Medicina Intensiva, Hospital Universitario Virgen de las Nieves, Granada, España
| | - M A Ballesteros Sanz
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - C de Haro López
- Servicio de Medicina Intensiva, Corporació Sanitària Parc Taulí, Sabadell, Barcelona, España
| | | | - A Serrano Lázaro
- Servicio de Medicina Intensiva, Hospital Clínico Universitario, Valencia, España
| | - M P Fuset Cabanes
- Servicio de Medicina Intensiva, Hospital Universitari i Politècnic la Fe, Valencia, España
| | - L J Terceros Almanza
- Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, España
| | - X Nuvials Casals
- Servicio de Medicina Intensiva, Hospital Universitari Vall d'Hebron, Barcelona, España
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Abstract
PURPOSE OF REVIEW The purpose of the review is to identify the recently validated minimally invasive or noninvasive monitoring devices used to both monitor and guide resuscitation in the critically ill patients. RECENT FINDINGS Recent advances in noninvasive measures of blood pressure, blood flow, and vascular tone have been validated and complement existing minimally invasive and invasive monitoring techniques. These monitoring approaches should be used within the context of a focused physical examination and static vital sign analysis. When available, measurement of urinary output is often included. All studies show that minimally invasive and noninvasive measure of arterial pressure and cardiac output are possible and often remain as accurate as invasive measures. The noninvasive techniques degrade in severe circulatory failure and the use of vasopressor therapy. Importantly, these output parameters form the treatment goals for many goal-directed therapies protocols. SUMMARY When coupled with a focused physical examination and functional hemodynamic monitoring analyses, these measures become even more specific at defining volume responsiveness and vasomotor tone and can be used to drive resuscitation strategies.
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Hernández-Tejedor A, Peñuelas O, Sirgo Rodríguez G, Llompart-Pou J, Palencia Herrejón E, Estella A, Fuset Cabanes M, Alcalá-Llorente M, Ramírez Galleymore P, Obón Azuara B, Lorente Balanza J, Vaquerizo Alonso C, Ballesteros Sanz M, García García M, Caballero López J, Socias Mir A, Serrano Lázaro A, Pérez Villares J, Herrera-Gutiérrez M. Recommendations of the Working Groups from the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC) for the management of adult critically ill patients. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.medine.2017.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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20
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Recommendations of the Working Groups from the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC) for the management of adult critically ill patients. Med Intensiva 2017; 41:285-305. [PMID: 28476212 DOI: 10.1016/j.medin.2017.03.004] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 02/25/2017] [Accepted: 03/11/2017] [Indexed: 12/14/2022]
Abstract
The standardization of the Intensive Care Medicine may improve the management of the adult critically ill patient. However, these strategies have not been widely applied in the Intensive Care Units (ICUs). The aim is to elaborate the recommendations for the standardization of the treatment of critical patients. A panel of experts from the thirteen working groups (WG) of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC) was selected and nominated by virtue of clinical expertise and/or scientific experience to carry out the recommendations. Available scientific literature in the management of adult critically ill patients from 2002 to 2016 was extracted. The clinical evidence was discussed and summarised by the experts in the course of a consensus finding of every WG and finally approved by the WGs after an extensive internal review process that was carried out between December 2015 and December 2016. A total of 65 recommendations were developed, of which 5 corresponded to each of the 13 WGs. These recommendations are based on the opinion of experts and scientific knowledge, and are intended as a guide for the intensivists in the management of critical patients.
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21
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Política editorial de Medicina Intensiva. Med Intensiva 2017; 41:63-66. [DOI: 10.1016/j.medin.2017.02.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 02/06/2017] [Indexed: 11/18/2022]
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22
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Monge García MI, Guijo González P, Gracia Romero M, Gil Cano A, Oscier C, Rhodes A, Grounds RM, Cecconi M. Effects of fluid administration on arterial load in septic shock patients. Intensive Care Med 2015; 41:1247-55. [DOI: 10.1007/s00134-015-3898-7] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2015] [Accepted: 05/27/2015] [Indexed: 12/21/2022]
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23
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Manzanares W, Aramendi I, Langlois PL, Biestro A. Hyponatremia in the neurocritical care patient: An approach based on current evidence. Med Intensiva 2015; 39:234-43. [PMID: 25593019 DOI: 10.1016/j.medin.2014.11.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 11/06/2014] [Accepted: 11/11/2014] [Indexed: 01/20/2023]
Abstract
In the neurocritical care setting, hyponatremia is the commonest electrolyte disorder, which is associated with significant morbimortality. Cerebral salt wasting and syndrome of inappropriate antidiuretic hormone have been classically described as the 2 most frequent entities responsible of hyponatremia in neurocritical care patients. Nevertheless, to distinguish between both syndromes is usually difficult and useless as volume status is difficult to be determined, underlying pathophysiological mechanisms are still not fully understood, fluid restriction is usually contraindicated in these patients, and the first option in the therapeutic strategy is always the same: 3% hypertonic saline solution. Therefore, we definitively agree with the current concept of "cerebral salt wasting", which means that whatever is the etiology of hyponatremia, initially in neurocritical care patients the treatment will be the same: hypertonic saline solution.
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Affiliation(s)
- W Manzanares
- Cátedra de Medicina Intensiva, Centro de Tratamiento Intensivo, Hospital de Clínicas, Facultad de Medicina, Universidad de la República (UdeLaR), Montevideo, Uruguay.
| | - I Aramendi
- Cátedra de Medicina Intensiva, Centro de Tratamiento Intensivo, Hospital de Clínicas, Facultad de Medicina, Universidad de la República (UdeLaR), Montevideo, Uruguay
| | - P L Langlois
- Hôpital Fleurimont, Centre Hospitalier Universitaire de Sherbrooke, Département d'Anesthésie-Réanimation, Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Québec, Canadá
| | - A Biestro
- Cátedra de Medicina Intensiva, Centro de Tratamiento Intensivo, Hospital de Clínicas, Facultad de Medicina, Universidad de la República (UdeLaR), Montevideo, Uruguay
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24
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García MIM, Romero MG, Cano AG, Aya HD, Rhodes A, Grounds RM, Cecconi M. Dynamic arterial elastance as a predictor of arterial pressure response to fluid administration: a validation study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2014; 18:626. [PMID: 25407570 PMCID: PMC4271484 DOI: 10.1186/s13054-014-0626-6] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2014] [Accepted: 10/28/2014] [Indexed: 12/19/2022]
Abstract
Introduction Functional assessment of arterial load by dynamic arterial elastance (Eadyn), defined as the ratio between pulse pressure variation (PPV) and stroke volume variation (SVV), has recently been shown to predict the arterial pressure response to volume expansion (VE) in hypotensive, preload-dependent patients. However, because both SVV and PPV were obtained from pulse pressure analysis, a mathematical coupling factor could not be excluded. We therefore designed this study to confirm whether Eadyn, obtained from two independent signals, allows the prediction of arterial pressure response to VE in fluid-responsive patients. Methods We analyzed the response of arterial pressure to an intravenous infusion of 500 ml of normal saline in 53 mechanically ventilated patients with acute circulatory failure and preserved preload dependence. Eadyn was calculated as the simultaneous ratio between PPV (obtained from an arterial line) and SVV (obtained by esophageal Doppler imaging). A total of 80 fluid challenges were performed (median, 1.5 per patient; interquartile range, 1 to 2). Patients were classified according to the increase in mean arterial pressure (MAP) after fluid administration in pressure responders (≥10%) and non-responders. Results Thirty-three fluid challenges (41.2%) significantly increased MAP. At baseline, Eadyn was higher in pressure responders (1.04 ± 0.28 versus 0.60 ± 0.14; P <0.0001). Preinfusion Eadyn was related to changes in MAP after fluid administration (R2 = 0.60; P <0.0001). At baseline, Eadyn predicted the arterial pressure increase to volume expansion (area under the receiver operating characteristic curve, 0.94; 95% confidence interval (CI): 0.86 to 0.98; P <0.0001). A preinfusion Eadyn value ≥0.73 (gray zone: 0.72 to 0.88) discriminated pressure responder patients with a sensitivity of 90.9% (95% CI: 75.6 to 98.1%) and a specificity of 91.5% (95% CI: 79.6 to 97.6%). Conclusions Functional assessment of arterial load by Eadyn, obtained from two independent signals, enabled the prediction of arterial pressure response to fluid administration in mechanically ventilated, preload-dependent patients with acute circulatory failure. Electronic supplementary material The online version of this article (doi:10.1186/s13054-014-0626-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Manuel Ignacio Monge García
- Servicio de Cuidados Intensivos y Urgencias, Hospital SAS de Jerez, C/Circunvalación s/n, 11407, Jerez de la Frontera, Spain. .,Department of Intensive Care Medicine, St George's Healthcare NHS Trust and St George's University of London, Blackshaw Road, Tooting, London, SW17 0QT, UK.
| | - Manuel Gracia Romero
- Servicio de Cuidados Intensivos y Urgencias, Hospital SAS de Jerez, C/Circunvalación s/n, 11407, Jerez de la Frontera, Spain.
| | - Anselmo Gil Cano
- Servicio de Cuidados Intensivos y Urgencias, Hospital SAS de Jerez, C/Circunvalación s/n, 11407, Jerez de la Frontera, Spain.
| | - Hollmann D Aya
- Department of Intensive Care Medicine, St George's Healthcare NHS Trust and St George's University of London, Blackshaw Road, Tooting, London, SW17 0QT, UK.
| | - Andrew Rhodes
- Department of Intensive Care Medicine, St George's Healthcare NHS Trust and St George's University of London, Blackshaw Road, Tooting, London, SW17 0QT, UK.
| | - Robert Michael Grounds
- Department of Intensive Care Medicine, St George's Healthcare NHS Trust and St George's University of London, Blackshaw Road, Tooting, London, SW17 0QT, UK.
| | - Maurizio Cecconi
- Department of Intensive Care Medicine, St George's Healthcare NHS Trust and St George's University of London, Blackshaw Road, Tooting, London, SW17 0QT, UK.
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25
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Kolettas A, Grosomanidis V, Kolettas V, Zarogoulidis P, Tsakiridis K, Katsikogiannis N, Tsiouda T, Kiougioumtzi I, Machairiotis N, Drylis G, Kesisis G, Beleveslis T, Zarogoulidis K. Influence of apnoeic oxygenation in respiratory and circulatory system under general anaesthesia. J Thorac Dis 2014; 6 Suppl 1:S116-45. [PMID: 24672687 DOI: 10.3978/j.issn.2072-1439.2014.01.17] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2014] [Accepted: 01/12/2014] [Indexed: 12/15/2022]
Abstract
Apnoeic oxygenation is an alternative technique of oxygenation which is recommended in the consecutive oxygen administration with varying flows (2-10 lt/min) through a catheter which is positioned over the keel of the trachea. Apnoeic oxygenation maintains for a significant period of time the oxygenation of blood in breathless conditions. This technique was first applied in 1947 by Draper, Whitehead, and Spencer and it was studied sporadically by other inventors too. However, the international literature shows few studies that have examined closely apnoeic oxygenation and its effects on Hemodynamic image and the respiratory system of the human body. Recently they have begun to arise some studies which deal with the application of this technique in several conditions such as difficult tracheal intubation, ventilation of guinea pigs in campaign conditions where the oxygen supply is limited and calculable, the application of this technique in combination with the use of extracorporeal removal of carbon dioxide (CO2). All the above indicate, the clinical use of this technique.
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Affiliation(s)
- Alexander Kolettas
- 1 Anaesthesiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 2 Anaesthesiology Department, 3 Cardiology Department, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 6 Surgery Department (NHS), University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 7 Internal Medicine Department, "Theageneio" Cancer Hospital, Thessaloniki, Greece ; 8 Internal Medicine Department, Regional Hospital of Samos, Samos, Greece ; 9 Onocology Department, 10 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece
| | - Vasilis Grosomanidis
- 1 Anaesthesiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 2 Anaesthesiology Department, 3 Cardiology Department, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 6 Surgery Department (NHS), University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 7 Internal Medicine Department, "Theageneio" Cancer Hospital, Thessaloniki, Greece ; 8 Internal Medicine Department, Regional Hospital of Samos, Samos, Greece ; 9 Onocology Department, 10 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece
| | - Vasilis Kolettas
- 1 Anaesthesiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 2 Anaesthesiology Department, 3 Cardiology Department, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 6 Surgery Department (NHS), University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 7 Internal Medicine Department, "Theageneio" Cancer Hospital, Thessaloniki, Greece ; 8 Internal Medicine Department, Regional Hospital of Samos, Samos, Greece ; 9 Onocology Department, 10 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece
| | - Paul Zarogoulidis
- 1 Anaesthesiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 2 Anaesthesiology Department, 3 Cardiology Department, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 6 Surgery Department (NHS), University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 7 Internal Medicine Department, "Theageneio" Cancer Hospital, Thessaloniki, Greece ; 8 Internal Medicine Department, Regional Hospital of Samos, Samos, Greece ; 9 Onocology Department, 10 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece
| | - Kosmas Tsakiridis
- 1 Anaesthesiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 2 Anaesthesiology Department, 3 Cardiology Department, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 6 Surgery Department (NHS), University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 7 Internal Medicine Department, "Theageneio" Cancer Hospital, Thessaloniki, Greece ; 8 Internal Medicine Department, Regional Hospital of Samos, Samos, Greece ; 9 Onocology Department, 10 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece
| | - Nikolaos Katsikogiannis
- 1 Anaesthesiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 2 Anaesthesiology Department, 3 Cardiology Department, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 6 Surgery Department (NHS), University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 7 Internal Medicine Department, "Theageneio" Cancer Hospital, Thessaloniki, Greece ; 8 Internal Medicine Department, Regional Hospital of Samos, Samos, Greece ; 9 Onocology Department, 10 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece
| | - Theodora Tsiouda
- 1 Anaesthesiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 2 Anaesthesiology Department, 3 Cardiology Department, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 6 Surgery Department (NHS), University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 7 Internal Medicine Department, "Theageneio" Cancer Hospital, Thessaloniki, Greece ; 8 Internal Medicine Department, Regional Hospital of Samos, Samos, Greece ; 9 Onocology Department, 10 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece
| | - Ioanna Kiougioumtzi
- 1 Anaesthesiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 2 Anaesthesiology Department, 3 Cardiology Department, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 6 Surgery Department (NHS), University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 7 Internal Medicine Department, "Theageneio" Cancer Hospital, Thessaloniki, Greece ; 8 Internal Medicine Department, Regional Hospital of Samos, Samos, Greece ; 9 Onocology Department, 10 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece
| | - Nikolaos Machairiotis
- 1 Anaesthesiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 2 Anaesthesiology Department, 3 Cardiology Department, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 6 Surgery Department (NHS), University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 7 Internal Medicine Department, "Theageneio" Cancer Hospital, Thessaloniki, Greece ; 8 Internal Medicine Department, Regional Hospital of Samos, Samos, Greece ; 9 Onocology Department, 10 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece
| | - Georgios Drylis
- 1 Anaesthesiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 2 Anaesthesiology Department, 3 Cardiology Department, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 6 Surgery Department (NHS), University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 7 Internal Medicine Department, "Theageneio" Cancer Hospital, Thessaloniki, Greece ; 8 Internal Medicine Department, Regional Hospital of Samos, Samos, Greece ; 9 Onocology Department, 10 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece
| | - Georgios Kesisis
- 1 Anaesthesiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 2 Anaesthesiology Department, 3 Cardiology Department, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 6 Surgery Department (NHS), University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 7 Internal Medicine Department, "Theageneio" Cancer Hospital, Thessaloniki, Greece ; 8 Internal Medicine Department, Regional Hospital of Samos, Samos, Greece ; 9 Onocology Department, 10 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece
| | - Thomas Beleveslis
- 1 Anaesthesiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 2 Anaesthesiology Department, 3 Cardiology Department, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 6 Surgery Department (NHS), University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 7 Internal Medicine Department, "Theageneio" Cancer Hospital, Thessaloniki, Greece ; 8 Internal Medicine Department, Regional Hospital of Samos, Samos, Greece ; 9 Onocology Department, 10 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece
| | - Konstantinos Zarogoulidis
- 1 Anaesthesiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 2 Anaesthesiology Department, 3 Cardiology Department, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 6 Surgery Department (NHS), University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 7 Internal Medicine Department, "Theageneio" Cancer Hospital, Thessaloniki, Greece ; 8 Internal Medicine Department, Regional Hospital of Samos, Samos, Greece ; 9 Onocology Department, 10 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece
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