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Biomedical subjects

A Minuto

Publications and source records attributed to A Minuto.

12 recordsLinked to original sources
PubMed2004

[Non invasive mechanical ventilation in acute cardiogenic pulmonary edema: is it all done?].

The aim of the paper is to critically analyse the results obtained by recent literature concerning the most important aspects of application of Non Invasive Mechanical Ventilation for the treatment of Acute Cardiogenic Pulmonary Edema, and to elaborate a definition of what is, on the whole, widely accepted, focusing the attention on those issues which still remain unanswered and therefore require further studies. MEDLINE was searched and the bibliography of a selected group of articles was perused. The literature was analysed and the information gathered has proved to address the questions in a systematic way. All studies concerning the use of a non invasive ventilation technique in the treatment of acute pulmonary edema or acute respiratory failure which included pulmonary edema have been considered. New physiological issues have been introduced on the pathogenesis of acute pulmonary edema. Even though very little non invasive ventilation has been performed outside intensive care units, a growing interest is rising in the opportunity of transferring this technique to a different setting which would include critically ill patients. No random controlled trials and studies have ever established whether positive pressure support is really better than continuous airway pressure, but several trials appear to have excluded the potential for high-risk in the use of assisted ventilation. General opinion has not yet confirmed foreseeable failures in non invasive ventilation at the time of patient admission. A good deal of favorable experimental evidence supports the use of non invasive ventilation in the acute pulmonary edema and guarantees safety when used in intensive care units. Very few trials have been carried out in order to explore application on severe pulmonary edema outside intensive care unit. A whole new world of old and new issues on patient selection criteria, ventilation times, type of ventilation and predictability of failure, could be discovered.

Acute Disease↗
PubMed2003

Non-invasive mechanical ventilation in patients with acute cardiogenic pulmonary edema.

AIM: To evaluate the use of noninvasive mechanical ventilation (NIMV) in patients with acute cardiogenic pulmonary edema. METHODS DESIGN: prospective study. SETTING: Emergency Department at a University hospital. PATIENTS: 84 patients with acute respiratory distress due to pulmonary edema. Interven-tions: NIMV, using a pressure support mode and positive end-expiratory pressure (PEEP). A "weaning test" to evaluate clinical stability. MEASUREMENTS: heart rate, arterial blood pressure, respiratory rate, arterial blood gases, electrocardiogram and incidence of myocardial infarction before and after NIMV. Mortality and duration of hospital stay were also considered. RESULTS: A total of 84 patients received NIMV with 14+/-3.6 cm H2O pressure support over PEEP of 8.3+/-2.1 cm H2O and FiO2 1. At the end of the study period, 16 patients (19%) were considered "non responders" and required invasive ventilation; 62 patients (74%) were considered "responders" and subsequently transferred to the medical ward. The hospital mortality was 14% and 25% in the "responder" and "non responder" groups, respectively; the length of stay was 15.7+/-10.1 days in the "responder" group vs 16+/-10.6 days in the "non responder" group. We never found new episodes of myocardial infarction related to NIMV. The only significant difference between "responder" and "non responder" patients was arterial blood pressure. CONCLUSIONS: We hypothesize that "non responder" patients, characterized by blood pressure values lower than "responders", are less "cardiocompetent" and thus unable to cope with the increased work of breathing. NIMV avoided Intensive Care Unit admission for 74% of the observed patients.

Acute Disease↗
PubMed1998

[Ciaglia's percutaneous dilatative tracheostomy in intensive care. Perioperative complications and long-term results].

BACKGROUND AND AIM: The introduction of percutaneous tracheostomic techniques using dilatation (PDT) has led to the gradual disuse of conventional methods of surgery. The aim of this study was to evaluate ventilatory function in critical patients during the execution of PDT using Ciaglia's method as well as, in the postoperative phase, the long-term results, namely endotracheal lesions and cosmetic deformities of the stoma. EXPERIMENTAL DESIGN: A prospective study was carried out on a consecutive series of adult patients. SETTING: The intensive care ward of a 600-bed teaching hospital. PATIENTS: A group of 50 critical patients undergoing PDT from 1993 to 1996. Valuations of ventilatory function: expiratory volume (EV), PaO2 and PaCO2, were calculated in 40 patients undergoing PDT. Endoscopic controls of the trachea were performed in 21 surviving patients 60 days after the removal of the tracheostomic tube and a cosmetic evaluation of the tube insertion site was also made in the same patients. RESULTS: During PDT a mean reduction of EV was observed of 1.41/min and PaO2 values also diminished 15% accompanied by a 14.2% increase in PaCO2. The endoscopic control performed after 60 days in 21 out of 50 patients revealed a subglottal stenosis in 1 patient, the presence of nonstenosing cicatricial granuloma in 2 patients, edema in 2 patients and dysepithelisation of the tracheal mucosa in a further 2 patients. The remaining 66% showed flattening of the mucosa and complete restitutium ad integrum. No usurpations and cicatricial tractions of the tube insertion site were observed. CONCLUSIONS: This prospective study of intraoperative ventilatory function and the final outcome of PDT according to Ciaglia confirms that this is a reliable technique for the ventilatory management of critical patients with a low percentage of long-term complications.

Aged↗
PubMed1993

Continuous veno-venous hemofiltration in critically ill patients with multiple organ failure.

18 critically ill patients, with multiple organ failure (MOF) (from shock either septic, n = 15, or cardiogenic, n = 3), oliguria and increase in BUN and creatinine were treated with pump driven, high flux continuous veno-venous hemofiltration (CVVH). Replacement fluids were administered in predilution mode. All patients were under respiratory support and vasoactive drugs, and received early nutritional support (N input: 0.2-0.3 g/kg/day). Mean duration of treatment was 9.2 days and mean ultrafiltrate production was 21.4 l/day; treatment resulted in a significant reduction of both urea nitrogen and creatinine blood levels (-20 and -40% of initial values respectively) in spite of a very severe catabolism. The total amount of urea nitrogen removed through CVVH ranged from 15 to 73 g/day (mean 33.5), the median value of urea nitrogen clearance was 12.8 ml/min with a median ultrafiltration coefficient of 0.8. The mean duration of hemofilters was 69 hours (38-108); the efficacy of filters remained stable throughout the entire lifespan and changes were made in case of sudden decrease of ultrafiltration (< ml/min). No major complication was observed in over than 4000 hours of treatment. Pump driven, high flux CVVH proved effective in the control of water electrolyte balance and metabolic homeostasis in a group of critically ill, hemodynamically unstable, catabolic patients with MOF and acute renal failure. In no case we had to add intermittent hemodialysis or to use hemodiafiltration. The constant extracorporeal blood flow and the stable efficacy of hemofilters allowed an easy control of the overall effectiveness of this technique.

Adult↗
PubMed1990

[Intensive care of AIDS patients. Clinical experience].

Six patients with AIDS and severe respiratory failure from diffuse interstitial pneumonia, have been treated in one year in ICU. The authors describe diagnostic and therapeutic characteristics and management problems, underlining the good results in the short and medium term.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

[Automatic fluid control during high-flow continuous hemofiltration: the Equaline system].

OBJECTIVE: To describe the use of an automatic fluid control system, Equaline, during high flux continuous hemofiltration. DESIGN: Prospective descriptive study. SETTING: General intensive care unit in a general hospital. PATIENTS: 15 consecutive patients suffering from septic shock, hypercatabolic with acute renal failure. INTERVENTION: Pump driven continuous veno-venous hemofiltration (PDCVVH) with high flux was performed. All pts were intubated, under mechanical ventilation and treated with vasoactive agents for hemodynamic instability. Fluid balance was achieved with an automatic fluid control system, Equaline, on daily basis according to clinical needs. MEASURES: Length of treatment, daily amount of ultrafiltrate and urea removal, urea and creatinine blood level before and after the treatment were registered. RESULTS: Age was 59.1 years, SAPS 17.2. Patients were treated for an average period of 9 days obtaining a daily ultrafiltrate production of 21.4 L. In all pts, though the high catabolism (daily nitrogen production > 30 g), there was a significant decrease of urea and creatinine concentration. CONCLUSION: Equaline system was able to maintain intravascular volume in the face of high ultrafiltration rate avoiding clinically important discrepancies between ultrafiltrate formation and fluid replacement. We conclude that PDCVVH management is greatly improved with use of such servo-controlled feedback system.

Acute Kidney Injury↗