INTENSIVE CARE

ÖZET Perkutan Endoskopik Gastrostomi (PEG) tekniği ilk tanımlandığı 1980'lerden buyana, kritik olgularda uzun süreli enteral beslemede uygun bir erişim yolu olarak kullanılmıştır. Bu çalışmada Anestezi Yoğun Bakım Ünitemizde izlenen hastalarda saptadığımız PEG ...

Objective To examine the effects of positive end-expiratory pressure (PEEP) on extravascular lung water (EVLW), lung tissue, and lung volume. Design and setting Experimental animal study at a university research facility. Subjects Fifteen adult sheep. Interventions All animals were studied before and after saline washout-induced lung injury while ventilated with sequentially increasing PEEP (0, 7, 14, or 21 cmH2O). Measurements and results Lung volume was determined by computed tomography and EVLW by the thermal dye dilution technique. Saline washout significantly increased lung tissue volume (21±3 to 37±5 ml/kg) and EVLW (9±2 to 36±9 ml/kg). While increasing levels of PEEP reduced EVLW (30±7, 24±8, and 18±4 ml/kg), lung tissue volume remained constant. Total lung volume significantly increased (50±8 ml/kg at PEEP 0 to 77±12 ml/kg at PEEP 21). Nonaerated lung volume significantly decreased and was closely correlated with the changes in EVLW (r=0.67). In addition, a highly significant correlation was found between PEEP-induced decrease in nonaerated lung volume and decrease in transpulmonary shunt (r=0.83). Conclusions The main findings are as follows: (a) PEEP effectively decreases EVLW. (b) The decrease in EVLW is closely correlated with the PEEP-induced decrease in nonaerated lung volume, making EVLW a valuable bedside parameter indicating alveolar recruitment, similar to measurements of transpulmonary shunt. (c) As excess tissue volume remained constant, however, EVLW may not be suitable to reflect overall severity of lung disease

Decision-making bringing to an admission or not in intensive care is complex. The aim of this study is to analyze with an ethical point of view the making decision process leading to the refusal and its consequences. It is proposed a setting in prospect through the principles of beneficence, non-maleficience, respect for autonomy, justice, and the Leonetti law. Prospective study in surgical reanimation at the University Hospital of Rouen over 9 months (November 2007-September 2008). Systematic collection for each non-admitted patient of the general characters, the methods of decision making, immediate becoming and within 48 h Constitution of two groups: patients for whom an admission in intensive care could be an unreasonable situation of obstinacy, and patients for whom an admission in reanimation would not be about unreasonable if it occurred. One hundred and fifty situations were analyzed. The potentially unreasonable character of an admission does not involve necessarily a refusal of care in intensive care. The question of the lack of place and equity in the access to the care is real but relative according to the typology of the patients. The research of the respect of the autonomy of the patient is difficult but could be facilitated. The Leonetti law does not appear to be able to be a framework with the situation of refusal of care in intensive care. It is not a question of going towards a systematic admission in intensive care of any patient proposed, but to make sure that so if there is a refusal, it is carried out according to a step ethically acceptable.

BACKGROUND: Intensivists must provide enough analgesia and sedation to ensure dying patients receive good palliative care. However, if it is perceived that too much is given, they risk prosecution for committing euthanasia. The goal of this study is to develop consensus guidelines on analgesia and sedation in dying intensive care unit patients that help distinguish palliative care from euthanasia. METHODS:

Background: A child's risk of dying is highest in the first 28 days of life (the neonatal period). The central function of Chest physiotherapy in ventilated neonates is to assist in the removal of tracheobronchial secretions, remove airway obstruction, reduce airway resistance, enhance gas exchange, and reduce the work of breathing. Positioning is used with the aim to improve of ventilation/perfusion (V/Q) matching, lung volumes and mucociliary clearance and to reduce the work of breathing (WOB). Objective: To find out effectiveness of Chest Physiotherapy in prone Position on Respiratory Functions in Ventilated Neonates. Method: 6 ventilated Neonates (n=6) between day 1-day 28 fitting the inclusion criteria were selected. They received chest physiotherapy in prone position which was given to each participant in for 240 minutes/day in two divided sessions of 120 minutes each with a gap of 6 hours (10am-12 pm & 6pm-8pm) for consecutive three days. (i.e. six intervention sessions). Primary outcomes were Oxygen saturation (SpO2), Partial pressure of arterial oxygen (PaO2) & Peak Inspiratory Pressure (P.I.P.). Outcomes were recorded Pre & Post of Last (6 th) 120 minutes session (0 Min & 120 Mins). Results: On comparison of three parameters in two groups using paired t test we found that there was significant difference (p < 0.05) in SpO2, PaO2 and P.I.P at baseline and post intervention. Conclusion: The study concluded that chest Physiotherapy combined with prone positioning is a cost effective, non-invasive and affordable intervention which has a significant impact on improvement of SpO2, PaO2 and PIP in ventilated neonates. A randomized clinical trial evaluating the efficacy of this intervention seems warranted.

Study Objective: To determine whether intraoperative fluid management in spine surgery predicts postoperative intensive care unit length of stay (ICU LOS).Design: Retrospective case series.Setting: University-affiliated medical center.Patients: 103 adult ASA physical status I, II, and III patients undergoing spine surgery.Interventions: Patients were divided into three LOS groups: no ICU stay (LOS0) (n = 26), 1 day ICU stay (LOS1) (n