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Anaesthesiology Intensive Therapy
Journal Prestige (SJR): 0.658

Citation Impact (citeScore): 2
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This is an Open Access Journal

Open Access journal
ISSN (Print) 1642-5758 - ISSN (Online) 1731-2531
Published by Via Medica

[40 journals]

High flow oxygen therapy in intensive care and anaesthesiology
- Authors: Dariusz Maciejewski
  Abstract: Na podstawie przeglądu aktualnego piśmiennictwa przedstawiono zasady i praktyczne efekty zastosowania wysokoprzepływowego leczenia tlenem (WLT) wśród chorych intensywnej terapii i poddanych zabiegom operacyjnym. Rezultaty stosowania WLT wybiegają poza uzyskanie stabilnego i kontrolowanego stężenia tlenu w powietrzu oddechowym. Dodatkowe efekty związane są z uzyskiwaniem dodatnich ciśnień w fazie wydechu, zjawiska wypłukiwania CO2 i czynnościowego zmniejszania przestrzeni martwej, wzrostu końcowo – wydechowej objętości płuc w wyniku ograniczania mikro-niedodmy i poprawy dystrybucji objętości oddechowej. W wyniku optymalnego nawilżania i ogrzewania mieszaniny wdechowej dochodzi do zmniejszenia oporów wentylacji i pracy oddychania. Opisane efekty WLT skłaniają do prób jej wykorzystywania nie tylko jako narzędzia tlenoterapii biernej, ale również jako urządzenia alternatywnego dla wentylacji nieinwazyjnej lub wczesnej intubacji. Zakres zastosowań ocenionych w piśmiennictwie dotyczy ostrej hypoksemicznej niewydolności oddechowej, wstępnej fazy ARDS, POChP, okresu okołooperacyjnego oraz zastosowań podczas procesów diagnostycznych (gastroskopia, bronchoskopia). Szczególną formą WLT jest poddawana aktualnie ocenie adaptacja metody dla chorych z tracheostomią, usprawniająca głównie procesy nawilżania mieszaniny oddechowej. WLT wymaga dalszych ocen w dużych, randomizowanych badaniach, jednak dotychczasowe efekty stosowania są zachęcające.
  PubDate: 2019-03-31
  Issue No: Vol. 51 (2019)
Thrombocytopenia: the most frequent haemostatic disorder in the ICU
- Authors: Jan Pluta, Janusz Trzebicki
  Abstract: Thrombocytopenia is the most common haemostatic disorder in patients admitted to Intensive Care Units (ICUs). The mechanisms contributing to a decrease in the platelet count in critically ill patients are multifactorial, among which sepsis and trauma are the most frequent. A differential diagnosis of profound thrombocytopenia is crucial for effective treatment. A low platelet count is a strong independent predictor of morbidity and mortality because it is associated with life-threatening bleeding or thrombosis. This article aims to outline the definition and pathophysiology of thrombocytopenia and present a three-step algorithm of the clinical management of this haemostatic disorder.
  PubDate: 2019-03-21
  Issue No: Vol. 51 (2019)
Measures of preoperative anxiety
- Authors: Adam Jarosław Zemła, Katarzyna Nowicka-Sauer, Krzysztof Jarmoszewicz, Kamil Wera, Sebastian Batkiewicz, Małgorzata Pietrzykowska
  Abstract: The evaluation of treatment from the patient’s perspective (Patient Reported Outcomes, PROs) currently remains one of the most vibrant and dynamically developing fields of research. Among PROs, patient self-assessment of various symptoms, including one’s psychological state, is of great importance. Anxiety is one of the most frequently observed psychological reactions among patients awaiting various surgeries, and may occur even in up to 80% of patients scheduled for high-risk surgical procedures. An increased level of preoperative anxiety has been proved to be related to negative consequences, both psychological and somatic, and affecting, in consequence, anaesthesia, postoperative care and treatment, along with the rehabilitation process. It is also considered as a risk factor for mortality in patients after surgeries. Planning of necessary educational, pharmacological and psychological interventions should be preceded by the evaluation of anxiety level which should be considered a routine element of preoperative care. The assessment of anxiety intensity may be performed using psychometric scales. Various factors should be taken into consideration while choosing the scale, including its reliability and accuracy, the aim of the assessment, the patient’s age and clinical state, as well as the type of surgery being planned. In the current article, we present standardised and reliable methods which may be used in the evaluation of preoperative anxiety among patients scheduled for surgery, namely: the State-Trait Anxiety Inventory (STAI); the Hospital Anxiety and Depression Scale (HADS); the Amsterdam Preoperative Anxiety and Information Scale (APAIS); and the Visual Analogue Scale (VAS). A detailed description of the scales, including their main advantages and limitations, as well as their usefulness in both clinical evaluation of various patients’ groups and scientific research are presented.
  PubDate: 2019-03-21
  Issue No: Vol. 51 (2019)
Oxygen therapy with high-flow nasal cannulas in children with acute
bronchiolitis
- Authors: Anna Zielińska, Joanna Maria Jassem-Bobowicz, Joanna Kwiatkowska
  Abstract: Acute bronchiolitis is a common disease in children below 24 months of age. The most common aetiology of this disease is a respiratory syncytial virus infection. Since there is no effective treatment for bronchiolitis, supportive therapy alleviating symptoms and preventing respiratory failure is recommended. Oxygen therapy and appropriate nutrition during the disease are considered effective, particularly in severe cases. The choice of oxygen support is crucial. The present paper discusses oxygen therapy using high-flow nasal cannulas. Moreover, the safety of the method, its adverse side effects and practical pre-treatment guidelines are discussed.
  PubDate: 2019-03-19
  Issue No: Vol. 51 (2019)
Balancing sedation and ICU delirium management for better patient outcomes
- Authors: Katarzyna Kotfis
  PubDate: 2019-03-06
  Issue No: Vol. 51 (2019)
Neutrophil-to-lymphocyte ratio in patients with gram-negative sepsis
admitted to intensive care unit
- Authors: Naser Gharebaghi, Mohammad Amin Valizade hasanloei, Alireza Medizadeh khalifani, Shiva pakzad, Durna Lahooti
  Abstract: Introduction: Several studies have investigated the role of Neutrophil to Lymphocyte Ratio (N/L ratio) in the early diagnosis of infection, which had different results. We assessed this ratio in early diagnosis of Gram-negative sepsis admitted to ICU. Methods: This cross sectional study was approved by ethics committee of Urmia University of Medical Sciences and conducted during 2015. All patients with gram negative sepsis admitted to general intensive care unit (GICU) were enrolled. Demographic characteristics, APACHE II score, duration of mechanical ventilation and ICU length of stay, average neutrophil, lymphocyte count, and their ratio on the first, second and third day of hospitalization, and mortality were recorded. P < 0.05 was significant. Results: One hundred and thirty nine patients were studied during one year with mean age 68.29 ±17. 4 years. 136 patients received mechanical ventilation with mean 13.85 ±2.07 days. The mean white blood cells count on the first day of hospitalization was 11776.04±5789.60,and on the second and third days was 12446±2101.16 and 13241.01 ± 7077.17, respectively. The ratio of neutrophil to lymphocyte on the day of hospitalization was 11.38±1.02. This ratio on the second and third days was 11.98±0.99 and 12.94±1.3, respectively. Furthermore, 46.8% of patients died. According to the T-test, significant difference was seen between two groups in term of APACHEII score, count of neutrophil, WBC and N/L ratio on the second and third days (p < 0.05). Conclusion: Blood cell analysis and N/L ratio can be used as a predictor for severity of gram negative sepsis along with other diagnostic procedures.
  PubDate: 2019-03-06
  Issue No: Vol. 51 (2019)
Cost-effectiveness of home mechanical ventilation in children living in a
developing country
- Authors: Seyed Abbas Hassani, Safoura Navaei, Rohola Shirzadi, Hosein Rafiemanesh, Farzad Masiha, Majid Keivanfar, Leili Tahernia, Babak Moazzami, Gholamreza Azizi, Mohammad Aghaali, Mohammadreza Modaresi
  Abstract: Background: Home mechanical ventilation is a promising option for children requiring long-term mechanical-assisted ventilation, while data on cost-effectiveness of this approach is limited. Aims: To investigate the cost-effectiveness of home mechanical ventilation in children requiring long-term mechanical-assisted ventilation. Methods: A retrospective cohort was conducted on 67 children (32 girls, 47.7%) requiring mechanical-assisted ventilation. Underlying diseases of children were congenital airway malformations in 24, cystic fibrosis in 4, severe laryngomalacia in 16, poly neuropathy syndrome in 6, mitochondrial myopathy in 5, hypoxic ischemic encephalopathy in 6, and cerebral palsy in 2. Children were admitted in pediatric intensive care units (ICU) for 2 weeks. After discharge, they were on home mechanical ventilation and were followed for 1 year. Data on daily costs of admission at ICU, rehospitalizations, weaning, educational performance and muscle strength were gathered. Results: Mean age of children at time of initiation of mechanical-assisted ventilation was 5.8 years (ranged from 2 months to 15 years). Mean number of re-hospitalizations was 3.4_4.9 times with mean duration of 9.44_2.53 days. Of children on mechanical ventilation, 1 attended school, 2 were weaned, and 21 experienced improvement in muscle strength. No fatal or serious complications were observed while children were on home mechanical ventilation. Mean costs of daily ICU admission was 912_1028 $, while the mean daily cost of home mechanical ventilation was 60.86_4.95 $ (p < 0.001). Conclusions: Home mechanical ventilation is more cost-effective compared to ICU admission for only mechanical-assisted ventilation. < p> < /p>
  PubDate: 2019-03-06
  Issue No: Vol. 51 (2019)
Can we regulate endotracheal tube cuff pressure using an anaesthetic
machine'
- Authors: Luis Alberto Tafur, Eduardo Lema-Florez, Andrés Zorrilla-Vaca
  Abstract: Endotracheal tube obstruction caused by cuff hyperinflation can be a dangerous but preventable complication of the airway management. Some authors suggest that a trial of cuff deflation should be considered in algorithms for the management of patients with ventilation difficulty. Although it would be a good strategy, we think that preventive measures such as the regulation of the endotracheal tube (ETT) cuff pressure warrant further discussion and should be more propagated. It is known that the measurement of the ETT cuff pressure has shown to be useful in the prevention of postoperative pain, hoarseness, aspiration of secretions, subglottic stenosis and tracheal fistulas. However, the routine measurement of the cuff pressure is usually difficult given the low availability of the equipment designed for this purpose, the cost of acquisition, the lack of maintenance-calibration and the risk of cross-infection with use in multiple patients.
  PubDate: 2019-03-06
  Issue No: Vol. 51 (2019)
Supraclavicular block vs. intravenous regional anaesthesia for forearm
surgery
- Authors: Tomoki Nishiyama
  Abstract: Background: The purpose of this study was to compare the analgesic effect between intravenous regional anesthesia (IVRA) and supraclavicular block in forearm surgery. Methods: Eighty patients aged 30 to 70 years for forearm surgery were divided into Supraclavicular group and IVRA group. Supraclavicular block was performed with 1% lidocaine 20 mL. After analgesia was obtained, single tourniquet was used at 200 mmHg. For patients in the IVRA group, an intravenous catheter was inserted in the dorsum of the hand of surgery, double tourniquet was placed, an elastic bandage was wound up, then 1% lidocaine 20 mL was injected after proximal tourniquet was inflated at 200 mmHg. When analgesia did not occur in 30 minutes, the block was judged as a failure, and general anesthesia was administered. The onset time of analgesia, time to the first tourniquet pain, and duration of postoperative analgesia were measured. When patients felt pain at surgical site during surgery, fentanyl 50 μg was administered. Side effects were also checked. Results: Onset time, duration of postoperative analgesia, and time to the tourniquet pain were significantly shorter in the IRVA group. Number of patients with tourniquet pain was significantly larger and number of patients with additional fentanyl was significantly smaller in the IRVA group. No patients showed any side effects. Conclusion: IVRA had shorter onset time and needed less additional anesthetics during surgery, but induced more tourniquet pain and shorter duration of postoperative analgesia than supraclavicular block when 1% lidocaine 20 mL was used for forearm surgery.
  PubDate: 2019-03-04
  Issue No: Vol. 51 (2019)
Introducing a new sedation policy in a large district general hospital:
before and after cohort analysis
- Authors: Anne Frawley, John Hickey, Christine Weaver, James P Williams, Tamas Szakmany
  Abstract: Background: The management of pain, agitation and sedation for ventilated patients who are admitted to intensive care is an essential part of their care. The introduction of sedation protocols is associated with improved patient outcomes. Methods: We conducted an observational cohort study among mechanically ventilated patients in a 16-bed ICU over a two-year period. We retrospectively examined data from two patient populations, namely those before and after the introduction of a new sedation protocol in July 2015. The primary outcome was the duration of mechanical ventilation in both groups. Results: After the implementation of the new sedation protocol, there was a significant decrease in the mean duration of mechanical ventilation (1.45 days). Furthermore, we observed a non-significant reduction in the mean duration of ICU stay. Conclusion: The new protocol was associated with outcome improvements including: decreased mean duration of mechanical ventilation and a reduced number of ventilated days; and increased patient throughput with a slight increase in the length of vasopressor support. Moreover, the use of a structure-process-outcome model of quality improvement was associated with significant improvements in process measures of quality.
  PubDate: 2019-02-12
  Issue No: Vol. 51 (2019)
Epileptiform EEG patterns during different techniques of induction of
general anaesthesia with sevoflurane and propofol: a randomised trial
- Authors: Michał Jan Stasiowski, Radosław Marciniak, Anna Duława, Lech Krawczyk, Przemysław Jałowiecki
  Abstract: Background: The aim of the study was to assess the influence of volatile induction of general anaesthesia with sevoflurane using two different techniques and intravenous anaesthesia with propofol on the possible presence of epileptiform electroencephalograph patterns during the induction of general anaesthesia. Methods: Sixty patients (age 18-70 years) were recruited. Exclusion criteria included history of epilepsy, neurological or neurosurgical diseases, pre-existing EPs in initial EEG recordings, medication interfering with EEG patterns. Patients were randomly allocated into three different groups: A (sevoflurane, increasing concentrations technique); B (sevoflurane, vital capacity technique); C (intravenous propofol). The clinical and instrumental monitoring included arterial blood pressure, heart rate, standard electrocardiography II, arterial oxygen saturation, facial electromyography, fraction of inspired sevoflurane, fraction of expired sevoflurane, minimal alveolar concentration of sevoflurane, and BIS. Results: Neurophysiological analysis of EEGs showed different EPs: polyspikes (PS), rhythmic polyspikes (PSR), and periodic epileptiform discharges (PED). EPs (p < 0.05) were observed in Group A (56%) and Group B (37%), but not in Group C. One patient in group B presented with clinical seizures. No significant differences in the vital parameters and anaesthesia parameters between groups was observed, regardless of the presence of EPs, which were associated with both low and more likely high (falsely indicating awakening from anaesthesia) BIS scores. Conclusion: Our study shows that the BIS score variations do not detect epileptiform activity, which was associated with both low and high scores. The sevoflurane concentration reached either sedative or toxic concentrations.
  PubDate: 2019-02-06
  Issue No: Vol. 51 (2019)
Complications associated with nasotracheal intubation and proposal of
simple countermeasure
- Authors: Tomohiro Yamamoto, Miriam Flenner, Ehrenfried Schindler
  Abstract: To the Editor, Nasotracheal intubation is a widely used technique in anaesthesia management for procedures including oropharyngeal, dental, and maxillofacial surgeries[1-3]. It provides an uninhibited access to the mouth and plays an important role when dealing with difficult airways[4-6]. It is also used in patients with cervical spine instability owing to injury[7] or in patients with a cervical spine fixation owing to a disease or previous operation[8]. Moreover, it is selected for patients who require prolonged intubation for intensive care[9]. However, nasotracheal intubation may lead to certain complications, with epistaxis being the most common. Epistaxis generally occurs due to damage of the Kiesselbach’s plexus in the anterior part of the nasal septum[10-12] where branches from several arteries, including branches of the ophthalmic, maxillary, and facial arteries, anastomose to form a vascular plexus. To avoid this complication, the tracheal tube should be inserted into the nasal cavity such that its bevel tip comes to the lateral side of naris. However, if the bleeding occurs on insertion of the tube, the nasotracheal intubation should be completed to chiefly protect the airway and also to tamponade the bleeding point. Risk of sinusitis is another disadvantage associated with nasotracheal intubation[13]. Sinusitis can induce oedema around the opening of the maxillary sinus. Mucosal oedema in the nasopharynx can also result in the middle-ear problem. Superficial necrosis of the nasal ala is another common complication associated with the nasotracheal intubation[3,9,14,15]. Several measures have been suggested to avoid this necrosis problem [15-18]; however, these measures cannot always be applied in paediatric patients as their naris do not provide enough space for them. Nasotracheal intubation has also been reported to cause bacteraemia owing to abrasion of the nasal mucosa [19,20]. The nasotracheal intubation-related carriage of bacteria into the trachea should be also avoided. It is reported that prior treatment of nostrils and anterior nasal septum with mupirocin is effective to avoid this complication[21,22]. However, the cheapest and easiest countermeasure to avoid such a complication during the nasotracheal intubation for inducing anaesthesia involves removal of the nasal dirt from the tip of the tracheal tube; in short, the tracheal tube should be pulled out with the aid of Magill forceps through the patient’s mouth and the dirt should be wiped with a clean cotton (Figure 1). Additionally, dirt from the pharynx should be completely sucked under direct vision laryngoscope if required, before advancing the tracheal tube into the larynx. Once the tube tip and the pharynx are cleaned, the tube should be pulled again into the oral cavity by pulling the proximal side of the tube near the patient’s nostril. Subsequently, the tube tip can be advanced into the larynx with the aid of Magill forceps. This series of treatment does not take longer than 10 seconds to perform once the anaesthesiologist and nurse anaesthetist get accustomed to it, thereby preventing an extreme fall in the peripheral capillary oxygen saturation (SpO2), even in paediatric patients. If the SpO2 value goes below the permissible range during the procedure, the patient can be easily ventilated by connecting the ventilation hose from the anaesthesia machine to the tracheal tube thereby completely closing the nose and mouth of patient (Figure 2), whereas some anaesthesiologists believe that the tracheal tube should be completely drawn from the patient’s nose again to ventilate the patient with a mask On the other hand, some anaesthesiologists advance the tracheal tube further into the trachea in almost a panic condition, even when they have recognised the nose dirt on its tip (Figure 3), to prevent SpO2 fall, especially in paediatric patients. Therefore, knowledge of the ventilation technique via the tracheal tube inserted in the patient’s nostril can be of great advantage while performing nasotracheal intubation. It can allow anaesthesiologists to calmly pull out the tip of tracheal tube using Magill forceps through the patient’s mouth, when they recognise the nose dirt on it, to advance a cleaned tracheal tube into the trachea, even in paediatric patients. In conclusion, we suggest a simple countermeasure to avoid possible complications of nasotracheal intubation. It involves movement of a cleaned tracheal tube into the trachea of patient. Moreover, we suggest a possible ventilation technique in case the SpO2 falls beyond the permissible range during the nasotracheal intubation.
  PubDate: 2019-02-03
  Issue No: Vol. 51 (2019)
Emergency caesarean section delivery and puerperium in a patient with
severe idiopathic pulmonary arterial hypertension — a case report
- Authors: Tomasz Maciejewski, Tomasz Darocha, Kazimierz Kiermasz, Barbara Budziarz, Piotr Duraj, Wojciech Szanecki, Mirosława Mackiewicz, Jarosław Myszor, Katarzyna Mizia-Stec, Ewa Kucewicz-Czech
  Abstract: Background: The aim of this paper is to describe the third pregnancy trimester, delivery and puerperium in patient with idiopathic pulmonary hypertension. Case report: a 30-year-old primigravida with idiopathic pulmonary hypertension was qualified for emergency Caesarean section. In the post partum period no improvement in managing pulmonary arterial hypertension was achieved. Because of progressive respiratory and circulatory failure as well as the pulmonary artery pressure exceeding the systemic pressure the AV ECMO was applied on postoperative day 6. During the ECMO period the emergency laparotomy due to bleeding was necessary. The further course of ICU treatment was uneventful. Conclusion: In described case things are left to chance or goodwill of specialists and final outcome depend on happy coincidences.
  PubDate: 2019-01-22
  Issue No: Vol. 51 (2019)