Review of literature
Monnet et al(1) published a review article on assessment of volume responsiveness in mechanically ventilated patients using heart and lung interactions. He explained that mechanical ventilation produces cyclic changes left ventricular stroke volume due to inspiration and expiration induced changes in LV preload. It denotes preload dependency of left ventricle indirectly right ventricle. He also describes various limitations of respiration variations in SV for predicting fluid responsiveness.
Guidet et al(2) conducted a study in sepsis patients to find haemodynamic efficacy and safety between 6%HES 130/0.4 vs 0.9% NaCl. He found that volume requirement was less with HES than NaCl in inial phase of fluid resuscitation and also the time required to reach haemodynamic stability was less with HES. There was no difference between AKIN and RIFLE criteria between two groups. There was also no difference in mortality upto 90days after resuscitation.
Christoph K Hofer et(3) al performed a study to find which system has better prediction of fluid responsiveness between FloTrac/Vigileo and PiCCO plus system, using stroke volume variation(SVV) as a predictor of fluid responsiveness. The study was performed in patients undergoing in elective cardiac surgery. He used a method to induce volume shift by changing body position from 30° head-up position to 30° head-down
Position. SVV was determined using radial Flotrac sensor and femoral PiCCO plus catheter. The decrease in SVV found using Flotrac and PiCCO plus were significant and also the correlation between found between the two SVVs were significant. He also found that SVV measured using FloTrac has lower threshold for prediction than the other.
Jan Be...
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...ilated. Through subcostal approach IVC diameter was measured at end inspiration(D max) and end expiration(D min) using echocardiography and distensibility index was calculated(dIVC=Dmax-Dmin/Dmin). Cardiac index(CI) measured using Doppler technique in pulmonary arterial trunk. Patients showing 15% increase in CI post volume infusion with 7ml/kg of plasma expanders were called as responders. A strong relation (r = 0.9) was observed between dIVC at baseline and the CI increase following blood volume expansion.
Stawiki SP(11) et al performed a study to compare the USG guided assessment of inferior vena cava collapsibility index (IVC-CI) and central venous pressure. He found an inverse relationship between CVP and IVC-CI. IVC-CI lesser than 25% is consistent with euvolemia or hypervolemia, while IVC-CI greater than 75% suggests intravascular volume depletion.
Sepsis is defined as an exaggerated, overwhelming and uncontrolled systemic inflammatory response to an initially localised infection or tissue injury, which may lead to severe sepsis and septic shock if left untreated (Daniels, 2009; Robson & Daniels, 2013; Dellinger et al, 2013; Perman, Goyal & Gaieski, 2012; Vanzant & Schmelzer, 2011). Septic shock can be classified by acute circulatory failure as a result of massive vasodilation, increased capillary permeability and decreased vascular resistance in the body, causing refractory hypotension despite adequate fluid resuscitation. This leads to irreversible tissue ischaemia, end organ failure and ultimately, death (McClelland & Moxon, 2014; Sagy, Al-Qaqaa & Kim, 2013, Dellinger et al, 2013).
This essay describes how the anaesthetic machine and airway management equipment are prepared in operating theatres and discusses how they are ensured safe for use. It evaluates the Association of Anaesthetists of Great Britain and Ireland (AAGBI) guidelines related to safe practice and the preparation of the ET tubes, laryngeal masks, guedels, Naso pharyngeal airways and the laryngoscope. The function of the anaesthetic workstation is to deliver a mixture of anaesthetic agents and gases safely to the patient during the induction process and throughout surgery. In addition, it also provides ventilation to support breathing and monitors the patient’s vital signs to minimise the anaesthetic risks to the patient whilst in the care of health professionals. The pre-use check is vital to patient safety as an inadequate check of the anaesthetic machine or airway management equipment can and does lead to significant harm of the patient including mortality (Medicines and Healthcare Products Regulatory Agency (MHRA), 2008 and Magee, 2012).
Also, cytokines are used as they can destroy the infection, however there is a problem with this diagnosis as excessive production can cause tissue and organ damage. The pathological physiological outcomes of sepsis is that there is a multi-organ dysfunction that includes the heart, brain, kidneys and the lungs. Acute respiratory distress syndrome (ARDS) is a condition where there is a low oxygen level in the blood, this mostly affects the lungs, people who have sepsis will be affected by ARDS as their breathing rate will decrease. Another reason for multi-organ dysfunction is that there is a lack of blood being given to the organs, this causes low blood pressure or as it’s called hypotension, this mostly affects diabetic people which leads them to having sepsis.
Previous research used noninvasive ventilation to help those with COPD improve their altered level of consciousness by allowing the alveoli to be ventilated and move the trapped carbon dioxide out of the lungs. When too much carbon dioxide is in the blood, the gas moves through the blood-brain barrier and causes acidosis within the body, because not enough carbon dioxide is being blown off through ventilation. The BiPAP machine allows positive pressure to enter the lungs, expand all the way to the alveoli, and create the movement of air and blood. Within the study, two different machines were used: a regular BiPAP ventilator and a bilevel positive airway pressure – spontaneous/timed with average volume assured pressure support, or AVAPS. The latter machine uses a setting for a set tidal volume and adjusts based on inspiration pressure.
In the case study it is the left lung that is in distress, and as the pressure increases within the left lung it can cause an impaired venus return to the right atrium (Daley, 2014). The increased pressure can eventually affect the right lung as the pressure builds in the left side and causes mediastinal shift which increases pressure on the right lung, which decreases the patients ability to breath, and diffuse the bodies tissues appropriately. The increase in pressure on the left side where the original traum... ... middle of paper ... ... 14, January 29).
Sayar S.,Turgut, S., Dogan, H., Ekici, A., Yurtsever, S., Dermirkan, F., Doruk, N., Tsdelen, B. (2009) Incidence of pressure ulcers in intensive care unit patients at risk according to the Waterlow scale and factors influencing the development of pressure ulcers. Journal of Clinical Nursing 18, 765-774.
Research by Hotchkiss, Monneret, & Payen’s (2013) has revealed that sepsis is an immunosuppressive disorder, therefore patients can benefit from immunostimulatory therapies used to treat those who have lowered immune systems. Accordingly, focusing on boosting the immune system has been shown to decrease mortality in patients (Hotchkiss et al. 2013). Hotchkiss et al. (2013) announces that while these statistics are encouraging, the mortality rate is still considered high and further research and techniques are needed in order to continue the downward trend. Hotchkiss et al. (2013) states that it is unclear why some patients survive sepsis and others do not recover. Until the true cause of death in sepsis is understood, the best course of action is prevention, early detection, and immune system support.
An electrocardiogram (ECG) is one of the primary assessments concluded on patients who are believed to be suffering from cardiac complications. It involves a series of leads attached to the patient which measure the electrical activity of the heart and can be used to detect abnormalities in the heart function. The ECG is virtually always permanently abnormal after an acute myocardial infarction (Julian, Cowan & Mclenachan, 2005). Julies ECG showed an ST segment elevation which is the earliest indication that a myocardial infarction had in fact taken place. The Resuscitation Council (2006) recommends that clinical staff use a systematic approach when assessing and treating an acutely ill patient. Therefore the ABCDE framework would be used to assess Julie. This stands for airways, breathing, circulation, disability and elimination. On admission to A&E staff introduced themselves to Julie and asked her a series of questions about what had happened to which she responded. As she was able to communicate effectively this indicates that her airways are patent. Julie looked extremely pale and short of breath and frequently complained about a feeling of heaviness which radiated from her chest to her left arm. The nurses sat Julie in an upright in order to assess her breathing. The rate of respiration will vary with age and gender. For a healthy adult, respiratory rate of 12-18 breaths per minute is considered to be normal (Blows, 2001). High rates, and especially increasing rates, are markers of illness and a warning that the patient may suddenly deteriorate. Julie’s respiratory rates were recorded to be 21 breaths per minute and regular which can be described as tachypnoea. Julies chest wall appeared to expand equally and symmetrical on each side with each breath taken. Julies SP02 levels which are an estimation of oxygen
Sepsis is a life threating health condition and if not treated early can lead to shock, multiple organ failure and death (Ho, 2012). The main study of which practice has been based world-wide is the Surviving Sepsis Campaign. The Surviving Sepsis Campaign was developed to create evidence-based management guidelines. The Surviving Sepsis Campaign completed this by using an educational program to implement the guidelines by integrating their recommendations into resuscitation and management bundles (Marik, 2011). The first Surviving Sepsis Campaign Guidelines were published in Critical Care Medicine in 2004 with an updated version published in 2008 with the core of the recommendation's remained largely unchanged (Ahrens, 2011).
...., & Jr, L. H. (1992). Release of vasoactive substances during cardiopulmonary bypass. Annals of Thoracic Surgery. doi:10.1016/0003-4975(92)90113-I-6
Ascertaining the adequacy of gaseous exchange is the major purpose of the respiratory assessment. The components of respiratory assessment comprises of rate, rhythm, quality of breathing, degree of effort, cough, skin colour, deformities and mental status (Moore, 2007). RR is a primary indicator among other components that assists health professionals to record the baseline findings of current ventilatory functions and to identify physiological respiratory deterioration. For instance, increased RR (tachypnoea) and tidal volume indicate the body’s attempt to correct hypoxaemia and hypercapnia (Cretikos, Bellomo, Hillman, Chen, Finfer, & Flabouris, 2008). The inclusive use of a respiratory assessment on a patient could lead to numerous potential benefits. Firstly, initial findings of respiratory assessment reveals baseline data of patient’s respiratory functions. Secondly, if the patient is on respiratory medication such as salbutamol and ipratropium bromide, the respiratory assessment enables nurses to measure the effectiveness of medications and patient’s compliance towards those medications (Cretikos, Bellomo, Hillman, Chen, Finfer, & Flabouris, 2008). Thirdly, it facilitates early identification of respiratory complications and it has the potential to reduce the risk of significant clinical
If there is a driveline emerging from the abdomen, the paramedic should not cut, bend, or twist it since this is the direct connection to the power source to the pump. Ther pareamedic should begin his/her assessment with the routine steps of assessment; however, when the paramedic gets to step C, the process will change. Though some VAD’s produce a pulsating flow of blood throughout the body, a larger number of devices use a continuing flow creating a non-pulsating continuous flow. Therefore, these patients will not have a pulse when assessed in the conventional manner. Also, attempting to take a blood pressure reading with a manual cuff does not produce an audible
(PC - IRV) suggested for severe hypoxemia when high positive end expiratory pressure (PEEP) and high FiO2 have failed to improve oxygenation in (ALI / ARDS) (ega). The result is maintenance of numerous alveoli open and intrinsic Positive end expiratory pressure (PEEP), improving arterial oxygenation (Bates). (IRV ) with low (PEEP) levels during conventional ventilation, (IRV) is successful in improving Pao2, moderate PEEP levels that prevent recruitment, and when use high PEEP levels are required in severe ARDS, oxygenation is better preserved with conventional ventilation due to a lower shunt (Ferrando).The study’s by (Chaco): the three randomized trials compared pressure control ventilation (PCV) versus volume control ventilation (VCV) in a total of 1089 adults with (ALI / ARDS) from 43 intensive care unit (ICU).The method was they use (PC-IRV),equivalent pressure-controlled model compared with (VCV), we included parallel-group randomized controlled trials (RCTs) and quasi-RCTs irrespective of their language or publication status. Primary outcomes are 1- In-hospital mortality, including ICU mortality2- Mortality at 28 days. The result was 1-(PCV) probably reduces ICU mortality of (ALI / ARDS) compared with (VCV), 2- Risk of barotrauma may not differ between (PCV) and (VCV). There is some studies have shown
Mechanical ventilation is defined as using a device that is called a ventilator to provide positive pressure oxygen flow to a patient who have partially or fully lost the ability to breath on their own. Typically patients will require a ventilator for anesthesia during surgeries, or respiratory compromise due to trauma or some sort of illness. When people imagine a ventilated patient they constantly think of the unconscious person who sustained some sort of major trauma who are more than likely brain dead. However there are many patients that have lost the ability to breathe that are now regaining consciousness only to find they cannot breath on their own. This condition could be permanent or they could take some time to regain the ability to breathe on their own in a process called weaning.
current literature has yet to determine which method is the best. This case series shows the how difficult is to assess the accurate fluid status in undifferentiated shock in critically ill patients and to predict the fluid responsiveness.