European journal of anaesthesiology. Supplement最新文献_第3页

Does ICP monitoring make a difference in neurocritical care? 颅内压监测对神经危重症护理有影响吗?

European journal of anaesthesiology. Supplement Pub Date : 2008-01-01 DOI: 10.1017/S0265021507003237

O L Cremer

{"title":"Does ICP monitoring make a difference in neurocritical care?","authors":"O L Cremer","doi":"10.1017/S0265021507003237","DOIUrl":"https://doi.org/10.1017/S0265021507003237","url":null,"abstract":"Raised intracranial pressure and low cerebral perfusion pressure are associated with ischaemia and poor outcome after brain injury. Therefore, many management protocols target these variables. However, there are no randomized controlled trials that have demonstrated the effectiveness of intracranial pressure-guided care in severely head-injured patients. Observational studies of such therapy have yielded inconsistent results, ranging from decreased mortality to no effect or increased morbidity or mortality. A recent cohort study supports the notion that the possible benefits of intracranial pressure monitoring after traumatic brain injury are small - if present - and would exceed a number needed for the treatment of 16. Furthermore, intracranial pressure monitoring and aggressive management of intracranial pressure and cerebral perfusion pressure have been associated with increased lengths of stay in the neurocritical care unit, conceivable costs and possibly an increased rate of complications. Against this background, there is sufficient clinical equipoise to warrant an adequately powered randomized controlled trial to compare intracranial pressure-guided care with supportive critical care without intracranial pressure monitoring in patients with severe traumatic brain injury. However, the realization of such a trial is likely to be problematic for a number of reasons, not least of which the firmly held biases of many clinicians.","PeriodicalId":11873,"journal":{"name":"European journal of anaesthesiology. Supplement","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2008-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1017/S0265021507003237","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27277620","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 28

Can we demonstrate the efficacy of monitoring? 我们能证明监控的有效性吗?

European journal of anaesthesiology. Supplement Pub Date : 2008-01-01 DOI: 10.1017/S026502150700347X

D Zygun

引用次数: 7

Iatrogenic causes of an ICH: OAT therapy. 脑出血的医源性原因:OAT治疗。

European journal of anaesthesiology. Supplement Pub Date : 2008-01-01 DOI: 10.1017/S0265021507003171

A Iorio

引用次数: 1

Coping with relatives during end-of-life decisions. 在做出临终决定时如何与亲人相处。

European journal of anaesthesiology. Supplement Pub Date : 2008-01-01 DOI: 10.1017/S0265021507003195

S Baldinazzo

{"title":"Coping with relatives during end-of-life decisions.","authors":"S Baldinazzo","doi":"10.1017/S0265021507003195","DOIUrl":"https://doi.org/10.1017/S0265021507003195","url":null,"abstract":"Nurses have become independent over the last few decades in Italy, thanks to a series of legislative changes. When dealing with organ donation, the nurses usually face unexpected and complex situations from both a technical and interpersonal point of view. When the death of a loved one has to be communicated to the family, the coordinator nurse, along with the doctor, talks with the relatives to help them decide whether or not to donate organs. It is fundamental that the death of the patient is communicated by the doctor in charge of the case and this has to be done before the question of donation is raised. The idea of donation is suggested when we believe the family has understood that their beloved is dead. We try to adapt our communication style to the background of the family. Experience has shown us that these situations are emotionally complex and tiring for both the family members and health workers. Sometimes the stress level amongst health workers is so high that psychological support is needed after the interview. If the family decides to donate, the restitution phase is very important. A meeting is organized for a month after the event to inform the relatives of the success of donation.","PeriodicalId":11873,"journal":{"name":"European journal of anaesthesiology. Supplement","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2008-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1017/S0265021507003195","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27277991","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 8

Central nervous system inflammation. 中枢神经系统炎症。

European journal of anaesthesiology. Supplement Pub Date : 2008-01-01 DOI: 10.1017/S0265021507003390

S G Soriano, S Piva

引用次数: 27

Legal aspects of end-of-life decisions in Italy: the penal relevance of the limitation of treatment in the terminally ill and the problem of causality by omission. The legal puzzle of end-of-life care in Italy: is therapeutic limitation in the terminally ill patients a crime of omission liable to prosecution? 意大利临终决定的法律方面:限制临终病人治疗的刑罚相关性和疏忽造成的因果关系问题。意大利临终关怀的法律难题:对临终病人的治疗限制是一种可被起诉的不作为罪吗?

European journal of anaesthesiology. Supplement Pub Date : 2008-01-01 DOI: 10.1017/S0265021507003328

E P Fabris, M Piccinni

{"title":"Legal aspects of end-of-life decisions in Italy: the penal relevance of the limitation of treatment in the terminally ill and the problem of causality by omission. The legal puzzle of end-of-life care in Italy: is therapeutic limitation in the terminally ill patients a crime of omission liable to prosecution?","authors":"E P Fabris, M Piccinni","doi":"10.1017/S0265021507003328","DOIUrl":"https://doi.org/10.1017/S0265021507003328","url":null,"abstract":"The interruption of life support poses different problems for he who interrogates himself regarding the possible juridical role of omissible behaviour or activities by part of the physician when dealing with end-of-life interventions within the boundary of life and death. The present contribution proposes to trace the coordinates necessary to answer the main query regarding the obligations which may be incumbent on the physician. For this reason, the necessity to interpret the legal sanctions in a technical key is highlighted. This is performed in sight of a progressive and inevitable adaptation to problems which are the result of a social evolution, and to the conception of values which constitute an object responsibility, as renewed by the constitution. The laws that discipline crimes against life and individual integrity must be interpreted while keeping in mind that the objective of maintaining the patient in life must be integrated with the control of suffering and the guarantee of a dignified death. When identifying the principles which have to inspire the decisions during 'borderline or boundary situations', it is highlighted the way the physician has to resort to a just equilibrium between benefit, which can be reasonably expected, and sacrifice, which should be imposed, taking into consideration the criteria of good clinical practice, among which attention to the patient's will must be taken into consideration.","PeriodicalId":11873,"journal":{"name":"European journal of anaesthesiology. Supplement","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2008-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1017/S0265021507003328","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27277615","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 1

Cerebrospinal fluid dynamics: disturbances and diagnostics. 脑脊液动力学:干扰和诊断。

European journal of anaesthesiology. Supplement Pub Date : 2008-01-01 DOI: 10.1017/S0265021507003298

A Lavinio, Z Czosnyka, M Czosnyka

引用次数: 17

Advances in intracerebral haemorrhage management. 脑出血治疗的进展。

European journal of anaesthesiology. Supplement Pub Date : 2008-01-01 DOI: 10.1017/S0265021507003286

C S Kase

{"title":"Advances in intracerebral haemorrhage management.","authors":"C S Kase","doi":"10.1017/S0265021507003286","DOIUrl":"https://doi.org/10.1017/S0265021507003286","url":null,"abstract":"Intracerebral haemorrhage accounts for 10-15% of strokes and is associated with high mortality and severe disability in survivors. Despite its seriousness, the treatment options for intracerebral haemorrhage are limited. Measures aimed at decreasing elevated intracranial pressure are of limited effectiveness. This has stimulated an interest in attempting to improve the prognosis of intracerebral haemorrhage by addressing the haematoma directly, either removing it by surgical means or limiting its early spontaneous growth. The international Surgical Trial in Intracerebral Haemorrhage (STICH), which randomized subjects with intracerebral haemorrhage within 72 h of symptom onset to medical management vs. surgery, failed to document the superiority of one treatment over the other, when compared with regard to mortality and functional outcome at 90 days. The subgroup of patients with lobar haematomas located at a depth of 1 cm or less from the cortical surface fared better with surgery than with medical management. A similar comparison trial is planned for this subgroup of patients. The neutral results of The international Surgical Trial in Intracerebral Haemorrhage (STICH) prompted the assessment of haemostatic therapies, based on the observation that haematomas often enlarge substantially in the hours that follow the onset of symptoms. Recombinant activated factor VII has been shown in a phase IIb, dose-finding trial to result in a significant reduction of haematoma growth, and both mortality and functional scales trended in favour of recombinant activated factor VIIa. The main complication of this therapy was arterial thromboembolic events (myocardial infarction and ischaemic stroke). A phase III randomized trial has recently been completed.","PeriodicalId":11873,"journal":{"name":"European journal of anaesthesiology. Supplement","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2008-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1017/S0265021507003286","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27277679","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 4

Electrophysiological tests in intensive care. 重症监护中的电生理测试。

European journal of anaesthesiology. Supplement Pub Date : 2008-01-01 DOI: 10.1017/S0265021507003201

M Botteri, B Guarneri

{"title":"Electrophysiological tests in intensive care.","authors":"M Botteri, B Guarneri","doi":"10.1017/S0265021507003201","DOIUrl":"https://doi.org/10.1017/S0265021507003201","url":null,"abstract":"Neuromuscular complications encountered in intensive care can be due to peripheral nerves (polyneuropathies), muscles (myopathies), neuromuscular end-plate (transmission deficit) or a combination of these. Neurophysiopathological tests that enable us to diagnose and maybe differentiate between these causes are essentially electroneurographs and electromyographs. These assess, either directly or indirectly, the integrity of the peripheral system, both sensory (centripetal afferent pathways) and motor (lower motor neurones, neuromuscular junction, muscle membrane and contractile substrate). Electrical activity in the muscle is measured using a special device (an electromyograph) comprising preamplifiers, a computer with special programmes and algorithms for analysing, digitalizing, amplifying and filtering the recorded signal and a monitor on which to visualize the on-line trace. The machine also has speakers. These serve to recognize and identify the physiological events being recorded as they make such unusual, individual sounds. An electric stimulator with constant current can be used to stimulate branches of superficial nerves (motor, sensory or mixed) so that electric conduction speed can be studied and the sensory or motor response analysed. The results can be saved on a hard disc or on any magnetic or digital support, viewed off-line or even printed.","PeriodicalId":11873,"journal":{"name":"European journal of anaesthesiology. Supplement","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2008-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1017/S0265021507003201","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27277993","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 3

Does the brain become heavier or lighter after trauma? 脑外伤后是变重还是变轻?

European journal of anaesthesiology. Supplement Pub Date : 2008-01-01 DOI: 10.1017/S0265021507003304

T Lescot, V Degos, L Puybasset

{"title":"Does the brain become heavier or lighter after trauma?","authors":"T Lescot, V Degos, L Puybasset","doi":"10.1017/S0265021507003304","DOIUrl":"https://doi.org/10.1017/S0265021507003304","url":null,"abstract":"An uncontrolled rise in intracranial pressure is probably the most common cause of death in traumatic brain-injured patients. The intracranial pressure rise is often due to cerebral oedema. Diffusion-weighted imaging has been extensively used to study cerebral oedema formation after trauma in experimental studies. Nevertheless, this technology is difficult to perform at the acute phase, especially in unstable head trauma patients. For these reasons, a safe examination allowing us to better understand the pathophysiology of cerebral oedema formation in such patients would be of great interest. Radiological attenuation is linearly correlated with estimated specific gravity in human tissue. This property gives the opportunity to measure in vivo the volume, weight and specific gravity of any tissue by computed tomography. We recently developed a software package (BrainView) for Windows workstations, providing semi-automatic tools for brain analysis from DICOM images obtained from cerebral computed tomography. In this review, we will discuss the results of the in vivo analysis of brain weight, volume and specific gravity and consider the use of this software as a new technology to improve our knowledge of cerebral oedema formation after trauma and to evaluate the severity of traumatic brain-injured patients.","PeriodicalId":11873,"journal":{"name":"European journal of anaesthesiology. Supplement","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2008-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1017/S0265021507003304","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27277507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 5