The first issue of the Greek e-journal of Perioperative Medicine
for 2021 includes various articles concerning perioperative medicine.
The first article of this issue is a review of Bersot et al, which attempts to gather the evolving evidence on different ventilation strategies concerning severe "atypical" ARDS of COVID-19 patients. The authors conclude that the main features of respiratory mechanics, the response to treatment (such as oxygenation response to lung recruitment maneuvers or prone position) and prognosis are similar in COVID-19 and non- COVID-19 ARDS patients. The oxygenation response to LRM and a high PEEP appear to be very heterogeneous in COVID-19 ARDS; this would argue in favor of a personalized ventilation strategy... Continue reading
Respiratory failure due to Coronavirus 2019 (COVID-19) disease has triggered a debate about when and how to apply mechanical ventilation in these patients, as it has been proposed that severe "atypical" ARDS of COVID-19 cause an ARDS pandemic. As global database grows, it is evident that about 6% of patients will need admission to the ICU. About 75% of these will require invasive ventilation, and approximately 10% will need ventilation beyond 14 days. Different ventilation strategies are followed yet there is no strong evidence in favor of anyone. The present article attempts to gather the daily evolving evidence on the subject. Continue reading
Several prevention and treatment strategies have been applied in order to prevent hypoxemia after open heart surgery with comparable good results.
The aim of this study is to compare the effectiveness of two different alveolar recruitment maneuvers [RM] for the management of oxygenation impairment in cardiac surgical patients.
A total number of sixty patients were included in this study. All patients underwent cardiac surgical procedures with extracorporeal circulation and developed oxygenation impairment after withdrawal of extracirculation support and sternal closure.
Patients were randomly assigned into two Groups A and B according to the applied RM. In Group A three hyperinflations of the lungs were applied at an airway pressure of 40cmH2
O for 10 sec, whereas in Group B Pressure Control Ventilation was applied for 2min with the inspiratory pressure set at 40cmH2
O. After application of any of the two RM, PEEP was increased from 5 to 10 cmH2
O in all patients. Anesthesia induction and maintenance and mechanical ventilation settings were similar in both study Groups. Continue reading
Patient care in Intensive Care Units is characterized be high demanding tasks, which lead in daily high workload. In the present study, a questionnaire-based evaluation of ICU nurse’s workload was conducted at the adult general 7 - beds ICU of a small urban hospital. NASA Task Load Index (TLX) along with other two tools, used for the first time in healthcare environment: Instantaneous Self-Assessment (ISA) and Crew Status Survey (CSS) were used for that purpose. Information about every nurse’s professional background and basic demographics were also collected. Responses from 70% of total nurse staff were collected. Continue reading
The number of pregnant women with morbid obesity (BMI 40–49.9 kg/m2
) has significantly increased worldwide. Management of these patients presents a challenge for obstetric anesthesiologist. We report our management of cesarean delivery in a parturient with a BMI 47.3 kg/m2
. We present this case to emphasize usefulness of Tuohy needle as an introducer for performing spinal anesthesia with a long 27G pencil point needle. Literature review is discussed. Continue reading
Hemophagocytic Lymphohistiocytosis (HLH) is a life-threatening syndrome of excessive immune activation that mostly occurs as primary (hereditary) disease in children. Acquired HLH is associated with infections, cancer of rheumatological conditions. Both are rare in adults. Turicella otitidis is a bacterium, that is associated with ear infections and there is only one case report of bacteraemia. The present report describes a case of acquired HLH with invasive pulmonary Aspergillosis and Turicella otitidis bacteraemia in an adult patient; and also reviews the relative literature. In conclusion though rare, acquired HLH is a devastating condition that clinicians should have in mind when managing patients with multiple infection or underlying immunosuppression. Continue reading
Acute uvular edema is a rare complication that can be presented in the postoperative period, usually after general anesthesia. If severe enough, it can even result in a compromised airway. In this case report, we present a case of postoperative acute uvular edema occurred in an orthopedic patient, after spinal anesthesia and infraclavicular brachial plexus nerve block combined with intravenous sedation. Continue reading