Download Anaesthesia, Pain, Intensive Care and Emergency A.P.I.C.E.: by A. Gullo PDF

By A. Gullo

ISBN-10: 8847007720

ISBN-13: 9788847007727

Bettering criteria of care is a true problem in extensive Care drugs. enhancing scientific functionality, sufferer protection, possibility administration and audit represents the cornerstone for elevating the standard of care in ICU sufferers. verbal exchange is the platform from the place to begin to arrive a consensus in a very crowded sector, a distinct multidisciplinary and multiprofessional setting within which caliber of care and, finally, sufferer survival must be ameliorated.

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Additional info for Anaesthesia, Pain, Intensive Care and Emergency A.P.I.C.E.: Proceedings of the 22st Postgraduate Course in Critical Medicine Venice-Mestre, Italy - November 9-11, 2007

Example text

The respiratory variations in POP waveform amplitude were calculated using a formula similar to that proposed to assess DPP: DPOP (%) = 100 x {(POPmax – POPmin)/([POPmax + POPmin]/2)}. Finally, DPOP was evaluated on three consecutive respiratory cycles simultaneously with DPP measurements. We found a fair agreement and a good relationship between DPOP and DPP. Moreover, we found that the threshold DPOP value of 15% allowed discrimination between patients with a DPP >13% and patients with a DPP £ 13% with a sensitivity of 87%, a specificity of 100%, a positive predictive value of 100% and a negative predictive value of 94%.

NAD+ is regenerated from NADH when part of the pyruvate is metabolized to lactate. Ischaemia, that is an insufficient capillary blood flow, will limit the supply of oxygen and glucose forcing pyruvate to be metabolized to lactate in order to keep up the anaerobic energy production. The increase in lactate is soon followed by a decrease in pyruvate due to the decrease in glucose supplied by the capillary blood. The result will be an increase in the lactate/pyruvate ratio. Continuous Monitoring of Organ Chemistry – a Paradigm Shift in Management of Intensive Care 31 In the case of energy metabolism (Fig 1) it is of obvious value to sample glucose metabolism using markers such as glucose, lactate and pyruvate where the lactate/pyruvate ratio is a well known marker of the redox state of the tissue and an indicator of tissue ischaemia [6].

The data show the great difference in sensitivity to secondary damage between penumbra and normal tissue. Continuous Monitoring of Organ Chemistry – a Paradigm Shift in Management of Intensive Care 35 tip visible on CT was it possible to make proper use of the data from tissue chemistry monitoring in the brain. The catheter far from the lesion might signal normal brain metabolism while the catheter properly placed in the penumbra reveals the pathology relevant for guiding the treatment of the patient.

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