KẾT QUẢ NỘI SOI PHẾ QUẢN BẰNG ỐNG NỘI SOI SỬ DỤNG MỘT LẦN CHO BỆNH NHÂN HỒI SỨC CẤP CỨU

Tạp chí Y học Việt Nam · 2024

• Chemistry
• Organic chemistry

Mục tiêu: Nhận xét một số kết quả của thủ thuật nội soi phế quản bằng ống nội soi sử dụng một lần và một số khó khăn của thủ thuật. Đối tượng và phương pháp nghiên cứu: Nghiên cứu mô tả trên 34 bệnh nhân hồi sức cấp cứu được áp dụng nội soi phế quản bằng ống nội soi sử dụng một lần. Kết quả: Tuổi trung bình của nhóm bệnh nhân nghiên cứu là 63 ± 19 tuổi, trong đó nhóm tuổi chiếm trên 60 tuổi, chiếm 64,7%. Nam giới chiếm đa số trong nhóm bệnh nhân với tỷ lệ 85,3%. Thời điểm thực hiện nội soi phế quản phổ biến nhất là ngày thứ 4 của điều trị. Thời gian trung bình thực hiện nội soi phế quản là 10,7 ± 3,5 phút, trong đó ngắn nhất là 6 phút và dài nhất là 20 phút. Đa số bệnh nhân được thực hiện nội soi qua đường ống nội khí quản chiếm 79%. Trong 94% các trường hợp, ống nội soi phế quản tiếp cận được tất cả các phân thùy, 62% trường hợp khả năng hút dịch của ống nội soi phế quản sử dụng một lần tương đương với ống nội soi thông thường, 18% trường hợp nội soi bị gián đoạn. 21% trường hợp được đánh giá cao hơn nội soi phế quản thông thường, 50% trường hợp đánh giá tương đương và 29% trường hợp đánh giá thấp hơn ống nội soi phế quản thường dùng. Kết luận: Nội soi phế quản bằng ống nội soi phế quản sử dụng một lần là phương pháp an toàn, hiệu quả tương đương với nội soi phế quản truyền thống, dễ dàng triển khai tại các đơn vị hồi sức cấp cứu với phương tiện và nhân lực hạn chế.

Bilateral Pneumothoraces Secondary to Metastatic Proximal Epithelioid Sarcoma of the Perineum

2022

• Medicine
• Pathology
• Anatomy

An Introduction to Noninvasive Ventilation

2022-01-01

Use of High-Dose Hydroxocobalamin for Septic Shock: A Case Report

A&A Practice · 2018-11-14 · 15 citations

In this case report, we describe 2 patients with septic shock requiring high-dose vasopressors for hemodynamic support despite aggressive fluid resuscitation. After the administration of high-dose hydroxocobalamin for presumed septic vasoplegic syndrome, both patients had an immediate response to hydroxocobalamin with a rapid and lasting improvement of blood pressure that significantly reduced the need for vasopressor support.

Perioperative goal-directed therapy and postoperative outcomes in patients undergoing high-risk abdominal surgery: a historical-prospective, comparative effectiveness study

Critical Care · 2015-06-16 · 104 citations

INTRODUCTION: Perioperative goal-directed therapy (PGDT) may improve postoperative outcome in high-risk surgery patients but its adoption has been slow. In 2012, we initiated a performance improvement (PI) project focusing on the implementation of PGDT during high-risk abdominal surgeries. The objective of the present study was to evaluate the effectiveness of this intervention. METHODS: This is a historical prospective quality improvement study. The goal of this initiative was to standardize the way fluid management and hemodynamic optimization are conducted during high-risk abdominal surgery in the Departments of Anesthesiology and Surgery at the University of California Irvine. For fluid management, the protocol consisted in standardized baseline crystalloid administration of 3 ml/kg/hour and any additional boluses based on PGDT. The impact of the intervention was assessed on the length of stay in the hospital (LOS) and post-operative complications (NSQIP database). RESULTS: In the 1 year pre- and post-implementation periods, 128 and 202 patients were included. The average volume of fluid administered during the case was 9.9 (7.1-13.0) ml/kg/hour in the pre-implementation period and 6.6 (4.7-9.5) ml/kg/hour in the post-implementation period (p < 0.01). LOS decreased from 10 (6-16) days to 7 (5-11) days (p = 0.0001). Based on the multiple linear regression analysis, the estimated coefficient for intervention was 0.203 (SE = 0.054, p = 0.0002) indicating that, with the other conditions being held the same, introducing intervention reduced LOS by 18% (95% confidence interval 9-27%). The incidence of NSQIP complications decreased from 39% to 25% (p = 0.04). CONCLUSION: These results suggest that the implementation of a PI program focusing on the implementation of PGDT can transform fluid administration patterns and improve postoperative outcome in patients undergoing high-risk abdominal surgeries. TRIAL REGISTRATION: Clinicaltrials.gov NCT02057653. Registered 17 December 2013.

Goal directed therapy and hemodynamic optimization in the critical care setting: practical applications and benefits

Cambridge University Press eBooks · 2014-09-04

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Effects of phenylephrine on cardiac output and venous return depend on the position of the heart on the Frank-Starling relationship

Journal of Applied Physiology · 2012-05-04 · 117 citations

INTRODUCTION: phenylephrine is used daily during anesthesia for treating hypotension. However, the effects of phenylephrine on cardiac output (CO) are not clear. We hypothesized that the impact of phenylephrine on cardiac output is related to preload dependency. METHODS: eight pigs were studied at a preload independent stage (after CO augmentation) and at a preload dependent stage (after a 21 ml/kg hemorrhage). At each stage, phenylephrine boluses (0.5, 1.0, 2.0, and 4.0 μg/kg) were given randomly while mean arterial pressure (MAP), CO, inferior vena cava flow (IVCf) (both measured using ultrasonic flow probes), and pulse pressure variation were measured. RESULTS: at the preload independent stage, phenylephrine boluses induced significant increases in MAP (from 72 ± 6 to 100 ± 6 mmHg; P < 0.05) and decreases in CO and IVCf (from 7.0 ± 0.8 to 6.0 ± 1.1 l/min and from 4.6 ± 0.5 to 3.8 ± 0.6 l/min, respectively). At the preload-dependent stage, phenylephrine boluses induced significant increases in MAP (from 40 ± 7 to 65 ± 9 mmHg), CO (from 4.1 ± 0.6 to 4.9 ± 0.7 l/min), and IVCf (from 3.0 ± 0.4 to 3.5 ± 0.6 l/min; all data presented are for 4 μg/kg). Incremental doses of phenylephrine induced incremental changes in cardiac output. A pulse pressure variation >16.4% before phenylephrine predicted an increase in stroke volume with a 93% sensitivity and a 100% specificity. CONCLUSION: impact of phenylephrine on cardiac output is related to preload dependency. When the heart is preload independent, phenylephrine boluses induce on average a decrease in cardiac output. When the heart is preload dependent, phenylephrine boluses induce on average an increase in cardiac output.

Impact of non invasive and beat-to-beat arterial pressure monitoring on intraoperative hemodynamic management

Journal of Clinical Monitoring and Computing · 2012-02-29 · 45 citations