It's time to measure intra-abdominal pressure to optimize hemodynamics!
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Biomedical subjects
Publications and source records attributed to Enrico Calzia.
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This article summarizes the effects of catecholamines and vasopressin on the cardiovascular system, focusing on their metabolic and immunologic properties. Particular attention is dedicated to the septic shock condition.
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PURPOSE OF REVIEW: To provide some practical and clinical considerations that may guide users through the decision process when choosing mechanical ventilators RECENT FINDINGS: Although the complexity of mechanical ventilators is steadily increasing, the importance of many devices developed over the course of the technical evolution is still a matter of discussion. Recent data demonstrate that the technical performance of equivalent ventilators (ie, machines of the same generation and category) is pretty similar, suggesting that the different manufacturers keep in step with new developments. Thus, other factors than technical limitations will probably influence the choice of ventilators. Among them the ability of the staff to understand the rationale of the different devices and controls as well as deal with the complexity of the ventilator may be particularly important. SUMMARY: Choosing mechanical ventilators should begin by defining the algorithms of how to ventilate a patient. Once this is done, a ventilator should allow the transformation of specific strategies into practice and the adaptation of the mechanical support to the needs of the individual patient. This procedure is crucially important, because ventilator therapy should always be determined by the physician and based on solid physiologic rationales rather than by the technical features of the machine.
A recent study by Bruhn and colleagues, discussed here, confirms that even high levels of positive end-expiratory pressure (PEEP) - up to 20 cmH2O - may be applied in conditions of moderate acute respiratory distress syndrome. Such levels of PEEP were found to be safe in terms of their impact on cardiac output and adequacy of gastric mucosal perfusion once systemic haemodynamics were stabilized by adequate fluid replacement and catecholamine therapy. However, we strongly recommend that the reader does not oversimplify the conclusions of that study. PEEP therapy is not inherently safe with respect to haemodynamics and regional organ perfusion, but it may be used safely, even at high levels of up to 20 cmH2O, if haemodynamic therapy is appropriate.
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