Wpływ jednostronnego PEEP na biomechanikę obu płuc podczas niezależnej wentylacji u chorych znieczulanych do zabiegów torakochirurgicznych

Trela-Stachurska, Katarzyna; Nestorowicz, Andrzej; Kotlińska-Hasiec, Edyta; Sawulski, Sławomir; Dąbrowski, Wojciech

doi:10.5603/ait.2015.0001

Cited by 7 publications

(4 citation statements)

References 28 publications

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“…When prescribing fluids in patients with septic shock, we must take into account their composition and their pharmocodynamic and pharmacokinetic properties. In practice, we should consider the “four D’s” of fluid therapy: drug, dosing, duration and de-escalation (Table 1 ) [ 5 ]. Many clinicians already use these four D’s for the prescription of antibiotics (Table 1 ).…”

Section: The Four D’s Of Fluid Therapymentioning

confidence: 99%

“…Likewise, nutritional therapy in the critically ill should be seen as “medication” helping the healing process. As such, we might consider also the four D’s of nutritional therapy in analogy to how we deal with antibiotics and fluids [ 5 ]: drug (type of feeding), dose (caloric and protein load), duration (when and how long) and de-escalation (stop enteral nutrition and/or parenteral nutrition when oral intake improves) [ 37 ].…”

Section: The Four D’s Of Fluid Therapymentioning

confidence: 99%

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Principles of fluid management and stewardship in septic shock: it is time to consider the four D’s and the four phases of fluid therapy

Malbrain

Regenmortel

Saugel

et al. 2018

Ann. Intensive Care

403

306

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In patients with septic shock, the administration of fluids during initial hemodynamic resuscitation remains a major therapeutic challenge. We are faced with many open questions regarding the type, dose and timing of intravenous fluid administration. There are only four major indications for intravenous fluid administration: aside from resuscitation, intravenous fluids have many other uses including maintenance and replacement of total body water and electrolytes, as carriers for medications and for parenteral nutrition. In this paradigm-shifting review, we discuss different fluid management strategies including early adequate goal-directed fluid management, late conservative fluid management and late goal-directed fluid removal. In addition, we expand on the concept of the “four D’s” of fluid therapy, namely drug, dosing, duration and de-escalation. During the treatment of patients with septic shock, four phases of fluid therapy should be considered in order to provide answers to four basic questions. These four phases are the resuscitation phase, the optimization phase, the stabilization phase and the evacuation phase. The four questions are “When to start intravenous fluids?”, “When to stop intravenous fluids?”, “When to start de-resuscitation or active fluid removal?” and finally “When to stop de-resuscitation?” In analogy to the way we handle antibiotics in critically ill patients, it is time for fluid stewardship.

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Section: The Four D’s Of Fluid Therapymentioning

confidence: 99%

Section: The Four D’s Of Fluid Therapymentioning

confidence: 99%

Principles of fluid management and stewardship in septic shock: it is time to consider the four D’s and the four phases of fluid therapy

Malbrain

Regenmortel

Saugel

et al. 2018

Ann. Intensive Care

403

306

View full text Add to dashboard Cite

show abstract

“…Marik even suggested a primarily conservative approach of fluid bolus administration (in contrast to the SSC recommendations) [ 46 ]. With regard to factors that have to be considered during fluid therapy, Malbrain et al emphasized the importance of 4 key elements: drug, dosing, duration, and deescalation [ 49 ].…”

Section: Hemodynamic Management Of Patients With Septic Shockmentioning

confidence: 99%

Advanced Hemodynamic Management in Patients with Septic Shock

Saugel

Huber

Nierhaus

et al. 2016

BioMed Research International

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In patients with sepsis and septic shock, the hemodynamic management in both early and later phases of these “organ dysfunction syndromes” is a key therapeutic component. It needs, however, to be differentiated between “early goal-directed therapy” (EGDT) as proposed for the first 6 hours of emergency department treatment by Rivers et al. in 2001 and “hemodynamic management” using advanced hemodynamic monitoring in the intensive care unit (ICU). Recent large trials demonstrated that nowadays protocolized EGDT does not seem to be superior to “usual care” in terms of a reduction in mortality in emergency department patients with early identified septic shock who promptly receive antibiotic therapy and fluid resuscitation. “Hemodynamic management” comprises (a) making the diagnosis of septic shock as one differential diagnosis of circulatory shock, (b) assessing the hemodynamic status including the identification of therapeutic conflicts, and (c) guiding therapeutic interventions. We propose two algorithms for hemodynamic management using transpulmonary thermodilution-derived variables aiming to optimize the cardiocirculatory and pulmonary status in adult ICU patients with septic shock. The complexity and heterogeneity of patients with septic shock implies that individualized approaches for hemodynamic management are mandatory. Defining individual hemodynamic target values for patients with septic shock in different phases of the disease must be the focus of future studies.

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“…Currently, we have a new opportunity to institute independent ventilation with tidal volume equalisation by using the unique device designed, developed and patented by Polish engineers. The use of this device is practical, comfortable and safe, as demonstrated during our current study, the maximal pressure did not cross the safe level of 30 cmH 2 O. Additionally, the device enables selective PEEP application [ 27 ]. Moreover, the use of independent ventilation did not cause any adverse hemodynamic effects, as we showed in both the supine and the left and right lateral decubitus positions.…”

Section: Discussionmentioning

confidence: 96%

Successful 1:1 proportion ventilation with a unique device for independent lung ventilation using a double-lumen tube without complications in the supine and lateral decubitus positions. A pilot study

et al. 2017

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IntroductionAdequate blood oxygenation and ventilation/perfusion matching should be main goal of anaesthetic and intensive care management. At present, one of the methods of improving gas exchange restricted by ventilation/perfusion mismatching is independent ventilation with two ventilators. Recently, however, a unique device has been developed, enabling ventilation of independent lungs in 1:1, 2:1, 3:1, and 5:1 proportions. The main goal of the study was to evaluate the device’s utility, precision and impact on pulmonary mechanics. Secondly- to measure the gas distribution in supine and lateral decubitus position.Materials and methods69 patients who underwent elective thoracic surgery were eligible for the study. During general anaesthesia, after double lumen tube intubation, the aforementioned control system was placed between the anaesthetic machine and the patient. In the supine and lateral decubitus (left/right) positions, measurements of conventional and independent (1:1 proportion) ventilation were performed separately for each lung, including the following: tidal volume, peak pressure and dynamic compliance.ResultsOur results show that conventional ventilation using Robertshaw tube in the supine position directs 47% of the tidal volume to the left lung and 53% to the right lung. Furthermore, in the left lateral position, 44% is directed to the dependent lung and 56% to the non-dependent lung. In the right lateral position, 49% is directed to the dependent lung and 51% to the non-dependent lung. The control system positively affected non-dependent and dependent lung ventilation by delivering equal tidal volumes into both lungs with no adverse effects, regardless of patient's position.ConclusionsWe report that gas distribution is uneven during conventional ventilation using Robertshaw tube in the supine and lateral decubitus positions. However, this recently released control system enables precise and safe independent ventilation in the supine and the left and right lateral decubitus positions.

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Wpływ jednostronnego PEEP na biomechanikę obu płuc podczas niezależnej wentylacji u chorych znieczulanych do zabiegów torakochirurgicznych

Cited by 7 publications

References 28 publications

Principles of fluid management and stewardship in septic shock: it is time to consider the four D’s and the four phases of fluid therapy

Principles of fluid management and stewardship in septic shock: it is time to consider the four D’s and the four phases of fluid therapy

Advanced Hemodynamic Management in Patients with Septic Shock

Successful 1:1 proportion ventilation with a unique device for independent lung ventilation using a double-lumen tube without complications in the supine and lateral decubitus positions. A pilot study

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