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World Journal of Critical care medicine 2015年第1期4卷 47-54页

作者： Marcin K Karcz Peter J Papadakos department of anes-thesiology University of Rochester Division of Critical care medicine Departments of Surgery and NeurosurgeryUniversity of Rochester

Trauma patients are a diverse population with heterogeneous needs for ventilatory support. This requirement depends mainly on the severity of their ventilatory dysfunction, degree of deterioration in gaseous exchange, any associated injuries, and the individual feasibility of potentially using a noninvasive ventilation approach. Noninvasive ventilation may reduce the need to intubate patients with traumarelated hypoxemia. It is well-known that these patientsare at increased risk to develop hypoxemic respiratory failure which may or may not be associated with hypercapnia. Hypoxemia in these patients is due to ventilation perfusion mismatching and right to left shunt because of lung contusion, atelectasis, an inability to clear secretions as well as pneumothorax and/or hemothorax, all of which are common in trauma patients. Noninvasive ventilation has been tried in these patients in order to avoid the complications related to endotracheal intubation, mainly ventilator-associated pneumonia. The potential usefulness of noninvasive ventilation in the ventilatory management of trauma patients, though reported in various studies, has not been sufficiently investigated on a large scale. According to the British Thoracic Society guidelines, the indications and efficacy of noninvasive ventilation treatment in respiratory distress induced by trauma have thus far been inconsistent and merely received a low grade recommendation. In this review paper, we analyse and compare the results of various studies in which noninvasive ventilation was applied and discuss the role and efficacy of this ventilator modality in trauma.

关键词： Acute respiratory distress syndrome Noninvasive ventilation Pulmonary contusion Respiratory failure Trauma

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Implementation of enteral feeding protocol in an intensive care unit: Before-and-after study

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World Journal of Critical care medicine 2017年第1期6卷 56-64页

作者： Martin Padar Gerli Uusvel Liis Starkopf Joel Starkopf Annika Reintam Blaser department of Anaesthesiology and intensive care Tartu University Hospital department of Public Health Section of Bio-statistics Faculty of Health and Medical Sciences University of Copenhagen department of Anaes- thesiology and intensive care University of Tartu department of Anaesthesiology Intensive Care Emergency and Pain Medicine Lucerne Cantonal Hospital

AIM To determine the effects of implementing an enteral feeding protocol on the nutritional delivery and outcomes of intensive care *** An uncontrolled, observational before-and-after study was performed in a tertiary mixed medical-surgical intensive care unit(ICU). In 2013, a nurse-driven enteral feeding protocol was developed and implemented in the ICU. Nutrition and outcome-related data from patients who were treated in the study unit from 2011-2012(the Before group) and 2014-2015(the After group) were obtained from a local electronic database, the national Population Registry and the hospital's Infection ControlService. Data from adult patients, readmissions excluded, who were treated for at least 7 d in the study unit were analysed. RESULTS In total, 231 patients were enrolled in the Before and 249 in the After group. The groups were comparable regarding demographics, patient profile, and severity of illness. Fewer patients were mechanically ventilated on admission in the After group(86.7% vs 93.1% in the Before group, P = 0.021). The prevalence of hospitalacquired infections, length of ICU stay and ICU, 30-and 60-d mortality did not differ between the groups. Patients in the After group had a lower 90-d(P = 0.026) and 120-d(P = 0.033) mortality. In the After group, enteral nutrition was prescribed less frequently(P = 0.039) on day 1 but significantly more frequently on all days from day 3. Implementation of the feeding protocol resulted in a higher cumulative amount of enterally(P = 0.049) and a lower cumulative amount of parenterally(P < 0.001) provided calories by day 7, with an overall reduction in caloric provision(P < 0.001). The prevalence of gastrointestinal symptoms was comparable in both groups, as was the frequency of prokinetic use. Underfeeding(total calories < 80% of caloric needs, independent of route) was observed in 59.4% of the study days Before vs 76.9% After(P < 0.001). Inclusion in the Before group, previous abdominal surgery,

关键词： Gastrointestinal symptoms Underfeeding Nutrition protocol Feeding protocol Enteral feeding Enteral nutrition Parenteral nutrition Critical care

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Non-Invasive Pressure Support Ventilation in Major Lung Resection for High Risk Patients: Does It Matter?

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Open Journal of Thoracic Surgery 2012年第3期2卷 63-71页

作者： Bernhard CDanner Wolfgang Koerber Alexander Emmert Ulrike Olgemoeller Hilmar Doerge Michael Quintel Carl-PCriee Friedrich ASchoendube department of Thoracic and Cardiovascular Surgery University Medical Centre GottingenGottingenGermany department of Pneumology Respiratory Care and Sleep MedicineEvangelical Hospital WeendeGottingenGermany department of Anaes-thesiology Emergency and Intensive CareUniversity Medical Centre GöttingenGottingenGermany.

Background and purpose: Patients with severely impaired pulmonary function have an increased operative risk for major lung resection. The clinical benefits of pre- and perioperative, non-invasive pressure support ventilation (NIPSV) have up to now not been extensively evaluated. Patients with severely reduced pulmonary function were investigated in this prospective and randomised single centre clinical trial. Methods: Standard pulmonary evaluation was performed in all patients before major lung resection. To predict postoperative pulmonary function, a lung perfusion-ventilation scan was carried out. All patients enrolled in the study were instructed preoperatively on how to use a NIPSV respirator. Af-ter lung resection patients were randomised either for continuation of NIPSV or for standard treatment. Results: Of the 52 patients assessed, 21 patients met the inclusion criteria for the study protocol. Predicted mean postoperative FEV1 was 1.10 L (range 0.92 - 1.27 L). Lobectomy was performed in 14 patients, pneumonectomy in 6 patients and a segmentectomy in 1 patient. No inhospital deaths occurred. Pulmonary complications (reintubation, pneumonia) were more frequent in the NIPSV group than in the control group (3 patients versus 1 patient), without statistical significance (p = 0.31). Conclusions: We observed no mortality and a low morbidity in this high risk group. Postoperative continuation of NIPSV had no beneficial effect on the clinical outcome. Preoperative conditioning with NIPSV, however, seems to be a suitable tool for patients with severely impaired pulmonary function. This study may serve therefore as basis for further investigations for the potential clinical benefits of prophylactic NIPSV in major lung surgery.

关键词： Chronic Obstructive Lung Disease Clinical Trial Non-Invasive Positive-Pressure Ventilation Thoracic Surgery

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Echography in brain imaging in intensive care unit: State of the art

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World Journal of Radiology 2014年第9期6卷 636-642页

作者： Anselmo Caricato Sara Pitoni Luca Montini Maria Grazia Bocci Pina Annetta Massimo Antonelli department of anes-thesiology and intensive care medicine Catholic University of the Sacred Heart "A. Gemelli" Teaching Hospital Intensive Care Unit

Transcranial sonography(TCS)is an ultrasound-based imaging technique,which allows the identification of several structures within the brain *** the past it has been applied for bedside assessment of different intracranial pathologies in ***-ently,TCS is also used on adult patients to diagnose intracranial space occupying lesions of various origins,intracranial hemorrhage,hydrocephalus,midline shift and neurodegenerative movement disorders,in both acute and chronic clinical *** comparison with conventional neuroimaging methods(such as com-puted tomography or magnetic resonance),TCS has the advantages of low costs,short investigation times,repeatability,and bedside *** noninva-sive characteristics,together with the possibility of of-fering a continuous patient neuro-monitoring system,determine its applicability in the monitoring of multiple emergency and non-emergency ***,TCS is a still underestimated imaging modality that requires a wider diffusion and a qualified training *** this review we focused on the main indications of TCSfor the assessment of acute neurologic disorders in in-tensive care unit.

关键词： Brain sonography Transcranial sonography Ultrasounds Cerebral sonography Brain imaging Hy-drocephalus Cerebral hemorrhage

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Fast track anesthesia for liver transplantation: Review of the current practice

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World Journal of Hepatology 2015年第20期7卷 2303-2308页

作者： Stephen Aniskevich Sher-Lu Pai department of anes- thesiology Division of Hepatobiliary and Abdominal Organ Transplant Mayo Clinic Florida

Historically,patients undergoing liver transplantation were left intubated and extubated in the intensive care unit(ICU)after a period of *** of this practice argued that these patients were critically ill andneed time to be properly optimized from a physiological and pain standpoint prior to ***,there has been a growing movement toward early extubation in transplant centers *** fueled by research into early extubation following cardiac surgery,extubation in the operating room or soon after arrival to the ICU,has been shown to be safe with proper patient ***,as experience at determining appropriate candidates has improved,some institutions have developed systems to allow select patients to bypass the ICU entirely and be admitted to the surgical ward after *** discuss the history of early extubation and the arguments in favor and against fast track *** also described our practice of fast track anesthesia at Mayo Clinic Florida,in which,we extubate approximately 60%of our patients in the operating room and send them to the surgical ward after a period of time in the post anesthesia recovery unit.

关键词： Liver transplant Fast track anesthesia Early extub

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B-Aware试验中BIS监测对远期生存率的影响

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麻醉与镇痛 2012年第2期8卷 88-96页

作者： Kate Leslie, MBBS Paul S. Myles Andrew Forbes Matthew T. V. Chan 何欣（译）翁莹琪（校）郭曲练（校） department of Anaesthesia and Pain Management Royal Melbourne Hospital department ofPharmacology University of Melbourne department of Anaesthesia and Perioperative Medi- cine Alfred Hospital Academic Board of Anaesthesia and Perioperative medicine Monash U-niversity Melbourne National Health and Medical Research CouncilCanberra department ofEpidemiology and Preventive medicine Monash University Melbourne Australia departmentof Anaesthesia and intensive care The Chinese University of Hong I（ong Hong I（ong People＇sRepublic of China

背景当使用脑电双频指数（bispectral index，Bis）监测指导麻醉药用量时，通常仅需要较低剂量的镇静药，如果用较低剂量的麻醉药，术中低血压和器官毒性作用也许能避免。然而，这是否能减少严重并发症和术后死亡率还存争议。***试验将2... 详细信息

背景当使用脑电双频指数（bispectral index，Bis）监测指导麻醉药用量时，通常仅需要较低剂量的镇静药，如果用较低剂量的麻醉药，术中低血压和器官毒性作用也许能避免。然而，这是否能减少严重并发症和术后死亡率还存争议。***试验将2463例术中知晓高危的患者随机分为BIS指导麻醉组和常规麻醉组。我们假设使用BIS指导麻醉组患者死亡、心肌梗死（myocardial infarction，MI）和卒中的风险都低于常规麻醉组患者。方法对术后30天尚存活的所有患者的医疗记录进行回顾，记录他们的死亡日期、死亡原因以及心肌梗死或卒中的发生情况．然后对所有存活的点者主牛行由话随访．本研究的主要终点是存活。结果随访时间中位值4．1年（全距：0－6．5年），参加试验的患者中有548例（22．2％）术后死亡，220例（8．9％）发生了心肌梗死，115例（4．7％）发生卒中。BIS监测组与常规麻醉组的死亡风险没有显著差异{危害比=0．86[95％可信区间（CI）：0．72-1．01]；P=0．07]。但是，倾向性评分分析显示，BIS值〈40、持续时间〉5分钟的患者与其他BIS监测组的患者相比，死亡的危害比为1．41（95％CI：1．02-1．95；P=0．039），并且心肌梗死的优势比（OR）为1．94（95％CI：1．12-3．35；P=0．01），卒中的优势比为3．24（95％CI：1.29-8．07；P=0．01）。结论在B-Aware试验患者中，采用了BIS指导麻醉且从未出现BIS值低于40并持续超过5分钟，与存活率的增加及并发症的减少相关。

关键词： BIS监测 e试验远期生存率麻醉药用量术后死亡率严重并发症心肌梗死脑电双频指数

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Epidural anesthesia improves pancreatic perfusion and decreases the severity of acute pancreatitis

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World Journal of Gastroenterology 2015年第43期21卷 12448-12456页

作者： Samira M Sadowski Axel Andres Philippe Morel Eduardo Schiffer Jean-Louis Frossard Alexandra Platon Pierre-Alexandre Poletti Leo Bühler department of Visceral and Transplantation Surgery University Hospitals of Geneva department of anesthesiology University Hospital Geneva department of Gastroenterology University Hospital Geneva department of Radiology University Hospital Geneva

AIM: To study the safety of epidural anesthesia(EA),its effect on pancreatic perfusion and the outcome of patients with acute pancreatitis(AP).METHODS: From 2005 to August 2010,patients with predicted severe AP [Ranson score ≥ 2,C-reactive protein > 100 or necrosis on computed tomography(CT)] were prospectively randomized to either a group receiving EA or a control group treated by patientcontrolled intravenous analgesia. Pain management was evaluated in the two groups every eight hours using the visual analog pain scale(VAS). Parameters for clinical severity such as length of hospital stay,use of antibiotics,admission to the intensive care unit,radiological/clinical complications and the need for surgical necrosectomy including biochemical data were recorded. A CT scan using a perfusion protocol was performed on admission and at 72 h to evaluate pancreatic blood flow. A significant variation in blood flow was defined as a 20% difference in pancreatic perfusion between admission and 72 h and was measured in the head,body and tail of the ***: We enrolled 35 patients. Thirteen were randomized to the EA group and 22 to the control group. There were no differences in demographic characteristics between the two groups. The Balthazar radiological severity score on admission was higher in the EA group than in the control group(mean score 4.15 ± 2.54 vs 3.38 ± 1.75,respectively,P = 0.347) and the median Ranson scores were 3.4 and 2.7 respectively(P = NS). The median duration of EA was 5.7 d,and no complications of the epidural procedure were reported. An improvement in perfusion of the pancreas was observed in 13/30(43%) of measurements in the EA group vs 2/27(7%) in the control group(P = 0.0025). Necrosectomy was performed in 1/13 patients in the EA group vs 4/22 patients in the control group(P = 0.63). The VAS improved during the first ten days in the EA group compared to the control group(0.2 vs 2.33,P = 0.034 at 10 d). Length of stay and mortality were not

关键词： Severe acute pancreatitis Epidural anes thesia Pan

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