ABSTRACT
Aneurysmal subarachnoid hemorrhage (SAH) is a neurologic emergency and often a neurologic catastrophe. Nontraumatic subarachnoid hemorrhage is characterized by the extravasation of blood into the spaces covering the central nervous system. The leading cause of SAH is rupture of an intracranial aneurysm, which accounts for about 80-85% of cases. Mortality and morbidity can be reduced if SAH is treated urgently. Sudden, explosive headache is a cardinal but nonspecific feature in the diagnosis of SAH; computered tomography (CT) scanning is mandatory in all the patients with symp toms that are suggestive of SAH. Catheter angiography for detecting aneurysms is gradually being replaced by CT angiography. Diagnosing SAH can be challenging and treatment is complex, sophisticated and multidisciplinary. Reble eding is the most imminent danger, which must be prevented by endovascular occlusion with detachable coils (coiling) or by surgical clipping of the aneurysm; the risk of delayed cerebral ischemia is reduced with nimodipine and avoiding hypovolemia; hydrocephalus can be treated by ventricular drainage. Intensive care plays a more important role in the management of SAH than in any other neurological disorder. Excellence in neurologic diagnosis, in operative neurosurgery or neuroradiologic procedures must be accompanied by excellence in Intensive Care. This review emphasizes treatment in the Intensive Care Unit, surgical and endovascular therapeutic options and the current state of treatment of major complications such as rebleeding, cerebral vasospasm and acute hydrocephalus.
Subject(s)
Critical Care/methods , Subarachnoid Hemorrhage/therapy , Algorithms , Aneurysm, Ruptured/complications , Brain Ischemia/diagnosis , Brain Ischemia/etiology , Brain Ischemia/prevention & control , Cerebral Angiography , Combined Modality Therapy , Diagnostic Imaging/methods , Diagnostic Imaging/statistics & numerical data , Disease Management , Emergencies , Headache/etiology , Humans , Hydrocephalus/epidemiology , Hydrocephalus/etiology , Intracranial Aneurysm/complications , Multicenter Studies as Topic , Recurrence , Rupture, Spontaneous , Subarachnoid Hemorrhage/diagnosis , Subarachnoid Hemorrhage/etiology , Vasospasm, Intracranial/etiology , Vasospasm, Intracranial/prevention & controlABSTRACT
No disponible
Subject(s)
Humans , Intubation, Intratracheal/adverse effects , Intubation, Intratracheal/methodsABSTRACT
Extubation, like intubation, is a critical moment in general anesthesia. There are no algorithms or ordered sequences of steps for extubation. Rather, the approach to take is strict observation of the patient in a setting equipped with monitors, material for managing the difficult airway, and experienced staff who should be able to establish access immediately, provide oxygen, and facilitate gas exchange, keeping the airway open and safeguarding it in case of a failed extubation attempt. This review will analyze the clinical conditions and pathophysiology associated with extubations at high risk of complications. We will describe strategies for extubating in situations in which a difficult airway is known or suspected.
Subject(s)
Intubation, Intratracheal/methods , Algorithms , Equipment Design , Humans , Intubation, Intratracheal/adverse effects , Intubation, Intratracheal/instrumentationABSTRACT
No disponible
No disponible
Subject(s)
Humans , Intubation, Intratracheal/methods , Case Management , Equipment Design , Intubation, Intratracheal/instrumentation , Mouth , Nasal CavityABSTRACT
La extubación es, junto con la intubación, uno de los momentos críticos del desarrollo de la anestesia general. No existen algoritmos o secuencias ordenadas de procedimientos diseñados para la extubación, sin embargo, la estrategia de actuación ha de enfocarse hacia la observación estrecha del paciente en un entorno donde se disponga de monitorización, equipamiento o material adecuado para manejo de la vía aérea difícil, de personal experimentado para lograr el acceso inmediato a la vía respiratoria y capaz de facilitar el aporte e intercambio de oxígeno, manteniendo permeable y protegida la vía aérea, aún cuando la extubación haya sido fallida. En este artículo revisaremos las condiciones clínicas y hallazgos fisiopatológicos que se asocian a una extubación de alto riesgo de complicaciones y describiremos diferentes estrategias de extubación en pacientes con vía aérea difícil conocida o sospechada
Extubation, like intubation, is a critical moment in general anesthesia. There are no algorithms or ordered sequences of steps for extubation. Rather, the approach to take is strict observation of the patient in a setting equipped with monitors, material for managing the difficult airway, and experienced staff who should be able to establish access immediately, provide oxygen, and facilitate gas exchange, keeping the airway open and safeguarding it in case of a failed extubation attempt. This review will analyze the clinical conditions and pathophysiology associated with extubations at high risk of complications. We will describe strategies for extubating in situations in which a difficult airway is known or suspected
Subject(s)
Humans , Intubation, Intratracheal/adverse effects , Airway Obstruction/etiology , Intubation, Intratracheal/instrumentation , Intubation, Intratracheal/methods , Risk Factors , Anesthesia, General/adverse effects , Pulmonary Edema/etiology , Arrhythmias, Cardiac/etiology , Hypoventilation/etiology , Cough/etiology , Bronchial Spasm/etiology , Pneumonia, Aspiration/etiology , Larynx/physiopathology , Catheterization/instrumentation , Catheterization/methodsABSTRACT
Un paciente de 56 intervenido de glosectomía y vaciamiento radical de cuello, en el postoperatorio presentó una hemorragia intensa en cavidad oral, desviación traqueal con hematoma asfixiante y cianosis. Tras fracasar dos intentos de intubación por vía oral con el paciente despierto se utilizó la ventilación con jet transtraqueal como paso intermedio hasta establecer una vía aérea definitiva. La ventilación con jet transtraqueal es una técnica muy útil para manejo de la vía aérea y mantenimiento del intercambio gaseoso en situaciones de compromiso vital en las que no se puede intubar y no se puede ventilar al paciente, sin embargo, es poco utilizada para este fin. Es una técnica fácil y muy rápida de realizar, no muy utilizada en nuestro entorno, que proporciona una ventilación y oxigenación eficaz y tiempo para resolver de forma definitiva la emergencia (AU)
No disponible
Subject(s)
Middle Aged , Male , Humans , Intubation, Intratracheal , Respiration, Artificial , High-Frequency Jet Ventilation , Equipment DesignSubject(s)
Amides/adverse effects , Analgesics, Non-Narcotic/adverse effects , Drug Overdose , Medication Errors , Aged , Amides/administration & dosage , Analgesia, Epidural , Analgesics, Non-Narcotic/administration & dosage , Humans , Infusion Pumps , Male , Pain, Postoperative/drug therapy , Postoperative Complications , RopivacaineABSTRACT
No disponible
Subject(s)
Aged , Male , Humans , Drug Overdose , Medication Errors , Analgesia, Epidural , Analgesics, Non-Narcotic , Pain, Postoperative , Postoperative Complications , Amides , Infusion PumpsABSTRACT
A 56-year-old man recovering from a glossectomy and radical neck dissection presented severe oral bleeding, tracheal deviation with an asphyxiating hematoma and cyanosis. When 2 attempts at orotracheal intubation with the patient awake failed, transtracheal jet ventilation was used temporarily until a definitive airway could be established. Transtracheal jet ventilation is highly useful for managing an airway and maintaining gas exchange in life-threatening situations in which intubation and ventilation has become impossible, yet it is rarely used for that purpose. An easy, fast procedure that has not been widely used in Spain, this technique provides effective ventilation and oxygen while a definitive resolution of the emergency is sought.
Subject(s)
High-Frequency Jet Ventilation/methods , Intubation, Intratracheal , Equipment Design , High-Frequency Jet Ventilation/instrumentation , Humans , Male , Middle Aged , Respiration, Artificial/methodsABSTRACT
OBJECTIVE: To determine the utility of thoracic computed tomography (TCT) in the initial assessment of critically ill patients with chest injuries. DESIGN: Prospective observational study of cohorts. SETTING: Trauma intensive care unit (ICU) of a Spanish Level III hospital (US equivalent Level I). PATIENTS: Three hundred seventy-five patients with chest injuries were studied, grouped into two cohorts according to whether they underwent admission TCT (exposed cohort, group I, n = 104) or not (unexposed cohort, group II, n = 271). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Demographic data, initial severity scores, and chest radiograph (CXR)-based diagnosis were collected in all patients as independent variables. In patients of group I, we also recorded the TCT-based diagnosis and any incidents, complications, or therapy changes resulting from the TCT. The need for and duration of mechanical ventilation, length of ICU stay, and ICU mortality were gathered in the whole sample as dependent variables. The admission data were similar in the two groups, except for a higher Injury Severity Score (ISS) and thoracic ISS in group I. TCT proved to be more sensitive than CXR in detecting pulmonary contusion, hemothorax, pneumothorax, and vertebral fractures and in identifying the faulty placement of chest drainage tubes. TCT findings induced therapy changes in approximately 30% of patients in group I. In the other dependent variables studied, there were no differences between the two groups. In the multivariate analysis, the TCT screening had no effects on the time on mechanical ventilation, length of ICU stay, or mortality. CONCLUSIONS: TCT detects more chest injuries in trauma patients than does CXR and induces therapy changes in a considerable number of patients. However, this does not translate into an improvement in clinical outcomes.
