Effects of predeposit and intentional perioperative haemodilution on blood saving program in major orthopaedic surgery.

In this study we evaluated the effects of predeposit and intentional perioperative haemodilution on a blood saving program in major orthopaedic surgery. We demonstrated that autologous blood phlebotomy and maintenance of optimal levels of perioperative haemodilution by delaying blood transfusion, even autologous, are efficient techniques in reducing homologous, red blood cell (HRBC) transfusion. Patients who received autologous red blood cell (ARBC) or HRBC more than one day after surgery, while having Hb values <8 g/dl, are less at risk of needing the first or additional HRBCs. In conclusion, predeposit and intentional haemodilution obtained by delaying blood transfusions, even autotransfusional, is a correct way of conducting a blood saving program (BSP) in major orthopaedic surgery. These techniques are clinically effective in avoiding or reducing HRBC transfusion.

Physiologic evaluation of non-invasive pressure support ventilation in trauma patients with acute respiratory failure.

OBJECTIVE: To investigate the effectiveness of noninvasive (face mask) versus invasive (endotracheal tube) equal pressure values on blood gases and respiratory pattern and to evaluate the feasibility of using mask ventilation after the short term physiologic study. DESIGN: Open, prospective, physiologic study and uncontrolled clinical study. SETTING: Intensive care unit of a trauma center. PATIENTS: 22 intubated trauma patients were studied. INTERVENTIONS: Patients were intubated and ventilated in a pressure support mode (IPSV) of 13.5 +/- 1.5 cmH2O and a post end-expiratory pressure (PEEP) of 5.8 +/- 2.57 cmH2O. After a T-piece trial to assess patient's ability to breath spontaneously, patients were switched over to noninvasive pressure support (NIPSV). The pressure levels were set as during IPSV. Blood gases and respiratory parameters were measured during IPSV, during the T-piece trial, and after 1 h of NIPSV. After the physiologic study, all patients were asked if they wished to continue on NIPSV. The patient's subjective compliance with IPSV and NIPSV was measured by means of an arbitrary score. A successful outcome was defined as no need for reintubation. MEASUREMENTS AND RESULTS: IPSVand NIPSV showed no statistical differences for blood gas and respiratory parameters by using the same values of PSV (13 +/- 5 vs 12.8 +/- 1.7 cmH2O, NS) and PEEP (5.8 +/- 2.5 and 5.2 +/- 2.2 cmH2O NS). The median length of time on NIPSV was 47 h (range 6 to 144). All patients wished to continue on NIPSV, but 9 patients (40.9%) were reintubated after 54 +/- 54 h. Six of them died after 36 +/- 13 days while still on mechanical ventilation. There was no statistically significant difference in compliance score between IPSVand NIPSV. CONCLUSIONS: NIPSV is comparable to IPSV in terms of blood gases and respiratory pattern. The clinical uncontrolled study indicates that NIPSV could be used in selected trauma patients.

Pressure control ventilation and minitracheotomy in treating severe flail chest trauma.

OBJECTIVE: To evaluate pressure control ventilation (PCV) delivered through a minitracheotomy in treating severe flail chest trauma. DESIGN: Case report. SETTING: Intensive care unit of a trauma center. PATIENT: A 34-year-old woman affected by flail chest trauma and acute respiratory failure, who was initially treated with tracheal intubation to obtain internal pneumatic stabilization. The patient failed extubation and noninvasive mask treatment (pressure support ventilation plus PEEP) due to poor chestwall mechanics. INTERVENTIONS: Minitracheotomy was performed and ventilation was achieved with high levels of inspiratory pressure (PCV or assisted PCV) to overcome the resistance of the cannula (Mini-Trach II, Portex, ID 4 mm). Esophageal and carinal pressures were monitored. Ventilatory treatment was always performed with the full cooperation of the patient; the patient's glottic function was always intact. The patient was successfully treated with pressure control ventilation delivered through the Mini-Trach. After 7 days of PCV, the patient was switched to assisted PCV. On the 20th day after admission, she was weaned from mechanical ventilation. CONCLUSIONS: We conclude that a suitable gas exchange and pneumatic stabilization in a flail chest condition can be achieved using minitracheostomic ventilation. At the same time, this treatment could reduce some side effects of traditional tracheal intubation.

Monitoring propofol serum levels by rapid and sensitive reversed-phase high-performance liquid chromatography during prolonged sedation in ICU patients.

A quick and sensitive reversed-phase high-performance liquid chromatography (HPLC) method has been developed in order to determine the concentration of Propofol (2,6 diisopropylphenol) in human serum. Propofol can be isolated from serum by adding 0.5 mL precipitating solution. This consists of an acetonitrile and perchloric acid (67:33, v/v) mixture, which also contains dibutylphthalate (2 mg/100 mL) as internal standard. The sample is then mixed for 1 min on a vortex-mixer. The endogenous serum substances precipitated by acetonitrile and perchloric acid are further separated by centrifugation. The supernatant is directly injected into the HPLC system. A 250- x 4.6-mm column, packed with 10-microns Spherisorb reversed-phase octadecylsilane particles (C18), is used for chromatographic separation. The mobile phase consists of an acetonitrile-water mixture (67:33 ratio) with 0.4 mL acetic acid (pH 4). Propofol is monitored by a UV-visible detector at 270 nm and 0.1-0.002 absorbance units full scale (AUFS). The detection limit of Propofol (in human serum) is 0.1 mg/L for a 20-microL injection volume. The time of the assay is less than 20 min, including sample preparation.

Diagnóstico prenatal de malformaciones congénitas pesquisa masiva por dosificación alfafetoproteinas marzo 1985-febrero 1987

Durante un período de dos años comprendidos entre los meses de marzo 1985 a febrero 1987 se realizó pesquisa masiva de D.T.N. y otras malformaciones por dosificación de A.F.P. y ultrasonografía, con un total de 11103 pacientes estudiadas, de las cuales 036 fueron citadas a consultas por presentar A.F.P. elevada o baja. En este grupo de pacientes fue necesario realizar dosificación de A.F.P. en líquido amniótico a 244 pacientes por A.F.P. elevada en suero en dos oportunidades o por tener 21 semana o más, de estas fueron positivas 20 muestras que confirman el diagnóstico prenatal de malformaciones congénitas y que apoyados en la ultrasonografía, logramos diagnosticar 27 malformaciones congénitas en la etapa prenatal, que furon interrumpidas por método de Rivanol. (AU)