EFFECTS OF CPAP BREATHING ON CARDIAC OUTPUT AND OXYGENATION FOLLOWING OPEN - HEART SURGERY.

Η ΤΕΧΝΙΚΗ ΤΗΣ ΑΥΤΟΜΑΤΟΥ ΑΝΑΠΝΟΗΣ ΥΠΟ ΣΥΝΕΧΗ ΘΕΤΙΚΗΝ ΕΚΠΝΕΥΣΤΙΚΗΝ ΠΙΕΣΙΝ (CPAP) ΕΦΗΡΜΟΣΘΗ ΕΙΣ ΕΝΗΛΙΚΑΣ ΑΣΘΕΝΕΙΣ ΑΝΑΡΡΩΝΥΟΝΤΑΣ ΕΞ ΕΓΧΕΙΡΗΣΕΩΝ ΑΝΟΙΚΤΗΣ ΚΑΡΔΙΑΣ ΥΠΟ ΕΞΩΣΩΜΑΤΙΚΗΝ ΚΥΚΛΟΦΟΡΙΑΝ. ΕΥΡΕΘΗ ΟΤΙ: Α) Η ΚΑΡΔΙΑΚΗ ΠΑΡΟΧΗ ΠΑΡΕΜΕΙΝΕΝ ΑΜΕΤΑΒΛΗΤΟΣ ΕΠΙ ΤΟΥ ΣΥΝΟΛΟΥ ΤΩΝ ΑΣΘΕΝΩΝ, ΗΥΞΗΘΗ ΔΕ ΕΛΑΦΡΩΣ ΕΙΣ ΤΗΝ ΟΜΑΔΑ ΤΩΝ ΑΣΘΕΝΩΝ ΑΝΕΥ ΠΝΕΥΜΟΝΙΚΗΣ ΑΓΓΕΙΑΚΗΣ ΝΟΣΟΥ, Β) Η ΟΞΥΓΟΝΩΣΙΣ ΤΟΥ ΑΙΜΑΤΟΣ ΕΒΕΛΤΙΩΘΗ,ΜΕ ΑΠΟΤΕΛΕΣΜΑ ΤΗΝ ΣΗΜΑΝΤΙΚΗΝ ΜΕΙΩΣΙΝ ΤΗΣ ΚΥΨΕΛΙΔΟ - ΑΡΤΗΡΙΑΚΗΣ ΔΙΑΦΟΡΑΣ ΤΗΣ ΤΑΣΕΩΣ ΟΞΥΓΟΝΟΥ (Α - APO2) ΙΔΙΑ ΕΙΣ ΤΟΥΣ ΑΣΘΕΝΕΙΣ ΜΕΤΑ ΠΝΕΥΜΟΝΙΚΗΣ ΥΠΕΡΤΑΣΕΩΣ ΚΑΙ ΜΙΤΡΟΕΙΔΟΠΑΘΕΙΑΣ ΚΑΙ Γ) Η ΠΟΣΟΤΗΣ ΤΟΥ ΜΕΤΑΦΕΡΟΜΕΝΟΥ ΠΡΟΣ ΤΟΥΣ ΙΣΤΟΥΣ ΟΞΥΓΟΝΟΥ ΟΜΟΙΩΣ ΗΥΞΗΘΗ, ΕΙΣ ΤΟΥΣ ΑΣΘΕΝΕΙΣ ΜΕΤΑ ΠΝΕΥΜΟΝΙΚΗΣ ΑΓΓΕΙΑΚΗΣ ΝΟΣΟΥ. ΕΠΟΜΕΝΩΣ, Η ΧΡΗΣΙΣ ΤΗΣ ΑΥΤΟΜΑΤΟΥ ΑΝΑΠΝΟΗΣ ΜΕΤΑ CPAP ΒΕΛΤΙΩΝΕΙ ΤΗΝ ΑΡΤΗΡΙΑΚΗΝ ΚΑΙ ΙΣΤΙΚΗΝ ΟΞΥΓΟΝΩΣΙΝ, ΑΝΕΥ ΕΠΙΔΕΙΝΩΣΕΩΣ ΤΗΣ ΚΑΡΔΙΑΚΗΣ ΠΑΡΟΧΗΣ.CONTINUOUS POSITIVE AIRWAY PRESSURE (CPAP) BREATHING WAS USED TO WEAN PATIENTS FROM IPPV AFTER OPEN - HEART SURGERY IN ADULT PATIENTS. SPONTANEOUS RESPIRATION (SR) UNDER ATMOSPHERIC PRESSURE WAS USED AS A CONTROL PERIOD. IT WAS FOUND THAT THE CARDIAC OUTPUT WAS NOT ADVERSELY AFFECTED BY CPAP AS COMPARED TO IPPVAND SR IN FACT, INCREASED SLIGHTLY IN THE GROUP OF PATIENTS WITHOUT PULMONARYVASCULAR DISEASE. THE OXYGEN TRANSPORT ALSO IMPROVED DURING THE CPAP BREATHING. THE ALVEOLAR TO ARTERIAL OXYGEN TENSION GRADIENT NARROWED SIGNIFICANTLY, IN PARTICULAR IN THE PATIENTS WITH MITRAL VALVE DISEASE AND PULMONARY HYPERTENSION

Gastrointestinal motility following thoracic surgery: the effect of thoracic epidural analgesia. A randomised controlled trial

Abstract Backgrounds Impairment of gastrointestinal (GI) motility is an undesirable but inevitable consequence of surgery. This prospective randomised controlled study tested the hypothesis that postoperative thoracic epidural analgesia (TEA) with ropivacaine or a combination of ropivacaine and morphine accelerates postoperative GI function and shortens the duration of postoperative ileus following major thoracic surgery compared to intravenous (IV) morphine. Methods Thirty patients scheduled for major thoracic surgery were randomised to three groups. All patients had bowel motility assessments 1 week preoperatively. All patients received general anaesthesia. Group Ep-R received TEA with ropivacaine; group Ep-RM received TEA with ropivacaine and morphine and group IV-M received IV morphine via patient controlled analgesia pump (PCA). Bowel motility was assessed by clinical examination in addition to oro-ceacal transit time (OCTT) on the first and third postoperative days and colonic transit time (CTT). Results Overall the OCTT demonstrated a 2.5-fold decrease in bowel motility on the first postoperative day. The OCTT test revealed statistically significant differences between all groups (Ep-R vs Ep-RM, p = 0.43/Ep-R vs IV-M, p = 0.039 / Ep-RM vs IV-M, p < 0.001). Also, very significant differences were found in the OCCT test between days (Ep-R vs Ep-RM, p < 0.001/Ep-R vs IV-M, p < 0.001 / Ep-RM vs IV-M, p = 0.014). There were no significant differences in the CTT test or the clinical signs between groups. However, 70% of the patients in the Ep-R group and 80% in the Ep-RM group defecated by the third day compared to only 10% in the IV-M group, (p = 0.004). Conclusions Objective tests demonstrated the delayed motility of the whole GI system postoperatively following thoracic surgery. They also demonstrated that continuous epidural analgesia with or without morphine improved GI motility in comparison to intravenous morphine. These differences were more pronounced on the third postoperative day. Trial registration ISRCTN number: 11953159 , retrospectively registered on 20/03/2017

A survey of key opinion leaders on ethical resuscitation practices in 31 European Countries.

BACKGROUND Europe is a patchwork of 47 countries with legal, cultural, religious, and economic differences. A prior study suggested variation in ethical resuscitation/end-of-life practices across Europe. This study aimed to determine whether this variation has evolved, and whether the application of ethical practices is associated with emergency care organisation. METHODS A questionnaire covering four domains of resuscitation ethics was developed based on consensus: (A) Approaches to end-of-life care and family presence during cardiopulmonary resuscitation; (B) Determinants of access to best resuscitation and post-resuscitation care; (C) Diagnosis of death and organ donation (D) Emergency care organisation. The questionnaire was sent to representatives of 32 countries. Responses to 4-choice or 2-choice questions pertained to local legislation and common practice. Positive responses were graded by 1 and negative responses by 0; grades were reconfirmed/corrected by respondents from 31/32 countries (97%). For each resuscitation/end-of-life practice a subcomponent score was calculated by grades' summation. Subcomponent scores' summation resulted in domain total scores. RESULTS Data from 31 countries were analysed. Domains A, B, and D total scores exhibited substantial variation (respective total score ranges, 1-41, 0-19 and 9-32), suggesting variable interpretation and application of bioethical principles, and particularly of autonomy. Linear regression revealed a significant association between domain A and D total scores (adjusted r(2)=0.42, P<0.001). CONCLUSIONS According to key experts, ethical practices and emergency care still vary across Europe. There is need for harmonised legislation, and improved, education-based interpretation/application of bioethical principles. Better application of ethical practices may be associated with improved emergency care organisation

European Curriculum for Emergency Medicine

The essential features of a clinical specialty include a unique field of action, a defined body of knowledge and a rigorous training programme. Emergency Medicine has a unique field of action, both within the Emergency department and in the community. The European Society for Emergency Medicine (EuSEM) first published a European Core Curriculum for Emergency Medicine in 2002. The present paper presents the new and expanded version of the Curriculum. The document was developed by a Curriculum Task Force of EuSEM (which included representatives of 17 National Societies), has been reviewed by the Multidisciplinary Joint Committee of the Union Europeenne des Medecins Specialistes (MJC-UEMS), and finally approved by EuSEM on May 2009. This curriculum document not only incorporates the relevant body of knowledge and associated competencies but also establishes the essential principles for a rigorous training programme and should constitute a guideline for the development and organisation of recognised training programmes of comparable standard across Europe. The recommended minimum period of training for the specialists in Emergency Medicine is five years even though it is now accepted that the duration of a training programme should be determined more by the length of time needed to acquire the necessary competencies. European countries are encouraged to adopt this curriculum and to train Emergency Physicians to a European standard which will enable them to transfer their skills across national borders. [Emergencias 2009;21:456-470