Ultrasound in critical care

Ultrasound has been revolutionising our specialty. The introduction of new, portable machines and goal-directed protocols has led many anaesthetists to use this diagnostic tool in their daily practice. Immediate, bedside ultrasound diagnosis of many life-threatening emergencies (pneumothorax, cardiac tamponade, or internal haemorrhage) enables not only the institution of proper treatment, but also the monitoring of its effectiveness. Ultrasound guided invasive procedures (such as vascular cannulations, toraco- and pericardiocentesis) have superseded the old anatomical landmarks-based techniques due to a greater safety margin. In order to perform a credible ultrasound examination, a proper level of competence is required. In this review article, the authors present various critical ultrasound applications

The influence of fluid therapy on short- and long-term outcomes in patients undergoing liver resection for malignant indications

Although fluid therapy in hepatic surgery affects the postoperative course and morbidity, there is a paucity of unequivocal guidelines in the literature as to which of three fluid strategies to use: liberal, restrictive or goal-directed. We performed a review of literature regarding fluid management strategies in major abdominal procedures, focusing on hepatic sur­gery. The quantity and quality of fluids infused perioperatively is often dependent on the preference of the physician, institutional experience and practices. A liberal fluid regimen carries the risk of impaired wound healing and prolonged ileus, furthermore in liver surgery it may increase blood loss. Restrictive fluid therapy is the mainstay of the anesthetic management in hepatic resections, keeping the central venous pressure low controls outflow from the liver and results in a decrease in intraoperative blood loss. In recent years, goal-directed fluid therapy ( GDFT), as a component of enhanced recovery pathways after surgery (ERAS) programs, has gained in popularity. It is based on the concept of hemodynamic optimization in order to ensure optimal tissue perfusion and oxygen delivery. Furthermore, a fluid infusion strategy should be individualized in terms of the unique pathophysiology of the patient (e.g. cirrhosis) and the specific requirements of the surgical technique (laparoscopic procedures). Controversy regarding often contradictory data, leaves the clinician at a loss as to which fluid strategy will best serve the patient. Therefore, it is imperative to design and conduct clinical trials in a homogenous group of patients to define the optimal type and amount of fluid for patients undergoing hepatic surgery

Standards of the Polish Ultrasound Society. Ultrasound examination in anesthesiology and intensive care

This article has been prepared on the basis of the Ultrasonography Standards of the Polish Ultrasound Society (2011) and updated based on the latest findings and reports. Various applications of ultrasonography are used in anesthesiology and intensive therapy both for diagnosis and as a supportive tool during invasive procedures (such as vascular cannulation or regional anesthesia). Ultrasound examinations performed by anesthesiologists in intensive care units are not detailed scans, but they are focused on immediate identification of pathologies that lead to life-threatening conditions. Performing repeated US exams in time intervals enables a physician to monitor the effectiveness of the instituted treatment. Many simplified protocols are used in clinical practice which help to systemize the examination. Focused US examination should be verified by a physician competent in this imaging method as soon as possible. Due to the specificity of anesthesiologists’ practice and spatial limitations of operating rooms and intensive care units, portable robust ultrasound equipment with short power-on to scanning time is preferable. A growing number of indications show that ultrasound machine should be equipped with three basic transducers (linear, convex and sector), and in higher-reference centers with a transesophageal probe. The specificity of certain procedures guided by ultrasonography requires adherence to safety measures, e.g. full sterility condition during vein cannulation.Pracę przygotowano na podstawie Standardów badań ultrasonograficznych Polskiego Towarzystwa Ultrasonograficznego (2011) i zaktualizowano, opierając się na najnowszych doniesieniach z piśmiennictwa. Specyfiką zastosowania różnych aplikacji ultrasonografii w anestezjologii i intensywnej terapii jest wykorzystanie tej metody obrazowania zarówno w diagnostyce, jak i w celu wspomagania niektórych inwazyjnych procedur (np. kaniulacji naczyń, znieczulenia regionalnego). Badania ultrasonograficzne wykonywane przez anestezjologa na oddziale intensywnej terapii nie mają charakteru szczegółowego, lecz są ukierunkowane na identyfikację patologii prowadzącej do stanu zagrożenia życia. Powtarzanie badania w odstępach czasowych ułatwia monitorowanie efektywności wdrożonego leczenia. W diagnostyce wykorzystywane są często uproszczone protokoły, które pozwalają usystematyzować badanie. Powinny być one w miarę możliwości zweryfikowane przez kompetentnego w tej technice obrazowej lekarza. Ze względu na specyfikę pracy anestezjologa oraz ograniczenia powierzchniowe sali operacyjnej i oddziału intensywnej terapii najlepiej sprawdzają się mobilne, odporne na uszkodzenia aparaty ultrasonograficzne, gotowe do pracy w krótkim czasie od uruchomienia. Rosnąca liczba wskazań powoduje, że uzasadnione jest dysponowanie aparatem wyposażonym w trzy podstawowe głowice (liniowa, convex i sektor), a w ośrodkach o wyższym poziomie referencyjności również w głowicę przezprzełykową. Specyfika niektórych procedur wykonywanych pod kontrolą ultrasonografu wymaga zachowania odpowiednich procedur bezpieczeństwa, np. w trakcie kaniulacji naczyń konieczne jest przestrzeganie pełnej jałowości

Scheveningen: from a fishing village to the seaside resort

This history thesis aims to answer the question of how the development of modern tourism has affected the identity of Scheveningen at the turn of the 19th and 20th centuries. The study is based on the analysis of predefined components of the identity of a place, based on research in the field of sociology, modern tourism and identity, as well as archival materials on Scheveningen. These sources include photo albums, illustrations, texts, newspapers and maps. Based on the theories and definitions from the field of sociology and environmental psychology, in particular on the triadic interpretation based on J.G. Bennet’s systematics in the context of place, place identity and phenomenology by David Seamon (2012), the components of place identity are determined at the first place. Thus, the analysis of the Scheveningen identity is focused on three main areas, defined in the main theoretical and methodological axis of the thesis. Firstly, the identity of Scheveningen is explored at the level of community life. This section covers topics such as notion of community, the clash of local customs and European lifestyle, as well as focal points of social interactions. Secondly, the thesis explores the physical environment of Scheveningen. The issues of both the urban layout and transitions in the architecture are presented. At the end, the aspect of hidden meanings and contexts in Scheveningen environment, considered as a factor between the physical and social layers, is thoroughly examined.The conclusion of the thesis explains exactly what changes took place on the three main levels of the Scheveningen identity, caused by the development of modern toursim at the turn of the 19th and 20th centuries.Architecture, Urbanism and Building Science

Module+: Towards Affordable and Qualitative Student Housing

This Master Thesis is an attempt to address the lack of a sufficient number of affordable and qualitative student housing by creating an experimental, universal design strategy called MODULE+, combining computational design and modular architecture. The strategy consists of three main elements - individually designed flexible timber modules, an algorithm that generates the functional layout of the building based on them and optimizes it in relation to selected objectives, as well as carefully selected further design directions that allow the transformation of the generated solutions into a qualitative living environment. The developed strategy became the basis for the design of a complex of residential buildings for students within the TU Delft Campus.Architecture, Urbanism and Building Science

Ultrasound in critical care

Ultrasound has been revolutionising our specialty. The introduction of new, portable machines and goal-directed protocols has led many anaesthetists to use this diagnostic tool in their daily practice. Immediate, bedside ultrasound diagnosis of many life-threatening emergencies (pneumothorax, cardiac tamponade, or internal haemorrhage) enables not only the institution of proper treatment, but also the monitoring of its effectiveness. Ultrasound guided invasive procedures (such as vascular cannulations, toraco- and pericardiocentesis) have superseded the old anatomical landmarks-based techniques due to a greater safety margin. In order to perform a credible ultrasound examination, a proper level of competence is required. In this review article, the authors present various critical ultrasound applications.Ultrasound has been revolutionising our specialty. The introduction of new, portable machines and goal-directed protocols has led many anaesthetists to use this diagnostic tool in their daily practice. Immediate, bedside ultrasound diagnosis of many life-threatening emergencies (pneumothorax, cardiac tamponade, or internal haemorrhage) enables not only the institution of proper treatment, but also the monitoring of its effectiveness. Ultrasound guided invasive procedures (such as vascular cannulations, toraco- and pericardiocentesis) have superseded the old anatomical landmarks-based techniques due to a greater safety margin. In order to perform a credible ultrasound examination, a proper level of competence is required. In this review article, the authors present various critical ultrasound applications

Study of thermal-flow processes in ash cooler cooperating with CFB boiler

The article presents an example of thermal-flow analysis of the bottom ash cooler cooperating with the circulating fluidized bed boiler. There is presented a mathematical model of series-parallel hydraulic system supplying the ash cooler in cooling water. The numerical calculations indicate an influence of changes of the pipeline geometrical parameters on the cooling water flow rate in the system. Paper discusses the methodology of the studies and presents examples of the results of thermal balance calculations based on the results of measurements. The numerical results of the thermal-flow analysis in comparison with the measurements on the object indicate that the presented approach could be used as a diagnostic tool investigating the technical state of the bottom ash cooler

The influence of fluid therapy on short- and long-term outcomes in patients undergoing liver resection for malignant indications

Although fluid therapy in hepatic surgery affects the postoperative course and morbidity, there is a paucity of unequivocal guidelines in the literature as to which of three fluid strategies to use: liberal, restrictive or goal-directed. We performed a review of literature regarding fluid management strategies in major abdominal procedures, focusing on hepatic sur­gery. The quantity and quality of fluids infused perioperatively is often dependent on the preference of the physician, institutional experience and practices. A liberal fluid regimen carries the risk of impaired wound healing and prolonged ileus, furthermore in liver surgery it may increase blood loss. Restrictive fluid therapy is the mainstay of the anesthetic management in hepatic resections, keeping the central venous pressure low controls outflow from the liver and results in a decrease in intraoperative blood loss. In recent years, goal-directed fluid therapy ( GDFT), as a component of enhanced recovery pathways after surgery (ERAS) programs, has gained in popularity. It is based on the concept of hemodynamic optimization in order to ensure optimal tissue perfusion and oxygen delivery. Furthermore, a fluid infusion strategy should be individualized in terms of the unique pathophysiology of the patient (e.g. cirrhosis) and the specific requirements of the surgical technique (laparoscopic procedures). Controversy regarding often contradictory data, leaves the clinician at a loss as to which fluid strategy will best serve the patient. Therefore, it is imperative to design and conduct clinical trials in a homogenous group of patients to define the optimal type and amount of fluid for patients undergoing hepatic surgery