sedationstation

Driving Pressure and Survival in the Acute Respiratory Distress Syndrome Marcelo B.P. Amato, M.D., Maureen O. Meade, M.D., Arthur S. Slutsky, M.D., Laurent Brochard, M.D., Eduardo L.V. Costa, M.D., David A. Schoenfeld, Ph.D., Thomas E. Stewart, M.D., Matthias Briel, M.D., Daniel Talmor, M.D., M.P.H., Alain Mercat, M.D., Jean-Christophe M. Richard, M.D., Carlos R.R. Carvalho, M.D., and Roy G. Brower, M.D. N Engl J Med 2015; 372:747-755 February 19, 2015 DOI: 10.1056/NEJMsa1410639 BACKGROUND Mechanical-ventilation strategies that use lower end-inspiratory (plateau) airway pressures, lower tidal volumes (V T ), and higher positive end-expiratory pressures (PEEPs) can improve survival in patients with the acute respiratory distress syndrome (ARDS), but the relative importance of each of these components is uncertain. Because respiratory-system compliance (C RS ) is strongly related to the volume of aerated remaining functional lung during disease (termed functional lung size)...

Rivaroxaban: Anti-FXa activity PT and aPTT modified according to the reagent (PT more sensitive) Apixaban: Anti-FXa activity PT and aPTT not really prolonged Dabigatran: Ecarin clotting time, Haemoclott or anti-IIa PT, aPTT and TT modified according to the reagent (aPTT more sensitive) Ref. MM Samama et al Clin Chem Lab Med 2011;49,761

                                                            click here to access may 2014 issue

Mechanical Ventilation in Pregnancy The indications for intubation of a pregnant patient are no different than the non-pregnant patient. The guiding principle of ventilating the pregnant patient is ensuring adequate oxygen delivery. The goal is a PaO2 of >90 mmHg. Positive end-expiratory pressure (PEEP) should be applied to keep the FiO2 <60%, but the patient should be kept in the left lateral decubitus position to minimize the effect of PEEP on venous return. Permissive hypercapnia, a strategy used in acute lung injury, may lead to fetal distress. If higher PaCO2 levels are being sustained in the pregnant patient, then continuous fetal monitoring is required. Sedation with propofol and opioid drugs are safe, though the fetus may need to be intubated on delivery as these drugs cross the placenta. Benzodiazepines should be avoided as they have been shown to increase the incidence of cleft palate. Higher than normal peak and plateau airway pressures can be expected on the venti...

- Use is encouraged when expected surgical blood loss > 800 ml. - It is indicated when Hemoglobin value is between 10 and 13 without iron deficiency anemia. - Dose approved is 600 U/kg/week subcutaneously. - It is given in 3 injections.  - It should be started 3 weeks prior to surgery without exceeding hemoglobin target level of 15. - Monitor blood pressure before each injection. Ref. MAPAR 2014

Delta 0-3 Hz Deep sleep or deep anesthesia; hypoxia, hypocapnea, ischemia, Electrolyte disturbances Theta 4-7 Hz Sleep and anesthesia Alpha 8-13 Hz Resting, awake with eyes closed