By A. Gullo

ISBN-10: 8847005701

ISBN-13: 9788847005709

Developing sectors within the in depth care box - and in serious care medication usually - require particular degrees of competence having a comparable universal denominator: an in-depth wisdom of human pathophysiology. even if this quantity offers lots of issues in consistent evolution, as witnessed via the gathering of chapters compiled by means of numerous researchers, this version contains, particularly, fields within which choice making on the patient’s bedside prevails over theoretical argumentation. In different phrases, the 1st and top-rated message this variation desires to supply is for the reader to concentration his/her awareness on evidence-based medicine.

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Extra info for Anaesthesia, Pain, Intensive Care and Emergency A.P.I.C.E.: Proceedings of the 21st Postgraduate Course in Critical Medicine: Venice-Mestre, Italy - November 10-13, 2006

Example text

In addition to the obvious manifestations of overdistension, there are also more subtle types of injury that can be induced by mechanical ventilation. Wedd and Tierney [18] produced dramatic evidence that overdistension associated with high peak airway pressures could lead to the development of pulmonary oedema and death within 1 h in rats. Since this seminal finding, a large number of investigators have observed that high end-inspiratory lung stretch can lead to diffuse alveolar damage, pulmonary oedema, increased fluid filtration, epithelial permeability and microvascular permeability [19].

The same technique can be used to determine the UIP and the closing pressure on the deflation limb, which will be discussed below [25]. In the expiratory limb of the P–V curve a distinct closing volume can be identified as lung volume declines [5]. This behaviour is more pronounced in older persons and in those affected by some pulmonary diseases. In the first segment, the decrease in pressure represents the relaxation of overstretched units as volume decreases from total lung capacity. The second part of the deflation curve reflects the elastic-retraction properties of patent lung tissue.

The pressure–volume curve 37 Present views Initially, LIP, UIP and closing pressure were identified manually. The lack of standard procedures to determine these points led Venegas et al. [42] to create a method for evaluation of P–V curve parameters [43]. Their approach is applicable both to the inspiratory and expiratory limbs of the curve and depends on a mathematical fitting procedure to the P–V curve. Mathematic modelling and experimental and clinical data indicate that alveolar recruitment takes place over the entire range of the P–V curve [31, 44, 45].

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