The Greek e-journal of Perioperative Medicine

2-6

Authors: Katsanoulas C

In the field of paediatric critical care, there is considerable uncertainty and variation in the area of analgesia and sedation in critically ill children. Consensus guidelines on sedation and analgesia in critically ill children are available since 2006, although clinical practice reveals variations both in pharmacological agents and regimens used. A patient at comfort, free of pain and able to communicate when required, constitutes the current, widely accepted clinical endpoint of analgosedation. Newer agents like remifentanil, which is now widely used in paediatric practice, allowing for the application of newer algorithms of proven efficacy. The introduction of newer analgosedation algorithms definitely presupposes the extended use of pain and comfort assessment, using several, more or less validated tools. The difficulty with children is that with the progress of age and developmental stage, different scales are proposed with varied degrees of difficulty in application. Directing treatment to specific and individualized goals through analgosedation algorithms will assure that the patient’s needs are met.

37-46

Authors: Nictari V, Diamantaki H, Stefanakis G, Bareka M, Papaioannou A

Mechanical ventilation can have adverse effects on pulmonary function. The present review focuses on what has recently emerged as one of the most serious potential complications of mechanical ventilation, ventilation-induced lung injury (VILI). For the purposes of this review, the forms of lung injury will be discussed according to the following headings: barotrauma, volutrauma, atelectrauma, and biotrauma.

66-82

Authors: Aslanidis Th, Charitidou S, Matiaki E, Bogiatzopoulos M, Dolzenko E, Georgopoulou E, Milonas A, Anagnostara E

The essential contribution of medical emergency teams (M.E.T) is to decrease the frequency of sudden deaths and the pointless transportation of patients in the intensive care units. The aim of the present study is to record the number and the type of emergency in-hospital calls, the clinical follow up and outcome, the departments and the staff of hospital that were covered by M.E.T (medical and/or nursing) that participated in them, the medications that were used, and the number of involved individuals per incident, as well as the type of monitoring and the fluids that were used. This study covered a 5 months period of emergency calls. The emergency teams created, covered 24 hours a day 16 hospital departments. The main providers in M.E.T were anaesthetists. The results were juxtaposed with the results of a previous period that a M.E.T. was activated in the same hospital. (351calls in total, presented in a an already published study) In the current study we recorded 160 calls in total. Monitoring included, SpO2, arterial pressure, number of breaths per minute and an estimation of neurologic condition according to the Glasgow scale or AVPU scale, as well as the examination of the pupils. In the present study, more invasive methods of monitoring were used. Only one individual was needed in 87 (54%) incidents. The medium time of his involvement with every patient and the medium number of persons of the team involved per call was the same as the previous study. Nevertheless, the higher incidence of favorable immediate outcome after inhospital cardiac arrest (38.2% vs 18.2%) which was recorded, along with the drop in the number of patients who needed to be transported to an intensive care unit, implies a better coordination between the different departments and the M.E.T. It also points at an improvement in the management of such incidents; thus a step up in the spread and implementation of appropriate clinical practice regarding intrahospital emergencies. Conclusions: The implementation of criteria as well as the institution and around the clock existence of organized teams for inhospital emergency medical response, facilitated the objective recognition of befalling crisis as well as the better and more systematic recording and management of such incidents.