The Greek e-journal of Perioperative Medicine

3-16

Authors: Passakiotou M.

Europe is currently experiencing an unprecedented influx of refugees, asylum seekers and other migrants. More than 1.5 million people arrived in the European Union (EU) and European Economic Area (EEA) in 2015, fleeing countries affected by war, conflict or economic crisis. Member States are increasingly faced with the need to address the public health consequences of this massive arrival of migrants from various parts of the world, which puts national health systems under pressure. The migrant and refugee crisis in Europe has reached a critical point. The great majority of migrants and refugees are in a good physical condition; however, many are challenged with medical and mental problems, social isolation and economic devastation. There are different migrant groups with different rights to access of care. Many European countries are experiencing an increased wave of migrants and refugees and should consider therefore assessing their overall preparedness and response capacity for the management of the disease burden in this population which should be made on the actual migration flows, global disease patterns and consequent needs. Public health interventions in refugee camp settings will not only benefit migrants and refugees at individual level but also assist their integration in to the new home countries. In particular, it is important to consider the economic benefit of early interventions. Intersectoral and international collaboration is important to meet the heterogeneous needs of these populations which could foster integration. Providing newly arrived migrants and refugees a more systematic health-reception, based on a holistic approach by a multidisciplinary team, will not only benefit migrants and refugees but also will protect the public health of host countries. European Member States are facing a challenge to provide accessible and effective health care services for immigrants. It remains unclear how best to achieve this and what characterizes good practice in increasingly multicultural societies across Europe. Although local political debate, level of immigration and the nature of local health care systems influenced the selection and rating of factors within each country, there was a broad European consensus on most factors. Yet, discordance remained both within countries, e.g. on the need for prioritizing cultural differences, and between countries, e.g. on the need for more consistent governance of health care services for immigrants. Experts across Europe asserted the right to culturally sensitive health care for all immigrants. There is a broad consensus among experts about the major principles of good practice that need to be implemented across Europe. However, there also is some disagreement both within and between countries on specific issues that require further research and debate.

36-49

Authors: Margaritis A, Patsouras D, Tsigaridas N, Rammos A, Bolosi M, Ygropoulou O, Tzimas P, Papadopoulos G.

The aim of this study was to determine how low and moderate levels of PEEP affect right ventricular structure and function. The study involved 14 patients under mechanical ventilation (pressure controlled). To perform the study, we used transesophageal echocardiography (M-mode, two-dimensional,tissue Doppler) and 10 parameters were recorded. Measurements were performed initially with PEEP 0 cmΗ2Ο, then 10 minutes after applying PEEP 5cmΗ2Ο and 10 minutes after applying PEEP 10cmΗ2Ο. After applying PEEP 5 cmH2O, there was no statistically significant change observed in any parameter. In contrast, after the application of PEEP 10cmH2O, significant changes in most parameters were recorded: St changed from 10,86±3,8 cm/sec (mean±SD) at ΡΕΕΡ 0 cmH2O to 8,7±2,9 at PEEP 10 cmH2O, TAPSE changed from 2,876±0,643cm to 2,385±0,556cm, IVA from 2,2692±0,93m/sec2 to 2,8536±1,628m/sec2, ΕΤ from 259,27±17,47 msec to 229,34±31,22msec,EDA from 21,372±5,01cm2 to 18,87±4,15cm2, left ventricular eccentricity index at end-diastole from 0,9±0,07 to 0,99±0,08. After applying PEEP 10cmH2O, a trend towards an increase in MPI index of right ventricle and a decline in ESA of the right ventricle were recorded. With respect to other parameters no statistically significant differences were recorded. After applying ΡΕΕΡ=5cmH2O there is no significant change noted in the overall structure and function of right heart. After applying ΡΕΕΡ=10cmH2O changes were recorded in the structure and function of right ventricle caused mainly by the reduction of preload and less by the augmentation of afterload.

67-70

Authors: Karakosta P, Aslanidis T

Central venous catheters (CVC) are an extremely usefull tool in clinical medicine. Yet, its placement and use is not without complication. In the present paper, a case report of Central venous catheter malposition is presented.