Anaesthesia, Pain, Intensive Care and Emergency A.P.I.C.E.: by A. Gullo

By A. Gullo

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

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Extra resources 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

Clin Chest Med 11(4):673–690 6. Agostini E, Hyatt RE (1986) Static behavior of the respiratory system. In: Geiger SR (ed) Handbook of physiology. American Physiological Society, Bethesda, pp 113–130 7. Mead J, Whittenberger JL, Radford EP (1957) Surface tension as a factor in pulmonary volume–pressure hysteresis. J Appl Physiol 10(2):191–196 8. Radford EP Jr (1964–1965) Static mechanical properties of mammalian lungs. In: Fenn WO (ed) Handbook of physiology. American Physiological Society, Bethesda, pp 429–449 9.

At lung volumes below functional residual capacity (FRC), the chest wall contributes more significantly to the curvature (fall in compliance) because of its progressively increasing rigidity (the anatomical structures do not allow a further decrease in volume) and large outward expansion force. R. A. Zin lung compliance falls at low lung volumes owing to alveolar instability and airway collapse [5]. At FRC, the inward retractile force of the lung counterbalances the outward expansion force of the chest wall, setting the elastic equilibrium volume of the respiratory system.

When tidal volume was kept constant, the PEEP level set by the closing pressure had both benefits and drawbacks [48]. For many years, modifications of the P–V curve in ARDS were attributed to changes in lung compliance. More recently, the role of the chest wall in the slope of the curve has been stressed, showing that the chest wall properties should also be taken into account. R. A. Zin In patients with inhomogeneously distributed ARDS interpretation of the P–V curve is a rather difficult task.

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