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General Reviews

Respiratory complications following resection and reconstruction of the esophagus

Bolca Ciprian1, Radu Stoica2, Cristian Paleru1, Ioan Cordoş1
1Clinica I Chirurgie Toracică, Institutul de Pneumologie „Marius Nasta” Bucureşti, 2Secţia ATI, Institutul de Pneumologie „Marius Nasta” Bucureşti
Esophageal resection remains a dreadfull surgical intervention accompanied by consistently higher morbidity and mortality when compared with other surgical procedures. The respiratory complications are the most important contributor to morbidity and mortality after this kind of surgery. Intimate knowledge on risk factors and physiopathology and carefull treatment of these complications goes with good postoperative results. This article discusses the factors affecting respiratory complications and strategies to reduce the incidence of these complications after esophagectomy.

Keywords: esophageal surgery, respiratory complications, postoperative mortality and morbidity

Sedation of patients with respiratory failure in ICU

Radu T. Stoica1, Anca Macri2
1Secţia ATI, Institutul de Pneumoftiziologie „Marius Nasta“, Bucureşti 2Clinica de Pneumologie, Institutul de Pneumoftiziologie „Marius Nasta“, Bucureşti
Sedation in patients with acute or chronic respiratory disease needing ventilatory support is provocative. Agitation, anxiety and pain interfere with the measures to alleviate respiratory failure and to improve gas exchanges (invasive or non-invasive ventilation), while most sedatives and analgetics are respiratory depressants. Benzodiazepines, propofol and opioids are widely used, but it does not exist a consensus in medication selection, sedation and pain score scales recomended, implementation of protocols of sedation and recovery from the drugs administrated. The use of old and new sedative/analgesic medication, frequently combined, generates the need for understanding pharmacological interferences and for a strategy in preventing oversedation. Creating a specific protocol and guidelines in each respiratory ICU for sedation/ analgesia in mechanically ventilatied patients can improve outcome and reduce the ICU and hospital stay.

Keywords: ventilatory support, sedation monitoring, sedation scale