tailieunhanh - Critical Care Obstetrics part 23

Critical Care Obstetrics part 23 provides expert clinical guidance throughout on how you can maximize the chances of your patient and her baby surviving trauma. In this stimulating text, internationally recognized experts guide you through the most challenging situations you as an obstetrician are likely to face, enabling you to skillfully:Recognize conditions early-on which might prove life threatening, Implement immediate life-saving treatments in emergency situations, Maximize the survival prospects of both the mother and her fetus | Non-Invasive Monitoring patients. The findings of this study showed a high correlation between invasive and non-invasive techniques in the measurement of stroke volume and cardiac output. Ventricular filling pressures and pulmonary artery pressures also showed a similar significant correlation with invasive techniques 11 . The specific choice of echocardiographic technique for estimating stroke volume and ejection fraction was explored in the same group of patients. Comparisons between M-mode and two- dimensional Doppler techniques revealed similar findings although M-mode echocardiography was not possible in 2 out of 11 subjects secondary to body habitus and paradoxical motion of the intraventricular septum. This study also allowed calculation of the ejection fraction by dividing the stroke volume by the end- diastolic volume. Using this equation similar results were obtained by all the methods employed for estimating left ventricular function in pregnant women 12 . Belfort et al. have reported a series of 14 patients with an indication for invasive hemodynamic monitoring in whom Doppler ultrasound was used as a guide to clinical management. These 14 women had a spectrum of pathologies ranging from intractable hypertension to complex cardiac lesions and included women with oliguria and pulmonary edema. This pilot study concluded that the non-invasive monitoring had facilitated management and only two patients went on to have invasive monitoring in order to allow continuous monitoring. Large volumes of fluid were administered to some of these patients up to 8 L of crystalloid without the development of fluid overload or pulmonary edema. To date this is the only study that has indicated the potential utility of routine rapid echocardiographic assessment of left ventricular function in critically ill obstetric patients 13 . that increased atrial distension in pre-eclampsia triggered a diuretic response. These data have been contested. The most detailed study to date