Minerva anestesiologica
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Minerva anestesiologica · Apr 2004
ReviewThe pulmonary artery catheter in critically ill patients. Does it change outcome?
Initially described more than 30 years ago, the Pulmonary Artery Catheter (PAC) technique was becoming more and more used in the following years. This hemodynamic monitoring device can be used according 2 different therapeutic attitudes. The first one strives to achieve supranormal hemodynamic values, particularly in terms of cardiac index and oxygen consumption. ⋯ Furthermore, because it is an invasive procedure, the safety of the PAC has been seriously questioned for several years. However, the recent study of Richard and coworkers clearly demonstrated that the use of PAC was not responsible for increased mortality in severely ill patients with circulatory shock and/or acute respiratory distress syndrome. The development of educational programs would allow to improve the quality of the collection and interpretation of hemodynamic parameters with the hope to enhance the efficiency of the PAC for the management of critically ill patients.
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The authors briefly review the clinical applications of non-invasive ventilation (NIV) in patients with chronic obstructive pulmonary disease (COPD), mostly focusing on the application of NIV in the intensive care setting. After a short discussion of the main pathophysiologic aspects of NIV administration in patients with acute exacerbation of COPD, the most relevant clinical trials are shortly reviewed, particularly focussing on prospective randomised trials. NIV application is analysed both in its early administration, as a tool to prevent endotracheal intubation and its main complication, and as a technique alternative to endotracheal intubation in patients requiring mechanical ventilation. Finally, the main contraindications for NIV are reviewed and discussed.
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Minerva anestesiologica · Apr 2004
Randomized Controlled Trial Clinical TrialHemofiltration in the prevention of radiocontrast agent induced nephropathy.
The aim of the study was to investigate the role of hemofiltration in preventing contrast nephropathy in patients with renal failure. ⋯ In patients with renal failure undergoing PCI, peri-procedural hemofiltration is effective for the prevention of contrast nephropathy, and is associated with improved in-hospital and long-term outcome.
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Minerva anestesiologica · Apr 2004
Review[Moderate hypothermia in traumatic brain injury: results of clinical trials].
The concept of neuroprotection' by hypothermia dates back to ancient times. This paper reviews the results of clinical trials using mild hypothermia (3235 degrees C) in patients with severe traumatic brain injury over the past decade. Induced hypothermia has been used in experimental models mostly to prevent or attenuate secondary neurological injury and has been used to provide neuroprotection in traumatic brain injury, both in animal models and clinical trials. ⋯ These differences may be explained by differences in study protocols (i.e. speed and duration of cooling, speed of re-warming), prevention of side effects and various supportive measures in the ICU. Although induced hypothermia appears to be a highly promising treatment in various forms of neurological injury including traumatic brain injury, the difficulties in realising its therapeutic potential are underscored by the negative results from a large multi-center trial. Routine usage of hypothermia in traumatic brain injury can not currently be recommended.
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The concept of analgo-sedation in intensive care medicine has changed considerably since the last decades. Deep sedation, keeping patients artificially unconscious, is not necessary anymore, it postpones weaning from mechanical ventilation, it provokes complications, and prolongs the length of ICU stay. On the other hand, recent surveys have shown that patients recall their intensive care experience still as stressing and painful. ⋯ Regularly repeated assessment of the sedation level (e.g. by Ramsay score) is mandatory; a sedation protocol seems advantageous. To avoid inadvertent accumulation and overdose, it is recommended to keep the patient at a sedation level at which communication is still possible. A daily interruption of the sedation has shown to shorten the duration of mechanical ventilation and the length of ICU stay.