Minerva anestesiologica
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Minerva anestesiologica · Apr 2008
ReviewFunctional hemodynamic monitoring and dynamic indices of fluid responsiveness.
Knowing whether or not a fluid infusion can improve cardiac output (fluid responsiveness) is crucial when treating hemodynamically unstable patients. Generally, cardiac filling pressures (central venous pressure, pulmonary artery occlusion [''wedge''] pressure) and volumes (end-diastolic left and right ventricular volume) are used, although they are not reliable predictors of fluid responsiveness. For this reason, new indices, the so-called dynamic indices of fluid responsiveness, have been recently introduced in clinical use. ⋯ Among them, variation of cardiac output induced by passive leg raising (PLR) has raised particular interest since it can identify fluid responders even among spontaneously breathing and non-sinus rhythm patients. Although promising, the dynamic indices of fluid responsiveness have been studied only retrospectively in a relatively small number of patients and evidence that clinical use of these indices can improve outcome is still limited. Further investigations are needed to confirm their clinical validity.
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Minerva anestesiologica · Apr 2008
Randomized Controlled TrialVolatile anesthetics and mucociliary clearance.
The aim of this prospective, randomized, double blind study was to evaluate the possible modification of in vivo nasal mucociliary clearance by three different volatile agents: sevoflurane, isoflurane and desflurane, following intravenous induction and tracheal intubation. ⋯ Anaesthesia with volatile agents does not modify mucociliary clearance of nasal epithelium.
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Minerva anestesiologica · Apr 2008
The 2005 European Guidelines for cardiopulmonary resuscitation: major changes and rationale.
During the 2005 International Consensus Conference on Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care Science, a rigorous evidence-based evaluation process was conducted. The consensus reached during that Conference constituted the basis of the current CPR guidelines of the European Resuscitation Council (ERC), published in December 2005. Those guidelines included many important changes, made on the basis of emerging evidence. ⋯ New timing of defibrillation shocks is now advised: the three-stacked shock sequence has been replaced by high-energy single shocks followed by two-minute cycles of CPR, in order to reduce CPR interruptions. Timing for administration of drugs has been adapted to the new shock sequence and the advanced life support (ALS) universal algorithm has been modified. Some controversial topics are still a matter of investigation and debate, including the use of therapeutic hypothermia in non-shockable cardiac arrests, the efficacy of a period of CPR before defibrillation in long-lasting cardiac arrests, and the chest-compression-only CPR for first responders of out-of-hospital cardiac arrests.