Minerva anestesiologica
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Minerva anestesiologica · Dec 2011
Acute physiologic effects of a stepwise recruitment maneuver in acute respiratory distress syndrome.
Stepwise recruitment maneuvers (RM) applied with high airway pressures may optimize lung recruitment, but this kind of intervention may lead to widely heterogeneous responses with possible side effects. To assess the clinical impact of these maneuvers, we performed a stepwise maximal-recruitment strategy superimposed on routine mechanical ventilation. ⋯ Although stepwise-RM improves oxygenation, it has a heterogeneous impact on respiratory mechanics and may cause adverse hemodynamic effects and transient hypoxemia. If the use of this kind of RM is considered, it should be adapted to individual patient needs, applied carefully and closely monitored.
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Minerva anestesiologica · Dec 2011
Impact of early vs. late tracheostomy on weaning: a retrospective analysis.
Early tracheostomy has been advocated for a number of reasons. Especially in association with weaning from mechanical ventilation, it is known that an early timepoint can help patients being weaned more rapidly from the ventilator. However, timing of tracheostomy is still unknown and evidence is lacking. The effects of early tracheostomy compared with intermediate and late tracheostomy were assessed in critically ill patients. ⋯ The length of weaning after tracheostomy is not affected by the timing. It seems beneficial to favour early tracheostomy in order to reduce the time of mechanical ventilation and its associated risks.
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Minerva anestesiologica · Dec 2011
Randomized Controlled TrialA randomized control trial of patient-controlled epidural analgesia (PCEA) with and without a background infusion using levobupivacaine and fentanyl.
Continuous infusion associated with patient-controlled epidural analgesia (PCEA) is used in many maternal units. This randomized controlled study evaluated the effect of a 10 mL/h background infusion associated with a 10 mL-20 minutes lockout time demand-only PCEA protocol using L-bupivacaine plus fentanyl in terms of local anaesthetic consumption, pain management and maternal satisfaction. ⋯ When a levobupivacaine plus fentanyl PCEA protocol with high volume boluses and long lockout interval is used for labour analgesia, the background infusion increased the total local anesthetic dose with no change in pain management and maternal satisfaction.
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Minerva anestesiologica · Dec 2011
Strategies for diagnosis and treatment of iatrogenic tracheal ruptures.
Management of tracheal ruptures in critically ill patients is challenging. Conservative treatment has been described, but in mechanically ventilated patients with distal tracheal ruptures surgical repair might be inevitable. Strategies for diagnosis and treatment of tracheal ruptures and handling of mechanical ventilation remain to be clarified. Our aim was to comprise a structured diagnostic and treatment protocol for patients suspicious of tracheal injury, including detailed principles of mechanical ventilation and specific indications for conservative or surgical treatment. ⋯ Invasiveness of mechanical ventilation and obstruction of tracheal lumen might indicate conservative or surgical treatment strategies in long-term ventilated patients suffering from iatrogenic tracheal rupture. Indications for surgical repair remain to be further clarified.