Minerva anestesiologica
-
Minerva anestesiologica · Sep 2011
ReviewWhen, where and how to initiate hypothermia after adult cardiac arrest.
Therapeutich hypothermia (TH) has been shown to improve neurological outcome and survival after witnessed cardiac arrest (CA) that is due to ventricular fibrillation. Although TH is widely used following witnessed CA as well as all forms of initial rhythm, the mortality rate after CA remains unacceptably high, and additional study is needed to understand when and how to implement hypothermia in the post-resuscitation phase. ⋯ Thus, hypothermia use should not be limited to the Intensive Care Unit but can be initiated in the field/ambulance or in the Emergency Department, then continued after hospital admission- even during specific procedures such as coronary angiography-as part of the global management of CA patients. Various methods (both non-invasive and invasive) are available to achieve and maintain the target temperature; however, only some of these methods-which include cold fluids, ice packs, iced pads and helmet and trans-nasal cooling- are easily deployed in the pre-hospital setting.
-
Minerva anestesiologica · Sep 2011
Invasive and non-invasive long-term mechanical ventilation in Italian children.
To date, few studies have been published regarding the number of children in Italy who require long-term mechanical ventilation (LTV) and their underlying diagnoses, ventilatory needs and hospital discharge rate. ⋯ Managing pediatric home LTV requires tremendous effort on the part of the patient's family and places a significant strain on community financial resources. In particular, neurological patients require more health care than patients in other categories. To further improve the quality of care for these patients, it is essential to establish a dedicated national database.
-
Minerva anestesiologica · Sep 2011
Review Meta AnalysisSteroids in severe pneumonia: a literature review.
Despite more than sixty years of scientific medical research, severe pneumonia, either community-acquired or nosocomial, remains a leading cause of death regardless of the patients' immunity state. The clinical introduction of new and more potent antibiotic molecules and the continuous development of efficient respiratory assistance devices may not be able to radically improve the clinical outcome of pneumonia. Adjunctive therapies based on the physiopathological mechanisms of lung damage in severe pneumonia have been strongly advocated, and corticosteroids, which present many properties that theoretically interfere with these pathways, have been widely used, with conflicting results. ⋯ In severe pneumonia, preclinical data, including cytokine level detection and animal studies, have shown encouraging results, although the clinical data is controversial. Moreover, large randomized controlled trials have not been conducted to determine steroid side effects and the risk of immunosuppression-induced superinfections. The benefits of steroid use in patients with severe pneumonia have not been proven by current literature, but ongoing investigations of anti-inflammatory molecules probably represent the key point of severe infection management in the near future.
-
Minerva anestesiologica · Sep 2011
Changes in calculated arterio-jugular venous glutamate difference and SjvO2 in patients with severe traumatic brain injury.
Cerebral metabolic impairment is feared to induce secondary brain damage following traumatic brain injury (TBI). The present study was designed to assess the temporal profile of calculated arterio- jugular venous differences in glutamate (AJVDglu) and SjvO(2) in patients subjected to continuous pharmacologic coma. Metabolic impairment was assumed to be reflected by increased jugular venous glutamate levels and decreased jugular venous oxygen saturation (SjvO(2)). ⋯ During pharmacologic coma increased ICP was associated with significantly decreased SjvO(2) which coincided only with a trend to increased cerebral glutamate release. Calculated AJVDglu appears to be inferior in unmasking altered brain metabolism compared to SjvO(2) whenever ICP is increased.