Minerva anestesiologica
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Minerva anestesiologica · Sep 2011
ReviewAre guidelines for non-invasive ventilation during weaning still valid?
Noninvasive ventilation (NIV) has gained increasing acceptance over the years to reduce endotracheal intubation, pneumonia and to prevent or treat respiratory failure in patients with different diagnoses. The international consensus conference, and the British society guidelines on NIV ventilation have analyzed its use during the weaning phase concluding that there were still conflicting results of its use. However, recent clinical trials have shown clear clinical benefits on the use of NIV in several patient populations during the weaning period. ⋯ The latest published randomized trials on the application of NIV for acute respiratory failure following extubation failed to demonstrate any favorable outcome. Even so, the use of NIV during the process of weaning in patients experiencing multiple weaning failure or as a preventive therapy in patients at higher risk of respiratory deterioration showed improved clinical outcomes only in chronic obstructive pulmonary disease and in particular in hypercapnic patients. Reduced invasive mechanical ventilation, tracheostomy and lower mortality rate at 90 days were the major advantages.
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Minerva anestesiologica · Sep 2011
ReviewEnd of life care in Italian intensive care units: where are we now?
Most patients in the ICU are unable to make decisions for themselves at the end of life (EOL), and the responsibility for these decisions falls to the medical staff and patients' relatives. Therefore, clinicians must frequently communicate with patients' relatives to understand the patients' values and preferences as they perform medical decision making. The family's role in this process varies: the entire burden of decision making could rest with the family, or family members could be informed of the decisions without admission into the decision-making process. ⋯ In this latter scenario, the effectiveness of the discussions that take place between clinicians and family members becomes a crucial marker of high-quality intensive care. In this review, we provide an overview of the current literature concerning the state of EOL care in European and Italian ICUs and then summarize several European and American recommendations for improving EOL care in the ICU. Finally, we examine the opportunity to use shared decision making to improve EOL care in the ICU through interdisciplinary communication, open and realistic discussion of prognosis with families, and an approach respecting different cultural perspectives.
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Minerva anestesiologica · Sep 2011
Electrophysiologic neuromonitoring during repair of the thoracoabdominal aorta by anesthesiologists.
Surgical repair of the thoracoabdominal aorta is associated with risk of spinal ischemia. Electrophysiologic neuromonitoring reduces this risk, but is usually performed by neurophysiologists not always available. In this study repair of the thoracoabdominal aorta monitored by anesthesiologists has been investigated. ⋯ Electrophysiologic neuromonitoring during surgical repair of the descending aorta can be successfully provided by anesthesiologists and should be predominately encouraged where neurophysiologists are not available due to organizational or financial shortcomings.
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Minerva anestesiologica · Sep 2011
Management of acute respiratory complications from influenza A (H1N1) infection: experience of a tertiarylevel Intensive Care Unit.
The novel influenza A (H1N1) pandemic was associated with an epidemic of critical illness. ⋯ In the majority of our patients, critical illness caused by pandemic influenza A (H1N1) was associated with severe hypoxemia, multiple organ failure, requirement for mechanical ventilation and frequent use of rescue therapies and ECLS support.
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Minerva anestesiologica · Sep 2011
Systemic adverse events during 2005 phacoemulsifications under monitored anesthesia care: a prospective evaluation.
The aim of the study was to evaluate the systemic adverse events triggering on-call anesthesiologist's intervention during 2005 phacoemulsification under topical anesthesia on a day-surgery monitored anesthesia care regimen. ⋯ One-day cataract surgery performed under topical anesthesia with monitored anesthesia care required anesthesiologist intervention in 21.6% of cases, mainly because of agitation or hypertension. Agitation occurred more often in younger patients with neurological or psychiatric comorbidities. Hypertension occurred more often in older patients with higher ASA scores.