Minerva anestesiologica
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Minerva anestesiologica · Dec 2012
ReviewLimits and pitfalls of haemodynamic monitoring systems in liver transplantation surgery.
Cardiac output (CO) and other hemodynamic variables measured during liver transplantation are often obtained by pulmonary artery catheter (PAC) and in many centers by the transthoracic thermodilution method and/or intraoperative transesophageal echocardiography (TEE). Newer non-invasive technology, such as the PiCCO(®) system, the LiDCO(®) Plus monitor, and the FloTrac/Vigileo(®), have been proposed as more reflective of ongoing hemodynamic response to intraoperative manoeuvres. In contrast to the standard "semicontinuous" thermodilution method, which gives information over a set period of time, the new monitoring systems use a different time period or measure over a running several beat average. ⋯ However, as the use of these technologies has spread, so has the understanding of their limitations. This has led to an increased scepticism among the previously enthusiastic "pioneering" practitioners. Given the poor agreement reported in various studies on liver transplant surgery between PAC and the new "calibrated" and "uncalibrated"-derived measurements, multicenter trials aiming at evaluating the performance of the non-invasive methods in different hemodynamic conditions and dedicated monitoring-driven treatment protocols are necessary.
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Minerva anestesiologica · Dec 2012
ReviewBiomarkers for acute kidney injury in critically ill patients.
Acute kidney injury (AKI) is a common and frequently fatal illness in critically ill patients, with a high associated-mortality. Early recognition of kidney injury and prompt corrective measures may improve outcome. Finding an early, accurate and reproducible biomarker for AKI is a research priority. ⋯ However, their ability to predict worsening of AKI and need for renal replacement therapy (RRT) is not clear, and current available data are insufficient to recommend the use of these biomarkers routinely for clinical decision-making. Thus, using a combination of different urinary and plasma biomarkers and clinical observations, such as oliguria, may modify the clinical variability for therapeutic interventions, such as RRT initiation, and improve outcome. The purpose of this review was to summarize recent findings concerning biomarkers for AKI, especially in the intensive care unit setting, to highlight their strengths and weaknesses, and to determine their usefulness in clinical practice.
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Minerva anestesiologica · Dec 2012
Randomized Controlled TrialSoft tissue depression at the iliac crest prominence: a new landmark for identifying the L4-L5 interspace.
One of the most common approaches to identifying the L4-L5 interspace is using the iliac crest as a landmark. We propose a new landmark to identify the L4-L5 interspace based on the soft tissue depression palpable at the iliac crest prominence. The aim of this study was to assess the reliability and time saving when using this new landmark compared to using the iliac crest to perform a lumbar plexus block. ⋯ Use of the palpable soft tissue depression at the iliac crest prominence for performing a lumbar plexus block offered several potential advantages over the standard inter-iliac crest approach.
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Minerva anestesiologica · Dec 2012
Performance of SAPS II and SAPS III scores in post-cardiac arrest.
Cardiac arrest is a major public health issue affecting an estimated 300,000 patients in the United States each year. The American Heart Association has recommended the Simplified Acute Physiology Score II and III (SAPS) to assess severity of illness and to predict outcomes in the post-cardiac arrest population. Our objective was to determine if SAPS II and SAPS III scores predict outcomes in post-cardiac arrest patients. ⋯ SAPS II and SAPS III scores have only moderate discrimination and are not clinically relevant tools to predict outcome in post-cardiac arrest patients. Further study is needed to identify a more reliable severity of illness score in the post-arrest population.
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The aim of this paper was to study long-term survival in patients treated in the Intensive Care Unit (ICU) and who survived to hospital discharge. ⋯ Patients who survive ICU treatment have a high risk of dying during the next year. This risk is almost as great the risk of dying during ICU and hospital treatment and increases with age and illness severity on admission to the ICU.