Minerva anestesiologica
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Minerva anestesiologica · Feb 2012
ReviewBridging to lung transplantation by extracorporeal support.
Ideally, bridging patients with end stage severe respiratory failure to lung transplantation should significantly extend the pretransplant life expectancy to increase the chances to receive a suitable organ, as well as efficiently preserve the post-transplant long-term life expectancy by maintaining physiological homeostasis and avoiding multi-organ dysfunction. Various advanced strategies of extracorporeal circulation can replace at least in part the respiratory function of the lung and can potentially provide the appropriate mode and level of cardiopulmonary support for each patient's physiologic requirements. Therefore, patients on the lung transplant waiting list developing severe hypoxemic and/or hypercapnic respiratory failure can be supported for a prolonged period of time before the transplant, preserving a satisfactory post-transplant life expectancy. However, a more systematic clinical study on this issue is warranted in order to define the actual efficacy of these treatments in reducing the mortality rate on the waiting transplant list, and eventually improve the outcome of patients with end stage respiratory failure.
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Minerva anestesiologica · Feb 2012
ReviewAcute and chronic pain: where we are and where we have to go.
In recent years, increasing attention has been focused on the treatment of acute and chronic pain with a considerable number of publications about it. Nevertheless all the attention focused on it, the evidence of pain treatments is still unfolding, and occasionally conflicting. Hence it is still necessary that we point out our research efforts in trying to obtain a better understand of pathophysiology of pain and of real efficacy and safety of acute and chronic pain treatments. ⋯ As opioids are currently widely used to control chronic oncologic and non-oncologic pain, in this review we analyzed the level of evidence for their use, how to manage them better and psychological factors that can affect their success and/or determine addiction. Finally, we summarized the current evidence about Failed Back Surgery Syndrome focalizing our attention both in diagnosing it correctly and treating this syndrome with specific knowledge of the anatomic space that we have to approach and applying the possible treatments depending on pain pathophysiology and patient characteristics. In conclusion, it is important to try to personalize even better the therapy of patients with acute and chronic pain through a more accurate knowledge of anatomy, pathophysiology of pain, pharmacokinetic of pain drugs and of new device/therapies available.
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Minerva anestesiologica · Feb 2012
Comparative StudyComparison of newer scoring systems with the conventional scoring systems in general intensive care population.
The aim of this study was to assess the performance of Acute Physiology and Chronic Health Evaluation (APACHE) IV, Simplified Acute Physiology Score (SAPS) III, and Mortality Probability Model (MPM) III0 and compare these systems to more widely validated prognosis prediction tools like APACHE II, III, SAPS II, MPM II0 and Sequential Organ Failure Assessment (SOFA) score. ⋯ Overall, the newer scoring systems performed better than their older counterparts and were more accurate. Nevertheless, the difference in efficacy was not statistically significant and the choice of scoring system may depend on the ease of use and local preferences.