Minerva anestesiologica
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Minerva anestesiologica · Feb 2013
Manuscript title: Super Refractory Status Epilepticus: The development of a paradigm for critical care management.
Super Refractory status epilepticus (SRSE) is a sub category of status epilepticus recently defined as seizures that persist following 24 hours of critical care sedation. SRSE is associated with a high morbidity and mortality. ⋯ The majority of the published literature relates to anecdotal reports, case series, reviews and opinion. The objective of this review is to consolidate the knowledge of the treatment of SRSE and develop a management paradigm providing a clear clinical guide to future clinical management and clinical trials.
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Minerva anestesiologica · Feb 2013
ReviewLung imaging in patients with acute respiratory distress syndrome: from an understanding of pathophysiology to bedside monitoring.
Over the last 25 years, lung imaging has changed our understanding of acute respiratory distress syndrome. Alveolar recruitment, hyperinflation, and positive end-expiratory pressure-induced changes in lung aeration have become evaluable using CT, PET, and ultrasonography. ⋯ Bedside tools allowing monitoring of mechanical ventilation, and testing of ventilator settings, are urgently required. The aim of the present review is to consider how lung imaging has facilitated the evolution of knowledge of this syndrome, and to place such knowledge in a clinical perspective.
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The aim of the present study was to evaluate the frequency of different techniques, indications, timing, as well as procedural features, sedation and ventilation protocols, early and late complications of tracheostomy in Intensive Care Unit (ICU). ⋯ Percutaneous tracheostomy is well established in Italian ICUs and CBR is the most popular technique performed in patients requiring prolonged mechanical ventilation. Tracheostomy is usually performed by a dedicated team using a specific sedation-analgesia-neuromuscular blocking and ventilation protocol, guided by fiberoptic bronchoscope and/or neck ultrasounds. Bleeding controlled by compression was the most common early and late complication.