Minerva anestesiologica
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Minerva anestesiologica · Sep 2013
ReviewLactate or ScvO2 as an endpoint in resuscitation of shock states?
In the current management of critically ill patients, variables such as blood pressure, urine output or central venous pressure guide resuscitative efforts. Unfortunately, global tissue hypoxia may persist leading to multiple organ failure and death. To address tissue well-being, indices such as central venous oxygen saturation (ScvO2) and Lactatemia are widely used and are strongly linked to outcome. ⋯ Nevertheless, choosing one index over the other remains controversial. Herein, we review the physiology and rationale for ScvO2 and lactate monitoring. Clinical uses, evidence-based outcome implications and limitations are also examined to aid the clinician in daily practice.
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Minerva anestesiologica · Sep 2013
Randomized Controlled Trial Comparative StudyComparison of oxidative stress in ASA physical status I patients scheduled for minimally invasive surgery under balanced or intravenous anesthesia.
The effects of anesthetics on inflammation and oxidative parameters, evaluated in patients without comorbidities undergoing minor surgery, remain unknown. The present study aimed to investigate the inflammatory and oxidative stress status in adult patients undergoing elective minimally invasive surgery, using different anesthetic techniques. ⋯ BAL anesthesia maintained with isoflurane and TIVA maintained with propofol are safe by virtue of not causing oxidative stress status in ASA physical status I patients undergoing minimally invasive surgeries. Moreover, even in minor surgeries, TIVA with propofol produces an antioxidant effect in patients.
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Minerva anestesiologica · Sep 2013
Multicenter Study Observational StudyEpidemiology and outcome of sepsis syndromes in Italian ICUs:A multicentre, observational cohort study in the region of Piedmont.
Sepsis is an important cause of mortality and morbidity in the intensive care unit (ICU). We performed a study to describe the epidemiology of sepsis syndromes in patients admitted to ICUs of the Piedmont region. ⋯ Sepsis is a common occurrence in critically ill patients. Our data underscore the regional variability in the epidemiology and outcome of sepsis syndromes and may be useful to guide appropriate resource allocation.
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Minerva anestesiologica · Sep 2013
ReviewECMO in acute and chronic adult respiratory failure: recent trends and future directions.
Extracorporeal membrane oxygenation (ECMO) can be used to preserve or enhance systemic oxygen delivery in patients with refractory cardiac or respiratory failure. Although widely accepted as a standard of care for many indications in children and for adult cardiogenic shock, ECMO for adult respiratory failure is more controversial. ⋯ In spite of this, there is probably now more evidence to support the use of ECMO in refractory acute respiratory distress syndrome than for any other form of rescue therapy. The purpose of this review is to update clinicians regarding trends in ECMO research over the last 12 months and speculate on how the clinical use of ECMO and associated technology will evolve.