Minerva anestesiologica
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Minerva anestesiologica · Feb 2014
Postoperative hemoglobin levels and its association with myocardial ischemia in non-cardiac surgical patients.
Low hemoglobin (Hb) levels as well as cardiac complications are common conditions in postoperative surgical patients and both are associated with poor outcome. The aim of this study was to determine the influence of postoperative Hb levels on myocardial ischemia in high-risk patients who underwent non-cardiac surgery. ⋯ Postoperative Hb levels are independently associated with postoperative myocardial ischemia in high-risk patients undergoing non-cardiac surgery.
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We organized a training program for oral fiber optic intubation (FOI) under conscious sedation. The efficacy of the program was evaluated by comparing the performances of experts and novices. ⋯ This study highlights the importance of a structured FOI training program, demonstrating that it is possible to learn to perform FOI proficiently by practicing on dummies.
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Minerva anestesiologica · Feb 2014
Observational StudyUse of B-type natriuretic peptides to detect the existence and severity of diastolic dysfunction in non-cardiac critically ill patients: a pilot study.
This observational study was designed to evaluate and compare the usefulness of BNP and NT-proBNP concentrations to detect the existence and severity of left ventricular diastolic dysfunction (LVDD) in critically ill patients. ⋯ Both BNP and NT-proBNP are useful screening tools to detect the presence of advanced degrees of LVDD, and especially to rule out elevated filling pressures.
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Minerva anestesiologica · Feb 2014
Randomized Controlled TrialImpact of PEEP during laparoscopic surgery on early postoperative ventilation distribution visualised by electrical impedance tomography.
General anesthesia, mechanical ventilation and pneumoperitoneum affect ventilation distribution at different extent. It should be clarified if an intraoperative positive end-expiratory pressure (PEEP) level of 10 cmH2O influences early postoperative ventilation. Electrical impedance tomography (EIT) was used to assess changes in regional ventilation. ⋯ Changes of postoperative ventilation can be imaged by EIT. Intraoperative PEEP ventilation has a positive effect on early postoperative ventilation distribution, even though not all PEEP patients benefit from mechanical PEEP ventilation the same way. Intraoperative PEEP results in a more homogeneous ventilation distribution by trend.
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During the last decade, inhaled antibiotics, especially colistin, has been widely used worldwide as a therapeutic option, supplementary to conventional intravenous antibiotics, for the treatment of multidrug-resistant (MDR) Gram-negative nosocomial and ventilator-associated pneumonia (VAP). Antimicrobial aerosols are commonly used in mechanically ventilated patients with VAP, although information regarding their efficacy and optimal technique of administration has been limited. Recent studies showed that the administration of inhaled antibiotics in addition to systemic antibiotics provided encouraging results associated with low toxicity for the management of VAP mainly due to MDR Gram negative bacteria. ⋯ Additionally, this route of antibiotic delivery has not been approved until now neither by the FDA nor by the European Medicines Agency (EMEA) in patients with VAP. However, since the problem of VAP due to MDR bacteria has been increased worldwide RCTs are urgently needed in order to prove the safety, efficiency and efficacy of inhaled antimicrobial agents administered alone or in conjunction with parenteral antibiotics for the management of VAP in critically ill patients. Indeed, more data are needed to establish the appropriate role of inhaled antibiotics for the treatment of VAP.