Minerva anestesiologica
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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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Minerva anestesiologica · Feb 2014
ReviewA Review of Therapeutic Attempts to Recruit the Microcirculation in Patients with Sepsis.
Microcirculatory dysfunction is a pivotal element of the pathogenesis of severe sepsis and septic shock. Technological development, including sidestream darkfield videomicroscopy, now allows for bedside assessment of the microcirculation. A number of clinical studies have established the importance of the microcirculation in sepsis. The objective of this review is to discuss human trials that have assessed interventions aimed at improving microcirculatory flow in patients with sepsis.
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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.
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Minerva anestesiologica · Feb 2014
Randomized Controlled TrialUltrasound-guided oblique subcostal transversus abdominis plane block for analgesia after laparoscopic cholecystectomy; a randomized, controlled,observer-blinded study.
The oblique subcostal transversus abdominis plane (OSTAP) block has been described as an effective analgesic method for upper abdominal surgery. We evaluated the postoperative analgesia of the OSTAP block and compared it with that of the transversus abdominis plane (TAP) block in patients undergoing laparoscopic cholecystectomy (LC). ⋯ The OSTAP block can provide better analgesia than the TAP block or standard care during the postoperative 24 h period in patients undergoing LC.
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Minerva anestesiologica · Feb 2014
CommentEsmolol for septic shock: more than just heart rate control?
Excessive adrenergic stimulation may be associated with several adverse events and contribute to increase mortality in critically ill septic patients. Few clinical data exist on the effects of adrenergic blockade in this setting. The objective of this study was to investigate the effect of a short acting b-blocker (esmolol) in septic shock patients. ⋯ Mortality was 49.4% in the esmolol group and 80.5% in the control group (P<0.01). This is the first study showing an improvement in cardiac function and 28-day mortality in septic patients adding b-blockers to standard therapy. We discussed several statistical and methodological limitations that may influence the generability of these results.