Minerva anestesiologica
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Minerva anestesiologica · Mar 2014
Review Meta AnalysisA systematic review and individual patient data meta-analysis on intra-abdominal hypertension in critically ill patients: the wake-up project. World initiative on Abdominal Hypertension Epidemiology, a Unifying Project (WAKE-Up!).
Intra-abdominal hypertension (IAH), defined as a pathologically increase in intraabdominal pressure, is commonly found in critically ill patients. While IAH has been associated with several abdominal as well as extra-abdominal conditions, few studies have examined the occurrence of IAH in relation to mortality. The aim of this paper was to evaluate the prognostic role of IAH and its risk factors at admission in critically ill patients across a wide range of settings and countries. ⋯ Five hundred thirteen patients (30.8%) died in intensive care. The independent predictors for intensive care mortality were IAH, SAPS II score, SOFA score and admission category. This systematic review and individual patient data meta-analysis shows that IAH is frequently present in critically ill patients and it is an independent predictor for mortality.
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Minerva anestesiologica · Mar 2014
ReviewThe "Normobaric Oxygen Paradox": a new tool for the anaesthetist?
Hypoxia is the natural trigger for endogenous EPO production but recently the use of intermittent hyperoxia to stimulate EPO has been postulated and this phenomenon has been called the "normobaric oxygen paradox" (NOP). The "NOP" is a mechanism by which oxygen regulates the expression of the Hypoxia Inducible Factor 1 alpha (HIF-1α). The HIF-1α-depending gene regulation is responsible for many different genetic expressions including EPO and VEGF. ⋯ The precise level of inspired oxygen and the exact timeframe for its iterative administration are not totally known. N-Acetyl-L-Cysteine (NAC) supplementation has been shown to help. All the reported data demonstrate how hyperoxic and hypoxic states can potentially be manipulated if oxygen is been considered as a multifaceted molecule more than just a gas.
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Minerva anestesiologica · Mar 2014
ReviewMechanical circulatory support for acute heart failure in 2013: an update on available devices, indications and results.
Severe acute heart failure often requires some form of mechanical support to circulation. The use of intraaortic balloon counterpulsation in postinfarction cardiogenic shock - perhaps the most common scenario of this kind - has been recently questioned in the IABP SHOCK trial. ⋯ Moreover, advances in technology and a reducing number of donors are leading to more extended indications to the implantation of ventricular assist devices. Herein, we offer a focused review on recent articles dealing with mechanical support to circulation in acute heart failure, which we found relevant in terms of their possible impact on therapeutic strategies and indication.
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Minerva anestesiologica · Mar 2014
Prone Positioning During Veno Venous Extra Corporeal Membrane Oxygenation For Severe Acute Respiratory Distress Syndrome in Adults.
Veno-venous extracorporeal membrane oxygenation (VV-ECMO) is an effective rescue therapy for improving oxygenation in selected severe acute respiratory distress syndrome (ARDS). Prone position (PP) is usually considered before vvECMO and few data are available on the association of PP during VV-ECMO. Thus, we investigated the effect on oxygenation and the safety of PP during vvECMO. ⋯ PP may be considered in selected patients difficult to wean or remaining very hypoxemic despite VV-ECMO support.