Minerva anestesiologica
-
Minerva anestesiologica · May 2014
Review Meta AnalysisHigh volume hemofiltration in critically ill Patients - a systematic review and Meta-analysis.
High volume hemofiltration (HVHF) has been proposed as method for blood purification, especially under the condition of systemic inflammatory syndromes. Our goal was to evaluate the effects of HVHF in critically ill patients. ⋯ No clear overall beneficial effect of HVHF or PHVHF compared to standard volume hemofiltration can be detected.
-
Minerva anestesiologica · May 2014
Hemodynamics and tissue oxygenation after hemodilution with ultrahigh molecular weight polymerized albumin.
Compared to blood transfusion, plasma expanders (PEs) are more cost effective, have a longer shelf-life, and elicit a milder immune response. High molecular weight (MW) dextrans preserve microvascular function during extreme hemodilution. Dextrans, however, evokes negative hemostatic effects, including red blood cell (RBC) aggregation and reduce platelet adhesion, that limit their clinical use. Therefore, polymerization of human serum albumin (HSA) presents a simple strategy to increase HSA's molecular size. ⋯ PolyHSA during extreme anemia supported systemic and microvascular hemodynamics by increasing plasma viscosity without increasing vascular resistance. These findings can aid to design of studies to understand the role of the PE biophysical properties in clinical scenarios.
-
Minerva anestesiologica · May 2014
Influence of apneic oxygenation and minimal tidal volumes on ventilator associated lung injury.
Protective tidal volumes such as 6 mL/kg can still result in tidal hyperinflation and expose the lung to mechanical stress. Further reduction of tidal volume and apneic oxygenation might mitigate lung injury. We aimed to assess the influence of minimal tidal volumes and apneic oxygenation in combination with arterio-venous extracorporeal lung assist (av-ECLA) on ventilator-associated lung injury. ⋯ In combination with highly effective CO2-removal, the reduction of tidal volumes up to 0 mL was feasible. Tidal hyperinflation could be reduced in the upper lung areas, yet inflammation in the lower lung was higher with low tidal volumes. This stresses the differing mechanical properties of inhomogeneous injured lungs.