Minerva anestesiologica
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Acute respiratory failure (ARF) in cancer patients remains a frequent and severe complication, despite the general improved outcome over the last decade. The survival of cancer patients requiring ventilatory support in Intensive Care Unit (ICU) has dramatically improved over the last years. The diagnostic approach, including an invasive strategy using fiber optic bronchoscopy or a non-invasive strategy, must be effective to identify a diagnostic, as it is a crucial prognostic factor. ⋯ The number of organ failure at admission and over the first 7 ICU days governs outcomes. Ventilatory support can thus be included in different management contexts: full code management with unlimited use of life sustaining therapies, full code management for a limited period, no-intubation decision, or the use of palliative NIV. The objectives of this review article are to summarize the modified ARF diagnostic and therapeutic management, induced by improvements in both intensive care and onco-hematologic management and recent literature data.
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Minerva anestesiologica · Jun 2014
ReviewUpdate on haemodynamic monitoring and management in septic patients.
Severe sepsis and septic shock are associated with significant mortality. Effective management of this clinical syndrome includes early resuscitation with fluids and vasoactive drugs to maintain vital organ perfusion and oxygen delivery. Understanding the different approach to the management of sepsis during the resuscitation and ongoing management phases is essential to initiate context- and time-specific interventions. ⋯ Minimally invasive and completely non-invasive cardiac output monitors have been developed, but require validation in this specific cohort of patients. The trend in hemodynamic parameters is particularly important when any intervention to augment cardiac output is carried out (functional hemodynamic monitoring). Cardiac output monitors and surrogates of tissue oxygenation are only able to guide management, as patient outcome is determined by acquisition and interpretation of accurate data, and suitable management decisions.
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Minerva anestesiologica · Jun 2014
Assessment of Perioperative Transfusion Requirement for Cirrhotic Patients Undergoing Elective Hepatectomy.
The possibility of outlining a risk profile for perioperative blood transfusion of cirrhotic patients submitted to hepatic resection can help to rationalize transfusion policy. ⋯ The risk profile for transfusion of cirrhotic patients undergoing hepatectomy can be better assessed with a model that combines already known clinical factors and hepatic function indexes.
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Minerva anestesiologica · Jun 2014
A pharmacokinetic study of 48-hour sevoflurane inhalation using a disposable delivery system (AnaConDa©) in ICU patients.
Little is known regarding sevoflurane kinetics and toxicity during long-term sedation of intensive care unit (ICU) patients using the AnaConDa® system. The objective of the present study was to establish a pharmacokinetic description of 48-h sevoflurane administration, and to estimate plasma concentrations of metabolites. ⋯ Following 48 hours of sedation using sevoflurane inhalation administered using an AnaConDa® delivery device, sevoflurane washout was rapid. Plasma fluoride levels accumulated over the study period without apparent nephrotoxicity.