Minerva anestesiologica
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Minerva anestesiologica · Oct 2016
ReviewThe risk of infusing gelatin? Die-hard misconceptions and forgotten (or ignored) truths.
Fluid therapy is considered a cornerstone of perioperative and critical care medicine. However, the type of fluids used varies widely among different countries. Synthetic colloids may negatively affect coagulation and are potentially nephrotoxic. "Modern" hydroxyethyl starches (HES) were widely used until recently when their association to mortality and renal replacement therapy risk among critically ill patients brought to restriction by the European Medicines Agency in 2013. ⋯ The aim of this contribution is to warn clinicians that gelatins share all potential adverse effects of other synthetic colloids, and are possibly even more nephrotoxic than HES. Moreover, gelatins have no beneficial effects on outcomes as compared with crystalloids (on the contrary, they might even increase mortality), and are also more expensive. Accordingly, a "return" to gelatins should be strongly discouraged.
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Minerva anestesiologica · Oct 2016
Randomized Controlled TrialA comparison of three videolaryngoscopes for double-lumen tubes intubation in simulated easy and difficult airways. A randomised trial.
The King Vision™ (KVL) and Airtraq® videolaryngoscopes may reduce the time to double lumen tube (DLT) intubation compared to the GlideScope® and MacIntosh in simulated easy and difficult airways. ⋯ The Airtraq® and non-channeled KVL required more time over the MacIntosh for DLT intubation, as a primary outcome, but the success rates for the 3 videolaryngoscopes were very high.
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Minerva anestesiologica · Oct 2016
Right ventricle dilation as a prognostic factor in refractory ARDS requiring VV-ECMO.
The aim of this study was to assess the incidence and prognostic role of echocardiographic abnormalities in consecutive patients with refractory acute respiratory distress syndrome (ARDS) before veno-venous extracorporeal membrane oxygenation (VV-ECMO). ⋯ At echocardiography, 25 patients showed normal findings (33.8%), 32 patients exhibited isolated pulmonary hypertension (43.2%) and the remaining 17 patients showed RV dilation and pulmonary hypertension (23%). A reduced LVEF (<50%) was observed in 14 patients (18.9%), while RV dysfunction (as indicated by TAPSE<16 mm) was documented in 21 patients (28.4%). The in-Intensive Care Unit [ICU] mortality rate was 41.8%. At stepwise regression analysis the following variables were independent predictor for in-ICU mortality (when adjusted for TAPSE<16 mm): RV end diastolic area/LV end diastolic area (OR 0.21, 95%CI 0.062-0.709, P=0.012), Body Mass Index (BMI) (OR 0.87, 95%CI 0.802-0.958, P=0.004) CONCLUSIONS: In consecutive patients with refractory ARDS, echocardiographic alterations were common, mainly represented by systolic pulmonary hypertension associated or not with RV dilatation. Moreover, RV dilatation and BMI were independent predictors of in-ICU mortality. On clinical grounds, our findings strongly suggest that echocardiography helps to risk stratifying patients with refractory ARDS requiring VV-ECMO.