Minerva anestesiologica
-
Minerva anestesiologica · Oct 2016
Point-of-care-based protocol with first-line therapy with coagulation factor concentrates is associated with decrease allogenic blood transfusion and costs in cardiovascular surgery: an Italian single-center experience.
Transfusion in patients having cardiac surgery has been associated with increased morbidity, mortality, and costs. This analysis assessed the impact of a rotational thromboelastometry (ROTEM®)- and functional platelet assessment (Multiplate®)-based protocol for bleeding management on perioperative outcomes and costs in patients undergoing cardiac surgery. ⋯ ROTEM-guided bleeding management in patients undergoing cardiac surgery was cost-effective and associated with an increase of administration of coagulation factor concentrates and a decrease of ICU length of stay.
-
Minerva anestesiologica · Oct 2016
Hazards of intubation in the ICU: role of nasal high flow oxygen therapy for preoxygenation and apneic oxygenation to prevent desaturation.
Acute respiratory failure is one the most common motives for intensive care unit admission. Although results from recent studies with high flow nasal oxygen have challenged our current management of these patients, a substantial number of them will require invasive mechanical ventilation and tracheal intubation. Life-threatening hypoxemia is the most frequent complication of these intubations. ⋯ Studies comparing high flow oxygen to noninvasive ventilation are ongoing and will help clarify the indications of each technique. This paper aims to show the evidence on the potential high flow nasal oxygen bears to improve preoxygenation for intubation outside the operating room. A practical algorithm to decide which preoxygenation device to use is proposed.