Minerva anestesiologica
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Minerva anestesiologica · Mar 2016
Point-of-care coagulation management algorithms during ECMO support: are we there yet?
Haemorrhagic and thromboembolic events are common and the main cause for morbidity and mortality in patients treated with extracorporeal membrane oxygenation (ECMO). Monitoring of an adequate anticoagulation is, therefore, essential in patients during ECMO therapy. This review aims to describe the current evidence and emerging data relating to anticoagulation therapy and point-of-care (POC) coagulation monitoring in ECMO patients. ⋯ However, no single laboratory-based or POC coagulation test can reliably predict the emergence of haemorrhagic or thrombotic events. Further, treatment algorithms based on POC testing are scarce for ECMO patients. Larger prospective studies are necessary to evaluate the usefulness of POC coagulation monitors or a combination of them in potentially improving anticoagulation and decreasing haemorrhagic and thromboembolic complications.
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Minerva anestesiologica · Mar 2016
Serious renal and urological complications in fast-track primary total hip and knee arthroplasty; a detailed observational cohort study.
Overall medical complications have been reduced after fast-track total hip (THA) and knee arthroplasty (TKA), but data on specific renal and urological (RU) complications are limited. ⋯ The overall incidence of serious RU complications after fast-track THA and TKA was 0.61 %. AKI occurred in 0.49% and was most often due to pre-existing kidney disease and postoperative hypotension, calling for increased focus on perioperative fluid management and optimisation of the perioperative care of patients with pre-existing kidney disease.
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Minerva anestesiologica · Mar 2016
Near-zero difficult tracheal intubation and tracheal intubation failure rate with the "Besta Airway Algorithm" and "Glidescope® in morbidly obese" (GLOBE).
Unpredicted Difficult Tracheal Intubation (DTI) with Macintosh occurs frequently in obese patients. We investigated the incidence of DTI using an algorithm based on pre-operative assessment with the El-Ganzouri Risk Index (EGRI) and Glidescope® routine use. ⋯ The incidence of Difficult Tracheal Intubation and Intubation Failure was reduced to near-zero using Glidescope® and the Besta Airway Algorithm in this sample of morbidly obese patients.
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Minerva anestesiologica · Mar 2016
ReviewImmunonutrients in critically ill patients: an analysis of the most recent literature.
Modulation of inflammatory and immune response to critical illness has been the goal of much research in the last decade and a variety of drugs and nutrients (so called "immunonutrients") have been tested in experimental models with promising results. Though, in the clinical setting of intensive care, their efficacy have been inconsistently proven, most likely because the effects of each drug may vary in relation to the timing, the dose, the route of administration, the interaction with other nutrients, the severity of illness and many other factors. ⋯ Reviewing the latest evidence-based documents on this subject (multicenter trials, systematic reviews, meta-analyses and international guidelines), there is no convincing evidence that immunonutrients may be beneficial in the critically ill. Considering that these substances invariably increase the costs of health care and may be unsafe or even harmful in some subgroups, particularly in septic patients, we conclude that routine administration of immune-nutrients (glutamine, arginine, omega-3 fatty acids, selenium, etc.) cannot be currently recommended in the critically ill.