Minerva anestesiologica
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Minerva anestesiologica · Mar 2016
ReviewHow to optimize and use predictive models for postoperative pulmonary complications.
Pulmonary complications are a source of greater postoperative morbidity and mortality and longer hospital stays. Although many factors have been implicated as predictors, few models have been developed with the rigorous methodology required for clinically useful tools. ⋯ Above all, we stress that we still lack evidence for the clinical and cost effectiveness of many measures proposed for reducing risk or for managing complications perioperatively. For a good predictive model to truly prove its utility in clinical decision-making, such evidence is required.
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Minerva anestesiologica · Mar 2016
Review'Why can't I give you my organs after my heart has stopped beating?' An overview of the main clinical, organisational, ethical and legal issues concerning organ donation after circulatory death (DCD) in Italy.
Donation after circulatory death (DCD) is a valuable option for the procurement of functioning organs for transplantation. Clinical results are promising and public acceptance is quite good in most western countries. Yet, although DCD is widespread in Europe, several problems still persist in Italy as well as in some other countries. ⋯ Currently, as regards DCD, Italy is somewhat different from other countries. Therefore, every effort should be made for the safe and effective implementation of DCD programs: uncontrolled DCD programs should be promoted and encouraged, within the framework of shared and authoritative rules. At the same time, we need to tackle the question of controlled DCD, promoting debate among all involved subjects regarding the fundamental issues of end-of-life care within protocols that best integrate the highest standard of care for the dying and the legitimate interests of those awaiting a life-saving organ.
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Minerva anestesiologica · Mar 2016
ReviewThe role of genomics to identify biomarkers and signaling molecules during severe sepsis.
Early strategies to diagnose, manage and predict outcome of sepsis are essential to further improve morbidity and mortality of sepsis. Whereas biomarkers have become mainstay in other fields of medicine, their clinical utility in sepsis remains generally much less proven and so biomarkers are much less used clinically. The Human Genome Project embellished genomics, transcriptomics, proteomics and metabolomics and continues to expand our knowledge of the genetic, gene expression, protein translational and metabolic discoveries that could lead to clinical biomarker tests related to sepsis thereby allowing insight into the disease as never seen before. We explore the genomic approach to biomarker identification and validation by reviewing pertinent studies related to the diagnosis (diagnostic biomarkers), prediction of response to therapies (predictive biomarkers) and (prognostic biomarkers) outcomes of sepsis.
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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.
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Minerva anestesiologica · Mar 2016
Comparative StudyComparison of blood culture and multiplex real-time pcr for the diagnosis of nosocomial sepsis.
In many cases of suspected sepsis, causative microorganisms cannot be isolated. Multiplex real-time PCR generates results more rapidly than conventional blood culture systems. ⋯ SeptiFast may be useful when added to blood culture in the diagnosis and management of sepsis.