Minerva anestesiologica
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In patients with septic shock, a mean arterial pressure higher than 65 mmHg is recommended by the Surviving Sepsis Campaign Guidelines. However, a precise mean arterial pressure target has not been delineated. The aim of this paper was to review the physiological rationale and clinical evidence for increasing mean arterial pressure in septic shock. ⋯ The SEPSISPAM Trial, a large prospective, randomized, controlled study, compared the targets of High (i.e. 80 to 85 mm Hg) versus Low (i.e. 65 to 70 mm Hg) mean arterial pressure in patients with septic shock. The mortality was not different in the two groups. However in patients with chronic hypertension, there were significantly less renal failure in the high mean arterial pressure group than the low mean arterial pressure group.
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Minerva anestesiologica · Jul 2016
Randomized Controlled TrialHow can postoperative delirium be predicted in advance? A secondary analysis comparing three methods of early assessment in elderly patients.
Postoperative impairment of the cerebral function can appear immediately after general anesthesia and may be predictive for a postoperative delirium. We compared three tools assessing patients on recovery room admission in order to detect early signs of postoperative brain dysfunction: the Postanesthetic Recovery Score (PARS), the Richmond Agitation-Sedation Scale (RASS) and the Nursing Delirium Screening Scale (Nu-DESC). ⋯ The RASS and Nu-DESC were independent predictors for a delirium within seven postoperative days. Very early assessment of the cerebral function may help to advance detection, prevention and treatment of postoperative delirium in elderly patients.
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Minerva anestesiologica · Jul 2016
Observational StudyMid-regional pro-adrenomedullin as prognostic biomarker in septic shock.
The aim was to ascertain the prognostic value of mid-regional pro-adrenomedullin (MR-proADM), measured within 24 hours from the onset of septic shock (SS). ⋯ In our study MR-proADM levels measured on admission correlates with 28-day mortality in patients with septic shock.
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Minerva anestesiologica · Jul 2016
Observational StudyProspective study of residual neuromuscular block and postoperative respiratory complications in patients reverted with neostigmine versus sugammadex.
Postoperative residual curarization (PORC) is an important complication of neuromuscular blocking drug (NMBD) use. This study evaluates the incidence of PORC in the Postanesthesia Care Unit (PACU), its relation to the type of muscle relaxant and reversal agent used, and its implication in the development of postoperative respiratory complications. ⋯ PORC in the PACU is associated to a greater incidence of major and minor respiratory complications. The use of rocuronium-sugammadex significantly reduces the incidence of PORC in the PACU.