Minerva anestesiologica
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Both the optimal caloric intake and the best route of delivery of nutrition to critically ill patients fuel an intense debate. Recently, two large pragmatic, multicenter, controlled, randomized clinical trials evaluated these issues in large cohorts of patients. In the CALORIES Study, the authors compared the parenteral with the enteral route as the most effective way to deliver early (e.g. within 36 hours from admission) nutritional support in critically ill adults in 33 English ICUs (N.=2388). ⋯ In the PermiT Study, 894 enterally fed patients from 7 ICUs were randomized to a restrictive strategy for non-protein calories (e.g. "permissive underfeeding" - 40% to 60% of energy expenditure) or to standard feeding (70 to 100% of energy expenditure) for up to 2 weeks. The primary endpoint (90-day mortality) was similar in both groups (27.2% in the permissive-underfeeding group and 28.9% in the standard-feeding group) without significant differences in feeding intolerance, diarrhea or ICU-acquired infections. We herein discuss how these studies should be interpreted with regard to the existing evidence and propose some practical suggestions for nutrition management in the critically ill patient.
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Minerva anestesiologica · Aug 2016
The Impact of patient controlled analgesia on prognosis of patients receiving major abdominal surgery.
Postoperative pain is a major disease burden after surgery. Patient-controlled analgesia has been wide used for pain management in surgical patients, yet, large-scaled studies are lacking to assess its impact on the prognosis of patients. ⋯ Intravenous patient-controlled analgesia was related to improved survival, less complications and chronic post-surgical pain after major abdominal surgery, reiterating the important role of pain management for the prognosis of patients who underwent surgery.
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Minerva anestesiologica · Aug 2016
Coagulation monitoring in postcardiotomy ECMO: conventional tests, point-of-care, or both?
The aim of this study was to assess the association of the coagulation point-of-care (POC) tests activated clotting time (ACT) and thromboelastography-derived parameters reaction time (R-time) and maximum amplitude (MA) with the standard coagulation tests during postcardiotomy extracorporeal membrane oxygenation (ECMO), finding adequate values predictive for the target range of the standard coagulation tests. ⋯ Diagnostic-therapeutic algorithms based on coagulation POC-tests may be useful to manage anticoagulation during postcardiotomy ECMO. The best PPV for prompting therapeutic decision is provided by a combination of ACT and visco-elastic tests.
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Minerva anestesiologica · Aug 2016
Validation of a novel index of hemorrhage using a lower body negative pressure shock model.
Vital signs are late indicators of blood loss in trauma patients. Indexed Heart to Arm Time (iHAT) is a non-invasive index based on a modified pulse transit time (mPTT) indexed to the time between R waves on the electrocardiogram (RR interval). We aimed to investigate how early iHAT is able to detect central hypovolemia during the progression from mild to severe simulated hemorrhage induced by applying lower body negative pressure (LBNP). ⋯ iHAT measures both the reduction in preload and the parabolic heart rate increase due to the linear decrease in stroke volume. iHAT was able to detect a progressive central volume loss in a model of hemorrhage in healthy volunteers undergoing LBNP. A rising trend in iHAT can be a useful marker for progressive volume loss during moderate to severe bleeding.