Minerva anestesiologica
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Minerva anestesiologica · Mar 2017
Utilizing bi-spectral index (BIS) for the monitoring of sedated adult ICU patients: a systematic review.
The ideal level of sedation in the ICU is an ongoing source of scrutiny. At higher levels of sedation, the current scoring systems are not ideal. BIS may be able to improve both. We evaluated literature on effectiveness of BIS monitoring in sedated mechanically ventilated (MV) ICU patients compared to clinical sedation scores (CSS). ⋯ BIS monitoring in the mechanically ventilated ICU patient may decrease sedative drug dose, recall, and time to wake-up. The studies suggesting this are severely limited methodologically. BIS, when compared to subjective CSSs, is not, at this time, clearly indicated. An appropriately powered randomized, controlled study is needed to determine if this monitoring modality is of use on the ICU.
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Severe injuries such as severe sepsis, burn, trauma and major surgery lead to an overlapping development of pro- and anti- inflammatory responses. It is now well established that these injuries are associated with the secondary development of immune suppression, which results in significant morbidity and mortality. ⋯ In the present review, we discuss potential biomarkers of injury-induced immunoparalysis, mainly focusing on these that have been associated with poor outcome in various clinical settings. We namely present clinical data on monocyte human leukocyte antigen DR, lymphopenia, PD-1/PD-L1 and transcriptomic approach.
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Minerva anestesiologica · Mar 2017
Altered liver function in patients undergoing veno-arterial extracorporeal membrane oxygenation (ECMO) therapy.
Multiple organ dysfunction can occur in patients undergoing Veno-arterial Extra Corporal Membrane Oxygenation (VA-ECMO); however, liver function has not been well studied in this setting. ⋯ A substantial proportion of patients needing VA-ECMO have early ELE, which usually improves over days. The prognostic implications are not evident.