Minerva anestesiologica
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Minerva anestesiologica · Jun 2019
Randomized Controlled TrialClosed loop administration of propofol based on a Smith predictor: a randomized controlled trial.
Delay in the propofol pharmacodynamics effect is commonly observed in total intravenous anesthesia (TIVA). To face the delay in the hypnosis control, we have proposed a proportional-integral (PI) controller with a Smith predictor (PI+Smith). We have evaluated the feasibility of this closed-loop control for propofol administration and compared the performance with manual administration guided by the Bispectral Index (BIS). ⋯ The use of a specific mechanism in the PI controller to deal with the delay outperformed satisfactorily manual practice. The controller was able to regulate propofol administration, maintaining the BIS value within a desirable range and coping with oscillations.
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Minerva anestesiologica · Jun 2019
ReviewPatient-ventilator asynchrony in adult critically ill patients.
Patient-ventilator asynchrony is considered a major clinical problem for mechanically ventilated patients. It occurs during partial ventilatory support, when the respiratory muscles and the ventilator interact to contribute generating the volume output. In this review article, we consider all studies published on patient-ventilator asynchrony in the last 25 years. ⋯ Given the varying outcomes considered and the erratic results, it remains unclear whether asynchronies really affects patient outcome, and the relationship between asynchronies and outcome is causative or associative.
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Minerva anestesiologica · Jun 2019
Levels of circulating microparticles in septic shock and sepsis-related complications: a case-control study.
Microparticles (MP) have been largely studied as potential biomarkers in septic shock (SS) though their biological and clinical relevance is still unclear. This case-control study describes the trend of various MP subtypes during SS to evaluate their possible association with severity of illness and sepsis-related complications (disseminated intravascular coagulation [DIC] and acute kidney injury [AKI]). ⋯ A global response through extra-vesiculation of endothelial cells, leukocytes and platelets during the early stages of SS was confirmed. The cellular activation was detected until day 3 after diagnosis. PMP/platelets ratio at diagnosis may be useful to evaluate SS severity and DIC occurrence.
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Minerva anestesiologica · Jun 2019
Clinical Trial Observational StudyFrequency, predictive factors and therapy of Emergence Delirium: data from a large observational clinical trial in a broad spectrum of postoperative pediatric patients.
Emergence delirium (ED) is an important postanesthetic complication in children. Although it has been thoroughly studied, data on frequency, predictive factors, and therapy of this phenomenon are inconclusive. In this study, we seek to obtain a better understanding of the frequency of ED and different therapeutic approaches, making use of the large amount of patients in our university hospital. ⋯ ED was less frequently diagnosed than expected. In spite of its self-limited nature, an additional pharmacological treatment was necessary in one quarter of children with ED.
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Abstract