Minerva anestesiologica
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Minerva anestesiologica · Sep 2019
Long-term functional and psychological recovery in a population of ARDS patients treated with VV-ECMO and in their caregivers.
Acute respiratory distress syndrome (ARDS) survivors are affected with long-term physical/mental impairments, with improvements limited mostly to the first year after intensive care (ICU) discharge. Furthermore, caregivers of ICU patients exhibit psychological problems after family-member recovery. We evaluated the long-term physical and mental recovery of ARDS survivors treated with veno-venous extracorporeal membrane oxygenation (VV-ECMO), and the long-term psychological impact on their caregivers. ⋯ At almost three-year follow-up, ARDS survivors treated with VV-ECMO showed reduced health-related quality-of-life and high risk of psychological impairment, in particular PTSD. Caregivers of this population were at high psychological risk as well.
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Minerva anestesiologica · Sep 2019
Randomized Controlled Trial Multicenter Study Comparative StudyPostoperative analgesia and early functional recovery after day-case anterior cruciate ligament reconstruction: a randomized trial on local anesthetic delivery methods for continuous infusion adductor canal block.
This study assessed the effects of different local anesthetic delivery techniques for continuous adductor canal block, after arthroscopic day-case anterior cruciate ligament reconstruction (ACLR). ⋯ Intermittent boluses did not provide superior analgesia over continuous infusion for adductor canal block after outpatient ACLR, but significantly decreased the local anesthetic consumption. Both techniques are suitable for the early functional recovery.
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Minerva anestesiologica · Sep 2019
ReviewRole of automated pupillometry in critically ill patients.
Pupillary examination has fundamental diagnostic and prognostic values in clinical practice. However, pupillary assessment was relied until present on manual, qualitative, examination, using manual flash penlights or lamps. ⋯ The potential for quantitative pupillometry is multiple in the setting of critical care, for the monitoring and detection of secondary cerebral insults and to assess brainstem dysfunction and early coma outcome prognostication, and in the intra-operative anesthesiology setting, to assess analgesia and opioid requirement. Here, we describe the pupillometry technique and review recent critical care and anesthesiology studies that demonstrate the value and potential clinical utility of quantitative pupillometry as neuromonitoring bedside modality.
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Minerva anestesiologica · Sep 2019
ReviewPatient self-inflicted lung injury: implications for acute hypoxemic respiratory failure and ARDS patients on non-invasive support.
The role of spontaneous breathing among patients with acute hypoxemic respiratory failure and ARDS is debated: while avoidance of intubation with noninvasive ventilation (NIV) or high-flow nasal cannula improves clinical outcome, treatment failure worsens mortality. Recent data suggest patient self-inflicted lung injury (P-SILI) as a possible mechanism aggravating lung damage in these patients. P-SILI is generated by intense inspiratory effort yielding: (A) swings in transpulmonary pressure (i.e. lung stress) causing the inflation of big volumes in an aerated compartment markedly reduced by the disease-induced aeration loss; (B) abnormal increases in transvascular pressure, favouring negative-pressure pulmonary edema; (C) an intra-tidal shift of gas between different lung zones, generated by different transmission of muscular force (i.e. pendelluft); (D) diaphragm injury. ⋯ For them, current evidence indicates that high-flow nasal cannula alone may be superior to intermittent sessions of low-PEEP NIV delivered through face mask, while continuous high-PEEP helmet NIV likely promotes treatment success and may mitigate lung injury. The optimal initial noninvasive treatment of hypoxemic respiratory failure/ARDS remains however uncertain; high-flow nasal cannula and high-PEEP helmet NIV are promising tools to enhance success of the approach, but the best balance between these techniques has yet to be identified. During noninvasive support, careful clinical monitoring remains mandatory for prompt detection of treatment failure, in order not to delay intubation and protective ventilation.
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The growing number of laparoscopic surgical procedures performed in obese patients has increased the need to explore suitable analgesic techniques for a prone population to postoperative complications. The morbidly obese population may particularly benefit from the opioid-sparing or the opioid-free anesthesia/analgesia, which maximize the use of locoregional techniques. ⋯ Inadequate needle positioning, failed regional analgesia, and possible related risks must be counterbalanced by adequate evidence of effectiveness. The present article will discuss the pros and cons of TAP block in the treatment of obese patients.