Minerva anestesiologica
-
The standard conditions of critical illness (including sepsis, acute respiratory distress syndrome, and multiorgan failure) cause enormous global mortality and a growing economic burden. Increasing evidence suggests that critical illness may be associated with loss of commensal microbes and overgrowth of potentially pathogenic and inflammatory bacteria. ⋯ Although the precise mechanisms of microbiome-directed treatments such as prebiotics, probiotics, and fecal microbiota transplantation remain to be determined, they can be utilized in the Intensive Care Unit (ICU) setting. The current review aims to offer intensivists an evidenced-based approach on what we currently know about the role of the microbiome in critical illness and how the microbiome could be targeted in the clinical practice to improve ICU-related outcomes.
-
Prognostic models are often used to assess the quality of healthcare. Several scores were developed to predict mortality after cardiac surgery, but none has reached optimal performance in subsequent validations. We validate the most used scores (EUROSCORE I and II, STS, and ACEF) on a cohort of cardiac-surgery patients, assessing their robustness against case-mix changes. ⋯ Cardiac surgery scores calibrate poorly when the case-mix of validation and development samples differs. To grant reliability for benchmarking, they should be validated in the clinical settings on which they are applied and updated periodically. Advanced statistical tools are essential for the correct interpretation and application of severity scores.
-
Minerva anestesiologica · Jul 2020
Observational StudyInfluence of mechanical ventilation and loading modifications on left ventricular global longitudinal strain in patients undergoing general anesthesia. A pilot study.
The modifications of left ventricular systolic function assessed with global longitudinal strain (GLS) after general anesthesia and invasive mechanical ventilation are poorly described. ⋯ Systolic function assessed with GLS is impaired after general anesthesia and invasive mechanical ventilation in patients without cardiovascular co-morbidities but remains within normal range.