Minerva anestesiologica
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Minerva anestesiologica · Nov 2021
Thromboprophylaxis in critically ill patients: balancing on a tightrope.
Venous thromboembolism (VTE), including deep vein thrombosis and pulmonary embolism, is a common and potentially fatal complication in the Intensive Care Unit (ICU). Critically ill patients have some special characteristics that increase the risk for VTE and complicate risk stratification and diagnosis. Given the positive effect of thromboprophylaxis on main outcomes, its use is mandatory in these patients, which is documented by various studies and recommended by all published guidelines. ⋯ If the patient is at high risk of bleeding or there is a contraindication to pharmacologic prophylaxis, he should receive mechanical thromboprophylaxis mainly with intermittent pneumatic compression or graduated compression stockings. Thromboprophylaxis compliance with the guidelines is a prerequisite for moving from theory to practice. Direct oral anticoagulants have been studied in ICU patients and have no place at present in VTE prophylaxis requiring further research.
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Minerva anestesiologica · Nov 2021
Controlled Clinical TrialEvaluation of the impact of HMS Plus on postoperative blood loss compared with ACT Plus in cardiac surgery.
The standardized management of anticoagulation during the cardiopulmonary bypass seems inaccurate because of patients and surgeries variability. This study evaluates if an individualized management of heparin and protamine guided by the HMS Plus system during cardiopulmonary bypass could reduce postoperative blood loss. ⋯ HMS Plus did not reduce the mean blood-loss volume during the first 24 postoperative hours compared with ACT Plus. Its utility for potential transfusion rate reduction remains to be proven.
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Minerva anestesiologica · Nov 2021
Observational StudySubcostal TAPSE measured by anatomical M-mode: prospective reliability clinical study in critically ill patients.
Tricuspid annular plane systolic excursion (TAPSE), evaluated from a four-chamber apical view, is an echocardiographic parameter for the detection of right ventricular systolic dysfunction (RVD). We decided to assess the reliability of TAPSE measured from subcostal view (sTAPSE) by anatomical M-mode imaging (AMM) for evaluation of right ventricular systolic function and prediction of RVD in the critically ill patients by comparison with other echocardiographic parameters. ⋯ The sTAPSE measured by AMM in a population of critically ill patients has been found to be a reliable parameter of right ventricular systolic function and predicted RVD with high reliability.
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Minerva anestesiologica · Nov 2021
Observational StudyComparison of renal replacement therapy and renal recovery before and during the COVID-19 pandemic. A single centre observational study.
Our objective was to the describe indications, management, complications and outcomes of renal replacement therapy (RRT) in COVID-19 critically ill patients. To contextualize these findings, comparisons were made against 36 non-COVID-19 consecutive patients requiring RRT on ICU. ⋯ The requirement for RRT in COVID-19 patients was primarily related to fluid balance. Using lower CVVHF exchange rates was effective to correct metabolic abnormalities. Renal recovery occurred in all but one patient by 60 days in the 40% of patients who survived.
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Minerva anestesiologica · Nov 2021
Fever management in critically ill COVID-19 patients: a retrospective analysis.
Fever has been reported as a common symptom in COVID-19 patients. The aim of the study was to describe the characteristics of COVID-19 critically ill patients with fever and to assess if fever management had an impact on some physiologic variables. ⋯ In our study, male gender and severe impairment of oxygenation were independently associated with fever in critically ill COVID-19 patients. Fever treatment reduced heart rate and respiratory rate and improved systemic oxygenation.