Minerva anestesiologica
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Minerva anestesiologica · Aug 2020
Meta AnalysisS100β as a potential biomarker of incident delirium: a systematic review and meta-analysis.
Delirium is an acute and fluctuating change in cognition, attention and consciousness, defined as an acute neuropsychiatric syndrome, but mechanism is extremely complex and still not well understood. Recently, the S100 calcium-binding protein B protein (S100β) has received attention in the biomarker research area of delirium. This meta-analysis was designed to investigate the relationship between S100β levels and delirium. ⋯ This meta-analysis provides evidence that serum S100β seems to be of limited value as a biomarker of delirium, but CSF S100β elevation may be more meaningful.
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Intra-abdominal hypertension (IAH) is a common complication in critically ill patients that may lead to multiorgan failure and is associated to worse outcome. Respiratory failure is among the most important consequences of IAH and it is originated by different mechanisms, such as chest wall elastance increase, functional residual capacity reduction, compression atelectasis and lung edema formation through reduction in lymphatic drainage. Many experimental studies showed that total lung capacity and functional residual capacity can be decreased by 40% during abdominal hypertension, while respiratory system and chest wall pressure-volume curves can be significantly shifted downward and to the right. ⋯ The measurement of intra-abdominal pressure and esophageal pressure (as a surrogate of pleural pressure) may be useful in assessing the condition and guiding mechanical ventilation. Positive end-expiratory pressure (PEEP) must be carefully selected to counteract IAH-related diaphragm displacement, but too high PEEP levels are associated with hemodynamic failure. Continuous negative extra-abdominal pressure is a promising approach, but its clinical application needs more investigation.
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Minerva anestesiologica · Aug 2020
Principled decisions and virtuous care: an ethical assessment of the Siaarti guidelines for allocating intensive care resources.
This article sets forth ethical principles for responding to extraordinary circumstances in which the demand for medical care threatens to overwhelm available resources, as in the COVID-19 pandemic. In light of these principles, the author then assesses the ethics of the SIAARTI guidelines for rationing ICU beds and ventilators under such circumstances.