Minerva anestesiologica
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Minerva anestesiologica · Jan 2015
Randomized Controlled Trial Multicenter Study Comparative StudyAutonomic cardiovascular modulation with three different anesthetic strategies during neurosurgical procedures.
Autonomic cardiovascular modulation during surgery might be affected by different anesthetic strategies. Aim of the present study was to assess autonomic control during three different anesthetic strategies in the course of neurosurgical procedures by the linear and non-linear analysis of two cardiovascular signals. ⋯ Despite an important reduction of cardiovascular signal variability, the analysis of RR and SAP signals were capable to detect information about autonomic control during anesthesia. Symbolic analysis (non-linear) seems to be able to highlight the differences of both the sympathetic (slow) and vagal (fast) modulation among anesthetics, while spectral analysis (linear) underlines the same differences but only in terms of balance between the two neural control systems.
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Minerva anestesiologica · Jan 2015
ReviewNovel multi-drug resistant microorganisms in critically ill: a potential threat.
Infections due to multidrug resistant (MDR) pathogens are among the major threats in critically ill patients. Reduced vancomycin susceptibility in Staphylococcus aureus, high-level aminoglycoside resistance in enterococci, extended spectrum beta-lactamase and carbapenemases production in Enterobacteriaceae, carbapenem and colistin resistance in Pseudomonas spp. and Acinetobacter spp. are increasing in many intensive care units around the world. In the last few years some new anti-Gram-positive agents have been developed, whereas for Gram-negatives the available options are very limited. Infections control and antimicrobial stewardship programs are currently the only available options to avoid a further increase of these pathogens.
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The mortality of postcardiac arrest patients has gradually reduced in years but it still is as high as 50%, despite advancements in the diagnostic and therapeutic approaches, i.e. revascularization and therapeutic moderate hypothermia. However, recent evidence suggests that other therapeutic interventions aimed to minimize progressive deterioration of the brain and other organs function might be helpful to reduce in-hospital mortality and improve neurologic outcome as well as quality of life after cardiac arrest. ⋯ In pediatric patients, hypoxia and hyperoxia were not associated with higher in-hospital mortality, while hypocapnia and hypercabia with higher in-hospital mortality worse neurologic outcome. We propose a general bundle for ventilator treatment after cardiac arrest, including: 1) therapeutic hypothermia for 12-24 hours; 2) mean arterial pressure ≥65-75 mmHg; 3) PaO2 between 60-200 mmHg and PCO2 between 30 and 50 mmHg; 4) protective MV with tidal volume of 6-8 mL/kg and positive end expiratory pressure of between 5-10 cmH2O; 5) monitoring of respiratory mechanics, extravascular lung water, hemodynamics, non-invasive transcranial Doppler and intracranial pressure monitoring; and 6) others supportive care, i.e. blood sugar and seizures control.
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Minerva anestesiologica · Jan 2015
Factors of tidal volume variation during augmented spontaneous ventilation in patients on extracorporeal carbon dioxide removal - a multivariate analysis.
Extracorporeal carbon dioxide removal (ECCO2-R) allows lung protective ventilation using lower tidal volumes (VT) in patients with acute respiratory failure. The dynamics of spontaneous ventilation under ECCO2-R has not been described previously. This retrospective multivariable analysis examines VT patterns and investigates the factors that influence VT, in particular sweep gas flow and blood flow through the artificial membrane. ⋯ Higher sweep gas flow is associated with low VT in patients on extracorporeal lung assist and augmented spontaneous ventilation. Such a technique can be used for prolonged lung protective ventilation even in the patient's recovery period.
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Minerva anestesiologica · Jan 2015
ReviewCoagulopathy induced by acidosis, hypothermia and hypocalcaemia in severe bleeding.
Acidosis, hypothermia and hypocalcaemia are determinants for morbidity and mortality during massive hemorrhages. However, precise pathological mechanisms of these environmental factors and their potential additive or synergistic anticoagulant and/or antiplatelet effects are not fully elucidated and are at least in part controversial. Best available evidences from experimental trials indicate that acidosis and hypothermia progressively impair platelet aggregability and clot formation. ⋯ Rewarming hypothermic bleeding patients is highly recommended because it improves patient outcome. Despite the absence of high-quality evidence, calcium supplementation is clinical routine in bleeding management. Buffer administration may not reverse acidosis-induced coagulopathy but may be essential for the efficacy of coagulation factor concentrates such as recombinant activated factor VII.