Minerva anestesiologica
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Minerva anestesiologica · Mar 2014
Review Meta AnalysisA systematic review and individual patient data meta-analysis on intra-abdominal hypertension in critically ill patients: the wake-up project. World initiative on Abdominal Hypertension Epidemiology, a Unifying Project (WAKE-Up!).
Intra-abdominal hypertension (IAH), defined as a pathologically increase in intraabdominal pressure, is commonly found in critically ill patients. While IAH has been associated with several abdominal as well as extra-abdominal conditions, few studies have examined the occurrence of IAH in relation to mortality. The aim of this paper was to evaluate the prognostic role of IAH and its risk factors at admission in critically ill patients across a wide range of settings and countries. ⋯ Five hundred thirteen patients (30.8%) died in intensive care. The independent predictors for intensive care mortality were IAH, SAPS II score, SOFA score and admission category. This systematic review and individual patient data meta-analysis shows that IAH is frequently present in critically ill patients and it is an independent predictor for mortality.
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Minerva anestesiologica · Mar 2014
Randomized Controlled Trial Comparative StudyComparison of the Efficacy of Different Concentrations and Volumes of Levobupivacaine in Axillary Brachial Plexus Blockade.
The aim of this study was to compare the effect of the same dosage but different concentrations and volumes of levobupivacaine used for axillary block on the onset and intensity of the block. ⋯ Decreasing the concentration and increasing the volume of levobupivacaine without changing its dosage prolongs the duration of analgesia, although it delays the onset and decreases the intensity of sensory and motor block in axillary block.
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Oxygenation maintenance is the cornerstone of airway management in the obese patient related to anatomic and pathophysiologic issues. Difficult mask ventilation (DMV) risk is increased in obese patients according recognized predictors (Body Mass Index [BMI]>26 kg/m2, age >55 years, jaw protrusion severely limited, lack of teeth, snoring, beard, Mallampati class III or IV) and should systematically search. Difficult tracheal intubation (DTI) risk may be increased and risk should be assessed in a careful manner. ⋯ In unexpected difficult airway, the very first priority is oxygenation and a predefined strategy has to be implemented with oxygenation devices first (supraglottic devices or ILMA). Lastly, the final step of the obese airway management is tracheal extubation and recovery. A strategy with a fully awake patient, without residual paralysis, and a 25° head-up position is mandatory.
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Minerva anestesiologica · Mar 2014
Prone Positioning During Veno Venous Extra Corporeal Membrane Oxygenation For Severe Acute Respiratory Distress Syndrome in Adults.
Veno-venous extracorporeal membrane oxygenation (VV-ECMO) is an effective rescue therapy for improving oxygenation in selected severe acute respiratory distress syndrome (ARDS). Prone position (PP) is usually considered before vvECMO and few data are available on the association of PP during VV-ECMO. Thus, we investigated the effect on oxygenation and the safety of PP during vvECMO. ⋯ PP may be considered in selected patients difficult to wean or remaining very hypoxemic despite VV-ECMO support.