Minerva anestesiologica
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Minerva anestesiologica · Nov 2012
Review Meta AnalysisLung ultrasound in the ICU: from diagnostic instrument to respiratory monitoring tool.
Imaging has greatly contributed to the understanding of lung disease in the critically ill and currently serves as a tool to diagnose lung pathology, monitor its course, and guide clinical management. Lung ultrasound is a real-time imaging modality that is simple, non-invasive, potentially ubiquitous, and free of ionizing radiation. ⋯ While the utility of lung ultrasound in the emergency setting is unquestioned, its potential role in the more complex and resource-rich intensive care environment is still under investigation. The purpose of this paper was to describe current and potential uses of lung ultrasound in the specific setting of adult intensive care, with an emphasis on respiratory monitoring, and to provide a framework for the practical application of this tool at the bedside.
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Fever is a common symptom of sepsis usually believed to predict better survival. Experimental data suggest that body temperature elevation may slow micro-organism growth and enhance host immune responses. In patients with sepsis, however, the high energy cost of fever may exacerbate the life-threatening situation. ⋯ A recent controlled trial in patients with septic shock suggests that external cooling for fever control may diminish vasopressor requirements and improve early survival. In this review, we examine the benefits and risks of fever and of controlled normothermia. The fever control modalities that provide the best risk/benefit ratio in sepsis are discussed.
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Minerva anestesiologica · Nov 2012
Randomized Controlled TrialRespiratory mechanics at different PEEP level during general anesthesia in the elderly: a pilot study.
General anesthesia could imply that the closing capacity exceed the functional residual capacity. This phenomenon, associated with a reduction of maximal expiratory flow, could lead to expiratory flow limitation (EFL). The aim of our study was to verify 1) a new method of determining EFL during anesthesia (PEEP test); 2) if anesthesia could be associated with the development of EFL; 3) if the use a small amount of PEEP is able to reverse the possible negative effects of low lung volume ventilation. ⋯ The PEEP test allowed to verify that EFL during anesthesia is a valuable phenomenon. The use of 5 cmH(2)O of PEEP was helpful to prevent the deterioration of lung mechanics that occurs during surgery.
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Minerva anestesiologica · Nov 2012
Randomized Controlled TrialTransversus abdominis plane block in combination with general anesthesia provides better intraoperative hemodynamic control and quicker recovery than general anesthesia alone in high-risk abdominal surgery patients.
Patients with severe cardiovascular disease are frequently hemodynamically unstable during abdominal surgery. Improving the safety of such patients by stabilizing intraoperative hemodynamics remains a major concern for anesthesiologists. Transversus abdominis plane (TAP) block in combination with general anesthesia may facilitate optimum anesthetic management of these high-risk patients. ⋯ For abdominal surgery in patients with severe cardiovascular disease, combining TAP block with general anesthesia promotes intraoperative hemodynamic stability and early emergence from anesthesia.
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Minerva anestesiologica · Nov 2012
Do established prognostic factors explain the different mortality rates in ICU septic patients around the world?
The aim of this paper was to clarify if previously established prognostic factors explain the different mortality rates observed in ICU septic patients around the world. ⋯ Severe sepsis mortality varies widely in different countries. All known markers of disease severity and prognosis do not fully explain the international differences in mortality. Country income does not explain this disparity either. Further studies should be developed to verify if other organizational or structural factors account for disparities in patient care and outcomes.