Minerva anestesiologica
-
Minerva anestesiologica · Aug 2012
ReviewCommunity acquired methicillin resistant Staphylococcus aureus pneumonia: an update for the emergency and intensive care physician.
Pneumonia caused by community-acquired (CA) methicillin-resistant Staphylococcus aureus (MRSA) among individuals without healthcare-associated (HA) risk factors was first recognized a decade ago. CA-MRSA has now been established as a pathogen responsible for rapidly progressive, frequently fatal disease manifesting as necrotizing pneumonia, severe sepsis and necrotizing fasciitis. The frequency of occurrence, risk factors, and optimal treatment of CA-MRSA pneumonia remain unclear and vary significantly across countries. ⋯ Prompt hospitalization and aggressive treatment with intravenous antibiotics is warranted to improve outcomes. Therapeutic approach for severe CA-MRSA infections and particularly pneumonia is generally the same as that for invasive HA-MRSA infections. New anti-MRSA agents and possible combinations are of great importance to be evaluated in the future.
-
Minerva anestesiologica · Aug 2012
Randomized Controlled TrialSigh improves gas exchange and respiratory mechanics in children undergoing pressure support after major surgery.
Children undergoing major surgery can develop lung de-recruitment and gas exchange impairment in the postoperative period. The aim of this study was to assess the effect of periodic sigh breaths (Sighs) during pressure support ventilation (PSV) on gas exchange and respiratory pattern in children after major surgery. ⋯ The addition of one Sigh per minute during PSV in the post-operative period of children that underwent major surgery improved gas exchange and decreased respiratory drive without producing major short-term complications. Further long-term studies are necessary to evaluate the efficacy and safety of Sigh in pediatric patients.
-
Minerva anestesiologica · Aug 2012
Post-hoc revision of the pediatric anesthesia emergence delirium rating scale: clinical improvement of a bedside-tool?
Pediatric delirium (PD) is a severe neuropsychiatric disorder often seen at the pediatric intensive care unit (PICU). The Pediatric Anesthesia Emergence Delirium (PAED) scale assesses five behavioral items on a five-level severity scale, and is easily applicable in children. However, the five-level severity scales are rather arbitrarily anchored and subjective. This study aimed to pilot a practical and clinical improvement of the PAED by condensing the five-level scales of the five behavioral items to a more objectively anchored two- and three-point scale. ⋯ A three-level severity scale for the five PAED-items may be optimal to diagnose PD. Further prospective research is required to determine whether a revised PAED has adequate psychometric properties and is applicable across different clinical settings.
-
Minerva anestesiologica · Aug 2012
Hypersensitivity reactions during anesthesia. Results from the ninth French survey (2005-2007).
Hypersensitivity reactions occurring during anesthesia remain a major cause of concern for anesthesiologists. We report the results of the ninth consecutive survey of hypersensitivity reactions observed during anesthesia in France. This report will be used as an epidemiologic reference prior to this intervention. ⋯ These changes in the epidemiology of allergic reactions confirm the need for regular epidemiologic surveys of anaphylaxis in the perioperative period.
-
Minerva anestesiologica · Aug 2012
Ascites characterizes perioperative clinical indices better than preoperative body mass index. A study in orthotopic liver transplant candidates.
Preoperative body mass index (pre-BMI) affecting patients' recovery from orthotropic liver transplantation (OLT) is controversial. Pre-BMI measurements may be exaggerated by ascites. Aim of the study was the assessment of early outcome associated with pre-BMI and ascites. ⋯ Pre-OLT BMI does not correlate with ascites or postoperative BMI, nor does it affect duration of ventilation, especially <6 h after surgery. These results dissociate ascites from pre- and post-OLT.