Minerva anestesiologica
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Minerva anestesiologica · Jun 2012
Randomized Controlled Trial Comparative StudyIntercomparison of three recruitment maneuvers in acute respiratory distress syndrome: the role of Body Mass Index.
The aim of this paper was to investigate the effectiveness of three different recruitment maneuvers (RMs) on respiratory and hemodynamic indexes, in patients with acute respiratory distress syndrome (ARDS), and determine the impact of patients' body mass index (BMI) on RMs efficacy. ⋯ In our cohort, recruitment by two sustained inflations resulted in a more persistent improvement of oxygenation as compared with recruitment by pressure controlled ventilation or consecutive sighs with the same airway pressure. BMI seems to have an impact on RMs effectiveness, most probably by altering the effective transpulmonary pressure. More studies are required to elucidate this observation.
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Minerva anestesiologica · Jun 2012
Five years of therapeutic drug monitoring in the intensive care did not change vancomycin prescription behaviour: perceived needs for decision support.
This study aims to assess clinicians' behaviour in prescribing vancomycin in the Intensive Care Unit (ICU) and their adherence to local guidelines for therapeutic drug monitoring (TDM). ⋯ Five years of TDM did not achieve the desired prescription behaviour in the ICU and clinicians feel there is a need for computerized decision support. Local projects should measure adherence and implement appropriate solutions.
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Minerva anestesiologica · Jun 2012
Case ReportsLaryngeal tube as airway rescue device from prehospital tracheostomy: a case report.
Airway management is a priority for the critically ill patient. The insertion of a cuffed tracheal tube is the best practice to obtain an airway control; however, it is associated with many practical problems in prehospital trauma care. When this common procedure is not available, it can be substituted by an extraglottic airway. ⋯ Due to the impossibility of endotracheal intubation the patient underwent surgical tracheostomy as suggested by the ear nose throat surgeon consultant. This case suggests that LT could be an important alternative device for airway management in trauma patients after a failed tracheal intubation. LT is a precious tool to achieve good ventilation and oxygenation from the field to the operatory theatre.
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Minerva anestesiologica · Jun 2012
Perioperative management in orthotopic liver transplantation: results of an Italian national survey.
No data are available on the perioperative approach during orthotopic liver transplantation (OLT) in Italy, apart from sporadically single center studies. ⋯ The results of this survey show that in Italy the perioperative management of patients undergoing OLT is not homogeneous. This database allows to debate on the best practices and pathways for perioperative management of these patients, and to stimulate future clinical trials aimed to assess the different component and steps forwards of the whole process.