Minerva anestesiologica
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Minerva anestesiologica · Feb 2012
Case ReportsDifficult airway in a pediatric patient with Klippel-Feil syndrome and an unexpected lingual tonsil.
Klippel-Feil Syndrome (KFS) is a congenital defect characterized by the fusion of at least two cervical vertebrae. This article presents the case of a 12-year-old girl with KFS planned for scoliosis surgery. ⋯ Imaging tests showed lingual tonsil hypertrophy and a deviation of the tracheal axis, clarifying the causes of the failed intubation and suggesting new approaches for airway management. As far as we know, the association of KFS and lingual tonsil hypertrophy has not been reported before in the literature.
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Minerva anestesiologica · Feb 2012
Comparative StudyComparison of newer scoring systems with the conventional scoring systems in general intensive care population.
The aim of this study was to assess the performance of Acute Physiology and Chronic Health Evaluation (APACHE) IV, Simplified Acute Physiology Score (SAPS) III, and Mortality Probability Model (MPM) III0 and compare these systems to more widely validated prognosis prediction tools like APACHE II, III, SAPS II, MPM II0 and Sequential Organ Failure Assessment (SOFA) score. ⋯ Overall, the newer scoring systems performed better than their older counterparts and were more accurate. Nevertheless, the difference in efficacy was not statistically significant and the choice of scoring system may depend on the ease of use and local preferences.
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Minerva anestesiologica · Feb 2012
Comparative StudyTarget fraction of inspired oxygen during open lung strategy in neonatal high frequency oscillatory ventilation: a retrospective study.
There is no agreement to define the target FiO2 to adopt in the lung recruitment phase during HFOV in preterm infants. We report our experience of an optimal lung volume strategy (OLVS), defined as FiO2≤0.25 during the recruitment phase, in a cohort of neonates with gestational age (GA) ≤27 weeks treated with elective HFOV for respiratory distress syndrome (RDS) between July 2006 and September 2008. ⋯ OLVS to fully recruit the lungs achieving FiO2≤0.25 during elective HFOV is associated with better short-term pulmonary outcomes respect to a strategy where the patients received a FiO2>0.25 during the recruitment phase. Utilizing HFOV in this way provides a more effective means to recruit and protect acutely injured lungs.
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Minerva anestesiologica · Feb 2012
Arterial lactate above 2 mM is associated with increased brain lactate and decreased brain glucose in patients with severe traumatic brain injury.
Lactate fuels cerebral energy-consuming processes and it is neuroprotective. The impact of arterial lactate on brain metabolism determined by microdialysis was investigated retrospectively in patients with severe traumatic brain injury (TBI). ⋯ Increased arterial lactate levels were associated with increased cerebral lactate uptake and elevated brain lactate. At the same time brain glucose uptake and brain glucose were significantly reduced. It remains unclear whether arterial lactate is the driving force for the increased cerebral lactate levels or if the reduced glucose uptake also contributed to the increased cerebral lactate levels. Further studies are required to assess the impact of lactate infusion under clinical conditions.