Minerva anestesiologica
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Minerva anestesiologica · Aug 2011
Review Meta AnalysisThe preventive role of higher PEEP in treating severely hypoxemic ARDS.
This review summarizes knowledge and evidence on the use of positive end-expiratory pressure (PEEP) in patients with severely hypoxemic acute respiratory distress syndrome (ARDS). More specifically, it documents the current evidence on the effects of higher PEEP in preventing (or attenuating) lung damage during the ventilatory management of patients with severely hypoxemic ARDS. No established threshold has been set to define severely hypoxemic ARDS and higher PEEP. ⋯ Higher PEEP should be used with caution in patients less severe hypoxemic (acute lung injury). To deliver optimal PEEP to those ARDS patients with the highest lung recruitability, this technique should be monitored at the bedside. Alternative methods are under investigation as part of a decremental PEEP trial.
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Minerva anestesiologica · Jul 2011
Randomized Controlled TrialA liberal preoperative fasting regimen improves patient comfort and satisfaction with anesthesia care in day-stay minor surgery.
The aim of this study was to evaluate whether a single preoperative limited oral intake of a carbohydrate drink could improve perioperative patient comfort and satisfaction with anesthesia care in elective day-stay ophthalmologic surgery. ⋯ Standardized limited oral preoperative fluid intake increases patient comfort and satisfaction with anesthesia care and should be a part of modern day-stay ophthalmologic surgery.
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Minerva anestesiologica · Jul 2011
ReviewEffects of hypercapnia and hypercapnic acidosis on attenuation of ventilator-associated lung injury.
Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are associated with impaired gas exchange, severe inflammation and alveolar damage including cell death. Patients with ALI or ARDS typically experience respiratory failure and thus require mechanical ventilation for support, which itself can aggravate lung injury. Recent developments in this field have revealed several therapeutic strategies that improve gas exchange, increase survival and minimize the deleterious effects of mechanical ventilation. ⋯ The clinical implications of hypercapnia and hypercapnic acidosis are still not entirely clear. However, future research should focus on the intracellular signaling pathways that mediate ALI development, potentially focusing on the role of reactive biological species in ALI pathogenesis. Future research can also elucidate how such pathways may be targeted by hypercapnia and hypercapnic acidosis to attenuate lung injury.