Minerva anestesiologica
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Minerva anestesiologica · Mar 2011
ReviewAlternative approaches to ventilator-associated pneumonia prevention.
Ventilator-associated pneumonia (VAP), which develops in patients receiving mechanical ventilation, is the most common nosocomial infection in patients with acute respiratory failure. The major mechanism of lower respiratory tract colonization is aspiration of bacteria-colonized secretions from the oropharynx into the lower airways. The hydrostatic pressure of the secretions that collect in the subglottic space, which is the area above the endotracheal tube (ETT) cuff, or aerosolization of bacteria from the secretions collected within the respiratory tubing may facilitate the leakage into the lower airways. ⋯ Future large studies should be designed to test the hypothesis that VAP can be prevented with these novel strategies. While there is a current focus on the use of respiratory devices to prevent biofilm formation and microaspiration, it is important to remember that lower respiratory tract colonization is multifactorial. Prevention of VAP cannot be achieved solely by eliminating bacterial biofilm on respiratory devices, and more comprehensive care of the intubated patient needs to be implemented.
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Minerva anestesiologica · Mar 2011
ReviewBlood transfusion in trauma patients: unresolved questions.
Massive transfusion is an essential part of resuscitation efforts in acute trauma patients. The goal is to quickly correct trauma-induced coagulopathy and replace red blood cell (RBC) mass with the minimal number as well as the appropriate choice of blood components to minimize the possible adverse effects of transfusions. Early trauma induced coagulopathy (ETIC) is present in about 20% of patients upon hospital admission and predicts for decreased survival. ⋯ When creating an MTP, product wastage due to inappropriate activation and improper product storage should be considered and closely monitored. Another area of discussion regarding transfusion in trauma includes the potential association of prolonged storage of RBCs and adverse outcomes, which has yet to be confirmed. Significant progress has been made in the transfusion management of trauma patients, but further studies are required to optimize patient care and outcomes.
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Minerva anestesiologica · Mar 2011
Randomized Controlled Trial Comparative StudyA randomized clinical comparison of the Intersurgical i-gel and LMA Unique in non-obese adults during general surgery.
The i-gel is a cuffless, single-use supralaryngeal airway device designed to provide a more effective seal than the laryngeal mask airway (LMA). Although the superiority of the i-gel compared to the LMA Classic was determined in a previous study, no studies have been performed that compare it to the disposable LMA Unique. The aim of this study was to compare the Intersurgical i-gelTM against the LMA UniqueTM (uLMA) in terms of ease of placement, time of insertion, and adequacy of placement through a randomized, controlled clinical trial. ⋯ Although the i-gel had a faster insertion time in comparison to the uLMA, there was a greater need for repeat insertions. The weight criteria established by the manufacturer may need to be readjusted to recommend a larger size device in some patients less than 90 kg because all of the repeat insertions were in patients weighing more than 80 kg. In all other aspects of its use, the i-gel performed similarly to the uLMA.
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In the last thirty years, the rapid evolution of surgical techniques, together with the use of innovative immunosuppressive strategies and optimal chemoprofilaxis, has dramatically extended the applicability of solid organs transplantation. However, despite the increase of post-transplantation survival rate, respiratory complications remain the main cause of morbidity and one of the main causes of mortality. Accordingly, the use of aggressive treatments has also increased the survival rates in patients with hematologic malignancies, but at price of an increased susceptibility to infections. ⋯ In this situation, the early application of positive pressure ventilation is aimed at restoring the decreased lung volume, increasing oxygenation, and reducing both the work of breathing and the respiratory drive; moreover to re-establish patient's equilibrium allows to buy time for an effective etiologic treatment. According to the results of several prospective randomized and non-randomized trials, the application of NIV seems able both to decrease the rate of nosocomial infectious complications, and to improve gas exchange with optimal patients tolerance. The aim of this review will be to shortly analyze the fields of application and the clinical results obtained with NIV in patients with immunosuppression of various origin.
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Minerva anestesiologica · Mar 2011
Comparative StudyA comparison of the performance of Simplified Acute Physiology Score 3 with old standard severity scores and customized scores in a mixed medical-coronary care unit.
Recently, the Simplified Acute Physiology Score (SAPS) 3 was developed. The objective of this study was to compare the performance of SAPS 3 with those of SAPS II, the Acute Physiology and Chronic Health Evaluation (APACHE) II and customized scores in predicting hospital mortality in critically ill mixed medical-coronary patients. ⋯ The SAPS 3 score provided excellent discrimination but poor calibration, as did the SAPS II and APACHE II scores in our critically ill mixed medical patients. The customization of the severity score improved the calibration performance, and thus this customization may serve as a tool for adjusting the equation of the score to predict mortality and quality assessment in intensive care units (ICUs).