Minerva anestesiologica
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Minerva anestesiologica · Mar 2011
Case ReportsUnexpected effects on arterial oxygenation during reduction in oxygen flow via a pumpless lung assist system.
The authors describe the effect of marked increase in PaO2 in a patient with acute respiratory distress syndrome and treatment by a pumpless extracorporeal lung assist following reduction in oxygen sweep flow.
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Minerva anestesiologica · Mar 2011
Effectiveness of treatments for severe sepsis: data from the bundle implementation programs.
In severe sepsis, several studies, a recent meta--analysis and studies evaluating multifaceted strategies for quality improvement, have shown that bundled care can improve survival. Here, the effectiveness of treatments for severe sepsis included in the bundles was analyzed. ⋯ The results of are very consistent: early sepsis recognition with the administration of broad-spectrum antibiotics in all patients and specific treatments for patients in shock, such as activated protein C, or those on mechanical ventilation play a role in improving sepsis outcome. Hospitals should recognize this new evidence and design strategies to guarantee bundled care for severe sepsis.
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Traumatic brain injury (TBI) is one of the major causes of disability in modern society. The World Health Organization has predicted that, by 2020, traffic accidents will represent the greatest burden of global disease and injury. ⋯ Currently, there is no consensus for the use of hypothermia in the treatment of secondary injury after TBI. Until the results of ongoing studies are published, maintaining normothermia and avoiding hyperthermia should be used in managing patient with TBI.
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Minerva anestesiologica · Mar 2011
Non-invasive ventilation outside of the Intensive Care Unit: an Italian survey.
Non-invasive ventilation (NIV) is increasingly utilized for patients with acute respiratory failure (ARF). The shortage of Intensive Care Unit (ICU) beds, a growing confidence with the technique, and the opportunity to treat ARF in a more responsive phase lead to the application of NIV outside of the ICU. The Study Group on Emergency of the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI) promoted a national survey to collect data on NIV use outside of the ICU. ⋯ In Italy, NIV is extensively applied in non-intensive wards, and its use is not free from criticalities and contradictions. Further prospective studies and possibly guidelines are needed.
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Corticosteroids are potent anti-inflammatory agents whose use has been life-saving in many diseases. Thus, it makes intuitive sense to use corticosteroids in septic shock, a disease where the inflammatory response is vigorously activated. Early studies examining the usage of corticosteroids in septic shock did not show any benefit, however, these studies administered very large doses. ⋯ Multi-center double blinded, randomized trials further added to the controversy without completely clarifying the issue. Moreover, the use of corticosteroids in critical illness must balance potential benefits with minimal side effects, however even such issues remain debatable as some studies show no untoward harm while other find the opposite. This review examines the use of corticosteroids in septic shock, discusses some of the shortcomings of the major clinical trials and outlines the most recent recommendations.