Minerva anestesiologica
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Minerva anestesiologica · Mar 2009
ReviewManagement to optimize organ procurement in brain dead donors.
The demand for donor organs continues to exceed the number of organs available for transplantation. Many reasons may account for this discrepancy, such as the lack of consent, the absence of an experienced coordinator team able to solve logistical problems, the use of strict donor criteria, and suboptimal, unstandardized critical care management of potential organ donors. This has resulted in efforts to improve the medical care delivered to potential organ donors, so as to reduce organ shortages, improve organ procurement, and promote graft survival. ⋯ Strategies for the management of organ donors exist and consist of the normalization of donor physiology. Management has been complicated by the recent use of ''marginal'' donors and donors of advanced age or with ''extended'' criteria. Current guidelines suggest that the priority of critical care management for potential organ donors should be shifted from a ''cerebral protective'' strategy to a multimodal strategy aimed to preserve peripheral organ function.
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Innovation over the past 25 years in the field of the airway management has led to the proliferation of new and improved techniques and devices. It is important to emphasize that the definition of a failed airway must include the inability to maintain acceptable oxygenation and not only the evidence of unsuccessful laryngoscopy and impossible intubation. We must ask ourselves: is it always necessary to intubate? Is it necessary in all patients? Our answer is absolutely ''no." Patients' oxygenation is the absolute priority, where the choice of whether or not to intubate represents only a technical problem. ⋯ Furthermore, the applicability of associated techniques could represent an efficacious strategy to overcome the limitations of the single device by strengthening their capabilities and chances of successful airway management. To date there is no technique found to be effective in every case or that can solve all airway problems. It is not the latest device or the latest technique that can solve an airway management problem, but the operator's experience and skill with the device and technique that he knows best and uses daily.
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Minerva anestesiologica · Mar 2009
ReviewEvidence-based renal replacement therapy for acute kidney injury.
Acute kidney injury (AKI) with the subsequent need for renal replacement therapy (RRT) represents a persistent challenge, arising in 4-5% in critically-ill patients, and remains associated with a high mortality (60%) and morbidity. As AKI is an independent risk factor for poor prognosis, appropriate management of patients with AKI becomes of utmost importance. ⋯ However, the timing of the initiation, the modality, and the dose of RRT are still controversial and the subject of ongoing clinical trials. This review presents and discusses currently available data regarding the use of RRT in critically-ill patients with AKI.
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Minerva anestesiologica · Mar 2009
The Competency-Based Training in Intensive Care Medicine in Europe (CoBaTrICE) Italian collaborative: national results from the Picker survey.
The aim of the Competency-Based Training in Intensive Care Medicine in Europe (CoBaTrICE) project is to create an internationally acceptable competency-based training program for specialists in intensive care medicine. The CoBaTrICE Project has performed a survey, in collaboration with the Picker institute, United Kingdom, to identify desirable characteristics of Intensive Care Unit (ICU) specialists, as expressed by patients and their relatives. ⋯ Priority in Italy was given to medical skills and competence. Involvement of patients and relatives in decision-making processes were among the items considered least important. Italian families preferred a paternalist approach to the end of life decision-making process.