Minerva anestesiologica
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Minerva anestesiologica · Jun 2013
Review Meta AnalysisNon-invasive ventilation during upper endoscopies in adult patients. A systematic review.
Upper endoscopies (UE) are widely performed. Non-invasive ventilation (NIV) during UE has been used to avoid respiratory complications, mainly in high-risk or sedated patients. We performed a systematic review on this topic. ⋯ This is the first systematic review addressing the use of NIV during upper endoscopies. Its use seems feasible, and based on the limited data available NIV appears safe and likely effective. The patients who would benefit the most are: high-risk and patients undergoing sedation.
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Minerva anestesiologica · Jun 2013
Review Meta AnalysisIntrathecal magnesium as analgesic adjuvant for spinal anesthesia: a meta-analysis of randomized trials.
Intrathecal magnesium extends analgesic duration of spinal opioids.
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Minerva anestesiologica · Jan 2013
Review Meta AnalysisAn updated meta-analysis to understand the variable efficacy of drotrecogin alfa (activated) in severe sepsis and septic shock.
Significant debate continues over the efficacy of drotrecogin alpha activated (DAA) in sepsis. This updated meta-analysis provides an updated summary effect estimate and explores the reasons for outcome heterogeneity in placebo-controlled randomized clinical trials of DAA on 28-day all-cause mortality in patients with severe sepsis or septic shock. ⋯ DAA is not associated with improved survival in patients with severe sepsis or septic shock. Further studies should be done to determine whether changes in supportive therapy for sepsis explain the variable efficacy of DAA in randomized controlled clinical trials observed over time.
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Minerva anestesiologica · Dec 2012
Review Meta AnalysisA systematic technical review of the systems for the continuous positive airway pressure.
Continuous positive airway pressure (CPAP) is the application in the airways of continuous positive pressure, close to the positive end expiratory pressure. The two common available systems are by a continuous (high/low) flow system and by a mechanical ventilator. Aim of this study was to compare the mechanical performance of the CPAP systems in intubated and not intubated patients. ⋯ The continuous flow systems are able to maintain acceptable airway pressure variations during normal breathing. The most recent mechanical ventilators equipped with flow by systems compared to the first one, presented a similar or better work of breathing compared to the continuous flow systems due to the application of a little amount of pressure support. Although the use of a continuous flow is cheaper compared to mechanical ventilators, it does not allow a continuous respiratory monitoring.
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Minerva anestesiologica · Nov 2012
Review Meta AnalysisLung ultrasound in the ICU: from diagnostic instrument to respiratory monitoring tool.
Imaging has greatly contributed to the understanding of lung disease in the critically ill and currently serves as a tool to diagnose lung pathology, monitor its course, and guide clinical management. Lung ultrasound is a real-time imaging modality that is simple, non-invasive, potentially ubiquitous, and free of ionizing radiation. ⋯ While the utility of lung ultrasound in the emergency setting is unquestioned, its potential role in the more complex and resource-rich intensive care environment is still under investigation. The purpose of this paper was to describe current and potential uses of lung ultrasound in the specific setting of adult intensive care, with an emphasis on respiratory monitoring, and to provide a framework for the practical application of this tool at the bedside.