Minerva anestesiologica
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Minerva anestesiologica · Apr 2019
ReviewWhat have we learned from network meta-analysis applied to critical care? A narrative review.
It is widely accepted in modern medicine that medical decisions must be supported by scientific evidence. Identifying the best intervention when several options are available constitute a great challenge for every clinician. Traditional meta-analysis (TMA) allows summarizing evidence from studies that compare the same two interventions for one event (head to head studies or direct comparisons). ⋯ As a conclusion, NMA is an established, robust, objective and reproducible statistic technique that has been applied to several critical care areas. Clinical practice guidelines have started to include NMA evidence to support their recommendations. In future years, it seems highly probable that this technique will increase it applicability in almost all areas of critical care medicine.
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Minerva anestesiologica · Apr 2019
A systematic review of the diagnostic accuracy of epidural wave form analysis to identify the epidural space in surgical and labour patients.
Epidural failure due to misidentification of the epidural space is not uncommon. Epidural wave form analysis has been suggested to identify the epidural space. ⋯ Our study suggests that epidural wave form analysis is a reliable method for identification of the epidural space that could become a useful adjunct especially in anticipated difficult catheter placements or in teaching situations. Further research is warranted to define the role of epidural wave form analysis in pregnant women.
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The erector spinae plane (ESP) block is an interfascial block proposed to provide analgesia for chronic thoracic pain. It consists in an injection of local anesthetic in a plane between the transverse process and the erector spinae muscles group. ⋯ Although data suggests that ESP block is an easy and safe technique, more studies are needed to assess safety, complications rates and efficacy of this technique. In particular, we need well designed RCTs comparing ESP block to gold standard regional anesthesia technique. Nevertheless, ESP block is already a viable option for anesthesiologists all over the world.
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Postpartum chronic pain is a clinical reality which affects 6.1% to 11.5% of women after delivery and affects their recovery. The large range of incidence observed in the literature relies on criteria used to define chronic postpartum pain. The features depend on the type of delivery. ⋯ In opposite, after vaginal delivery, chronic pelvic pain and perineal pain have an important negative impact on women's mood and quality of life. As for any chronic pain, individual risk factors account more than degree of tissue trauma. From actual reports in the field, better pain education of both women and health care providers might help to reduce the problem.
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Minerva anestesiologica · Mar 2019
Prediction of extubation failure in intensive care unit: systematic review of parameters investigated.
Extubation failure (EF) refers to the inability to maintain spontaneous breathing after removal of endotracheal tube. The aim of this review is to identify the best parameter to predict EF in adult intensive care patients. ⋯ This review shows that all parameters used to predict EF have a low PPV. Therefore, the limitation of use of such predictive tests may prolong unnecessarily the intubation and increase the unfavorable outcome. A prospective study involving all variables could be useful to predict the EF in ICU.