Minerva anestesiologica
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Minerva anestesiologica · Jan 2016
ReviewThe evolution of nutritional support in long term ICU patients: from multisystem organ failure to persistent inflammation immunosuppression catabolism syndrome.
Multiple organ failure (MOF) is an evolving pathologic phenotype that plagues intensive care units globally. This manuscript aims to depict the evolution of single organ failure through multiple organ failure, ending in the newest phenotype called persistent inflammation, immunosuppression, catabolism syndrome (PICS). ⋯ Discussed in these sections are possible etiologies for the various progression of MOF, total enteral nutrition (TPN) versus early enteral nutrition (EEN), early versus late parenteral nutrition, glycemic control, and new enteral formulas. Finally, as the newest phenotype, PICS, has evolved we try to make inferences from similar pathologic states to recommend nutritional support that has proven beneficial.
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Minerva anestesiologica · Jan 2016
ReviewDynamic airway pressure-time curve profile (stress index): a systematic review.
The assessment of respiratory mechanics at the bedside is necessary in order to identify the most protective ventilatory strategy. Indeed in the last 20 years, adverse effects of positive ventilation to the lung structures have led to a reappraisal of the objectives of mechanical ventilation. ⋯ Among the different methods that have been proposed and validated, the analysis of dynamic P-t curve (named Stress Index, SI) represents an adequate tool available at the bedside, repeatable and, therefore, able to identify the amount of overdistension occurring in the daily clinical practice, when modifying positive end-expiratory pressure. In this review we will analyze the evidence that supports respiratory mechanics assessment at the bedside and the application of the dynamic P/t curve profile (SI) to optimize protective ventilation in patients with acute respiratory failure.
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Minerva anestesiologica · Jan 2016
ReviewOpioids for chronic non-cancer pain: A critical view from the other side of the pond.
Opioid analgesics are important therapeutic options for chronic non-cancer pain (CNCP), recognized as a major public health issue with high social and economic burden. The increasing therapeutic opioid use for CNCP, misuse and abuse of prescription opioids have become matters of severe concern in USA. The recent position paper of the American Academy of Neurology (AAN) about the use of opioids in USA expresses growing alarms about opioid misuse/abuse, and has alerted physicians worldwide to rethink about their prescription practice. ⋯ In this position paper it is explained that any change in clinical behavior should not be based on an uncritical generalization of the US data that do not reflect the European situation. The primary objective of pain physicians remains to adequately treat chronic pain. Opioids are and will continue to remain an essential part of the "armamentarium against pain"; physicians should use them in the best way, i.e. after thorough diagnosis, assessment of alternative therapeutic options in the context of a multimodal treatment concept, and with repeated careful re-evaluations of the proper indication by a close long-term follow-up of any chronic opioid patient.
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Minerva anestesiologica · Dec 2015
ReviewMaxillofacial trauma in the emergency department: pearls and pitfalls in airway management.
Maxillofacial trauma poses a challenge for the anesthesiologist because injuries can often compromise the patient's airways. Airway maintenance is the first step in the American College of Surgeons Advance Trauma Life Support (ATLS®) protocol. However, clinical dilemmas may arise about the best way to manage a potentially life-threatening injury. ⋯ It is also necessary to recognize and be able to manage specific problems in this scenario where clinical priorities may be conflicting, may suddenly change or may be hidden. This clinical review discusses the complexity of this scenario, providing an overview of the conditions at greatest risk for airway obstruction and the options for airway management, on the basis of the recent literature. Clinicians must recognize the milestones and pitfalls of this topic in order to adopt a systematic approach for airway management, to identify specific characteristics associated with it, and to establish the utility of different instruments for airway management.