Minerva anestesiologica
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Minerva anestesiologica · Oct 2009
ReviewVentilator associated pneumonia (VAP): an impossible diagnosis? Call for a pragmatic approach.
Many years after the introduction of the protected specimen brush (PSB) by Wimberley et al. as a tool to diagnose ventilator associated pneumonia (VAP), new sampling techniques have increased the controversy concerning the diagnosis of VAP. Agreement exists only on the high sensibility and low specificity of the clinical symptoms combined with imaging data. ⋯ Because a proven diagnosis is very rare, a more pragmatic approach to VAP diagnosis seems necessary. More specifically, the questions we must focus on include the following: ''Which patients with possible pneumonia or lower respiratory infection require antibiotic treatment ?'' and ''In which patients with possible/suspected VAP is empiric treatment not immediately necessary and for which of these patients can empiric treatment be limited or discontinued?''
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Pediatric regional anesthesia has attained wide use internationally because of its efficacy and safety; its use is supported by the existence of extensive data from the international literature underlining the safety and efficacy of this technique. Safer drugs and dedicated pediatric tools are the keys to this success. Indeed, if we compare the drugs available to pediatric anesthesiologists for use in performing a block years ago with those in use today, it can be seen that progress in this area has been tremendous. ⋯ Real-time ultrasound guidance for peripheral regional anesthesia is not a foolproof technique. New data have emerged suggesting that the novice ultrasonographer may often commit repeated errors, the two most common being failure to visualize the needle during advancement and unintentional probe movement. For this reason, the American Society of Regional Anesthesia and the European Society of Regional Anesthesia created a Joint Committee, and a document was produced ''to recommend to members and institutions the scope of practice, the teaching curriculum, and the options for implementing the medical practice of ultrasound-guided regional anesthesia services".