Minerva anestesiologica
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Minerva anestesiologica · Dec 2011
Case ReportsAn unusual cause of delayed awakening following coronary artery surgery.
Neurological deficits are a frequent complication of adult cardiac surgery. Dandy-Walker malformation (DWM) is a rare posterior fossa malformation defined by hypoplasia and upward rotation of the cerebellar vermis, cystic dilation of the fourth ventricle and, on occasion, hydrocephalus. We report an incidental diagnosis of DWM in an adult following coronary artery surgery complicated by delayed awakening.
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Renal support, intended as a refined and context-sensitive form of severe acute kidney injury management, might be achieved by administering renal replacement therapy with the correct timing and indication, correct prescription and, also, by the expertise and capacity of clinicians to tailor different RRTs to different patients. Furthermore, technical evolution and extended indications for extracorporeal treatments, currently allow the support of multiple organs, other than the isolated kidney failure. Unfortunately, current literature in the field of optimal management of severe acute kidney injury is controversial and lacks a standard of care. This review aims to describe the recent clinical, scientific and technical evolution of renal replacement therapy and the potential suggestive concept of multiple organ support therapy.
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Fluid resuscitation is an essential aspect of the management of patients with severe sepsis and septic shock, especially in the early stages of disease. Which fluid should be used for this purpose has been a topic of ongoing and sometimes heated debate for many years, yet this is still little evidence to support one fluid over another. ⋯ In this article, we will review the advantages and limitations of the key fluid types currently used for the resuscitation of critically ill patients with sepsis, including the crystalloids (saline solutions and Ringer's lactate), and the colloids (albumin, gelatins, dextrans, and hydroxyethyl starches). We will then briefly summarize the limited evidence to support use of one fluid type over another, and provide general suggestions for fluid use in these patients.
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Minerva anestesiologica · Dec 2011
Acute physiologic effects of a stepwise recruitment maneuver in acute respiratory distress syndrome.
Stepwise recruitment maneuvers (RM) applied with high airway pressures may optimize lung recruitment, but this kind of intervention may lead to widely heterogeneous responses with possible side effects. To assess the clinical impact of these maneuvers, we performed a stepwise maximal-recruitment strategy superimposed on routine mechanical ventilation. ⋯ Although stepwise-RM improves oxygenation, it has a heterogeneous impact on respiratory mechanics and may cause adverse hemodynamic effects and transient hypoxemia. If the use of this kind of RM is considered, it should be adapted to individual patient needs, applied carefully and closely monitored.