Minerva anestesiologica
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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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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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Minerva anestesiologica · Dec 2011
ReviewUse of synthetic colloids in sepsis: a critical review on efficacy, safety and patient benefits.
In this narrative review, the studies and analyses are discussed that pertain to benefits and detriments of synthetic colloids versus natural colloids or crystalloids used for fluid resuscitation in sepsis and septic shock. The relative amount of fluid infusions used to reach clinical or hemodynamic end-points are reviewed, as well as potential toxicity of starch solutions on the kidney. Hence, it cannot be excluded that adverse effects partly offset beneficial hemodynamic effects that are similar to that of natural colloids, so that in most analyses a mortality benefit of synthetic colloid fluid resuscitation in sepsis and septic shock cannot be demonstrated.
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Minerva anestesiologica · Dec 2011
ReviewNew experimental Oximes in the management of organophosphorus pesticides poisoning.
Organophosphorus compounds (OPCs) are widely used in agriculture as pesticides and occasionally in industrial settings. They have also been developed as warfare nerve agents. OPCs poisoning from intentional, accidental, and occupational exposure is a major public health problem, especially across the rural developing world. ⋯ They act by reactivation of AChE inhibited by OPCs. However, their activity in poisonings with pesticides and warfare nerve agents is different, and there is still no universal oxime sufficiently effective against all known OPCs. The aim of this article was to review the most recent findings in this field and compare the protection conferred by the new K-oximes and sugar oximes with the effect of the four recommended pyridinium oximes (pralidoxime, obidoxime, trimedoxime, and HI-6), in the search for a broad-spectrum AChE reactivator.