Minerva anestesiologica
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Minerva anestesiologica · Feb 2011
Closed tracheal suction and fluid aspiration past the tracheal tube. Impact of tube cuff and airway pressure.
This study investigated the effect of different tube cuff types and airway pressures on fluid leakage past the tracheal tube cuff during suction with a closed tracheal suction system (CTSS). ⋯ The use of PU tube cuffs and intermittent transient increases in cuff pressure during suction can effectively reduce fluid leakage past the tracheal tube during closed tracheal suctioning.
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Corticosteroids are potent anti-inflammatory agents whose use has been life-saving in many diseases. Thus, it makes intuitive sense to use corticosteroids in septic shock, a disease where the inflammatory response is vigorously activated. Early studies examining the usage of corticosteroids in septic shock did not show any benefit, however, these studies administered very large doses. ⋯ Multi-center double blinded, randomized trials further added to the controversy without completely clarifying the issue. Moreover, the use of corticosteroids in critical illness must balance potential benefits with minimal side effects, however even such issues remain debatable as some studies show no untoward harm while other find the opposite. This review examines the use of corticosteroids in septic shock, discusses some of the shortcomings of the major clinical trials and outlines the most recent recommendations.
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Minerva anestesiologica · Feb 2011
Randomized Controlled Trial Comparative StudyQT interval and QT dispersion during the induction of anesthesia and tracheal intubation: a comparison of remifentanil and fentanyl.
The aim of this paper was to determine if there were any significant differences between the effects of fentanyl delivered as a bolus or remifentanil delivered as a continuous infusion on the QT interval and QT dispersion (QTD) during the induction of anesthesia and tracheal intubation. ⋯ Both remifentanil and fentanyl did not prolong the QT interval. QTD decreased after the induction of anesthesia and did not increase after tracheal intubation in patients receiving c.i. remifentanil in comparison with fentanyl. Overall, remifentanil infusion may be the opioid-based treatment regimen of choice in patients at risk of dysrhythmias.
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Despite the remarkable advances in antibiotic therapies, diagnostic tools, prevention campaigns and intensive care, community-acquired pneumonia (CAP) is still among the primary causes of death worldwide, and there have been no significant changes in mortality in the last decades. The clinical and economic burden of CAP makes it a major public health problem, particularly for children and the elderly. ⋯ Particular attention is given to some aspects related to the clinical management of CAP, such as the microbial etiology and the available tools to achieve it, the usefulness of new and old biomarkers, and antimicrobial and other non-antibiotic adjunctive therapies. Possible scenarios in which pneumonia does not respond to treatment are also analyzed to improve clinical outcomes of CAP.