Minerva anestesiologica
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This article presents the case of a pregnant woman affected by A/H1N1 flu progressed to ARDS requiring rescue therapy by VV ECMO. Due to the early gestational age, the patient was placed on ECMO before delivery. ⋯ One week after delivery, the patient was weaned from ECMO and at 8 weeks from admission she was discharged home without O2 support. The newborn is alive and was discharged at 40 days of age on neurological follow-up.
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Minerva anestesiologica · Jun 2011
ReviewPreoperative evaluation in geriatric surgery: comorbidity, functional status and pharmacological history.
The demand for elective and emergency surgery by older patients is increasing. This review examines the current practice of preoperative evaluation in geriatric anesthesia and provides an overview of new insights in this field. Preoperative anesthesia consultation is essential to examine the patient, evaluate the operative risk and plan preventive perioperative actions. ⋯ A strong joint action with the surgical team is essential. Currently, while many resources are employed to assess preoperative cardiac risk and despite the dramatic increase in the number of elderly surgical patients, the association between older age itself and surgical complications has not been fully investigated, and preoperative evaluation of functional status is not yet a part of routine preoperative practice. Creating a new culture and developing appropriate clinical, scientific and relational approaches to these patients represent the core of the challenge.
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Minerva anestesiologica · Jun 2011
ReviewVentilator-induced lung injury and sepsis: two sides of the same coin?
Unequivocal evidence from both experimental and clinical research has shown that mechanical ventilation can damage the lungs and initiate an inflammatory response, possibly contributing to extrapulmonary organ dysfunction. This type of injury, referred to as ventilator-induced lung injury (VILI), resembles the syndromes of acute lung injury (ALI) and the acute respiratory distress syndrome (ARDS). VILI can trigger a complex array of inflammatory mediators, resulting in a local and systemic inflammatory response. ⋯ On the other hand, current scientific evidence supports a link between VILI and the development of extrapulmonary organ dysfunction, similar to how most severe cases of sepsis are clinically manifested. In addition, functional genomics approaches using a gene array methodology to measure lung gene expression have identified differential patterns of gene expression in animal models of VILI, similar to those gene pathways activated during experimental and clinical sepsis. In this line of thought, we hypothesize that injurious mechanical ventilation could be responsible for the perpetuation and worsening of sepsis in some patients and for the development of a sepsis-like syndrome in others.