Minerva anestesiologica
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Minerva anestesiologica · Oct 2012
ReviewRecent advances in interfaces for non-invasive ventilation: from bench studies to practical issues.
The interface is the defining element of non-invasive ventilation (NIV). Nowadays different types of interfaces, which differ in terms of shape, mechanical properties and comfort, are available, and their choice and fitting is a key element of NIV success. In the last decade, larger masks covering the entire face and specifically designed helmets have been developed for delivering NIV, theoretically improving comfort and patient tolerance. ⋯ Thus, with the exception of the nasal mask and the mouthpiece, a variety of interfaces for NIV can be used in the acute care setting. However, prevention and monitoring of interfaces related side-effects and evaluation of patient tolerance are crucial to avoid NIV failure. To optimize effectiveness and costs, an interface strategy for NIV in acute respiratory failure could be convenient in clinical practice.
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Minerva anestesiologica · Oct 2012
ReviewWhat's new in the "Berlin" definition of acute respiratory distress syndrome?
A valid operative definition for ARDS is essential for the appropriate institution of a standardized 'best-evidence' treatment and for the identification of subgroups of patients who may benefit from specific adjunctive interventions, as well as to assist with prognostication, resource allocation and the design of new research trials. Here, we will discuss some of the methodology used by the ARDS Definition Task Force to develop the new 'Berlin' definition of ARDS, briefly discussing the rationale for the divergence from the AECC definition. The Berlin definition improves on the predictive validity for mortality of the American-European Consensus Conference's (AECC) definition and clarifies both the conceptual model of ARDS and the definition criteria of the syndrome and of its spectrum of severity. This should facilitate case recognition and more consistent treatment strategies based on severity.
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Minerva anestesiologica · Oct 2012
Comparative StudyComparison of transpulmonary thermodilution, transthoracic echocardiography and conventional hemodynamic monitoring in neonates and infants after open heart surgery: a preliminary study.
Transpulmonary thermodilution (TPTD) is an increasingly popular method used to monitor the complex hemodynamic changes in critically ill children. The purpose of our study was to examine the relationship between transthoracic echocardiographic (TTE) parameters and global hemodynamic variables derived from TPTD and those derived from conventional measurements in infants and neonates undergoing corrective cardiac surgery. ⋯ Both TPTD and TTE may be used in the estimating volumetric preload parameters. The time course of TPTD-derived parameters may have clinical relevance in pediatric critical care practice.