Minerva anestesiologica
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Minerva anestesiologica · Nov 2012
Review Meta AnalysisLung ultrasound in the ICU: from diagnostic instrument to respiratory monitoring tool.
Imaging has greatly contributed to the understanding of lung disease in the critically ill and currently serves as a tool to diagnose lung pathology, monitor its course, and guide clinical management. Lung ultrasound is a real-time imaging modality that is simple, non-invasive, potentially ubiquitous, and free of ionizing radiation. ⋯ While the utility of lung ultrasound in the emergency setting is unquestioned, its potential role in the more complex and resource-rich intensive care environment is still under investigation. The purpose of this paper was to describe current and potential uses of lung ultrasound in the specific setting of adult intensive care, with an emphasis on respiratory monitoring, and to provide a framework for the practical application of this tool at the bedside.
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Minerva anestesiologica · Nov 2012
Plasma renin concentration as a predictor of outcome in a medical intensive care setting: a retrospective pilot study.
Renin and aldosterone are involved in an organ perfusion pathway that may be an estimate of disease severity. The primary objective was to explore the relationship between outcome and aldosterone and renin levels at medical intensive care unit (MICU) admissions in comparison to SAPS II scores. ⋯ Renin was correlated to outcome in critically ill medical patients.
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Minerva anestesiologica · Nov 2012
ReviewNew membranes for extracorporeal blood purification in septic conditions.
Severe sepsis and septic shock are still the leading cause of mortality and morbidity in the intensive care unit. The inflammatory response to infection is associated with an impressive, systemic release of pro- and anti-inflammatory mediators, which results in generalized endothelial damage, multiple organ failure and altered cellular immunological responsiveness. ⋯ However, the use of extracorporeal blood purification techniques during sepsis still remains controversial, thus precluding any definitive recommendations on the benefit of these methods. More data are needed to better recognize septic patients who are most likely to benefit from blood purification treatments, and clarify the optimal timing, duration, and number of applications of these techniques in the daily clinical practice.
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Minerva anestesiologica · Nov 2012
Do established prognostic factors explain the different mortality rates in ICU septic patients around the world?
The aim of this paper was to clarify if previously established prognostic factors explain the different mortality rates observed in ICU septic patients around the world. ⋯ Severe sepsis mortality varies widely in different countries. All known markers of disease severity and prognosis do not fully explain the international differences in mortality. Country income does not explain this disparity either. Further studies should be developed to verify if other organizational or structural factors account for disparities in patient care and outcomes.
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Minerva anestesiologica · Nov 2012
Clinical TrialProcedural complications of central venous catheter insertion.
Central venous catheters (CVC) have complication rates as high as 20% and are associated with significant morbidity and mortality. In this study we wished to determine the incidence of procedural related complications at different venous access sites as well as the impact of ultrasound (US) use, operator experience and level of supervision of trainees in a prospective observational study. ⋯ Immediate procedural-related complications during CVC insertion are common. To reduce the incidence of procedural-related complications we advocate multiple strategies to assure central venous cannulation safety: 1) the internal jugular vein should be the primary target vessel; 2) trainees with <25 previous catheter insertions should be supervised at all times; 3) ultrasound may reduce the incidence of procedural-related complications.