Minerva anestesiologica
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The use of antibiotic therapy combining at least two drugs remains controversial in patients with severe sepsis and septic shock. Some studies have suggested an improvement in patients' outcome with combination therapy over monotherapy, especially in those patients with expected mortality exceeding 25%. ⋯ Also, mortality rates were similar at 28 days and at 90 days in both groups. Considering some opposite observations coming from other recent non-randomized studies, we aimed to discuss the raisons of these conflicting findings on antimicrobials combination in patients with severe sepsis and septic shock.
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Minerva anestesiologica · Nov 2013
Editorial CommentGut overgrowth is bad news for the critically ill.
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Minerva anestesiologica · Nov 2013
ReviewNoninvasive ventilation in acute respiratory failure with altered consciousness syndrome: a bargain or an hazard?
Non-invasive ventilation (NIV) is contraindicated or at least not recommended in patients with altered consciousness syndrome (ACS) given to the poor compliance of confused/agitated patients, difficult management of accumulated secretion in depressed cough reflex, and risk of aspirative pneumonia in absence of airways protection. Conventional mechanical ventilation (CMV) via endotracheal intubation (ETI) has been usually considered as the "golden standard" ventilator treatment in ACS. However, the possibility of avoiding ETI-related life-threatening complications by means of NIV, especially in fragile, older patients with multiple comorbidities, is an appealing option. ⋯ In this clinical scenario, an initial cautious NIV trial may be attempted as long as there are no other contraindications and the technique is provided by experienced caregivers in a closely monitored setting where ETI is always readily available. The concomitant use of techniques for removing secretion and/or controlled analgo-sedation performed by expert teams may be considered in highly selected cases. The purpose of this paper was to review rationale, clinical feasibility, advantages and risks correlated with the use of NIV in ACS.
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Minerva anestesiologica · Nov 2013
Randomized Controlled Trial Comparative StudyEffect of feedback content on novices' learning ultrasound guided interventional procedures.
Feedback, of various forms, is effective at improving performance of medical procedures in simulated and clinical settings. Our objectives were to compare the effects of two forms of feedback on i) novice learning of in-plane technique for ultrasound-guided interventional procedures and ii) to evaluate novice retention of skill 24 hours after a standard learning session. ⋯ When feedback was based on KP, novices acquired pre-defined skills more quickly and made fewer errors during the learning phase (compared with controls). When feedback content was based on KR novices acquired pre-defined skills more quickly but made similar numbers of errors during the learning phase (compared with controls). In conclusion, these findings should inform development of training and assessment programs for peripheral nerve blockade.