Minerva anestesiologica
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Minerva anestesiologica · Dec 2013
Review Meta AnalysisThe Efficacy of Intravenous Lidocaine versus Placebo on Attenuating Cardiovascular Response to Laryngoscopy and Tracheal Intubation: A Systematic Review of Randomized Controlled Trials.
Cardiovascular response to laryngoscopy and tracheal intubation may be harmful in surgical patients with cardiovascular and cerebral diseases. The efficacy of intravenous lidocaine on attenuating the hemodynamic changes remains controversial. This systematic review aims to determine the efficacy of lidocaine versus placebo. ⋯ No significant publication bias across trials was found. Intravenous lidocaine helps reduce cardiovascular responses to laryngoscopy and tracheal intubation in patients of all age groups compared to placebo. Further studies are needed to clarify the effects of dosage and timing of lidocaine on hemodynamic changes.
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Minerva anestesiologica · Dec 2013
ReviewDiagnosis of pneumonia in mechanically ventilated patients. What is the meaning of the CPIS?
Ventilator associated pneumonia (VAP) is one of the most common nosocomial infections in critically ill patients, especially in those being mechanically ventilated. Beside increased healthcare costs due to prolonged hospital stay, VAP is associated with a consistently high morbidity and mortality. Although pathomechanisms leading to VAP are well known, it remains challenging to diagnose VAP accurately and in a timely manner. ⋯ Several evidence based strategies have been described for the diagnosis of ventilator associated pneumonia, potentially leading to better or faster treatment and thereby influencing the outcome. Current diagnostic approaches and the value of the CPIS are therefore considered within this article. A bundle approach, regarding time management and several diagnostic pathways should be evaluated in further studies.
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Interest in techniques and applications of the transversus abdominis plane (TAP) block has expanded exponentially since its introduction over ten years ago. The choice of techniques and approaches has been assisted with the availability of ultrasound, but the optimal injection for certain surgical incisions are not yet clear. A literature search was performed looking at anatomical and distribution studies, and clinical trials evaluating the effects of TAP blocks in patients undergoing abdominal surgery. ⋯ Clinical and contrast studies indicate that the landmark and ultrasound guided TAP blocks differ in their spread and mode of action. Regardless, both techniques provide effective analgesia for abdominal surgery. Further research is required to compare TAP blocks with epidural analgesia.
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Minerva anestesiologica · Dec 2013
ReviewFungal Sepsis in the ICU: Are We Doing Better? - Trends in Incidence, Diagnosis, and Outcome.
Despite the availability of broad-spectrum antifungal agents, fungal sepsis remains an issue in Intensive Care Unit (ICU) patients. In terms of occurrence rates, the most important fungal infections are invasive candidiasis and invasive pulmonary aspergillosis. Early diagnosis is essential to optimize the chances of survival. ⋯ Given the problematic diagnosis of invasive aspergillosis no reliable trend data are available. Outcome following fungal sepsis remains cumbersome. Given the availability of potent antifungal agents any progress in survival is likely to come from a more timely diagnosis.