Minerva anestesiologica
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Minerva anestesiologica · Feb 2013
ReviewLung imaging in patients with acute respiratory distress syndrome: from an understanding of pathophysiology to bedside monitoring.
Over the last 25 years, lung imaging has changed our understanding of acute respiratory distress syndrome. Alveolar recruitment, hyperinflation, and positive end-expiratory pressure-induced changes in lung aeration have become evaluable using CT, PET, and ultrasonography. ⋯ Bedside tools allowing monitoring of mechanical ventilation, and testing of ventilator settings, are urgently required. The aim of the present review is to consider how lung imaging has facilitated the evolution of knowledge of this syndrome, and to place such knowledge in a clinical perspective.
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Rituximab is a monoclonal chimeric antibody used in the treatment of CD20-positive B-cell malignancies and rheumatoid arthritis. However, it is used in several other off-label indications including acute graft-versus-host disease. We sought to critically examine the role of rituximab in the treatment of acute graft versus host disease (aGVHD) in critically ill patients and the potential associations with infectious complications in transplant recipients.
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Colistin is a re-emerging old antibiotic that is used as a salvage treatment against multidrug-resistant Gram-negative infections. Because it is administrated as an inactive prodrug, colistin methanesulfonate (CMS) that undergoes rapid hydrolyze to colistin, pharmacokinetic studies using biological assays are unreliable. With the recent development of new assays using high performance liquid chromatography (HPLC) accurate pharmacokinetic of CMS and formed colistin is now available in various populations. This article aims to update previous reports on pharmacodynamics, pharmacokinetics, safety and clinical use of colistin, with a special focus on data useful to treat critically ill patients.
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Minerva anestesiologica · Feb 2013
ReviewWhen the end is really the end? The extubation in the difficult airway patient.
Difficult airway management remains one of the most important sources of anesthesia related accidents; recent reviews and dedicated guidelines suggest that not only intubation, but extubation too is a critical phase in terms of potential accidents and serious complications. This paper will highlight some fundamental concepts regarding extubation related problems, focusing particularly on epidemiology, risk factors and time course of difficult extubation, suggesting some conceptual points to plan and manage patients in which a difficult extubation might be expected, including parameters and test to be performed to assess and predict such a situation.