Minerva anestesiologica
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Minerva anestesiologica · Jul 2013
Postoperative hemoglobin levels and its association with myocardial ischemia in non-cardiac surgical patients.
Background: Low hemoglobin (Hb) levels as well as cardiac complications are common conditions in postoperative surgical patients and both are associated with poor outcome. The aim of this study was to determine the influence of postoperative Hb levels on myocardial ischemia in high-risk patients who underwent non-cardiac surgery. Methods: In this retrospective observational cohort study, we evaluated 3638 consecutive patients admitted to the 24-hour postoperative anesthesia care unit between 2006 and 2010. 273 (8%) high-risk patients, defined as three or more cardiac risk factors, were selected for analyses. ⋯ Results: Postoperative myocardial ischemia was present in 73 (27%) of the 273 patients. After adjustment for significant pre-, intra- and postoperative risk factors, 4 independent risk factors remained for postoperative myocardial ischemia in male patients: age (OR 1.1; 95% CI: 1.0 - 1.1), a history of ischemic heart diseases (OR 4.2; 95% CI: 1.0 - 17.8), renal failure (OR 5.4; 95% CI: 2.1 - 13.9) and postoperative Hb levels: intermediate tertile (10.3-11.6 g/dL) (OR 5.8; 95% CI: 1.6 - 20.9) and lowest tertile (7.9-10.2 g/dL) (OR 12.9; 95% CI: 3.0 - 55.5). Conclusion: Postoperative Hb levels are independently associated with postoperative myocardial ischemia in high-risk patients undergoing non-cardiac surgery.
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Minerva anestesiologica · Jul 2013
ReviewOutcomes after ARDS: a distinct group in the spectrum of disability after complex and protracted critical illness.
ARDS represents an important public health problem for patients, family caregivers and society. The last decade has seen a burgeoning literature focussed on the outcomes of this patient group and has informed important new knowledge about the devastating and often irreversible morbidity related to nerve, muscle and brain injury More recent studies have reinforced these robust themes of physical and neuropsychological morbidity in other patient groups and have shown that outcomes after ARDS are one segment of a spectrum of disability and may not be widely generalizable across older patients with multiple comorbidities and protracted length of stay in the critical care unit. Our literature has reached theme saturation in terms of morbidity and needs to identify and begin to address the research agenda for the next decade. Several of these themes will be addressed here and include the following: 1) to generate large diverse datasets to understand different outcome trajectories over time to facilitate risk stratification and inform development of rehabilitation programs; 2) to embrace mixed methodology as a new longitudinal study standard to facilitate detailed qualitative observations to augment insights from quantitative data; 3) to educate patients, families, colleagues and decision-makers about outcomes after critical illness to inform policy and decision-making; 4) to embrace family caregivers and provide intervention when needed and ongoing support across transitions of care; 5) prioritize functional outcome measures over those targeted at health-related quality of life for construction of more focussed rehabilitation interventions; 6) embrace translational research programs to elucidate the relationship between functional outcome and molecular mechanism to gain further insight into the pathophysiology of critical illness, muscle and brain injury and potential insights into novel therapeutic strategies.
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Minerva anestesiologica · Jul 2013
ReviewSleep in the Intensive Care Unit measured by polysomnography.
Sleep deprivation has deleterious effects on most organ systems. Patients in the Intensive care unit (ICU) report sleep deprivation as the second worst experience during their stay only superseded by pain. The aim of the review is to provide the clinician with knowledge of the optimal sleep-friendly care and environment. ⋯ Sedation should be kept at a minimum and interrupted once daily. Care interventions should be clustered and noise reduced and/or masked with earplugs. NAVA, proportional assist+ or assist-control ventilation should be preferred to pressure support ventilation and adjusted to allow smaller tidal volumes, thus avoiding central apnoeas.
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Minerva anestesiologica · Jul 2013
Practice GuidelineII Italian intersociety consensus statement on antithrombotic prophylaxis in orthopedics and traumatology.
Pharmacological prophylaxis for preventing venous thromboembolism (VTE) is a worldwide established procedure in hip and knee replacement surgery, as well as in the treatment of femoral neck fractures, but few data exist to its regard in other fields of orthopedics and traumatology. Indeed, no guidelines or recommendations are available in the literature, except for a limited number of weak statements about knee arthroscopy and lower limb fractures. ⋯ The Italian Society for Studies on Hemostasis and Thrombosis (SISET), the Italian Society of Orthopedics and Traumatology (SIOT) and the association of Orthopedic Traumatology of Italian Hospitals (OTODI) together with the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI) and the Italian Society of General Medicine (SIMG) have set down quick and easy suggestions for VTE prophylaxis in a number of surgical conditions for which only scarce evidence is available. This inter-society consensus statement aims at simplifying the approach to VTE prophylaxis in the single patient with the goal of improving its clinical application.
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Minerva anestesiologica · Jul 2013
Clinical severity of ischemic stroke and neural damage biomarkers in the acute setting: the STROke MArkers (STROMA) study.
Stroke is a leading cause of long-term morbidity and mortality affecting several hundred-thousand people annually in the Western Countries. Various panels of biomarkers of neural damage have been developed and validated. The primary objective of this investigation was to measure the correlation between the clinical severity of stroke and the serum/plasma concentrations of neural damage biomarkers. ⋯ MMP-9, S100β, NT pro-BNP and D-dimer showed a good correlation with the clinical severity of stroke which may become an additional resource in the acute patient evaluation and potentially follow-up.