Minerva anestesiologica
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Non-invasive ventilation (NIV) is a very effective technique for severe acute exacerbations of COPD/COLD and acute pulmonary edema, but its interest is still a matter of debate for severe asthma attacks. However, despite a slow decrease in asthma mortality, which actually mainly concerns older people, the prevalence of asthma is still raising and is associated to a high level of emergency visits and ICU hospitalizations for severe asthma attacks. ⋯ From a technical point of view, one can expect in the future some improvements by combining NIV and nebulization and/or helium-oxygen therapy. Finally, there is a need for positive large randomized clinical trials before routine clinical use can be firmly recommended.
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Minerva anestesiologica · Aug 2013
ReviewExtracorporeal lung support in patients with chronic obstructive pulmonary disease.
When patients with chronic obstructive lung disease (COPD) and acute on chronic respiratory insufficiency fail non-invasive ventilation (NIV) they are commonly intubated and treated with invasive mechanical ventilation (IMV) to ensure adequate gas exchange. However, IMV itself is associated with considerable complications which can aggravate any pre-existing lung disease and contribute to morbidity and mortality. ⋯ Recent technological improvements of extracorporeal devices have made ECLA more efficient and safe. This article discusses different types of ECLA, their potential indications in patients with COPD as well as the preliminary clinical evidence for their effectiveness and safety.
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Minerva anestesiologica · Aug 2013
Predicting hospital mortality in adult patients with prolonged stay (>14 days) in surgical intensive care unit.
The aim of this paper was to identify the factors at surgical intensive care unit (SICU) admission and during the following SICU course that influence hospital mortality of patients with prolonged SICU stay (>14 days). ⋯ This validated predictive model reached clinically accurate discriminatory power, and may serve to improve patient care and resource utilization in the SICU.
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Minerva anestesiologica · Aug 2013
Diagnostic contribution from pulmonary biopsies in hematology patients with acute respiratory failure from undetermined etiology.
In about 20% of patients with malignancies with acute respiratory failure (ARF), no etiology can be determined, whatever the diagnostic strategy used. Lung biopsy could then be a precious diagnostic tool leading to therapeutic adaptations and increasing chances for cure. The aim of this study was to assess the diagnostic contribution of lung biopsy in patients for whom a complete diagnosis strategy failed to identify ARF etiology. ⋯ Diagnostic lung biopsy is rarely needed in hematology patients with ARF. But, it has a 73% therapeutic impact and has overall no major complications. Contribution from post-mortem biopsies seems less relevant.
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Minerva anestesiologica · Aug 2013
Neurally adjusted ventilatory assist in non-invasive ventilation.
This manuscript describes the motivation for developing neurally adjusted ventilatory assist (NAVA) and its subsequent use with a non-invasive interface. The challenges with conventional, pneumatically controlled non-invasive modes are briefly described, followed by a mini-review on the upper airways and the diaphragm electrical activity (EAdi) signal. ⋯ In summary, non-invasive NAVA provides a truly synchronized mode of non-invasive ventilation, both in time and in level of assist. Along with EAdi monitoring, NAVA can increase the confidence to treat respiratory failure non-invasively.