Minerva anestesiologica
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Minerva anestesiologica · Sep 2013
Tracheal amylase dosage as a marker for microaspiration: a pilot study.
Devices that limit microaspiration through the cuffs of endotracheal tubes could help prevent ventilator-associated pneumonia (VAP). The amount of tracheal microaspirations could be a relevant study endpoint. The aim of our study was to assess whether amylase measured in tracheal secretions constituted a relevant marker for microaspiration. ⋯ Tracheal amylase was easy to collect, transport, and measure. The T/O amylase ratio is a first step towards quantifying oropharyngeal to tracheal microaspiration in mechanically-ventilated patients.
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The infusion of hydroxyethylstarch (HES) containing fluids has been extremely common worldwide over the last decade. Until recently, HES was probably the most commonly prescribed colloidal preparation in the world. Such prescription continued despite concerns that starch molecules might accumulate in vital organs and that starch preparations might decrease the coagulability of blood. ⋯ Subsequent meta-analyses have confirmed these findings. In response to such strong evidence, over the last few weeks, the Food and Drug Administration has issued a major warning and, in Europe, the EMA suspended the marketing authorization for HES. At least in Europe, the clinical story of HES seems to have come to an end.
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Minerva anestesiologica · Sep 2013
Global and regional parameters to visualize the 'best' PEEP during a PEEP trial in a porcine model with and without acute lung injury.
Setting the optimal level of positive end-expiratory pressure (PEEP) in critically ill patients remains a matter of debate. "Best" PEEP is regarded as minimal lung collapse and overdistention to prevent lung injury. In this study, global and regional variables were evaluated in a porcine model to identify which variables should be used to visualize "best" PEEP. ⋯ Most of the evaluated parameters indicate comparable 'best' PEEP levels. However, a combination of these parameters, and especially EIT-derived intratidal gas distribution, might provide additional information. The application of lung recruitment was beneficial in both ALI and the "healthy" lung.
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Minerva anestesiologica · Sep 2013
Letter Case ReportsParadoxical air embolism after cardiac Computed tomography scan.