Minerva anestesiologica
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Minerva anestesiologica · Oct 2014
Dysnatremia on intensive care unit admission is a stronger risk factor when associated with organ dysfunction.
Dysnatremia present at the time of intensive care unit (ICU) admission is associated with mortality. In this study, we investigated the epidemiology of dysnatremia present on ICU admission and the impact of organ dysfunction on the association between dysnatremia and mortality. We hypothesized that dysnatremia comorbid with organ dysfunction is associated with higher risk of mortality. ⋯ Below 125 and above 150 mmol/L sodium levels at ICU admission are risk factors for higher mortality rates in patients with comorbid organ dysfunction. The effect of dysnatremia on mortality is observed when organ dysfunction is present.
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Minerva anestesiologica · Oct 2014
Parameters from Preoperative Overnight Oximetry Predict Postoperative Adverse Events.
Continuous home monitoring of oxygen saturation has become a reliable and feasible practice. The objective of this study was to investigate the role of preoperative overnight oximetry in predicting postoperative adverse events. ⋯ Patients with mean preoperative overnight SpO2 <92.7% or ODI >28.5 events/h or CT90 >7.2% are at higher risk for postoperative adverse events. Overnight oximetry could be a useful tool to stratify patients for the risk of postoperative adverse events.
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Minerva anestesiologica · Oct 2014
ReviewManagement of oxygen and carbon dioxide pressure after cardiac arrest.
Experimental evidence shows that derangements of arterial partial pressures of either oxygen (PaO2) and carbon dioxide (PaCO2) immediately after resuscitation from cardiac arrest may increase the severity of organ dysfunction due to whole body ischemia and subsequent reperfusion. Hyperoxia is believed to increase reperfusion injury, especially to mitochondrial membrane due to increased production of reactive oxygen species. Two large observational studies in human adults showed that hyperoxia (defined as a PaO2≥300 mmHg) in the first 24 h after hospital admission was associated with increased mortality or lower likelihood of independent functional status at hospital discharge. ⋯ The PaCO2 derangements are very common in resuscitated patients. Maintaining normal levels of both PaO2 and PaCO2 and in particular avoiding both hyperoxia and hypocapnia may reduce morbidity and improve survival of cardiac arrest survivors. Available clinical evidence is however almost exclusively limited to observational studies which may be biased by potential uncontrolled confounders.
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Minerva anestesiologica · Oct 2014
ReviewAminoglycosides for life-threatening infections: a plea for an individualized approach using intensive therapeutic drug monitoring.
Aminoglycosides are potent antibiotics with a renewed interest due to the increase in multidrug resistant infections. Their use in life-threatening infections ‑ in combination with other antibiotics ‑ has been debated due to the lack of clear outcome benefits. ⋯ Toxicity on the other hand remains a concern, with nephrotoxicity as the most relevant negative effect in the critically ill. Short term, intensively monitored treatment strategies - with monitoring both peak and trough levels - may increase efficacy as well as reduce toxicity in the critically ill patient.