Minerva anestesiologica
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Minerva anestesiologica · Nov 2014
Observational StudyFactors associated with adherence to the low-tidal volume strategy for acute lung injury and acute respiratory distress syndrome and their impacts on outcomes: an observational study and propensity analysis.
The purpose of this study was to investigate the factors affecting adherence to the low-tidal volume (LTV) strategy in acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) and their impacts on outcomes. ⋯ Adherence to the LTV strategy was strongly associated with the lung injury score, muscle relaxant use, and depth of sedation. Propensity score-based analysis showed that the use of LTV ventilation and muscle relaxants reduced 28-day and 1-year mortality in ALI/ARDS patients.
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Minerva anestesiologica · Nov 2014
Experimental validation of frequent used echocardiographic right ventricular impedance parameters.
Aim of the study was to validate commonly used bedside right-ventricular (RV) impedance parameters, which are utilized in determining heart-lung interactions during mechanical ventilation. ⋯ ACmean is a reliable parameter of RV impedance that can be used to study the heart-lung interactions during mechanical ventilation.
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Minerva anestesiologica · Nov 2014
ReviewA PROPOSED ALGORITHM FOR MULTIMODAL LIVER TRAUMA MANAGEMENT FROM A SURGICAL TRAUMA AUDIT IN A WESTERN EUROPEAN TRAUMA CENTER.
Management of liver trauma is challenging and may vary widely given the heterogeneity of liver injuries' anatomical configuration, the hemodynamic status, the settings and resources available. Perhaps the use of non-operative management (NOM) may have potential drawbacks and the role of damage control surgery (DCS) and angioembolization represents a major evolving concept.1 Most severe liver trauma in polytrauma patients accounts for a significant morbidity and mortality. Major liver trauma with extensive parenchymal injury and uncontrollable bleeding is therefore a challenge for the trauma team. ⋯ A systematic and standardized technique of perihepatic packing may contribute to improve hemostatic efficacy and overall outcomes if wisely combined in a stepwise "sandwich" multimodal approach. DCS philosophy evolved alongside with damage control resuscitation (DCR) in the management of trauma patients, requiring close interaction between surgery and resuscitation. Therefore, as a result of a combined surgical and critical care clinical audit activity in our western European trauma center, a practical algorithm for multimodal sequential management of liver trauma has been developed based on a historical cohort of 253 liver trauma patients and subsequently validated on a prospective cohort of 135 patients in the period 2010-2013.
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Regional anesthesia is associated with recognized physiological advantages; however trials evaluating its impact on postoperative outcomes have shown contrasting results, probably because these effects have not been utilized in a multimodal perioperative care program. Enhanced recovery has attracted clinical interest because of its standardized, coordinated, multidisciplinary perioperative care plan that incorporates several evidenced-based interventions with positive influence on postoperative patient recovery. ⋯ Clearly, there are synergistic benefits derived from integrating specific regional anesthetic and analgesic techniques with other perioperative elements characteristic of a particular surgical procedure. This challenge requires a team approach in delivering such integrated care, ultimately providing the best cure for patient.
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Minerva anestesiologica · Nov 2014
Comparative StudyBuprenorphine versus tramadol as perineural adjuvants for postoperative analgesia in patients undergoing arthroscopic rotator cuff repair under middle interscalene block. A retrospective study.
The aim of this retrospective study was to compare buprenorphine and tramadol, in order to assess their different efficacy in prolonging postoperative analgesia and their associated side effects when used as perineural adjuvants with a local anesthetic. ⋯ The results showed that the group treated with buprenorphine benefited from a longer post-operative analgesia than that treated with local anesthetic alone (P<0.0001). Otherwise, a less evident not statistically significant (P=0.4825) difference turned out between the group treated with the anesthetic alone and the group treated with tramadol as adjuvant. No difference turned out to be between the local anesthetic alone treatment and the tramadol-local anesthetic one (P=0.4825; HR=0.863, 95% CI 0.574-1.299); on the contrary, a significant difference was demonstrated between the buprenophine-local anesthetic group and the local anesthetic alone one (P<0.0001; HR=0.330, 95% CI 0.216-0.530) CONCLUSION: Both buprenorphine and tramadol are effective as perineural adjuvants used in order to prolong the postoperative analgesia, buprenorphine proving more efficacious for this purpose than tramadol.