Minerva anestesiologica
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Minerva anestesiologica · Dec 2014
Review Meta AnalysisThromboelastometry for Guiding Bleeding Management of the Critically Ill Patient: A Systematic Review of the Literature.
A systematic review of the published literature clearly demonstrates the usefulness of thromboelastometry (ROTEM®) in detecting coagulation disorders in severe trauma, cardiac and aortic surgery, liver transplantation, and postpartum haemorrhage reliably and within a clinically acceptable turn-around time. In all of the above-mentioned scenarios, the transfusion of any allogeneic blood products could be reduced significantly using ROTEM®-guided bleeding management, thereby minimising or avoiding transfusion-related side effects. Based on the current body of evidence as assessed by the GRADE system, the use of ROTEM® may be recommended in particular for management of severe bleeding after trauma and during cardiac and aortic surgery. However, as laboratory testing contributes only one part of severe bleeding management, the implementation of safe and effective treatment algorithms must be ensured at the same time.
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Minerva anestesiologica · Dec 2014
ReviewHypertrophic Cardiomyopathy: implications for anaesthesia.
Hypertrophic cardiomyopathy (HCM) is a genetic disorder and it is recognized as the most common cause of sudden cardiac death in the young, and an important substrate for disability at any age. Anesthetists may be confronted with clinically unrecognized HCM and must be prepared to anticipate the hemodynamic changes and cardiovascular instability that such patients may impose. When HCM patients are subjected to the stress of surgery, perioperative complications occur and can be devastating. ⋯ Factors that worsen the degree of left ventricle outflow tract obstruction and hemondynamic strategies to improve cardiac outoput are described in the present review. Strategies to respond to hypotension must be promptly instituted to prevent the development of cardiovascular collapse, and subsequent complications. Therefore, a complete understanding of the pathophysiology, hemodynamic changes and anesthetic implications is needed for successful perioperative outcome.
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Minerva anestesiologica · Dec 2014
ReviewCorticosteroids as adjunctive treatment in Community-Acquired Pneumonia.
Community-acquired Pneumonia (CAP) is the first leading infectious cause of death in developed countries. The mortality rate in severe CAP is very high and has not changed in recent years, despite advances in antimicrobial therapy and supportive measures. Several studies have identified an excessive host inflammatory response as a marker of poor prognosis in CAP. ⋯ However, two recent meta-analyses found improved mortality in the subgroup with severe CAP and/or receiving >5 days of glucocorticoid treatment. Dosage, duration of treatment and side effects are two important aspects not well determined yet. This review discusses the association of corticosteroids as adjunctive therapy and its association with clinical outcomes and side effects in patients with CAP.
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Minerva anestesiologica · Dec 2014
Comparative StudyExtended versus bolus infusion of meropenem and piperacillin: a pharmacokinetic analysis.
Extended infusion of beta-lactam antibiotics has been advocated as a method for optimizing antibiotic exposure in critically ill patients. The objective of this study was to compare the pharmacokinetics/pharmacodynamics of extended infusion versus bolus infusion of piperacillin and meropenem in critically ill patients with normal renal function. ⋯ This study confirms that extended infusion in critically ill patients result in advantageous pharmacokinetic profiles by increasing the fT>MIC for piperacillin and meropenem. In a significant subpopulation of critically ill patients with normal renal function, a 100% fT>MIC target is not reached, even with 3-hour extended infusions.