Minerva anestesiologica
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Minerva anestesiologica · Aug 2014
ReviewINTRA-ABDOMINAL HYPERTENSION AND ABDOMINAL COMPARTMENT SYNDROME: Pathophysiological and non-operative management.
Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are conditions that commonly manifest in critically ill patients. They are associated with a multiplicity of pathophysiological disturbances. ⋯ Additionally, the authors of this study have recently conducted a large study on intra-abdominal pressures of consecutive catheterised patients admitted to the Intensive Care Unit (N.=403). A preliminary analysis of this study has also been included.
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Minerva anestesiologica · Aug 2014
Multicenter Study Observational StudyClinical utility of preoperative screening with STOP-Bang questionnaire in elective surgery.
Obstructive sleep apnea (OSA) is a common disease which increases the risk of perioperative complications. The aim of this study is to assess the clinical utility of preoperative screening for OSA in determining the prevalence of patients at high risk of OSA in a surgical population, the incidence of difficult airway management and the incidence of perioperative complications. ⋯ In conclusion, this study demonstrates that the prevalence of high OSA risk patients in the surgical population is high. The increase in the rates of perioperative complications justifies the implementation of perioperative strategies that use the STOP-Bang as a tool for triage.
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Mechanical ventilation may induce or aggravate lung injury, a phenomenon known as ventilator induced lung injury (VILI). On a macroscopic level, the effects of mechanical stress and strain on lung tissue are well described. Increased tidal volumes may lead to volutrauma, raised airway pressures may cause barotrauma and cyclic collapse and reopening of alveolar units contributes to atelectrauma. ⋯ These cells are involved in sensing and translation of mechanical stimuli into an inflammatory response. This review provides insight into current knowledge of cellular and molecular pathways during the process of pulmonary epithelial mechanosensation and mechanotransduction under different mechanical conditions. Since evidence for specific pathways is generally lacking in some fields of alveolar epithelial mechanotransduction, this article aims at providing reasonable hypothesis for further investigation.
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Several methods are reported in the literature to analyze medically undesirable events during hospital care. Each method has several limitations, so no one has been defined as the standard tool to be able to detect failure during a medical process. The aim of this study was to compare an anesthesiological perioperative checklist with traditional Regional Incident Reporting (RIR) form in detecting and describing failures. ⋯ An anesthesiological checklist compared with traditional RIR provided a more sensible and complete framework for incident analysis during the perioperative period in patients undergoing gynecological and obstetrical surgeries.