Minerva anestesiologica
-
Minerva anestesiologica · Jul 2015
Randomized Controlled TrialThe effect of perfusion pressure on the splanchnic circulation after CPB: a pilot study.
The impact of different blood pressure targets is unknown for post cardiac surgery patient in the intensive care unit. We, therefore, investigated the effects of a mean arterial pressure (MAP) target of 65 or 85 mmHg on splanchnic oxygenation, metabolic function, cytokine regulation and gastric tonometry after cardiopulmonary bypass. ⋯ Achieving a MAP target of 85 mmHg by means of norepinephrine infusion after CPB appears safe for the splanchnic circulation.
-
Brain injury is frequently observed after sepsis and may be primarily related to the direct effects of the septic insult on the brain (e.g., brain edema, ischemia, seizures) or to secondary/indirect injuries (e.g., hypotension, hypoxemia, hypocapnia, hyperglycemia). Management of brain injury in septic patients is first focused to exclude structural intracranial complications (e.g., ischemic/hemorrhagic stroke) and possible confounders (e.g., electrolyte alterations or metabolic disorders, such as dysglycemia). Sepsis-associated brain dysfunction is frequently a heterogeneous syndrome. ⋯ Together with EEG and evoked potentials (EP), MRI is also important for coma prognostication. Emerging clinical evidence suggests monitoring of the brain in septic patients can be implemented in the ICU. The objective of this review was to summarize recent clinical data about the role of brain monitoring - including TCD, NIRS, EEG, EP, CT, and MRI - in patients with sepsis and to illustrate its potential utility for the diagnosis, management and prognostication.
-
Minerva anestesiologica · Jul 2015
ReviewSurveillance samples and selective digestive decontamination in the intensive care unit.
Surveillance cultures are essential in the management of infection in the intensive care unit. They are crucial in the assessment of the efficacy of selective digestive decontamination.
-
Minerva anestesiologica · Jul 2015
Epidemiology and clinical outcome of Healthcare-Associated Infections: a 4-year experience of an Italian ICU.
Due to their impact on the outcome, hospital-acquired infections (HAIs) in ICUs represent a critical issue of patients' assistance. This study describes microbiological and clinical findings of a surveillance program covering 4 years in an Italian ICU. ⋯ Our infection rates are higher than those reported by other studies. The use of devices and a medical admission share a significant relationship with infection presence. A greater degree of organ failure and the development of an abdominal sepsis are risk factors for mortality.
-
Minerva anestesiologica · Jul 2015
Observational StudyPreoperative autonomic nervous system analysis may stratify the risk of hypotension after spinal anaesthesia.
Studies on pregnant women undergoing cesarean delivery or elderly men scheduled for prostate brachytherapy have demonstrated the predictive value of heart rate variability (HRV) analysis for hypotension during spinal anesthesia. We conducted a prospective observational study to investigate if preoperative HRV analysis may have a role in identifying the risk of hypotension following spinal anesthesia in otherwise healthy patients. ⋯ Preoperative analysis of autonomic nervous system modulation might be useful to stratify the risk of post-spinal hypotension and it might indicate the need for careful monitoring or prophylactic fluids.