Minerva anestesiologica
-
Minerva anestesiologica · Apr 2016
Intracranial pressure and outcome in critically ill patients with aneurysmal subarachnoid hemorrhage: a systematic review.
Evidences supporting the use of ICP monitoring after aneurysmal subarachnoid hemorrhage (aSAH) are limited. The aim of our paper is to examine whether elevated intracranial pressure (ICP) and ICP-derived variables predict mortality and functional outcomes after aSAH. ⋯ Elevated ICP was associated with higher mortality however absolute ICP values per se were not independent predictors of functional recovery. Variables derived from ICP monitoring are more accurate than ICP absolute values in predicting outcome. Given the absence of good quality data, additional large studies may help to better define the prognostic value of ICP after aSAH.
-
Minerva anestesiologica · Apr 2016
Randomized Controlled TrialMechanical LUCAS resuscitation is effective, reduces physical workload and improves mental performance of helicopter emergency teams.
Physical and mental workload during cardiopulmonary resuscitation (CPR) is challenging under extreme working conditions. We hypothesized that the mechanical chest-compression device Lund University Cardiac Assist System (LUCAS) increases the effectiveness of CPR, decreases the physical workload and improves the mental performance of the emergency medical service (EMS) staff during simulated emergency helicopter flights. ⋯ During simulated helicopter flights LUCAS-CPR improved the efficacy of chest-compressions, was physically less demanding and provided enhanced cognitive performance of the EMS team as compared to manual CPR.
-
Minerva anestesiologica · Apr 2016
ReviewAnother failed attempt of neuroprotection: Progesterone for moderate and severe traumatic brain injury.
Two large phase-III prospective, multicenter, controlled, double-blind, randomized clinical trials (the PROTECT III study; the SYNAPSE study) evaluated the effectiveness of an early administration of progesterone in patients with moderate to severe traumatic brain injury (TBI). In the PROTECT III Trial, patients were included if the admission Glasgow Coma Scale (GCS) was within 4-12, whereas the SYNAPSE Trial only included patients with GCS 4-8. The total dose of progesterone was nearly similar in both studies and drug administration was initiated early after injury (within 4 hours for a total of 96 hours in PROTECT; within 8 hours for 120 hours in SYNAPSE). ⋯ In PROTECT, the proportion of patients with favourable outcome was similar between groups (51% for progesterone vs. 56% for placebo; RR 3.03 [95% CI 1.96-4.66]); in SYNAPSE, no difference in GOS between the progesterone and placebo group was found (OR 0.96 [95% CI 0.77-1.18]). There was no difference in 6-month mortality or any of the other secondary outcomes between groups in the two trials. These studies demonstrated that early progesterone administration did not provide any benefit on the neurological recovery of TBI patients.
-
Minerva anestesiologica · Apr 2016
Treatment of chronic cervicalbrachial pain with periradicular injection of meloxicam.
Cervicobrachial pain (CBP) is often resistant to conventional oral analgesics. We hypothesized that the periradicular injection of meloxicam would produce a significant reduction in their intractable CBP. The secondary objective was to assess the impact of the treatment on functional recovery. ⋯ Cervical periradicular injection of meloxicam reduced CBP by 81% at 90-day follow-up and also improved functional recovery.