Minerva anestesiologica
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Minerva anestesiologica · Apr 2017
ReviewClinical indices and biomarkers for perioperative cardiac risk stratification: an update.
European Society of Cardiology (ESC)/ European Society of Anesthesiology (ESA) highlighted that anesthesiologist has a leading role in perioperative cardiovascular assessment and management in the year of 2014. During cardiovascular assessment one can rely on cooperation of multidisciplinary specialists like: other anesthesiologists, cardiologists and surgeons. For the purpose of precise systematization and decision making the Lee Score or NSQUIP database can be used besides the traditionally used ASA Score. ⋯ Biomarkers are considered to represent a foundation of evidence based medicine and they help anesthesiologists in the decision-making process. They increase the chance to achieve the best clinical outcome for each patient. An ideal biomarker does not exist and therefore new research are currently being conducted with the aim to find and declare more specific biomarkers like heart-type fatty acid-binding protein, micro RNA, PAMP and high sensitivity troponins T.
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Manipulation of blood pressure (BP) is a mainstay of therapy in patients with acute brain injury (ABI). In the early emergent phase (first hours from injury), depending on intracranial pathology, BP manipulation aims to: 1) limit the progression of parenchymal hematomas or hemorrhagic transformation (in patients with ischemic/hemorrhagic stroke and aneurysmal subarachnoid hemorrhage [SAH]), and 2) attenuate hypoperfusion and secondary cerebral ischemic insults (in patients with traumatic brain injury [TBI]). During the intensive care unit (ICU) phase, BP management is primarily focused at identifying the so-called "optimal" BP/cerebral perfusion pressure (CPP), i.e. the threshold of mean arterial pressure (MAP)/CPP to prevent secondary cerebral ischemia. ⋯ Increasing clinical data support the use of surrogate monitoring modalities of cerebral perfusion (including trans-cranial Doppler and brain tissue oximetry) to indentify BP/CPP targets in ABI patients. We reviewed herein the actual evidence regarding BP control in the early phase after ABI and recent clinical investigations using multimodal monitoring to optimize CPP and BP in severe ABI patients. The main purpose of this review is to provide a pragmatic approach of BP management, taking into account the timing of injury and differences in brain pathologies.
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Minerva anestesiologica · Apr 2017
ReviewHigh flow oxygen therapy in adult critically ill patients.
High flow oxygen therapy is characterized for its ability to meet or exceed the high peak inspiratory flow of the patients with acute respiratory failure. Despite the lack of definitive evidence regarding its efficacy in improving clinically significant outcomes, its application has been rapidly spreading over the last decade. In this review we discuss the potential physiologic mechanisms of benefit as well as the most recent clinical trials investigating its role in adult critically ill patient.