Minerva anestesiologica
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Minerva anestesiologica · Jun 2017
ReviewFluid management in cardiac surgery patients: pitfalls, challenges and solutions.
Fluid administration is a powerful tool for hemodynamic stabilization as it increases preload and improves cardiac function in fluid-responsive patients. However, there are various types of fluid to choose from. The use of colloids and crystalloids in non-cardiac Intensive Care Units (ICU) has been reported, showing controversial results. ⋯ Improved clinical outcomes are evident in protocols for goal-directed therapy. In conclusion, the application of a close monitoring and a pre-defined goal-directed protocol are far more important than the choice of a single fluid. This review examines the available evidence on fluid management in cardiac surgery and in the ICU, and analyzes the key steps of fluid strategy in these settings.
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Minerva anestesiologica · Jun 2017
Multicenter Study Comparative StudyAggressive versus conservative antibiotic use to prevent and treat ventilator-associated pneumonia in patients with severe traumatic brain injury. Comparison of two case series.
In patients with traumatic brain injury (TBI), ventilator-associated pneumonia (VAP) is considered a dangerous complication, prompting early aggressive antibiotic treatment and prophylaxis. While this approach increases the selection of multidrug-resistant bacteria (MDR), its clinical benefit has not been demonstrated. ⋯ Although not conclusive, these results call into question the prevalent aggressive use of antibiotics in TBI patients and urge the scientific community to produce better evidence for clinical recommendations.
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Minerva anestesiologica · Jun 2017
ReviewNon-invasive ventilation improves respiratory distress in children with acute viral bronchiolitis: a systematic review.
Non-invasive ventilation (NIV) is a common treatment for bronchiolitis. However, consensus concerning its efficacy is lacking. The aim of this systematic review was to assess NIV effectiveness to reduce respiratory distress. Secondary objectives were to summarize the effects of NIV, identify predictive factors for failure and describe settings and applications. ⋯ NIV shows promising results for the reduction of respiratory distress in acute viral bronchiolitis, as shown in several recent studies. However, there is a lack of robust studies to confirm this.
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Minerva anestesiologica · Jun 2017
ReviewRemote ischemic preconditioning in cardiac anesthesia: a review focusing on translation.
Remote ischemic conditioning (RIC) is a powerful cardioprotective strategy. Its clinical application is simple, cheap and so far free from secondary side effects. Given the heterogeneous results of recent large-scale clinical trials, its clinical relevant benefit is still doubted. ⋯ Their results are as heterogeneous as their monitored outcome parameters or strategies to apply RIC. The impressive experimental and clinical evidence in favor of RIC is opposed by the neutral results of the latest large-scale trials. While the underlying reasons for these neutral results are matter of on-going debate and could not be answered by recent published sub-investigations, additional adequately designed studies are encouraged by the mentioned results of experimental and pilot studies to exclude any confounding factors.