Minerva anestesiologica
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Minerva anestesiologica · Aug 2019
Randomized Controlled Trial Multicenter StudyProportional Assist Ventilation feasibility in the early stage of respiratory failure: a prospective randomized multicenter trial.
Proportional assist ventilation (PAV+) is an assisted ventilator mode usually applied during weaning. We aimed to determine the feasibility of using PAV+ in the early phase of acute respiratory failure compared to volume-assist control ventilation (V-ACV) in order to shorten the length of mechanical ventilation (MV). ⋯ The use of high-assistance PAV+ in the early phase of MV does not present benefits compared to V-ACV. The high rate of PAV+ failure reinforces the need for sedative optimization, learning curve, and better patient selection.
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Minerva anestesiologica · Aug 2019
Meta AnalysisMusic therapy reduces stress and anxiety in critically ill patients: a systematic review of randomized clinical trials.
The underlying clinical condition and the Intensive Care Unit (ICU) environment make critical illness a stressful event. Although the usual management consists of sedation, non-pharmacological interventions such as music therapy have been suggested for their drug-sparing effect. Aim of the present review is to assess the current evidence on the effectiveness of music therapy in reducing stress and anxiety in critically ill, adult patients. ⋯ Despite significant heterogeneity in trial designs, timing and features of the intervention, music therapy is consistently associated with a reduction in anxiety and stress of critically ill patients.
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Minerva anestesiologica · Aug 2019
ReviewUsing opioid therapy for pain in clinically challenging situations: questions for clinicians.
Healthcare professionals and organizations increasingly face the conundrum of treating patients with active substance use disorder, a history of personal or familial substance use disorder, or those at elevated risk for substance abuse. Such patients need compassionate care when facing painful conditions; in fact, denying them pain control makes it likely that they will seek out ways to self-medicate with illicit drugs. Yet it remains unclear how to safely and effectively treat patients in these challenging situations. ⋯ It is tempting but inaccurate to label these individuals as "inappropriate patients," rather they are high-risk individuals in very challenging clinical situations. The challenge is that both options - being in pain or being treated with opioids to control pain - expose the patient to a risk of rekindling an addiction. The question is how do we, as clinicians, adequately respond to these very perplexing clinical challenges?
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Minerva anestesiologica · Aug 2019
Comparative StudyInterscalene brachial plexus catheter versus single-shot interscalene block with periarticular local infiltration analgesia for shoulder arthroplasty.
Interscalene brachial plexus block is a commonly employed regional anesthetic technique for total shoulder arthroplasty, and a continuous catheter is often placed to extend the analgesic benefit of the block. As periarticular local infiltration analgesia (LIA) for total joint arthroplasty is a re-emerging trend, we evaluated the analgesic efficacy of continuous interscalene block (CISB) compared to single-shot interscalene block (SSISB) with LIA. ⋯ SSISB with LIA may provide clinically similar postoperative analgesia compared to CISB, but with escalating doses of opioid requirements.
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Minerva anestesiologica · Aug 2019
Observational StudyEarly dysglycemia and mortality in traumatic brain injury and subarachnoid hemorrhage.
Traumatic brain injury (TBI) and subarachnoid hemorrhage (SAH) are the most common causes of severe acute brain injury in younger Intensive Care Unit (ICU) patients. Dysglycemia (abnormal peak glycemia, glycemic variability, mean glycemia, nadir glycemia) is common in these patients but its comparative outcome associations are unclear. ⋯ In TBI and SAH patients, greater dysglycemia is associated with greater mortality. This association is significantly stronger than in the general population and it is significantly stronger in patients with TBI compared with SAH.