Minerva anestesiologica
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Minerva anestesiologica · Oct 2020
The assessment of esophageal pressure using different devices: a validation study.
Although esophageal pressure measurement could help clinicians to improve the ventilatory management of acute respiratory distress syndrome (ARDS) patients, it has been mainly used in clinical research. Aim of this study was to compare the measurements of end-expiratory esophageal pressure, end-expiratory transpulmonary pressure and lung stress by three systems: a dedicated manual device, taken as gold standard, a new automatic system (Optivent) and a bedside equipment, consisting of a mechanical ventilator and a hemodynamic monitor. ⋯ Both Optivent and the bedside system showed clinically acceptability if compared to the gold standard device. The possibility to apply one of these systems could allow a wider use of esophageal pressure in clinical practice.
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Advantages of propofol use in children may include less airway complications, less emergence agitation, and less postoperative behavioral changes. However, needle phobia and the complexity of total intravenous anesthesia set-up, as well as the pharmacokinetic and pharmacodynamic restrictions may limit the wide use of propofol-based anesthesia in the form of total intravenous anesthesia. ⋯ Propofol has earned its place as a valuable choice in pediatric anesthesia. In addition, propofol and inhalation anesthesia should not be looked at as mutually exclusive; a combination of both may sometimes be the best approach to complex clinical dilemmas.
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The standard conditions of critical illness (including sepsis, acute respiratory distress syndrome, and multiorgan failure) cause enormous global mortality and a growing economic burden. Increasing evidence suggests that critical illness may be associated with loss of commensal microbes and overgrowth of potentially pathogenic and inflammatory bacteria. ⋯ Although the precise mechanisms of microbiome-directed treatments such as prebiotics, probiotics, and fecal microbiota transplantation remain to be determined, they can be utilized in the Intensive Care Unit (ICU) setting. The current review aims to offer intensivists an evidenced-based approach on what we currently know about the role of the microbiome in critical illness and how the microbiome could be targeted in the clinical practice to improve ICU-related outcomes.
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Minerva anestesiologica · Aug 2020
Multicenter Study Observational StudySafety and efficacy of a Staged-Extubation-Set in patients with difficult airway: a prospective multicenter study.
A safe extubation is the extension of any airway management strategy. Despite different guidelines, a number of extubation accidents still occurs. Re-intubation failure could be fatal, thus a strategy and safe and efficient devices for this purpose are essential. ⋯ The results from this study show a relatively satisfactory success rate with a relatively high number of re-intubations failure and a low incidence of complications when using a SES in a cohort of difficult airway patients, all failures due to guidewire dislodgement during or after extubation. Further research is needed to improve success rate; at the same time the need for an extubation protocol is strongly advocated.