Minerva anestesiologica
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Minerva anestesiologica · Sep 2015
ReviewBlood glucose amplitude variability in critically ill patients.
While the discussion on the optimal blood glucose (BG) level target in critically ill patients is on-going, attention shifts towards other aspects of the BG signal, such as hypoglycemia and blood glucose amplitude variability (BGAV). A large number of observational and mostly retrospective studies have demonstrated an association between increased BGAV and worse outcomes. ⋯ In this review article, intuitive concept of "variability" will be clarified, and possible metrics to quantify BGAV are discussed. Whether it is feasible to actively minimize BGAV in order to improve the outcome of critically ill patients, is questionable.
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Insights into the pathogenesis of lung deformation injury inspired a benchmark clinical trial, which demonstrated that reducing tidal volumes compared to previous norms was associated with improved patient survival in acute respiratory distress syndrome (ARDS). Since many critically ill patients without ARDS possess ventilator associated lung injury (VALI) risk factors, there is no need to expose them to tidal volumes that are larger than would be needed to achieve acceptable blood gas tensions. ⋯ We will review studies in the medical and surgical literature that have addressed "lung protective ventilation" in patients without ARDS and summarize them with a focus on tidal volume, positive end expiratory pressure and oxygen supplementation settings. In addition, we will briefly discuss under what circumstance one might consider deviating from a conventional approach.
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Minerva anestesiologica · Sep 2015
Careful monitoring of the use of sedative drugs at the end of life: the role of epidemiology. The ITAELD study.
Sedative drugs are often used at the end of life for different clinical indications, and sometimes sedation is not interrupted until the patient dies. The aim of this study was to estimate the prevalence of patients who died while deeply sedated in Italy in 2007. ⋯ Our study confirms the high prevalence of patients in Italy who die while being deeply sedated and shows that different practices may converge under the same label. Careful descriptive language is needed.
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Minerva anestesiologica · Sep 2015
Preoperative adherence to continuous positive airway pressure among obstructive sleep apnea patients.
Obstructive Sleep Apnea (OSA) increases the perioperative risk of complications. Chronic use of Continuous Positive Airway Pressure (CPAP) by patients decreases the importance of comorbidities caused by the OSA. However, many patients do not adhere to the treatment. Given the postoperative complications, it is important for the anesthesiologist to identify non-adherent patients. This prospective study was designed to identify factors that would predict patient adherence. ⋯ These four new criteria should preoperatively be sought, in order to detect non-adherent patients more efficiently.
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Minerva anestesiologica · Sep 2015
Confirmation of correct central venous catheter position in the pre-operative setting by echocardiographic "bubble-test".
Verification of the central venous catheters (CVCs) position by chest X-ray (CXR) is usually performed in the postoperative period with the risk related to possible malposition. This prospective observational study aimed to assess the diagnostic accuracy and reproducibility of ultrasound (US) and "bubble test" to detect malpositions of CVC in the preoperative setting. ⋯ CVC malposition was observed in a sizeable proportion of patients undergoing preoperative central venous cannulation. Measurement of "push-to-bubbles" time is a fast, accurate and highly reproducible tool for verifying the correct CVC position.