Minerva anestesiologica
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Minerva anestesiologica · Jul 2015
Epidemiology and clinical outcome of Healthcare-Associated Infections: a 4-year experience of an Italian ICU.
Due to their impact on the outcome, hospital-acquired infections (HAIs) in ICUs represent a critical issue of patients' assistance. This study describes microbiological and clinical findings of a surveillance program covering 4 years in an Italian ICU. ⋯ Our infection rates are higher than those reported by other studies. The use of devices and a medical admission share a significant relationship with infection presence. A greater degree of organ failure and the development of an abdominal sepsis are risk factors for mortality.
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Minerva anestesiologica · Jul 2015
Observational StudyPreoperative autonomic nervous system analysis may stratify the risk of hypotension after spinal anaesthesia.
Studies on pregnant women undergoing cesarean delivery or elderly men scheduled for prostate brachytherapy have demonstrated the predictive value of heart rate variability (HRV) analysis for hypotension during spinal anesthesia. We conducted a prospective observational study to investigate if preoperative HRV analysis may have a role in identifying the risk of hypotension following spinal anesthesia in otherwise healthy patients. ⋯ Preoperative analysis of autonomic nervous system modulation might be useful to stratify the risk of post-spinal hypotension and it might indicate the need for careful monitoring or prophylactic fluids.
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Minerva anestesiologica · Jul 2015
Targets of perioperative fluid therapy and their effects on postoperative outcome: A systematic review and meta-analysis.
Perioperative fluid management plays a fundamental role in maintaining organ perfusion, and is considered to affect morbidity and mortality. Targets according to which fluid therapy should be administered are poorly defined. This systematic review aimed to identify specific targets for perioperative fluid therapy. ⋯ Targeting any one of these goals resulted in less postoperative complications (pooled data analysis: OR 0.53; CI95, 0.34-0.83; P=0.005) and a shorter length of intensive care unit/hospital stay, but no difference in postoperative mortality (pooled data analysis: OR 0.61; CI95, 0.33-1.11; P=0.12). This systematic review identified three goals for perioperative fluid administration, targeting of which appeared to be associated with less postoperative complications and shorter intensive care unit/hospital lengths of stay. Perioperative mortality remained unaffected.
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Minerva anestesiologica · Jul 2015
Observational StudyPreoperative use of statins does not improve outcomes and development of acute renal failure after cardiac surgery. A propensity score analysis of ARIAM-Andalucía database.
Statin use prior to cardiac surgery has been reported to improve outcomes in the postoperative period because of other effects apart from decreasing lipid levels. Objective of the study was to analyse mortality and acute renal failure (ARF) during the cardiac surgery postoperative period in patients treated with or without statins. ⋯ Despite better outcomes for the statin users in the whole cohort, the matched analysis showed that statin use before cardiac surgery was not associated with a lower risk of ARF. Nor was presurgery statin use associated with lower hospital mortality.
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Minerva anestesiologica · Jul 2015
Observational StudyFunctional status and medium-term prognosis of very elderly patients after an ICU stay: a prospective observational study.
Because the proportion of elderly patients admitted to the intensive care unit (ICU) is increasing, the objective of this study was to test the hypothesis that very elderly patients with better preadmission functional status would have better medium-term survival and functional status after an ICU stay. ⋯ One-year mortality of very elderly patients after an ICU stay is not related to preadmission functional status but to the type of admission, existence of cancer, SOFA Score at ICU admission and occurrence of septic complications during the ICU stay. Despite functional decline in half of these patients, one year after admission 82.6% would agree to another ICU stay.