Minerva anestesiologica
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Minerva anestesiologica · Aug 2014
Randomized Controlled Trial Multicenter StudyColloids for fluid resuscitation: what is their role in patients with shock?
Fluid therapy is widely used in critically ill patients to restore effective intravascular volume and improve organ perfusion. Recent studies have questioned the administration of colloid-based solutions, especially if containing hydroxyethyl starch (HES), in different ICU populations; however, there is still uncertainty on the use of colloids as initial fluid therapy for early resuscitation. ⋯ These data suggest that mortality was not increased and probably decreased with the use of colloids in different forms of shock requiring early fluid resuscitation. We discussed herein some methodological issues that may explain the discrepancies of this trial with the other studies developed in the same field.
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Minerva anestesiologica · Aug 2014
ReviewINTRA-ABDOMINAL HYPERTENSION AND ABDOMINAL COMPARTMENT SYNDROME: Pathophysiological and non-operative management.
Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are conditions that commonly manifest in critically ill patients. They are associated with a multiplicity of pathophysiological disturbances. ⋯ Additionally, the authors of this study have recently conducted a large study on intra-abdominal pressures of consecutive catheterised patients admitted to the Intensive Care Unit (N.=403). A preliminary analysis of this study has also been included.
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Minerva anestesiologica · Aug 2014
Multicenter Study Observational StudyClinical utility of preoperative screening with STOP-Bang questionnaire in elective surgery.
Obstructive sleep apnea (OSA) is a common disease which increases the risk of perioperative complications. The aim of this study is to assess the clinical utility of preoperative screening for OSA in determining the prevalence of patients at high risk of OSA in a surgical population, the incidence of difficult airway management and the incidence of perioperative complications. ⋯ In conclusion, this study demonstrates that the prevalence of high OSA risk patients in the surgical population is high. The increase in the rates of perioperative complications justifies the implementation of perioperative strategies that use the STOP-Bang as a tool for triage.
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Minerva anestesiologica · Aug 2014
Percentage hematocrit variation (phevar) index as a quality indicator of patient blood management in cardiac surgery.
Severe hemodilution and perioperative bleeding are determinants of hematocrit (HCT) variations in cardiac surgery patients. These variations may be direct determinants of bad outcomes, and may trigger allogeneic blood product transfusions, which are associated with morbidity and mortality. The present study introduces the Percentage HEmatocrit VARiation (PHEVAR) index as a tool to assess the quality of patient blood management (PBM) and to possibly guide specific interventions. ⋯ The PHEVAR index reflects HCT variations during 7 days of hospital stay in cardiac surgery patients, is associated with mortality and morbidity, and may be used as a quality index for PBM.