Minerva anestesiologica
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Minerva anestesiologica · Dec 2013
Multicenter StudyClinical characteristics and prognosis of pneumonia and sepsis: multicenter study.
Pneumonia is the primary source of sepsis and is significantly associated with mortality. However, only a few studies focus on its clinical characteristics and outcomes. ⋯ In patients admitted with sepsis, the pneumonia infection independently predicts 28-day in-hospital mortality. Combining the levels of serum lactate and PF ratio could be a useful approach in predicting mortality of these patients.
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Minerva anestesiologica · Dec 2013
Case ReportsMechanical and electrical equipment interference provokes a misleading Neurally Adjusted Ventilatory Assist (NAVA) EAdi signal. A technical note.
Neurally Adjusted Ventilatory Assist (NAVA) offers synchronized proportional pressure in accordance with the electrical activity of the diaphragm (EAdi). NAVA relies on the EAdi to trigger the respiratory cycle and then adjusts the ventilatory assist to the neural drive. The technique necessitates a catheter with bipolar microelectrodes positioned near the crural diaphragm where this signal can be captured. Capturing a reliable EAdi signal is a condition sine qua non for using NAVA as a mode of ventilation. The displayed signal represents the sum of the electrical activity of the muscle action potential of the diaphragm and is expressed in microvolts. ⋯ We illustrate that the detection and therefore interpretation of the EAdi signal during NAVA can be influenced by mechanical and electrical interference by other equipment used in the ICU or from endogenous leaking cardiac activity.
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Minerva anestesiologica · Dec 2013
Review Meta AnalysisThe Efficacy of Intravenous Lidocaine versus Placebo on Attenuating Cardiovascular Response to Laryngoscopy and Tracheal Intubation: A Systematic Review of Randomized Controlled Trials.
Cardiovascular response to laryngoscopy and tracheal intubation may be harmful in surgical patients with cardiovascular and cerebral diseases. The efficacy of intravenous lidocaine on attenuating the hemodynamic changes remains controversial. This systematic review aims to determine the efficacy of lidocaine versus placebo. ⋯ No significant publication bias across trials was found. Intravenous lidocaine helps reduce cardiovascular responses to laryngoscopy and tracheal intubation in patients of all age groups compared to placebo. Further studies are needed to clarify the effects of dosage and timing of lidocaine on hemodynamic changes.
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Minerva anestesiologica · Dec 2013
ReviewDiagnosis of pneumonia in mechanically ventilated patients. What is the meaning of the CPIS?
Ventilator associated pneumonia (VAP) is one of the most common nosocomial infections in critically ill patients, especially in those being mechanically ventilated. Beside increased healthcare costs due to prolonged hospital stay, VAP is associated with a consistently high morbidity and mortality. Although pathomechanisms leading to VAP are well known, it remains challenging to diagnose VAP accurately and in a timely manner. ⋯ Several evidence based strategies have been described for the diagnosis of ventilator associated pneumonia, potentially leading to better or faster treatment and thereby influencing the outcome. Current diagnostic approaches and the value of the CPIS are therefore considered within this article. A bundle approach, regarding time management and several diagnostic pathways should be evaluated in further studies.