Minerva anestesiologica
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Minerva anestesiologica · Aug 2013
Review Meta AnalysisIdentifying clinical and acute psychological risk factors for PTSD after critical care: a systematic review.
Patients may suffer extreme psychological reactions in intensive care units (ICU), and post-traumatic stress disorder (PTSD) after leaving hospital. Previous systematic reviews of studies up to 2007 found that the true prevalence of and consistent risk factors for PTSD after ICU were not established, due to methodological shortcomings of studies. Therefore we aimed to conduct a systematic review of observational studies of post-ICU PTSD from 2008-2012, and to compare them to 1997-2007 studies, with regard to quality, prevalence estimates and risk factors. ⋯ The quality and number of post-ICU PTSD studies has increased over time, and we can be more confident in the accumulated findings. Evidence from both periods suggests that up to 27% of ICU survivors suffer from PTSD. There is also increasing evidence that use of benzodiazepines and duration of sedation, along with fear, stress and delirium in the ICU are likely risk factors for subsequent PTSD.
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Minerva anestesiologica · Aug 2013
Meta AnalysisEffect of angiotensin converting enzyme gene I/D polymorphism and its expression on clinical outcome in acute respiratory distress syndrome.
The role of the D allele of the angiotensin-converting enzyme (ACE) gene I/D polymorphism in the clinical outcomes of patients with acute lung injury and acute respiratory distress syndrome (ALI/ARDS) remains controversial. Our aim was to assess simultaneously the effect of the ACE I/D polymorphisms as well as the serum and BALF ACE levels on prognosis of patients with ARDS. ⋯ Serum ACE levels appear to be affected by the I/D polymorphism and are correlated with prognosis in patients with ALI/ARDS indicating that further investigation of the clinical significance of the ACE in ARDS might be of value.
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Non-invasive ventilation (NIV) is a very effective technique for severe acute exacerbations of COPD/COLD and acute pulmonary edema, but its interest is still a matter of debate for severe asthma attacks. However, despite a slow decrease in asthma mortality, which actually mainly concerns older people, the prevalence of asthma is still raising and is associated to a high level of emergency visits and ICU hospitalizations for severe asthma attacks. ⋯ From a technical point of view, one can expect in the future some improvements by combining NIV and nebulization and/or helium-oxygen therapy. Finally, there is a need for positive large randomized clinical trials before routine clinical use can be firmly recommended.
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Minerva anestesiologica · Aug 2013
Editorial CommentPerioperative administration of colloids: far from good?
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Minerva anestesiologica · Aug 2013
Predicting hospital mortality in adult patients with prolonged stay (>14 days) in surgical intensive care unit.
The aim of this paper was to identify the factors at surgical intensive care unit (SICU) admission and during the following SICU course that influence hospital mortality of patients with prolonged SICU stay (>14 days). ⋯ This validated predictive model reached clinically accurate discriminatory power, and may serve to improve patient care and resource utilization in the SICU.