Minerva anestesiologica
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Minerva anestesiologica · Apr 2013
Absent SEP during therapeutic hypothermia did not reappear after re-warming in comatose patients following cardiac arrest.
Early prediction of neurological outcome for patients resuscitated from cardiac arrest (CA) is a challenging task. Therapeutic hypothermia (TH) has been shown to improve neurological outcome after CA. Two recent studies indicated that somatosensory evoked potentials (SEP) recorded during TH retains high prediction value for poor neurological outcome. It remains unclear whether TH can influence the recovery of bilaterally absent (BA) N20 after re-warming. The primary endpoint of the present study was to evaluate if patients with BA SEPs during TH can recover cortical responses after re-warming. The secondary endpoint was to evaluate whether BA SEPs recorded during TH retains its prediction value for poor neurological outcome as in normothermic patients. ⋯ In a single centre cohort of comatose CA patients, our results showed that all patients with absent SEPs during early recording (6-24 hours) during TH showed bilaterally absent SEPs after re-warming. As a secondary result we confirmed previous data that BA SEPs during TH retains its prognostic value for poor neurological outcome, as in normothermic patients.
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Minerva anestesiologica · Apr 2013
Determination of the optimal length of insertion of central venous catheters in pediatric patients by endovascular ECG.
In children the position of the tip of central venous catheters (CVC) is most often examined by chest radiography. Endovascular electrocardiography (ECG), using the CVC as an electrode, permits the correct placement of a CVC without the need for a chest X-ray. The use of a commercialised endovascular ECG-system (Alphacard®) for CVC-placement was evaluated in pediatric patients. ⋯ ECG guidance of CVC-placement in children is a reliable technique, preventing children and health care providers from unnecessary X-ray exposure. Depending on local infrastructure and protocols it can furthermore shorten the procedure of CVC placement.
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Mortality and morbidity postcardiac surgery with cardiopulmonary bypass (CPB) remain relative stable over the last decades, while the number of patients with increased comorbidity and more complex cardiac disease increases. Nevertheless, end-organ dysfunction and/or failure remain an issue. Multiple perioperative variables, such as non-optimal oxygen delivery, manipulation of the aorta, hyperlactatemia, type of anesthesia, surgical procedure and myocardial protection can be hold responsible for end-organ failure postcardiac surgery. ⋯ Therefore, therapy should focus on controlling perioperative variables that, in combination with the predisposing factors, will further exacerbate organ dysfunction. In order to achieve this, more emphasis should be given to a patient-specific, goal-directed perfusion approach. This review will mainly focus on the impact of perioperative variables.
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Minerva anestesiologica · Mar 2013
Comparative StudyValidation of predisposition, infection, response and organ dysfunction score compared with standard severity scores in predicting hospital outcome in septic shock patients.
The aim of this study was to validate and compare the performance of Simplified Acute Physiology Score 3 Predisposition, Infection, Response and Organ failure (SAPS 3 PIRO) score with Acute Physiology and Chronic Health Evaluation (APACHE) II, SAPS II and SAPS 3 scores in predicting hospital outcome in septic shock patients. ⋯ The SAPS 3 PIRO score provided better discrimination than the APACHE II, SAPS II and SAPS 3 but had poor calibration in our septic shock patients. SAPS 3 PIRO could be used regarding risk stratification in septic shock patients, however, this score needed to be adapted and modified with new parameters for improving the performance.