Minerva anestesiologica
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Minerva anestesiologica · Jan 2013
ReviewHow to assess positive end-expiratory pressure-induced alveolar recruitment?
Randomized trials fail to demonstrate a decrease in mortality when high Positive End-Expiratory Pressure (PEEP) is applied to patients with acute respiratory distress syndrome. Use of PEEP in all patients without taking into consideration specific lung morphology, potential for recruitment and risk of lung hyperinflation could be one of explanations. Assessment of alveolar recruitment in each individual patient appears to reach a good compromise between optimization of mechanical ventilation and reduction of lung injury due to systematic application of high PEEP. ⋯ Different methods are available to assess PEEP-induced alveolar recruitment. Lung ultrasound and P-V curve method can be easily used at bedside to assess lung recruitability and test optimal PEEP. Further development is required for bedside assessment combing alveolar recruitment with hyperinflation.
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Minerva anestesiologica · Jan 2013
Multicenter StudyKidney biopsy in the critically ill patient, results of a multicentre retrospective case series.
The impact of a contributive result of kidney biopsy on the management of patients in the intensive care unit (ICU) has not been extensively investigated yet. ⋯ Kidney biopsy may have a significant impact on the management of critically ill patients. Further studies should be done to identify the groups of ICU patients likely to benefit from the procedure with minimum risk.
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Minerva anestesiologica · Jan 2013
Comparative StudyHigh molecular weight hydroxyethyl starch solutions are not more effective than a low wmolecular weight hydroxyethyl starch solution in a porcine model of septic shock.
There is evidence that suggests that early fluid resuscitation is beneficial in the treatment of sepsis. We previously demonstrated that hydroxyethyl starch (HES) 130/0.42 attenuated capillary leakage better than HES 200/0.5. Using a similar porcine fecal sepsis model, we tested the effects of two new synthetic high molecular weight (700 kDa) hydroxyethyl starches with the same molar substitution of 0.42 but with a different C2/C6 ratio compared to 6% HES 130/0.42 on plasma volume (PV), systemic and tissue oxygenation. ⋯ In this porcine fecal peritonitis model, the high molecular weight artificial colloids HES 700/2.5:1 and HES 700/6:1 were not more effective in maintaining plasma volume and systemic and tissue oxygenation than HES 130. In comparison to crystalloid RS, all HES solutions were more effective at maintaining plasma volume, mean arterial pressure (MAP), and systemic and tissue oxygenation.
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Minerva anestesiologica · Jan 2013
Hyperdynamic circulation in cirrhosis: predictive factors and outcome following liver transplantation.
Liver cirrhosis is associated with a hyperdynamic circulation (HC). In this observational study, we aimed to investigate the predictive factors of HC, its impact on intraoperative hemodynamic and postoperative outcome, early ICU and in-hospital mortality, in cirrhotic patients undergoing orthotopic liver transplantation (OLT). ⋯ MELD score was an independent predictor of HC, and beta-blockers resulted associated with lower incidence of HC in cirrhotic patients undergoing cadaveric OLT. Intraoperative HC correlates with hemodynamic alterations, requiring more blood products and vasopressor use, this may increase the risk of renal failure, early ICU death and in-hospital mortality.