Minerva anestesiologica
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Minerva anestesiologica · Sep 2011
ReviewEnd of life care in Italian intensive care units: where are we now?
Most patients in the ICU are unable to make decisions for themselves at the end of life (EOL), and the responsibility for these decisions falls to the medical staff and patients' relatives. Therefore, clinicians must frequently communicate with patients' relatives to understand the patients' values and preferences as they perform medical decision making. The family's role in this process varies: the entire burden of decision making could rest with the family, or family members could be informed of the decisions without admission into the decision-making process. ⋯ In this latter scenario, the effectiveness of the discussions that take place between clinicians and family members becomes a crucial marker of high-quality intensive care. In this review, we provide an overview of the current literature concerning the state of EOL care in European and Italian ICUs and then summarize several European and American recommendations for improving EOL care in the ICU. Finally, we examine the opportunity to use shared decision making to improve EOL care in the ICU through interdisciplinary communication, open and realistic discussion of prognosis with families, and an approach respecting different cultural perspectives.
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Minerva anestesiologica · Sep 2011
Changes in calculated arterio-jugular venous glutamate difference and SjvO2 in patients with severe traumatic brain injury.
Cerebral metabolic impairment is feared to induce secondary brain damage following traumatic brain injury (TBI). The present study was designed to assess the temporal profile of calculated arterio- jugular venous differences in glutamate (AJVDglu) and SjvO(2) in patients subjected to continuous pharmacologic coma. Metabolic impairment was assumed to be reflected by increased jugular venous glutamate levels and decreased jugular venous oxygen saturation (SjvO(2)). ⋯ During pharmacologic coma increased ICP was associated with significantly decreased SjvO(2) which coincided only with a trend to increased cerebral glutamate release. Calculated AJVDglu appears to be inferior in unmasking altered brain metabolism compared to SjvO(2) whenever ICP is increased.
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Minerva anestesiologica · Sep 2011
Electrophysiologic neuromonitoring during repair of the thoracoabdominal aorta by anesthesiologists.
Surgical repair of the thoracoabdominal aorta is associated with risk of spinal ischemia. Electrophysiologic neuromonitoring reduces this risk, but is usually performed by neurophysiologists not always available. In this study repair of the thoracoabdominal aorta monitored by anesthesiologists has been investigated. ⋯ Electrophysiologic neuromonitoring during surgical repair of the descending aorta can be successfully provided by anesthesiologists and should be predominately encouraged where neurophysiologists are not available due to organizational or financial shortcomings.
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Minerva anestesiologica · Sep 2011
Invasive and non-invasive long-term mechanical ventilation in Italian children.
To date, few studies have been published regarding the number of children in Italy who require long-term mechanical ventilation (LTV) and their underlying diagnoses, ventilatory needs and hospital discharge rate. ⋯ Managing pediatric home LTV requires tremendous effort on the part of the patient's family and places a significant strain on community financial resources. In particular, neurological patients require more health care than patients in other categories. To further improve the quality of care for these patients, it is essential to establish a dedicated national database.
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Minerva anestesiologica · Sep 2011
Systemic adverse events during 2005 phacoemulsifications under monitored anesthesia care: a prospective evaluation.
The aim of the study was to evaluate the systemic adverse events triggering on-call anesthesiologist's intervention during 2005 phacoemulsification under topical anesthesia on a day-surgery monitored anesthesia care regimen. ⋯ One-day cataract surgery performed under topical anesthesia with monitored anesthesia care required anesthesiologist intervention in 21.6% of cases, mainly because of agitation or hypertension. Agitation occurred more often in younger patients with neurological or psychiatric comorbidities. Hypertension occurred more often in older patients with higher ASA scores.