Minerva anestesiologica
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In the last thirty years, the rapid evolution of surgical techniques, together with the use of innovative immunosuppressive strategies and optimal chemoprofilaxis, has dramatically extended the applicability of solid organs transplantation. However, despite the increase of post-transplantation survival rate, respiratory complications remain the main cause of morbidity and one of the main causes of mortality. Accordingly, the use of aggressive treatments has also increased the survival rates in patients with hematologic malignancies, but at price of an increased susceptibility to infections. ⋯ In this situation, the early application of positive pressure ventilation is aimed at restoring the decreased lung volume, increasing oxygenation, and reducing both the work of breathing and the respiratory drive; moreover to re-establish patient's equilibrium allows to buy time for an effective etiologic treatment. According to the results of several prospective randomized and non-randomized trials, the application of NIV seems able both to decrease the rate of nosocomial infectious complications, and to improve gas exchange with optimal patients tolerance. The aim of this review will be to shortly analyze the fields of application and the clinical results obtained with NIV in patients with immunosuppression of various origin.
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Minerva anestesiologica · Mar 2011
Comparative StudyA comparison of the performance of Simplified Acute Physiology Score 3 with old standard severity scores and customized scores in a mixed medical-coronary care unit.
Recently, the Simplified Acute Physiology Score (SAPS) 3 was developed. The objective of this study was to compare the performance of SAPS 3 with those of SAPS II, the Acute Physiology and Chronic Health Evaluation (APACHE) II and customized scores in predicting hospital mortality in critically ill mixed medical-coronary patients. ⋯ The SAPS 3 score provided excellent discrimination but poor calibration, as did the SAPS II and APACHE II scores in our critically ill mixed medical patients. The customization of the severity score improved the calibration performance, and thus this customization may serve as a tool for adjusting the equation of the score to predict mortality and quality assessment in intensive care units (ICUs).
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Minerva anestesiologica · Mar 2011
Case ReportsUnexpected effects on arterial oxygenation during reduction in oxygen flow via a pumpless lung assist system.
The authors describe the effect of marked increase in PaO2 in a patient with acute respiratory distress syndrome and treatment by a pumpless extracorporeal lung assist following reduction in oxygen sweep flow.
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Minerva anestesiologica · Mar 2011
Effectiveness of treatments for severe sepsis: data from the bundle implementation programs.
In severe sepsis, several studies, a recent meta--analysis and studies evaluating multifaceted strategies for quality improvement, have shown that bundled care can improve survival. Here, the effectiveness of treatments for severe sepsis included in the bundles was analyzed. ⋯ The results of are very consistent: early sepsis recognition with the administration of broad-spectrum antibiotics in all patients and specific treatments for patients in shock, such as activated protein C, or those on mechanical ventilation play a role in improving sepsis outcome. Hospitals should recognize this new evidence and design strategies to guarantee bundled care for severe sepsis.
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Traumatic brain injury (TBI) is one of the major causes of disability in modern society. The World Health Organization has predicted that, by 2020, traffic accidents will represent the greatest burden of global disease and injury. ⋯ Currently, there is no consensus for the use of hypothermia in the treatment of secondary injury after TBI. Until the results of ongoing studies are published, maintaining normothermia and avoiding hyperthermia should be used in managing patient with TBI.