Minerva anestesiologica
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Minerva anestesiologica · Jul 2010
Cerebral oxygenation in the beach chair position before and during general anesthesia.
Ischemic brain damage related to the beach chair position is a matter of concern. The current study was designed to evaluate whether the beach chair position before and during general anesthesia differentially induces changes in cerebral oxygenation as determined by near-infrared spectroscopy (NIRS) in surgical patients. ⋯ Under general anesthesia, the beach chair position does not alter cerebral oxygenation in patients showing normal preoperative cerebral TOI values.
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Minerva anestesiologica · Jun 2010
Review Meta AnalysisProne positioning improves survival in severe ARDS: a pathophysiologic review and individual patient meta-analysis.
Prone positioning has been used for over 30 years in the management of patients with acute respiratory distress syndrome (ARDS). This maneuver has consistently proven capable of improving oxygenation in patients with acute respiratory failure. Several mechanisms can explain this observation, including possible intervening net recruitment and more homogeneously distributed alveolar inflation. ⋯ The available randomized clinical trials, however, have failed to demonstrate that prone positioning improves the outcomes of patients with ARDS overall. In contrast, the individual patient meta-analysis of the four major clinical trials available clearly shows that with prone positioning, the absolute mortality of severely hypoxemic ARDS patients may be reduced by approximately 10%. On the other hand, all data suggest that long-term prone positioning may expose patients with less severe ARDS to unnecessary complications.
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Minerva anestesiologica · Jun 2010
Effects of hemoperfusion with an immobilized polymyxin-B fiber column on cytokine plasma levels in patients with abdominal sepsis.
The beneficial role of hemofiltration with immobilized polymyxin-B fiber (PMX) columns in sepsis, especially sepsis due to gram-negative bacteria, has previously been emphasized. Although the efficacy of PMX-B fiber-mediated hemofiltration in reducing plasma levels of cytokines has been reported, other studies did not confirm this observation. Here we report the effects of PMX-B fiber-mediated hemofiltration on outcome and cytokine plasma levels in patients with abdominal sepsis. ⋯ Hemofiltration with a PMX fiber column was able to reduce plasma levels of IL-6, IL-10 and TNF-a, especially in patients surviving at 28 days. Use of the technique was associated with lower norepinephrine support and an increased PaO2/FiO2 ratio.
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The aim of this study was to describe the role of glucocorticoids in immune modulation during critical illness and to review clinical trials and recent meta-analyses of glucocorticoids in early and late acute respiratory distress syndrome (ARDS). Selected reviews of publications, clinical trials, and meta-analyses were considered for the study. Activation of the adrenal axis is an important component of the compensatory anti-inflammatory response to critical illness. ⋯ In conclusion, short-duration, high-dose glucocorticoid therapy is not effective in preventing ARDS and may be harmful. Lower doses for persistent ARDS improve lung function and shorten the duration of mechanical ventilation but the impact on long-term mortality is unclear. Additional trials are needed to determine if corticosteroids improve important clinical outcomes before they can be recommended for the routine use of patients with unresolved ARDS.