Minerva anestesiologica
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Minerva anestesiologica · Mar 2009
ReviewEvidence-based renal replacement therapy for acute kidney injury.
Acute kidney injury (AKI) with the subsequent need for renal replacement therapy (RRT) represents a persistent challenge, arising in 4-5% in critically-ill patients, and remains associated with a high mortality (60%) and morbidity. As AKI is an independent risk factor for poor prognosis, appropriate management of patients with AKI becomes of utmost importance. ⋯ However, the timing of the initiation, the modality, and the dose of RRT are still controversial and the subject of ongoing clinical trials. This review presents and discusses currently available data regarding the use of RRT in critically-ill patients with AKI.
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Minerva anestesiologica · Mar 2009
ReviewManagement to optimize organ procurement in brain dead donors.
The demand for donor organs continues to exceed the number of organs available for transplantation. Many reasons may account for this discrepancy, such as the lack of consent, the absence of an experienced coordinator team able to solve logistical problems, the use of strict donor criteria, and suboptimal, unstandardized critical care management of potential organ donors. This has resulted in efforts to improve the medical care delivered to potential organ donors, so as to reduce organ shortages, improve organ procurement, and promote graft survival. ⋯ Strategies for the management of organ donors exist and consist of the normalization of donor physiology. Management has been complicated by the recent use of ''marginal'' donors and donors of advanced age or with ''extended'' criteria. Current guidelines suggest that the priority of critical care management for potential organ donors should be shifted from a ''cerebral protective'' strategy to a multimodal strategy aimed to preserve peripheral organ function.
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Minerva anestesiologica · Mar 2009
Randomized Controlled Trial Comparative StudyEpidural plus general anesthesia vs general anesthesia alone for elective aortic surgery: effects on gastric electrical activity and serum gastrin secretion.
The aim of this study was to evaluate differences in electrogastrographic activity and serum gastrin secretion in patients subjected to general anesthesia (GA) vs blended anesthesia (BA = GA plus epidural analgesia) for abdominal aortic surgery. ⋯ An excess of EGG activity and serum gastrin secretion was observed in patients undergoing GA vs those submitted to BA. Thus, the latter procedure seems to affect gastric function less than GA alone.
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Minerva anestesiologica · Mar 2009
The Competency-Based Training in Intensive Care Medicine in Europe (CoBaTrICE) Italian collaborative: national results from the Picker survey.
The aim of the Competency-Based Training in Intensive Care Medicine in Europe (CoBaTrICE) project is to create an internationally acceptable competency-based training program for specialists in intensive care medicine. The CoBaTrICE Project has performed a survey, in collaboration with the Picker institute, United Kingdom, to identify desirable characteristics of Intensive Care Unit (ICU) specialists, as expressed by patients and their relatives. ⋯ Priority in Italy was given to medical skills and competence. Involvement of patients and relatives in decision-making processes were among the items considered least important. Italian families preferred a paternalist approach to the end of life decision-making process.