Minerva anestesiologica
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Minerva anestesiologica · Dec 2007
ReviewCritical care of HIV infected patients in the highly active antiretroviral therapy era.
Since there are more than 150 000 Italians (about 25 for every 10,000 inhabitants) infected with HIV, Intensive Care Units (ICU) often come across patients who are HIV positive. The aim of this study was to provide current information on the epidemiology of human immunodeficiency virus (HIV)-infected patients admitted to ICU during the era of highly active antiretroviral therapy (HAART) and to review issues related to the administration of antiretroviral therapy relevant to the ICU staff. ⋯ More HIV-infected patients survive ICU admission and are less likely to be admitted to the ICU for related infections; in most cases, they need critical care for problems unrelated to HIV infection or for conditions related to HAART toxicity. ICU staff need to be familiar with HAART for the following reasons: 1) to recognize life-threatening toxicities unique to these drugs; 2) to avoid drug interactions, which are extremely common and potentially life-threatening; and 3) to avoid enhancing HIV drug resistance, an occurrence that could have devastating consequences for the patient after discharge from the ICU.
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Minerva anestesiologica · Nov 2007
ReviewFeasibility, limits and problems of clinical studies in Intensive Care Unit.
In critical care medicine there is still a paucity of evidence on how to manage most of the clinical problems commonly encountered in critically ill patients. Randomized controlled trials (RCTs) are the most powerful instruments to evaluate the efficacy of a therapeutic intervention and to generate evidence for clinical practice. Unfortunately, the design and conduct of RCTs in our field are particularly complicated, because of some intrinsic and structural problems (e.g. lack of reliable nosography, concomitant use of different therapies, problems in the definition of end-points besides mortality) that will be discussed in this review. ⋯ A particularly stimulating opportunity of development is represented also by the relationship of critical care to EBM. Because of the above problems, metanalyses could be less informative than in other areas of medicine, as they are based on few trials which are often contradictory and of unsatisfactory quality. Few suggestions are formulated which could help looking forwards.
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Minerva anestesiologica · Nov 2007
Randomized Controlled Trial Multicenter Study Comparative StudyThe unanticipated difficult intubation: rigid or flexible endoscope?
Unanticipated difficult intubation occurs with a frequency between 1.5% and 8.5%. The aim of this study was to compare the use of flexible versus rigid endoscopy in such a patient population, with respect to the preparation time and feasibility of each device. ⋯ Both endoscopic techniques enable quick and safe intubation. The Bonfils method could be the method of choice in cases of already relaxed patients with unanticipated difficult conventional laryngoscopy, presuming that the anaesthetist is familiar with this technique. Because the clinical re-evaluation for possible predictors of difficult intubation revealed no unknown new factors, the preoperative examination for anatomical peculiarities and being aware are the best protection against unanticipated intubation problems.
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Minerva anestesiologica · Nov 2007
Acute renal failure after isolated CABG surgery: six years of experience.
A prospective observational study was carried out in a Cardiosurgical Intensive Care Unit (ICU) in order to evaluate the incidence of Acute Renal Failure (ARF) after coronary artery bypass graft surgery and identify its predictors. The effects of ARF on outcome were also investigated. ⋯ Preoperative renal dysfunction, blood transfusion, low-output syndrome, emergency surgery, low ejection fraction and age were independently associated with ARF. Length of ICU and hospital stay were reduced in patients not developing ARF.