Minerva anestesiologica
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Complications of liver disease are commonly seen in the intensive care unit (ICU). When evaluating patients with liver disease in the ICU, it is important to determine whether it is acute or chronic liver disease. ⋯ Chronic liver disease is best discussed in terms of the various complications that may ensue such as ascites, hepatorenal syndrome, spontaneous bacterial peritonitis, variceal hemorrhage and hepatic encephalopathy. Each of these conditions will be discussed with specific attention to critical care management.
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Minerva anestesiologica · May 2006
Comparative StudyAre hot-burning sensations produced by the axonal damage of afferent unmyelinated fibres?
Pain resulting from nerve lesions is classically referred to as a ''burning pain''. Both the axonal damage and sensitization of unmyelinated C-fibres have been considered as the possible generators of this sensation. The aim of this study was to verify the hypothesis that hot-burning sensations are produced by the axonal damage of afferent unmyelinated fibres in peripheral nerves. ⋯ This study does not confirm the hypothesis that hot-burning sensations are produced by the axonal damage of afferent amyelinated fibres in peripheral nerves. It agrees with clinical evidence suggesting that patients with different clinical conditions can complain of hot-burning sensations, independently of the presence of a nerve lesion.
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Minerva anestesiologica · Apr 2006
ReviewInterfacing spontaneous breathing and mechanical ventilation. New insights.
Mechanical ventilation (MV) with positive pressure insufflations of gas into the lung may be required to ensure sufficient oxygenation of blood and elimination of carbon dioxide in acute respiratory failure. Interfacing spontaneous breathing and mechanical ventilation has been used to improve gas exchange and may offer other advantages regarding integrity of lung tissue. Airway pressure release ventilation (APRV), or bilevel positive airway pressure (BiPAP), is a mechanical ventilatory mode with a low respiratory rate upon which spontaneous breaths can be superimposed during any time of the respiratory cycle. ⋯ Since blood flow goes preferentially to the dependent regions, the altered ventilation distribution results in improved matching of ventilation and perfusion, further enhancing or facilitating gas exchange. Moreover, there is less cyclic collapse, i.e. less re-collapse during expiration and reopening during inspiration than with MV alone. Further development of the interfacing technique can be expected, with synchronization and also dosing of the mechanical support and with triggering of the ventilator that is based on neural recordings rather than mechanical signals as pressure and flow.
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Minerva anestesiologica · Apr 2006
Non-invasive cardiac monitoring by aortic blood flow determination in patients undergoing hyperthermic intraperitoneal intraoperative chemotherapy.
The aim of this study was to evaluate the haemodynamic changes in patients undergoing cytoreductive surgery and intraperitoneal hyperthermic chemotherapy (IPHC) using an echo-Doppler device (Hemosonic 100). ⋯ These results suggest that the echo-Doppler device (Hemosonic 100) provided an easy-to-handle, non-invasive and reliable tool to monitor changes in cardiac parameters during IPHC.