Abstract:
:Asthma and chronic obstructive pulmonary diseases (COPD) lead to functional obstruction of airways, identified by increased inspiratory and expiratory resistances. Increased expiratory resistances cause, in turn, a reduction in expiratory flow. The analysis of flow-volume loops shows that, as the disease progresses, the flow generated during expiration of a tidal volume becomes very close to the flow generated during forced maximal expiration. In such condition, where there is little or no reserve of expiratory flow, higher tidal volumes need to be reached in order to increase the expiratory flow, and hyperinflation inevitably occurs. Hyperinflation, a key feature in COPD pathophysiology, is generated by two mechanisms: reduction of elastic recoil of the lung (static hyperinflation) and interruption of expiration at lung volumes still higher than FRC, due to reduction of expiratory flow (dynamic hyperinflation). When dynamic hyperinflation occurs, a residual positive pressure remains in the alveoli, which is defined as intrinsic positive end-expiratory pressure (PEEPi). Hyperinflation carries several consequences: 1) Respiratory mechanics: at lung volumes close to total lung capacity, lung compliance is physiologically reduced, and elastic work required to generate the same inspiratory volume is therefore increased; 2) Respiratory muscles: contractile properties of diaphragm deteriorate when the dome is pushed downward by an increased lung volume, inspiration is mainly performed by inspiratory muscles, and expiration becomes active; 3) Circulation: pulmonary vascular resistances increase due to compression exerted by hyperinflation on alveolar vessels and to hypoxic vasoconstriction; right ventricle afterload increases and right sided hypertrophy and dilation ensue; left ventricular afterload may increase due to increased negative intrapleural pressure which translates into an increased transmural pressure which needs to be overcome by ventricular contraction. Ventilatory support of COPD patients should decrease work of breathing and improve gas exchange without increasing hyperinflation. This target can be achieved during assisted ventilation by applying a positive pressure both during inspiration and expiration; the level of PEEP should equal PEEPi. During mechanical ventilation in sedated paralyzed patients hyperinflation should be limited by decreasing minute volume and by increasing expiratory time, eventually choosing controlled hypercapnia.
journal_name
Minerva Anestesioljournal_title
Minerva anestesiologicaauthors
Mergoni M,Rossi Akeywords:
subject
Has Abstractpub_date
2001-04-01 00:00:00pages
198-205issue
4eissn
0375-9393issn
1827-1596journal_volume
67pub_type
杂志文章,评审abstract::This article is a review of present knowledge of the hormonal and metabolic responses to trauma and surgery. The factors which may mediate the responses are discussed and the potential value of different therapeutic manipulations are reviewed. The accelerated breakdown of muscle following significant injury is the mos...
journal_title:Minerva anestesiologica
pub_type: 杂志文章,评审
doi:
更新日期:1992-06-01 00:00:00
abstract::Inhalation agents represent a basic drug used in modern balanced anesthesia. In the present review, the pharmacokinetics, effectiveness and clinical effects of inhalation agents on different systems are discussed. Data concerning the metabolism and related toxicity of halogenated agents is reviewed, with particular re...
journal_title:Minerva anestesiologica
pub_type: 杂志文章,评审
doi:
更新日期:2010-03-01 00:00:00
abstract::Chronic musculoskeletal pain is a highly prevalent condition that is commonly encountered in both general and specialist practice. Nonetheless, it still represents a significant challenge to the practitioners because of the lack of substantial evidence-based guidance. This review aimed to summarize the main pathophysi...
journal_title:Minerva anestesiologica
pub_type: 杂志文章
doi:10.23736/S0375-9393.20.14573-5
更新日期:2020-12-01 00:00:00
abstract:AIM:The study compares the intraoperative effects of combined versus general anesthesia during major liver surgery. METHODS:In this prospective randomized study, 70 patients were divided into 2 group of 35 subjects. Group A received general anesthesia (thiopentone, fentanyl, vecuronium, sevoflurane in a closed circuit...
journal_title:Minerva anestesiologica
pub_type: 临床试验,杂志文章,随机对照试验
doi:
更新日期:2003-12-01 00:00:00
abstract:BACKGROUND:The aim was to ascertain the prognostic value of mid-regional pro-adrenomedullin (MR-proADM), measured within 24 hours from the onset of septic shock (SS). METHODS:We performed a prospective, observational study on all patients admitted to our hospital's Intensive Care Unit with SS over a one year period fr...
journal_title:Minerva anestesiologica
pub_type: 杂志文章
doi:
更新日期:2016-07-01 00:00:00
abstract:BACKGROUND:The novel influenza A (H1N1) pandemic was associated with an epidemic of critical illness. METHODS:We describe the clinical profiles of critically ill patients with severe complications due to microbiologically confirmed pandemic influenza A (H1N1) infection admitted to a medical ICU in Monza, Italy, over a...
journal_title:Minerva anestesiologica
pub_type: 杂志文章
doi:
更新日期:2011-09-01 00:00:00
abstract:BACKGROUND:High volume hemofiltration (HVHF) has been proposed as method for blood purification, especially under the condition of systemic inflammatory syndromes. Our goal was to evaluate the effects of HVHF in critically ill patients. METHODS:A systematic review and meta-analysis was conducted of randomized controll...
journal_title:Minerva anestesiologica
pub_type: 杂志文章,meta分析,评审
doi:
更新日期:2014-05-01 00:00:00
abstract:BACKGROUND:Based on available data, there is no definite clinical research describing option, timing and effects of assisted as opposed to controlled ventilation to successfully treat acute severely brain-injured patients. This study demonstrates pressure support ventilation as a possible alternative to controlled vent...
journal_title:Minerva anestesiologica
pub_type: 杂志文章
doi:
更新日期:2002-04-01 00:00:00
abstract:BACKGROUND:To test validity, safety, costs and healing-outcome of surgical minitracheotomy after cannula removing. METHODS: DESIGN:Opened, perspective. Site: Polyvalent ICU. PATIENTS:40 patients underwent surgical minitracheotomy, in a year. Traditional surgical technique was adopted. Minitracheotomy was performed b...
journal_title:Minerva anestesiologica
pub_type: 临床试验,杂志文章
doi:
更新日期:2000-04-01 00:00:00
abstract::Excessive adrenergic stimulation may be associated with several adverse events and contribute to increase mortality in critically ill septic patients. Few clinical data exist on the effects of adrenergic blockade in this setting. The objective of this study was to investigate the effect of a short acting b-blocker (es...
journal_title:Minerva anestesiologica
pub_type: 评论,杂志文章
doi:
更新日期:2014-02-01 00:00:00
abstract:BACKGROUND:The goal of this paper was to investigate the association between patterns of intracranial hypertension (IH) and outcomes, to describe the treatment of patients with different patterns of IH, and to examine whether IH is an independent predictor of mortality and unfavourable outcome, respectively. METHODS:A...
journal_title:Minerva anestesiologica
pub_type: 杂志文章
doi:
更新日期:2014-12-01 00:00:00
abstract::The surgical treatment of cervico-medullary traumas is indicated, in unstable lesions, in large lesions of the mobile rachidic segment in the presence of neurological complications or following worsening of prior neurological symptomatology. The purpose of the operation is at least three-fold: to obtain alignment of v...
journal_title:Minerva anestesiologica
pub_type: 杂志文章,评审
doi:
更新日期:1989-03-01 00:00:00
abstract::In 1947 John Bonica as new Chief of Anesthesiology at Tacoma General Hospital organized one of the first around-the-clock labor anesthesia services and when became the first chairman of the new Department of Anesthesiology at the University of Washington (1960), caudal anesthesia was the primary technique used for pro...
journal_title:Minerva anestesiologica
pub_type: 传,历史文章,杂志文章
doi:
更新日期:2005-09-01 00:00:00
abstract:BACKGROUND:This study aimed to determine the accuracy of commonly used preoperative difficult airway indices as predictors of difficult mask ventilation (DMV) in obese patients (BMI >30 kg/m2). METHODS:In 309 consecutive obese patients undergoing general surgery, the modified Mallampati test, patient's Height/Thyromen...
journal_title:Minerva anestesiologica
pub_type: 杂志文章
doi:
更新日期:2014-02-01 00:00:00
abstract::Modulation of inflammatory and immune response to critical illness has been the goal of much research in the last decade and a variety of drugs and nutrients (so called "immunonutrients") have been tested in experimental models with promising results. Though, in the clinical setting of intensive care, their efficacy h...
journal_title:Minerva anestesiologica
pub_type: 杂志文章,评审
doi:
更新日期:2016-03-01 00:00:00
abstract:BACKGROUND:We hypothesized that the use of the channeled King Vision™ and Airtraq® would shorten the time for tracheal intubation compared with the Macintosh or GlideScope® laryngoscopes in patients with normal airways. METHODS:Eighty-six patients were randomly assigned to intubate the trachea using either the Macinto...
journal_title:Minerva anestesiologica
pub_type: 杂志文章,随机对照试验
doi:
更新日期:2016-12-01 00:00:00
abstract:BACKGROUND:Aim of the study was to validate commonly used bedside right-ventricular (RV) impedance parameters, which are utilized in determining heart-lung interactions during mechanical ventilation. METHODS:Fifteen pigs were equally assigned to either an open or a closed pericardium group. In all animals, an inflatab...
journal_title:Minerva anestesiologica
pub_type: 杂志文章
doi:
更新日期:2014-11-01 00:00:00
abstract::During the last decade, inhaled antibiotics, especially colistin, has been widely used worldwide as a therapeutic option, supplementary to conventional intravenous antibiotics, for the treatment of multidrug-resistant (MDR) Gram-negative nosocomial and ventilator-associated pneumonia (VAP). Antimicrobial aerosols are ...
journal_title:Minerva anestesiologica
pub_type: 杂志文章,评审
doi:
更新日期:2014-02-01 00:00:00
abstract:BACKGROUND:We prospectively evaluated the effect of insertion angle on the visibility of echogenic and nonechogenic needles in phantoms and in axillary nerve blocks in patients. METHODS:Conventional and echogenic needles were studied in phantoms at insertion angles of 0-30°, 30-45°, and ≥ 45°. Operators rated comfort ...
journal_title:Minerva anestesiologica
pub_type: 杂志文章,随机对照试验
doi:
更新日期:2015-04-01 00:00:00
abstract:INTRODUCTION:Extubation failure (EF) refers to the inability to maintain spontaneous breathing after removal of endotracheal tube. The aim of this review is to identify the best parameter to predict EF in adult intensive care patients. EVIDENCE ACQUISITION:We searched for publications in PubMed (2000-2016). Studies of...
journal_title:Minerva anestesiologica
pub_type: 杂志文章
doi:10.23736/S0375-9393.18.12627-7
更新日期:2019-03-01 00:00:00
abstract:METHODS:Published studies, including abstracts, has been reviewed and summarized. RESULTS:Studies in sheep have demonstrated no significant differences in pharmacokinetic and placental transfer of levobuvacaine when compared with bupivacaine. Clinical studies on cesarean section confirmed similar performance between t...
journal_title:Minerva anestesiologica
pub_type: 杂志文章,评审
doi:
更新日期:2001-09-01 00:00:00
abstract::Acute lung failure is associated with high mortality and usually requires mechanical ventilation to ensure adequate gas exchange. However, mechanical ventilation itself can be associated with major complications and can aggravate pre-existing lung disease, thus contributing to morbidity and mortality. Extracorporeal g...
journal_title:Minerva anestesiologica
pub_type: 杂志文章,评审
doi:
更新日期:2011-05-01 00:00:00
abstract::It is well known that the organizational model of day surgery, concerning surgical problems defined by the literature as minor, has the aim of optimising the use of hospital resources and facilitating patients and their families, from a psychological and social point of view, by reducing hospitalisation time and the a...
journal_title:Minerva anestesiologica
pub_type: 杂志文章
doi:
更新日期:2001-09-01 00:00:00
abstract:BACKGROUND:There is an equipoise regarding closed-loop ventilation modes and the ability to reduce workload for providers. On one hand some settings are managed by the ventilator but on another hand the automatic mode introduces new settings for the user. METHODS:This randomized controlled trial compared the number of...
journal_title:Minerva anestesiologica
pub_type: 杂志文章,随机对照试验
doi:10.23736/S0375-9393.17.11963-2
更新日期:2018-01-01 00:00:00
abstract::Propanidid is a competitive inhibitor not only of serum cholinesterase, but of neuromuscular plaque and brain acetylcholinesterase also. The I50 of plaque acetylcholinesterase occurs at much higher concentrations of anaesthetic than for serum enzyme, this may depend on the environmental conditions under which propanid...
journal_title:Minerva anestesiologica
pub_type: 杂志文章
doi:
更新日期:1980-06-01 00:00:00
abstract::In patients with strong suspicion of SAH, CT is the initial diagnostic procedure of choice. A lumbar puncture (LP) should be done if a CT is not available. If the patient has no focal deficit or papilloedema there is a little risk in LP. When a CT is negative there can be indication to do a LP: small leaks can be over...
journal_title:Minerva anestesiologica
pub_type: 杂志文章,评审
doi:
更新日期:1998-04-01 00:00:00
abstract:OBJECTIVE:To evaluate the effectiveness of two cardiac output measurement methods based on a modified Fick equation, that calculate the O2 consumption (VO2) dividing the CO2 production (VCO2) by a fixed respiratory quotient (RQ). DESIGN:Comparative study. SETTING:One 5 beds general intensive care unit in a 500 beds g...
journal_title:Minerva anestesiologica
pub_type: 临床试验,杂志文章
doi:
更新日期:1995-05-01 00:00:00
abstract::Pulmonary complications are a source of greater postoperative morbidity and mortality and longer hospital stays. Although many factors have been implicated as predictors, few models have been developed with the rigorous methodology required for clinically useful tools. In this article we attempt to describe what to lo...
journal_title:Minerva anestesiologica
pub_type: 杂志文章,评审
doi:
更新日期:2016-03-01 00:00:00
abstract::The Authors have controlled the validity of VQI to quantify pulmonary shunt (Qs/Qt). The survey involved (group A) patients who had undergone major surgery and (group B) patients hospitalized in ICU for cardiorespiratory failure. Four subgroups were identified in both the groups according to different values of SaO2. ...
journal_title:Minerva anestesiologica
pub_type: 杂志文章
doi:
更新日期:1992-01-01 00:00:00
abstract::Factor VIIa might be a useful treatment for coagulopathy and massive hemorrhage following implantation of a mechanical circulatory assist device, but there is a theoretical risk of device thrombosis. To date this complication has not been reported. We describe the first case of clotting of a left ventricular assist de...
journal_title:Minerva anestesiologica
pub_type: 杂志文章
doi:
更新日期:2008-04-01 00:00:00