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 (esmolol) in septic shock patients. In a single-center, controlled, open-label, phase 2 trial (from November 2010 to July 2012), Morelli et al. randomized patients with a need of norepinephrine to maintain a mean arterial pressure above 65 mmHg to receive either esmolol or standard of care. Patients were included if, after 24 hours of initial resuscitation, hypovolemia was excluded (wedge pressure ≥12 mmHg or central venous pressure ≥8 mmHg) and heart rate was above 95 bpm. Patients were excluded if they were younger than 18 years, had previous b-blockers therapy, cardiac index was ≤2.2 L/min/m² with wedge pressure >18 mmHg, were diagnosed with significant cardiac valvular diseases or were pregnant. The primary outcome was the reduction in heart rate between 80 and 94 bpm over a 96-hr period. Secondary outcomes included norepinephrine requirement, hemodynamic changes, organ function, adverse events and 28-day mortality. A total of 154 patients, 77 for each group, were enrolled. Esmolol was more effective than standard treatment to reduce heart rate within target limits; also, b-blocker therapy was associated with an increased stroke volume and left ventricular work index when compared to the control group. These favorable hemodynamic effects were associated with a better control of lactate levels, a higher reduction in norepinephrine and fluids requirement. Mortality was 49.4% in the esmolol group and 80.5% in the control group (P<0.01). This is the first study showing an improvement in cardiac function and 28-day mortality in septic patients adding b-blockers to standard therapy. We discussed several statistical and methodological limitations that may influence the generability of these results.
journal_name
Minerva Anestesioljournal_title
Minerva anestesiologicaauthors
Orbegozo Cortes D,Njimi H,Dell'Anna AM,Taccone FSsubject
Has Abstractpub_date
2014-02-01 00:00:00pages
254-8issue
2eissn
0375-9393issn
1827-1596pii
R02Y2014N02A0254journal_volume
80pub_type
评论,杂志文章abstract::Anaesthesia with atracurium, fentanyl, and continuous intravenous infusion of propofol in two myasthenic patients is described. There were no intra and postoperative problems and operative conditions were considered excellent. This technique offers a safe alternative to inhalational anaesthesia for patients with myast...
journal_title:Minerva anestesiologica
pub_type: 杂志文章,评审
doi:
更新日期:1992-03-01 00:00:00
abstract:BACKGROUND:Coronary artery bypass graft surgery with cardiopulmonary bypass induces a systemic inflammatory response. However, when thoracic epidural anaesthesia is administered as part of a combined anesthetic technique, the stress response associated with the cardiopulmonary bypass (CPB) may be attenuated. METHODS:T...
journal_title:Minerva anestesiologica
pub_type: 杂志文章,随机对照试验
doi:
更新日期:2008-11-01 00:00:00
abstract:AIM:The authors have evaluated remifentanil for intraoperative analgesia in endonasal endoscopic surgery for pituitary lesions. METHODS: EXPERIMENTAL DESIGN:a perspective, randomized and comparative study between remifentanil and fentanyl for intraoperative analgesia was performed in an operating room of the neurosur...
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:2003-03-01 00:00:00
abstract:OBJECTIVE:To describe the use of an automatic fluid control system, Equaline, during high flux continuous hemofiltration. DESIGN:Prospective descriptive study. SETTING:General intensive care unit in a general hospital. PATIENTS:15 consecutive patients suffering from septic shock, hypercatabolic with acute renal fail...
journal_title:Minerva anestesiologica
pub_type: 杂志文章
doi:
更新日期:1994-01-01 00:00:00
abstract:BACKGROUND:Combined epidural/general anaesthesia might theoretically emphasise the cardiovascular effects of epidural block alone. The goal of the present investigation was to evaluate the incidence of both hypotension and bradycardia during integrated epidural/general anaesthesia in a multicentric, observational study...
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:1998-07-01 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:BACKGROUND:The analysis of the arterial pulse contour obtained by means of a non-invasive device (Finapres) seems to be an ideal method to measure cardiac output (CO). An individual calibration factor (Z) dimensionally equal to aortic impedence is the necessary pre-requisite to calculate CO by pulse contour analysis. T...
journal_title:Minerva anestesiologica
pub_type: 临床试验,杂志文章
doi:
更新日期:1998-03-01 00:00:00
abstract:BACKGROUND:Surgical trauma inhibits cellular immunity. Dexmedetomidine produces opioid-sparing effect and an impact on immune response. METHODS:Eighty-six surgical patients were enrolled and received postoperative patient-controlled intravenous analgesia (PCIA) with either fentanyl alone (fentanyl group) or combined w...
journal_title:Minerva anestesiologica
pub_type: 杂志文章
doi:10.23736/S0375-9393.20.14581-4
更新日期:2021-01-12 00:00:00
abstract::Pulmonary gas exchange is regularly impaired during general anaesthesia with mechanical ventilation. This results in decreased oxygenation of blood. Major causes are collapse of lung tissue (atelectasis) and airway closure. Collapsed lung tissue is present in 90% of all subjects, both during spontaneous breathing and ...
journal_title:Minerva anestesiologica
pub_type: 杂志文章,评审
doi:
更新日期:2002-05-01 00:00:00
abstract::Upper airway obstruction (UAO) can cause severe respiratory distress in young children by increasing inspiratory muscle load and decreasing alveolar ventilation, ultimately resulting in hypercapnia and hypoxemia which have long term negative cardiovascular effects. Although non-invasive continuous positive airway pres...
journal_title:Minerva anestesiologica
pub_type: 杂志文章
doi:
更新日期:2015-02-01 00:00:00
abstract:BACKGROUND:A new pulmonary artery catheter and monitor for continuous cardiac output measurement (CCO), based on thermodilution principle, has been recently developed. Aim of our study was to evaluate the new system by comparing data obtained with the CCO with the standard bolus thermodilution method (TD). METHODS:Nin...
journal_title:Minerva anestesiologica
pub_type: 临床试验,杂志文章
doi:
更新日期:1998-09-01 00:00:00
abstract:BACKGROUND:Numerous animal models have demonstrated neuronal damage resulting from anesthetic exposure in the developing brain. Studies have shown a relationship between anesthetic exposure and brain hypoxia, neurodegeneration and apoptosis. The relevance of data derived from controlled experimental studies to human ne...
journal_title:Minerva anestesiologica
pub_type: 杂志文章
doi:
更新日期:2015-12-01 00:00:00
abstract:AIM:The aim of this study was to evaluate and compare the parameters for mechanical respiration in pediatric patients undergoing controlled ventilation with a laryngeal mask (LM) and an uncuffed orotracheal tube. METHODS:The study examined 100 ASA 1 patients undergoing general anesthesia with myoresolution and mechani...
journal_title:Minerva anestesiologica
pub_type: 临床试验,杂志文章
doi:
更新日期:2000-01-01 00:00:00
abstract::A case is presented of severe visceral leishmaniasis initially misdiagnosed owing to the old age of the patient and the contemporary presence of a carcinoma of the sigmoid. Admitted in ICU for severe post operative cardiorespiratory failure. During ICU stay the patients presented a bilateral pneumothorax and a long QT...
journal_title:Minerva anestesiologica
pub_type: 杂志文章
doi:
更新日期:1994-12-01 00:00:00
abstract:BACKGROUND:Disorders in cerebral circulation following elevated intra-abdominal pressure (IAP) may lead to silent brain ischemia, which can be serious problem in sedated critically ill patients. The aim of the present study was to analyse the possible association between jugular venous bulb pressure (JVBP) and jugular ...
journal_title:Minerva anestesiologica
pub_type: 杂志文章
doi:
更新日期:2014-07-01 00:00:00
abstract::Non invasive ventilation (NIV), primarily applied in cardiogenic pulmonary edema, decompensated COPD and hypoxemic respiratory failure, has also found a wide application in the postoperative period. The expanding indications to the transcatheter treatment of diseased left heart valves have led to an increase in cardia...
journal_title:Minerva anestesiologica
pub_type: 杂志文章,评审
doi:
更新日期:2011-07-01 00:00:00
abstract::Immediately following delivery a newborn infant was severely depressed. Because no respiratory effort was made and copious mucus was present, a Cole endotracheal tube was easily inserted into the trachea. Because of a mistaken manoeuvre for fastening the tube, the plastic adapter connection became dislodged from the t...
journal_title:Minerva anestesiologica
pub_type: 杂志文章
doi:
更新日期:1994-04-01 00:00:00
abstract:AIM:The aim of our study was to compare the efficacy of hyperbaric and isobaric solutions of intrathecal levobupivacaine for transurethral endoscopic surgery. METHODS:Urological patients who were scheduled for elective surgery under spinal anesthesia were enrolled. The heavy group received 13.5 mg of hyperbaric levobu...
journal_title:Minerva anestesiologica
pub_type: 杂志文章,随机对照试验
doi:
更新日期:2010-01-01 00:00:00
abstract::Two cases of Paraquat poisoning of anticonservative origin are described. A brief account of the chemical composition and mechanism of action of Paraquat is followed by a discussion of the clinical and therapeutic features of the two cases. The anatomopathological findings obtained from lung specimens examined during ...
journal_title:Minerva anestesiologica
pub_type: 杂志文章
doi:
更新日期:1979-12-01 00:00:00
abstract:BACKGROUND:The aim of this prospective, randomized, double-blind study was to evaluate the effects of adding 1 microg/kg clonidine to 20 ml of ropivacaine 0.75% for axillary brachial plexus anesthesia. METHODS:With Ethical Committee approval and written consent, 30 ASA physical status I-II in-patients, undergoing uppe...
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:2001-05-01 00:00:00
abstract:BACKGROUND:Overall medical complications have been reduced after fast-track total hip (THA) and knee arthroplasty (TKA), but data on specific renal and urological (RU) complications are limited. METHODS:To describe the incidence and consequences of serious RU complications resulting in length of stay > 4 days or 30-da...
journal_title:Minerva anestesiologica
pub_type: 杂志文章
doi:
更新日期:2016-03-30 00:00:00
abstract::Developing a computer program to simulate the uptake, distribution, and elimination of inhalational anesthetics allow the anesthesiologist to address specific problems, but intense skills are required to translate the involved process first into a set of mathematical equations and then into a satisfactory computer pro...
journal_title:Minerva anestesiologica
pub_type: 杂志文章
doi:
更新日期:1993-01-01 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::The use of epinephrine is currently recommended as a treatment option for patients with cardiac arrest. The primary objective of this systematic review was to determine if epinephrine use during cardiac arrest is associated with improved survival to hospital discharge. MEDLINE, EMBASE, The Cochrane Library (Cochrane D...
journal_title:Minerva anestesiologica
pub_type: 杂志文章,meta分析,评审
doi:
更新日期:2014-07-01 00:00:00
abstract::Non invasive ventilation (NIV) has been shown to be an effective therapy in selected patients with acute respiratory failure. Due to its benefit and relative ease of use, NIV is frequently used. In addition, the shortage and high cost of intensive care beds have prompted the use of NIV outside the intensive care unit....
journal_title:Minerva anestesiologica
pub_type: 杂志文章,评审
doi:
更新日期:2009-07-01 00:00:00
abstract::Over the last two decades, experimental and clinical data have begun to shape a more discriminating approach to intravascular (IV) fluid infusions in the resuscitation of trauma patients with presumed internal hemorrhage. This approach takes into account the presence of potentially uncontrollable hemorrhage (e.g., dee...
journal_title:Minerva anestesiologica
pub_type: 杂志文章,评审
doi:
更新日期:2011-10-01 00:00:00
abstract::Pulmonary tuberculosis can lead to acute respiratory distress syndrome (ARDS) which is associated with high mortality. We report the case of a patient with pulmonary tuberculosis and severe ARDS (PaO2/FiO2<100 mmHg) who was initially managed with advanced up-to-date treatments (protective ventilation and extracorporea...
journal_title:Minerva anestesiologica
pub_type: 杂志文章
doi:
更新日期:2012-03-01 00:00:00
abstract:BACKGROUND:Clinical studies have raised concerns about the safety of 6% hydroxyethylstarch (HES) 130/0.42, but the pathomechanisms of this renal impairment remain unknown. To evaluate the effects of different HES concentrations, molar substitutions and molecular weights in HES-induced renal impairment, we used a porcin...
journal_title:Minerva anestesiologica
pub_type: 杂志文章
doi:
更新日期:2015-06-01 00:00:00
abstract:BACKGROUND:The effort to decrease hospital stays and to increase operating room efficacy has become an important consideration in the practice of anesthesia. METHODS:Fifty-three patients who underwent shoulder rotator cuff repair in the sitting position were divided into four groups according to the anesthesia techniq...
journal_title:Minerva anestesiologica
pub_type: 杂志文章
doi:
更新日期:2001-09-01 00:00:00
abstract:BACKGROUND:In an acute care setting, diuretics are often prescribed to maintain or increase urine output in patients presenting with acute kidney injury (AKI). The rationale behind giving diuretics is that they may protect the kidney from ischemic injury by maintaining a nonoliguric state. There have been many studies ...
journal_title:Minerva anestesiologica
pub_type: 杂志文章,评审
doi:
更新日期:2009-05-01 00:00:00