Abstract：
INTRODUCTION:Recent data found that perioperative goal directed therapy (GDT) was effective only in higher control mortality rates (>20%) with a relatively high heterogeneity that limited the strength of evidence. The aim of the present meta-analysis was to clearly understand which high risk patients may benefit of GDT. EVIDENCE ACQUISITION:Systematic review of randomized controlled trials with meta-analyses, including a meta-regression technique. MEDLINE, EMBASE, and The Cochrane Library databases were searched (1980-January 2015). Trials enrolling adult surgical patients and comparing the effects of GDT versus standard hemodynamic therapy were considered. The primary outcome measure was mortality. Data synthesis was obtained by using Odds Ratio (OR) with 95% confidence interval (CI) by random-effects model. EVIDENCE SYNTHESIS:Fifty eight studies met the inclusion criteria (8171 participants). Pooled OR for mortality was 0.70 (95% CI 0.56-0.88, P=0.002, no statistical heterogeneity). GDT significantly reduced mortality when it is >10% in control group (OR 0.43, 95% CI 0.30-0.61, P<0.00001). The meta-regression model showed that the cut off of 10% of mortality rate in control group significantly differentiates 43 studies from the other 15, with a regression coefficient b of -0.033 and a P value of 0.0001. The significant effect of GDT was driven by high risk of bias studies (OR 0.48, 95% CI 0.34-0.67, P<0.0001). CONCLUSIONS:The present meta-analysis, adopting the meta-regression technique, suggests that GDT significantly reduces mortality even when the event control rate is >10%.
journal_name
Minerva Anestesioljournal_title
Minerva anestesiologicaauthors
Giglio M,Manca F,Dalfino L,Brienza Nsubject
Has Abstractpub_date
2016-11-01 00:00:00pages
1199-1213issue
11eissn
0375-9393issn
1827-1596pii
R02Y9999N00A16041302journal_volume
82pub_type
杂志文章,meta分析abstract：:An account is given of the employment of althesin as an induction and maintenance anaesthetic. It is free of the drawbacks observed with thiopentone induction, and has negligible haemodynamic and respiratory effects. Its association with leptophen permitted excellent analgesia at minimal leptophen doses, without secon...
journal_title：Minerva anestesiologica
pub_type： 杂志文章
doi：
更新日期：1980-02-01 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:The etiology of postoperative cognitive dysfunction (POCD) remains unclear but toxicity of anesthetic drugs and their metabolites could be important. We aimed to assess the possible association between POCD after propofol anesthesia and various phenotypes owing to polymorphisms in cytochrome P450 encoding ge...
journal_title：Minerva anestesiologica
pub_type： 临床试验,杂志文章,多中心研究
doi：
更新日期：2012-03-01 00:00:00
abstract：BACKGROUND:The NOL index is based on multiparametric analysis of heart rate (HR), skin conductance, wave plethysmography, and their time derivative. The aim of this study was to evaluate the NOL to detect standardized nociceptive stimuli with various remifentanil dosages under general anesthesia. METHODS:A prospective...
journal_title：Minerva anestesiologica
pub_type： 杂志文章
doi：10.23736/S0375-9393.18.12720-9
更新日期：2018-10-01 00:00:00
abstract：:For several years now, the need for improving healthcare quality has determined the adoption of a businesslike philosophy in American hospitals, through quality control and improvement systems. In Italy, the introduction of this business concept in public healthcare is recent, while quality assurance is still widely i...
journal_title：Minerva anestesiologica
pub_type： 杂志文章,评审
doi：
更新日期：1999-03-01 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：:In severe sepsis, several studies, a recent meta--analysis and studies evaluating multifaceted strategies for quality improvement, have shown that bundled care can improve survival. Here, the effectiveness of treatments for severe sepsis included in the bundles was analyzed. Despite the observational design of the stu...
journal_title：Minerva anestesiologica
pub_type： 杂志文章
doi：
更新日期：2011-03-01 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：:The anaesthetic technique chosen for a laparohysterectomy in a woman affected by Apert's acrocephalosyndactilia is described. Difficulties in performing tracheal intubation were overcome by mean of loco-regional anesthesia (LRA). In order to minimize the anaesthetic risk, a standardised preoperative evaluation and ass...
journal_title：Minerva anestesiologica
pub_type： 杂志文章
doi：
更新日期：1997-05-01 00:00:00
abstract：:A size 3 laryngeal mask was used in 20 patients who underwent elective general surgery. It consists of a silicon tube attached to mask which must be inserted into the hypopharynx and then inflated. No curarisation nor laryngoscopy is needed. Operations were performed in assisted or spontaneous ventilation, with good a...
journal_title：Minerva anestesiologica
pub_type： 杂志文章
doi：
更新日期：1992-05-01 00:00:00
abstract：:The authors describe a case of prolonged neuromuscular blockade following suxamethonlum in a patient with a normal cholinesterase activity and dibucaine number > or = 75%. In this case a peripheral nerve stimulator and capnography allowed neuromuscular blockade evaluation and fresh frozen plasma infusion led to a norm...
journal_title：Minerva anestesiologica
pub_type： 杂志文章
doi：
更新日期：1995-01-01 00:00:00
abstract：:The paper reports the case of a young male which was severely poisoned by anilyne shoe black. After a few hours, he was in a semicomatose state, accompanied by "very dark" arterial blood gases with oxygen tension in excess of 100 mmHg. Following the administration of intravenous methylene blue (2 mg/kg), methemoglobin...
journal_title：Minerva anestesiologica
pub_type： 杂志文章
doi：
更新日期：1990-12-01 00:00:00
abstract：:TOSS, together with severity of illness (SAPS) and intensity of processes (TISS), has been determined in 941 patients on the 9th day of ICU stay, to ascertain the validity of TOSS in the calculation of the nurse/patient ratio, not only at the time of admission to ICU but also during the stay. The mean values of all in...
journal_title：Minerva anestesiologica
pub_type： 杂志文章,多中心研究
doi：
更新日期：1992-12-01 00:00:00
abstract：:Even moderate temperature elevations soon acute cerebral damage may markedly worsen initial brain injury. These effects may justify aggressive antipyretic treatment in neurosurgical intensive care unit (NICU). On the basis of a literature survey, it is observed that fever is extraordinarily common in the neurosurgical...
journal_title：Minerva anestesiologica
pub_type： 杂志文章,评审
doi：
更新日期：2003-04-01 00:00:00
abstract：:Neuroleptic malignant syndrome (NMS) in its most severe form ranging from disorders of consciousness to coma is now reported relatively frequently in intensive care journals. Having observed such a case in the intensive care ward of their hospital, the Authors investigate the possibility of differential diagnosis betw...
journal_title：Minerva anestesiologica
pub_type： 杂志文章
doi：
更新日期：1992-07-01 00:00:00
abstract：BACKGROUND:Devices that limit microaspiration through the cuffs of endotracheal tubes could help prevent ventilator-associated pneumonia (VAP). The amount of tracheal microaspirations could be a relevant study endpoint. The aim of our study was to assess whether amylase measured in tracheal secretions constituted a rel...
journal_title：Minerva anestesiologica
pub_type： 杂志文章
doi：
更新日期：2013-09-01 00:00:00
abstract：BACKGROUND:Multiple organ dysfunction can occur in patients undergoing Veno-arterial Extra Corporal Membrane Oxygenation (VA-ECMO); however, liver function has not been well studied in this setting. METHODS:In a review of our institutional ECMO database (n=162), we collected aspartate (AST) and alanine (ALT) transamin...
journal_title：Minerva anestesiologica
pub_type： 杂志文章
doi：10.23736/S0375-9393.16.11442-7
更新日期：2017-03-01 00:00:00
abstract：AIM:An increased thyroxine requirement has been described in hypothyroid patients who have chronic gastritis as well as in patients who are treated with drugs that modify the acidic environment of the stomach. Patients with acute critical illnesses are generally treated with calorically dense enteral solutions and anta...
journal_title：Minerva anestesiologica
pub_type： 杂志文章
doi：
更新日期：2010-07-01 00:00:00
abstract：:The authors report the case of a patient suffering from central sleep apnea (CSA) who underwent neurosurgery for ventriculo-peritoneal derivation under general anesthesia. Given the risk of postoperative hypoventilation in CSA, intraoperative anesthesia was induced using remifentanyl, an opiate with a plasma half-life...
journal_title：Minerva anestesiologica
pub_type： 杂志文章
doi：
更新日期：1999-09-01 00:00:00
abstract：:The utility of laparoscopic cholecystectomy in reducing postoperative pain and patient's hospital discharge is already known. Nevertheless peritoneal gas insufflation required by surgical procedure can modify respiratory homeostasis during general anesthesia. The aim of this study was to evaluate the effect of laparos...
journal_title：Minerva anestesiologica
pub_type： 临床试验,杂志文章
doi：
更新日期：1994-03-01 00:00:00
abstract：:In 61 patients submitted to subdural anesthesia for orthopedic operations, postoperative somatic pain was treated by double-blind iv injection of lysine acetylsalicylate 1.8 g or placebo randomly. Patients with persistent pain received methadone 10 mg im. No placebo response was obtained; LAS had similar but shorter e...
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：1981-05-01 00:00:00
abstract：BACKGROUND:Gastric residual volume in ventilated critically ill may complicate gut function. Over the years studies suggested to tolerate progressively higher residuals. The relationship between such volumes and the development of ventilator-associated pneumonia (VAP) is still under debate. No reports deal with the rel...
journal_title：Minerva anestesiologica
pub_type： 杂志文章
doi：
更新日期：2014-04-01 00:00:00
abstract：:Data concerning antibiotic therapy in italian ICUs are presented. These data were not directly measured: they have been derived from a previous study on costs of intensive care treatments. 78% of 1065 patients received antibiotic therapy. Empirical therapy was started in 82% of septic patients. 93% of septic patients ...
journal_title：Minerva anestesiologica
pub_type： 杂志文章
doi：
更新日期：2001-04-01 00:00:00
abstract：BACKGROUND:Trapeziectomy is one of the most painful procedures in ambulatory surgery. This prospective randomized trial aimed to compare postoperative pain control using distal peripheral nerve blocks (dPNB) with a low concentration of a long-acting local anesthetic versus conventional systemic analgesia. METHODS:Fift...
journal_title：Minerva anestesiologica
pub_type： 杂志文章,随机对照试验
doi：10.23736/S0375-9393.18.12291-7
更新日期：2018-11-01 00:00:00
abstract：:Acute respiratory failure (ARF) in cancer patients remains a frequent and severe complication, despite the general improved outcome over the last decade. The survival of cancer patients requiring ventilatory support in Intensive Care Unit (ICU) has dramatically improved over the last years. The diagnostic approach, in...
journal_title：Minerva anestesiologica
pub_type： 杂志文章,评审
doi：
更新日期：2014-06-01 00:00:00
abstract：BACKGROUND:Acute normovolaemic anemia (ANA) frequently occurs during cardiopulmonary bypass (CPB) and major surgeries. We investigated whether fluids (with different compositions) used to replace blood elicit any degree of systemic or lung inflammatory response. METHODS:We evaluated systemic and pulmonary inflammatory...
journal_title：Minerva anestesiologica
pub_type： 杂志文章
doi：
更新日期：2013-10-01 00:00:00
abstract：BACKGROUND:Hypo- and hyperglycemia must be avoided to prevent additional brain damage following traumatic brain injury (TBI). However, the optimal blood glucose range requiring insulin remains unknown. Cerebral microdialysis is helpful in unmasking signs of metabolic impairment, thereby identifying deleterious blood gl...
journal_title：Minerva anestesiologica
pub_type： 杂志文章
doi：
更新日期：2010-11-01 00:00:00
abstract：:Aspecific cellular reactivity was assessed in patients who underwent open heart surgery. The authors conclude that depressed PMN activity measured as O2- production is not linked to anaesthesiological procedures, hemodilution and hypothermia. No conclusive reports are possible on the role of pulmonary reinfusion or pl...
journal_title：Minerva anestesiologica
pub_type： 杂志文章
doi：
更新日期：1989-07-01 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：:In this study we compared the efficacy of a reduced dose of medium term neuromuscular blocking agents atracurium (0.20 mg/kg) and vecuronium (0.04 mg/kg) in short-term (8-10 min) pediatric surgery. Eighty-four children (ASA I and II) undergoing adenotonsillectomy were selected for this study. Their average age was 56 ...
journal_title：Minerva anestesiologica
pub_type： 杂志文章
doi：
更新日期：1993-03-01 00:00:00
