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  • Author: Silvius Negoita x
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The Clinical Value of Red Blood Cell Distribution Width as a Prognosis Factor and Severity Marker in Sepsis and Septic Shock

Abstract

Red blood cell distribution width (RDW) is a hematological parameter usually measured with every complete blood count. Its place in daily practice is mainly in the differential diagnosis of anemia, but nowadays, researchers are focused on different approaches for the erythrocyte’s changes in function and morphology.

Sepsis and its most advanced form, septic shock, induces profound disturbances into organ system’s function and morphology. The red blood cells physiology and structure are directly and indirectly altered by these im balances produced in sepsis. RDW was studied in many diseases, like acute heart failure, acute stroke, inflammatory bowel diseases, chronic lung diseases and cancer, but also in sepsis. Its changes are seen to be mainly associated with prognosis. Higher values of RDW are correlated with mortality and severity of illnes in septic and all-cause critically ill patients. RDW was studied also as an independent variable in different predictive scores and some studies suggest it should be introduced in the scores use on a daily basis in critical care settings and emergency departments.

In this review we will focus on how RDW was associated with mortality and severity of illness in the recent literature, as an independent prognosis factor and as a component part in different predictive and severity scores.

Open access
Understanding Red Blood Cell Rheology in Sepsis and its Role in Clinical Practice. From Biomolecular Aspects to Possible Therapeutic Interventions

Abstract

Erythrocyte rheology is of interest in understanding microcirculation and oxygen delivery and consumption alterations induced by sepsis and septic shock. Several mechanisms are proposed: (i) direct or indirect RBC membrane alterations, (ii) abnormal intraerythrocytic homeostasis, (iii) RBCs interaction with other cells and extracellular molecules, (iiii) increased reactive species production and altered redox homeostasis. In this review, we describe in part these mechanisms and what’s the impact of these hemorheological disturbances on the outcome and mortality rate. Also, we outline the possible therapeutic interventions and further perspectives regarding sepsis and septic shock management.

Open access
Procedural Sedation and Analgesia in Adults - new trends in patients safety

Abstract

Sedation and analgesia may be need­ed for many interventional or diagnostic proce­dures, whose number has grown exponentially lately. The American Society of Anesthesiolo­gists introduced the term “procedural sedation and analgesia” (PSA) and clarified the termi­nology, moderate sedation and Monitored An­esthesia Care. This review tries to present a nondissociative sedation classification, follow­ing ASA guidelines as well as pre-procedural assessment and preparation, in order to choose the appropriate type and level of sedation, pa­tient monitoring and agents, which are most commonly used for sedation and/or analgesia, along with their possible side effects. The paper also lists the possible complications associated with PSA and a few specific particularities of procedural sedation.

Open access
Procedural Sedation and Analgesia in Adults - new trends in patients safety

Abstract

Sedation and analgesia may be needed for many interventional or diagnostic procedures, whose number has grown exponentially lately. The American Society of Anesthesiologists introduced the term “procedural sedation and analgesia” (PSA) and clarified the terminology, moderate sedation and Monitored Anesthesia Care. This review tries to present a nondissociative sedation classification, follow ing ASA guidelines as well as pre-procedural assessment and preparation, in order to choose the appropriate type and level of sedation, patient monitoring and agents, which are most commonly used for sedation and/or analgesia, along with their possible side effects. The paper also lists the possible complications associated with PSA and a few specific particularities of procedural sedation.

Open access
Neuromuscular monitoring: an update

Abstract

This review makes an advocacy for neuromuscular blockade monitoring during anaesthesia care, by: (i) describing the fundamental principles of the methods currently available, at the same time emphasizing quantitative recording measurements; (ii) describing the different ways in which muscles respond to the effect of neuromuscular blockade and their use in clinical practice; (iii) presenting results of different studies on timing and agents of neuromuscular block reversal, including a recommendation for sugammadex use and experimental results with calabadion and (iv) in the end emphasizing the need for implementing neuromuscular monitoring as a practice that should be used every time a neuromuscular block is required.

Open access
Pharmacological therapies for acute respiratory distress syndrome

Abstract

Acute respiratory distress syndrome (ARDS) has no specific treatment, the only effective therapy currently being limited to minimizing potentially harmful ventilation and avoiding a positive fluid balance. These treatments could not be completely effective in severe disease and several measures must be undertaken simultaneously, including pharmacological therapies aimed at correcting the etiology or targeting the pathogenesis. In this review article we provide update on pharmacological therapies in ARDS, showing their effect on outcome in recent trials.

Open access