668 research outputs found
Tracheostomy must be individualized!
No full textAbstract
Tracheostomy is one of the most frequent procedures carried out in critically ill patients with major advantages compared to translaryngeal endotracheal intubation such as reduced laryngeal anatomical alterations, reduced inspiratory load, better patient's tolerance and nursing. Thus, tracheostomy can enhance patient's care in patients who need prolonged mechanical ventilation and/or control of airways. The right timing of tracheostomy remains controversial, however it appears that early tracheostomy in selected severe trauma, burn and neurological patients could be effective to reduce the duration of mechanical ventilation intensive care stay and costs. Percutaneous tracheostomy techniques are becoming the procedure of choice in the majority of the cases, since they are safe, easy and quick, and complications are minor. However, percutaneous tracheostomies should be always performed by experienced physicians to avoid unnecessary additional complications. It is not clear the superiority of one percutaneous technique compared to another, but experience of the operator and clinical individual anatomical, physiopathological characteristics of the patient should be always considered. We believe that the operator should have experience of at least one intrusive and one extrusive percutaneous technique. The general "optimal" tracheostomy technique and timing do not exist, but tracheostomy should be targeted on the patient's individual clinical characteristics
The contribution of ethical reflection during the Coronavirus pandemic. A comparative analysis
No full textThe Coronavirus pandemic has deeply marked all ordinary health care activities and has dictated matters usually faced by the medicine of disasters. The most critical and dramatic dilemma has been the triage and the urge to select patients for Intensive Care Unit (ICU) because there was no place for all at the same time. The need to decide in a very short time has made this decision even more complex. The data of the Italian situation and namely of Lombardia reveal it clearly. Worldwide, there have been many different views on triage, sometimes with very peculiar emphasis. In this paper we will illustrate the contributions of the Unites States compared to the European ones. We have critically analyzed different views and we have highlighted that nevertheless there are several shared elements such as clinical criteria, if we consider only them we might underestimate the uniqueness of the patient, including vulnerable ones. There is a huge gap between the US view and the European view when it comes to the appointment of the final decision maker in triage. We propose the criteria of proportionality as a guide line to take decisions in triage because it allows to integrate collective public health objectives and the principle of ensuring protection for the individual patient. Finally, we envisage the potential role of ethics consultation in this pandemic scenario
The Extracellular Matrix of the Lung: The Forgotten Friend!
No full textThe extracellular matrix represents the three-dimensional scaffold of the alveolar wall, which is composed of a layer of epithelial and endothelial cells, their basement membrane, and a thin layer of interstitial space lying between the capillary endothelium and the alveolar epithelium [1]. In the segment where the epithelial and endothelial basement membranes are not fused, the interstitium is composed of cells, a macromolecular fibrous component, and the fluid phase of the extracellular matrix, functioning as a three dimensional mechanical scaffold characterized by a fibrous mesh consisting mainly of collagen types I and III, which provides tensile strength, and elastin conveying an elastic recoil [2, 3]. The three-dimensional fiber mesh is filled with other macromolecules, mainly glycosaminoglycans (GAGs), which are the major components of the non-fibrillar compartment of the interstitium [4]. In the lung, the extracellular matrix plays several roles, providing: a) mechanical ten sile and compressive strength and elasticity; b) a low mechanical tissue compliance, thus contributing to the maintenance of normal interstitial fluid dynamics [5]; c) low resistive pathway for effective gas exchange [2]; d) control of cell behavior by binding of growth factors, chemokines, cytokines, and interaction with cell-surface receptors [6]
Lumbar plexus terminal branch block, a safe alternative for transfemoral aortic valve implantation. Case report
No full textTranscatheter aortic valve implantation is an alternative treatment for patients with severe aortic stenosis, it is conventionally performed under general anaesthesia or local anaesthesia plus sedation. We present the first case of trans-femoral, trans-catheter aortic valve implantation, performed in our hospital in a patient with severe aortic stenosis, who was a high surgical risk. Anaesthesia consisted of a combination of bilateral selective blockade of the iliohypogastric, ilioinguinal and genitofemoral nerves with the patient awake without sedation, using an ultrasound-guided approach. Transcatheter aortic valve implantation was successful and passed without incident, the patient remained immobile, calm, did not report pain, and sedation or hypnotics were not necessary during dilation of the vascular accesses with the introducer. Standard monitoring demonstrated haemodynamic stability, without cardiovascular repercussions and did not necessitate vasopressor or inotropic drug support. After the intervention, the patient was sent to the Cardiac Intensive Care Unit, where he remained asymptomatic and stable. Subsequently, the patient was admitted to the cardiology ward from where he was discharged without complications
An integrated approach to prevent and treat respiratory failure in brain-injured patients.
No full text
Comparison of SAPS II, MPM II24 and SAPS in intensive care [Confronto fra SAPS II, MPM II24 e SAPS in terapia intensiva]
No full textOBJECTIVE: To compare the performance of the new SAPS II, new MPM2 and SAPS in a cohort of patients admitted to our polyvalent ICU. METHODS: Design: the ability of the SAPS II scoring system to predict the probability of hospital mortality was assessing calibration and discrimination (ROC curve) measures obtained using published coefficients and within relevant subgroups using formal statistic assessment (goodness of fit). Patients: from May 1997 to May 1998, 420 consecutive patients over 18 years old. RESULTS: When the parameters based on the standard model were applied, the SAPS II discrimination (area under ROC curve) was = 0.889 and calibration (chi square test) of SAPS II was = 4.448 with p = 0.879; MPM2 chi 2 = 0.9385, p = 0.402 and SAPS chi 2 = 27.089, p = 0.0001. The performance of SAPS II model was very good. Worst predictive accuracy was achieved in trauma and elective surgery patients. CONCLUSIONS: SAPS II model gave good results in terms of calibration and discrimination. SAPS II has better accuracy then SAPS and MPM2. Concerning the performance of models, large differences were apparent in relevant subgroups: trauma and sepsis patients. Moreover the choice of adequate statistic method to compare intensive care populations appeared to need more research
AGN Diagnostic Plot in the WISE and 3XMM Era: the Role of Variability
No full textAn efficient diagnostic method to find local (z<0.1) Compton-thick AGN consists in selecting sources characterized by hard X- ray colors and low hard X-ray over mid-IR flux ratio. This has been done efficiently in the past using 2XMM and IRAS data (Severgnini et al. 2012). In this talk I will present my thesis work in which I tested this technique using the latest 3XMM and WISE data for the sample presented by Severgnini et al. I will also briefly discuss the X-ray spectral properties of all of those sources showing flux and/or spectral variability in the XMM-Newton observations
SDSS J222428.53+261423.2: unique emission lines properties unveil a sub-kiloparsec dual AGN candidate
No full textIn this paper, we presented a detailed analysis of the Sloan Digital Sky Survey optical spectrum of a new sub-kpc scale dual AGN candidate SDSS J222428.53+261423.2 (=SDSS J2224). The target is one of the few AGNs with all the optical narrow emission lines characterized by double-peaked profiles and with peak separations in velocity units of about 930 km s-1. If the double-peaked narrow emission lines (DPNELs) are due to a dual AGN in SDSS J2224, the estimated physical separation between the two cores is about 500 pc. Meanwhile, three alternative explanations are also discussed in this paper, however, we can not find solid evidence to completely rule them out. Our results support the presence of a sub-kpc dual AGN with DPNELs in all lines, indicating a key episode of galaxy merging evolution at sub-kpc scale
- …
