118,701 research outputs found
Comparison of USCOM and PiCCO Cardiac Output Measurements in Intensive Care Unit
No full textObjective: In the management of haemodynamically unstable patients, cardiac output (CO) measurement provides clinicians with important data on organ tissue perfusion. This measurement can be performed by pulse-induced contour cardiac output (PiCCO) using thermodilution method, which is a less invasive method, and ultrasonic cardiac output monitoring (USCOM), which is completely non-invasive. The aim of this study was to investigate the clinical relevance of CO and cardiac index measurements obtained by USCOM in patient’s with sepsis and septic shock by comparing them with the PiCCO technique, which has been used as a reference measurement method in recent years.
Materials and Methods: In this prospective study, 36 patient’s with sepsis and septic shock ventilated with 8-10 mL/kg tidal volume without respiratory effort were included. Patient’s with arrhythmia, known heart failure or pulmonary embolism were excluded.
Results: After averaging the PiCCO and USCOM measurements performed by different clinicians, the heart rate was found to be 3.23 L/min/m2 with PiCCO and 2.24 L/min/m2 with USCOM. When the two results were compared, the difference was statistically significant (p=0.01). Stroke volume variation was 15.80% with PiCCO and 52.89% with USCOM. When the two results were compared, the difference was statistically significant (p=0.01).
Conclusion: There was no agreement between USCOM and PiCCO measurements in sepsis patient’s. In our opinion, more studies are needed for USCOM reliability
Gli interventi all'apparato sanzionatorio penale e amministrativo e lo stralcio dei debiti contributivi (artt. 8, commi 1-4. 23 e 23-bis, d.l. n. 48/2023, conv. in l. n. 85/2023)
No full textIl lanificio Picco al Bivio. Una strategia per rigenerare uno spazio di archeologia industriale attraverso una rete di itinerari culturali nel paesaggio biellese, tra fabbrica e natura
No full textRethinking an abandoned nineteenth-century industrial building, inserted into a fragile althoug rich in potential land, is apparently an impossible challenge. The starting point is the link between the single artifact, divided into parts - each one to be transformed and furtherly implemented – and the surrounding landscape, considering the building as a node of the territorial network: the communication routes, the rivers, the intangible historical and cultural networks weave a plot that enables the connections to other points of interest already on site.. In such territorial context, industrial tourism based on bicycle routes might be the new green clue in the strategy of rebirth. The wool mill, revitalized by contemporary functions, possibly implemented in the future with new uses such as hospitality, artistic residence or education, is at the center of a tangible and intangible network, leading to rethink historical industrial sites as a great opportunity to discover this important industrial archaeology district
Il limite del trattamento contributivo nella contrattazione di prossimità ex art. 8, D.L. n. 138/2011 (conv. in L. n. 148/2011)
No full textLa sentenza n. 182/2018 del Giudice del Lavoro del Tribunale di Livorno si segnala per aver affrontato l'importante questione riguardante la rilevanza a fini contributivi di un accordo di prossimità ai sensi dell'art. 8, D.L. n. 138/2011 (conv. in L. n. 148/2011). Dopo aver tratteggiato le peculiarità della contrattazione di prossimità, l'analisi si concentra sui limiti al potere di deroga attribuito alle parti sociali
The ability of PiCCO vesus LiDCO variables to detect changes in cardiac index: a prospective clinical study
No full textAbstract
BACKGROUND: Both PiCCO and LiDCO can provide dynamic preload parameters, pulse pressure variation (PPV) and stroke volume variation (SVV). The PiCCO device also provides a measure of intrathoracic blood volume index (ITBVI). We investigated the agreement between SVV and PPV, as well as the reliability of LiDCO- and PiCCO-measured SVV, PPV and ITBVI, in detecting fluid responsiveness before and after fluid challenge (FC).
METHODS: We performed a prospective clinical study in University Hospital ICU. Nine adult ICU patients with cardiovascular instability were enrolled in the study. All patients were sedated and mechanically ventilated with intermittent positive pressure ventilation. The PiCCO and LiDCO systems were both connected to each patient. The PiCCO pulse waveform system was joined by a 5-French (Fr) thermistor-tipped arterial catheter inserted into the femoral artery. LiDCO measurements were performed through radial artery pulse contour analysis. Fluid challenge was performed using a rapid infusion of 7 mL/kg of 6% hydroxyethylstarch over 30 min.
RESULTS: Measurements of CI, ITBVI, SVV, and PVV were made using both techniques before and after FC. Pre-FC cardiac index (CI) measurements were similar with both devices, although the reading was higher after FC with the PiCCO device (P<0.001). The correlation coefficient between PiCCO-CI and LiDCO-CI was 0.85 (95% CI: 0.69 to 0.93; P<0.001); for P-PPV and L-PPV, it was 0.74 (95% CI: 0.49 to 0.88; P<0.001). Only ITBV had a significant correlation with LiDCO-CI or PiCCO-CI.
CONCLUSION: We found a narrow bias but less accurate precision in cardiac index values measured by a radial artery-site LiDCO catheter and a femoral artery-site PiCCO catheter, with poor agreement between radial and femoral-derived SVV and PPV measurements. ITBVI proved to be the best predictor of fluid responsiveness. The SVV does not seem to be reliable for preload optimization in ICU patients
The effects of low-magnitude flow conditions on bedload mobility in a steep mountain stream
No full textThe transport of coarse material strongly controls the stability and evolution of mountain fluvial systems but, despite this, bedload dynamics are not yet fully understood especially in mountain streams. In this sense, particular attention was paid on the bedload magnitude (volume) expressed at event-scale and on the long-term, while few studies were focused on when and how the transport of the coarse material occurs. The aim of this work was to investigate the bedload mobility in the Rio Cordon, a mountain stream characterized by cascade and step-pool morphologies with a rough streambed. Here, the critical conditions for initiation of motion, transport distance and virtual velocity expressed by the coarse streambed material were assessed and their relationships with hydraulic forcing conditions and grain size were analyzed. To this end, a monitoring program based on bedload tracing was maintained over 7 years, allowing to analyze the bedload mobility during persistent high frequency/low magnitude flow conditions. To investigate the bedload mobility, 250 tracers were released between 2011 and 2012 and their propagation along study site was monitored until 2018. Overall, 14 tracer inventories were realized, determining 1697 tracer localizations. During the study period, the bedload dispersion resulted well described by the peak discharge magnitude (Qp, qp and ωp − ωc), while no significant relationships were observed with duration of competent flow (tover) and effective runoff volume (ER). Transport distance and tracer grain size were negatively correlated, whereas virtual velocity increased with increasing particle size. In this sense, the propagation velocity seems to be affected by the high frequency flows that, on the one hand triggered mobilization of the coarser tracers only through limited and impulsive events and, on the other hand favored a slowdown on the finer particles due to bedforms disturbance. Compared to other study sites, the Rio Cordon exhibited accentuated threshold conditions with lower transport distance and virtual velocity, confirming that steep mountain streams are generally influenced by a reduced transport efficiency due to protruding bedforms and macro-roughness that cause a pronounced energy dissipation. Interestingly, such condition seems to have progressively reduced from under- to near-bankfull flows. The results were compared to the bedload mobility observed in the Rio Cordon during 1993–1998, enabling to quantitatively assess how the bedload dispersion varied between a setting of stable armouring layer with protruding bedforms (2012–2018) and a partial alteration of these (1993–1998). An evident difference was observed in terms of transport distance, while critical conditions did not significantly change. Lastly, the long-term bedload tracing investigation highlighted that a certain legacy on the transport efficiency was produced by the persistent high frequency flow conditions. Over the study period, a general decrease of transport distance was observed that could be explained by a progressive stabilization of streambed material. Previous studies suggested that such condition can be interrupted by high magnitude/low frequency flood
- …
