1,720,991 research outputs found
Impact of protein intake on weaning from mechanical ventilation in ICU patients
Full text linkBackground: In pazienti ventilati meccanicamente, la nutrizione enterale, iniziata entro 24-48 ore
dal ricovero in terapia intensiva, ha dimostrato ridurre le complicanze infettive e la durata
dell’ospedalizzazione. A causa dell’insufficienza respiratoria associata, il 30% dei pazienti ricoverati
nelle terapie intensive richiede ventilazione meccanica. Lo svezzamento ritardato dalla ventilazione
meccanica aumenta i costi, i rischi di polmoniti nosocomiali, comorbidità cardiache associate e morte.
Uno svezzamento precoce dalla ventilazione spesso implica reintubazione e complicanze associate
allo svezzamento prolungato. La gestione della nutrizione rappresenta una sfida per l’intensivista. La
malnutrizione causa la diffusione di patologie associate alla disfunzione d’organo, difficoltà di
guarigione, riduce l’efficacia del sistema immunitario e si associa ad uno scarso successo di
svezzamento dalla ventilazione. La quantità di tessuto muscolare distrutto e la perdita di peso sono
inversamente correlati con la sopravvivenza a lungo termine dei pazienti critici. In questa tesi sarà
discusso il ruolo del supporto nutrizionale in un setting di malati critici, in associazione allo
svezzamento dalla ventilazione meccanica.
Obiettivi:
1. Valutazione dello stato nutrizionale (parametri clinici e antropometrici);
2. Differenza di outcome misurato come durata dello svezzamento dalla ventilazione, eventi
avversi e uso delle risorse (durata dell’ospedalizzazione e costi per la terapia intensiva).
Materiali e metodi: Sono stati arruolati pazienti > 18 anni, ricoverati tra novembre 2016 e novembre
2018. Sono stati raccolti dati antropometrici, dati relativi allo stato nutrizionale come BMI e peso,
tipo di nutrizione somministrata (enterale o parenterale), livelli di albumina, proteine totali, parametri
clinici come il P/F.
Risultati: Sono stati analizzati 30 pazienti (12 femmine). La durata media di ogni degenza è stata
25.6 ± 14.7 giorni. L’84% di pazienti è stato nutrito per via enterale. Non ci sono state alterazioni
statisticamente significative nei livelli di albumina e proteine totali durante l’intera degenza in terapia
intensiva. Diverse miscele nutrizionali influenzano le risposte cliniche (migliori P/F tra i pazienti
alimentati con queste ultime). Le calorie stimate e somministrate sono state adeguate alla fase
ventilatoria associata. Il supporto nutrizionale era appropriato, dal momento che BMI e peso sono
rimasti invariati nel confronto tra inizio e fine degenza in terapia intensiva.
Conclusioni: Applicando una strategia di supporto nutrizionale adeguato alla nostra terapia intensiva
non si aumentano i giorni di ospedalizzazione, riducendo l’incidenza di condizioni associate ad uno
svezzamento dalla ventilazione difficile o prolungato e le complicanze associate ad esso.Background: In mechanically ventilated ICU patients enteral nutrition started 24 to 48
hours of ICU admission, shown to reduce infectious complications and duration of
hospitalization. Due to acute respiratory failure 30% of patients admitted to ICUs
require mechanical ventilation. Delayed weaning increases costs, risks of nosocomial
pneumonia, cardiac-associated morbidity, and death. Early weaning often results in
reintubation, and associated complications due to prolonged ventilation. Nutritional
management poses a vital challenge to the intensivist in the ICU. Malnutrition causes
widespread organ dysfunction, associated with poor healing, reduce immune
competence & poor weaning from ventilator (decreasing the diaphragmatic
contractility and depressing the hypoxic drive & ventilatory drive to CO2). The extent
of muscle wasting and weight loss in the ICU is inversely correlated with long-term
survival of the patients. In this thesis will be discussed the role of the nutritional support
in the critical care setting when associated to weaning from mechanical ventilation.
Objectives:
1. Assessment of Clinical And Anthropometric nutritional status.
2. Differences in outcomes measuring weaning duration, harm (adverse events) and
resource use (ICU and hospital length of stay, cost).
Material and methods: Patients >18 y-o, admitted to the ICU from November 2016
to November 2018 were enrolled. Anthropometrics, nutritional status such as BMI and
weight, nutritional support such as enteral or parenteral nutrition, albumin and total
proteins levels, clinical parametrs such as P/F were recorded for the entire ICU stay.
Results: 30 consecutive patients (12 female) were enrolled. The average duration of
each admission to the ICU was 24.58 ± 14.7 days. The 84% of patients was enterally
fed. Albumine and total proteins were not significantly different throughtout the ICU
stay. Different enteral nutrition mixtures influence clinical response (better P/F).
Calories estimated and provided were adequate to the ventilatory phase associate. The
nutritional support was adequate, since BMI and weight were the same at admission
and discharge from the ICU.
Conclusions: through an optimal planning of the nutritional supply, in our ICU days
of hospitalization were not increased, avoiding the incidence of difficult or prolonged
weaning conditions and the consequences associated with it
Physiological Effects of the Open Lung Approach in Patients with Early, Mild, Diffuse Acute Respiratory Distress Syndrome: An Electrical Impedance Tomography Study
No full textBackground: To test the hypothesis that in early, mild, acute respiratory distress syndrome (ARDS) patients with diffuse loss of aeration, the application of the open lung approach (OLA) would improve homogeneity in lung aeration and lung mechanics, without affecting hemodynamics.
Methods: Patients were ventilated according to the ARDS Network protocol at baseline (pre-OLA). OLA consisted in a recruitment maneuver followed by a decremental positive end-expiratory pressure trial. Respiratory mechanics, gas exchange, electrical impedance tomography (EIT), cardiac index, and stroke volume variation were measured at baseline and 20 min after OLA implementation (post-OLA). Esophageal pressure was used for lung and chest wall elastance partitioning. The tomographic lung image obtained at the fifth intercostal space by EIT was divided in two ventral and two dorsal regions of interest (ROIventral and ROIDorsal).
Results: Fifteen consecutive patients were studied. The OLA increased arterial oxygen partial pressure/inspired oxygen fraction from 216 13 to 311 +/- 19 mmHg (P < 0.001) and decreased elastance of the respiratory system from 29.4 +/- 3 cm H2O/l to 23.6 +/- 1.7 cm H2O/l (P < 0.01). The driving pressure (airway opening plateau pressure - total positive end-expiratory pressure) decreased from 17.9 +/- 1.5 cm H2O pre-OLA to 15.4 +/- 2.1 post-OLA (P < 0.05). The tidal volume fraction reaching the dorsal ROIs increased, and consequently the ROIVentral/Dorsal impedance tidal variation decreased from 2.01 +/- 0.36 to 1.19 +/- 0.1 (P < 0.01).
Conclusions: The OLA decreases the driving pressure and improves the oxygenation and lung mechanics in patients with early, mild, diffuse ARDS. EIT is useful to assess the impact of OLA on regional tidal volume distribution
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Dispelling the Myths Behind First-author Citation Counts
Full text linkWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
- …
