Efficacy of fosfomycin-containing regimens in treating severe infections caused by KPC-producing klebsiella pneumoniae and carbapenem-resistant acinetobacter baumannii in critically ill patients.

Background: Fosfomycin (FOS) is gaining increasing importance as part of combination therapy for the treatment of carbapenem-resistant Acinetobacter baumannii (CRAB) and KPC-producing Klebsiella pneumoniae (KPC-Kp), thanks to its in vitro synergism with several antibiotics, high tissue distribution and good tolerability. We analyzed the effect on 30-day survival of FOS-containing regimens compared to non-FOS-containing regimens in critically ill patients admitted to the intensive care unit with CRAB or KPC-Kp infections. Secondary objectives were to evaluate clinical cure and microbiologic eradication in the FOS vs.

Clinical Benefits of Unilateral Adrenalectomy in Patients with Subclinical Hypercortisolism Due to Adrenal Incidentaloma: Results from a Single Center.

Introduction: This study was designed to evaluate the results of unilateral laparoscopic adrenalectomy in patients with subclinical hypercortisolism (SH) due to adrenal incidentaloma (AI) concerning the main cardiometabolic disorders.

Methods: We have studied between January 2000 to December 2015, 645 patients with AI (283 males and 362 females; mean age 61.9 ± 10 years) and we found 70 patients with SH (27 males and 43 females; mean age 61.

Noninvasive vs. conventional mechanical ventilation in patients with chronic obstructive pulmonary disease after failure of medical treatment in the ward: a randomized trial.

Objective: We conducted a randomized prospective study comparing noninvasive positive pressure ventilation (NPPV) with conventional mechanical ventilation via endotracheal intubation (ETI) in a group of patients with chronic obstructive pulmonary disease who failed standard medical treatment in the emergency ward after initial improvement and met predetermined criteria for ventilatory support.

Design And Setting: Prospective randomized study in a university hospital 13-bed general ICU.

Patients: Forty-nine patients were randomly assigned to receive NPPV (n=23) or conventional ventilation (n=26).

Non-invasive pressure support ventilation in patients with acute respiratory failure after bilateral lung transplantation.

Objective: To evaluate non-invasive ventilation (NIV) prospectively in a group of patients developing acute respiratory failure (ARF) after bilateral lung transplantation (BLT).

Setting: General intensive care unit (ICU) of Rome "La Sapienza" University.

Patients: Twenty-one patients (18 with cystic fibrosis) undergoing BLT.

Noninvasive ventilation for treatment of acute respiratory failure in patients undergoing solid organ transplantation: a randomized trial.

Context: Noninvasive ventilation (NIV) has been associated with lower rates of endotracheal intubation in populations of patients with acute respiratory failure.

Objective: To compare NIV with standard treatment using supplemental oxygen administration to avoid endotracheal intubation in recipients of solid organ transplantation with acute hypoxemic respiratory failure.

Design And Setting: Prospective randomized study conducted at a 14-bed, general intensive care unit of a university hospital.

Preimplantation retrograde pneumoplegia in clinical lung transplantation.

Objective: Retrograde pneumoplegia seems to improve early graft function in experimental and clinical lung transplantation. We evaluated the role of retrograde flushing in addition to antegrade pneumoplegia in clinical lung transplantation.

Methods: Fourteen patients undergoing lung transplantation were randomized into 2 groups: in group I we performed antegrade pulmonary artery flushing with alprostadil (prostaglandin E1) and modified Euro-Collins solution at the time of retrieval.

Risk factors for acute renal failure in trauma patients.

Objective: To elucidate the risk factors for the development of acute renal failure (ARF) in severe trauma.

Design: Prospective observational study.

Setting: A general intensive care unit (ICU) of a university hospital.

A comparison of noninvasive positive-pressure ventilation and conventional mechanical ventilation in patients with acute respiratory failure.

Background And Methods: The role of noninvasive positive-pressure ventilation delivered through a face mask in patients with acute respiratory failure is uncertain. We conducted a prospective, randomized trial of noninvasive positive-pressure ventilation as compared with endotracheal intubation with conventional mechanical ventilation in 64 patients with hypoxemic acute respiratory failure who required mechanical ventilation.

Results: Within the first hour of ventilation, 20 of 32 patients (62 percent) in the noninvasive-ventilation group and 15 of 32 (47 percent) in the conventional-ventilation group had an improved ratio of the partial pressure of arterial oxygen to the fraction of inspired oxygen (PaO2:FiO2) (P=0.

Comparative evaluation of the cardiorespiratory effects of assist control ventilation vs pressure support ventilation in patients following orthotopic liver transplantation.

Objective: 1) To compare the haemodynamic tolerance of ACV and PSV in patients mechanically ventilated after orthotopic liver transplantation; 2) to compare patients comfort during ACV and PSV.

Design: Prospective randomized cross-over study.

Setting: General ICU of the University of Rome "La Sapienza".

Respiratory system mechanics in the early phase of acute respiratory failure due to severe kyphoscoliosis.

Objective: To evaluate respiratory mechanics in the early phase of decompensation in a group of seven patients with severe kyphoscoliosis (KS) (Cobb angle > 90 degrees) requiring mechanical ventilatory support.

Design: Prospective clinical study with a control group.

Setting: General intensive care unit at University of Rome "La Sapienza".

Exogenous reactive oxygen species deplete the isolated rat heart of antioxidants.

The effects of reactive oxygen species (ROS) on myocardial antioxidants and on the activity of oxidative mitochondrial enzymes were investigated in the following groups of isolated, perfused rat hearts. I: After stabilization the hearts freeze clamped in liquid nitrogen (n = 7). II: Hearts frozen after stabilization and perfusion for 10 min with xanthine oxidase (XO) (25 U/l) and hypoxanthine (HX) (1 mM) as a ROS-producing system (n = 7).

Early and late onset bacteremia have different risk factors in trauma patients.

Objective: The aim of this study was to identify risk factors and to describe epidemiological patterns for early-(EOB) and late-onset bacteremias (LOB) after trauma.

Design: A prospective study conducted on 141 consecutive trauma patients.

Setting: A general intensive care unit (ICU) of a university hospital.

Paralysis has no effect on chest wall and respiratory system mechanics of mechanically ventilated, sedated patients.

Objective: To evaluate the separate effects of sedation and paralysis on chest wall and respiratory system mechanics of mechanically ventilated, critically ill patients.

Setting: ICU of the University "La Sapienza" Hospital, Rome.

Patients And Participants: 13 critically ill patients were enrolled in this study.

A new device to remove obstruction from endotracheal tubes during mechanical ventilation in critically ill patients.

Objective: To evaluate the efficiency of a new device developed to remove obstructions from endotracheal tubes (ETT) in mechanically ventilated patients.

Design: Open study in mechanically ventilated sedated and paralyzed ICU patients.

Setting: General ICU and Laboratory of Respiratory Mechanics of the University of Rome "La Sapienza".

Evaluation of respiratory system resistance in mechanically ventilated patients: the role of the endotracheal tube.

Objective: To investigate the role played by the endotracheal tube (ETT) in the correct evaluation of respiratory system mechanics with the end inflation occlusion method during constant flow controlled mechanical ventilation.

Setting: General ICU, university of Rome "La Sapienza".

Patients: 12 consecutive patients undergoing controlled mechanical ventilation.

Risk factors for early onset pneumonia in trauma patients.

Study Objectives: The aim of the study was to identify risk factors for early onset pneumonia (EOP) in trauma patients, in order to seek possible intervention strategies.

Study Population: Participants included 124 consecutive trauma patients admitted to a general intensive care unit (ICU) of a university hospital from December 1990 to February 1992 inclusive.

Data Collection: The following data were prospectively collected for each patient: demographics, severity of trauma according to the abbreviated injury scale (AIS), severity of coma according to the Glasgow coma scale (GCS), presence of pneumothorax, pulmonary contusion, rib fractures, hemothorax, and mechanical ventilation.

Propofol induces bronchodilation in mechanically ventilated chronic obstructive pulmonary disease (COPD) patients.

The aim of this study was to evaluate the effects of propofol administration (2 mg.kg-1 i.v.

Early prediction of successful weaning during pressure support ventilation in chronic obstructive pulmonary disease patients.

Objective: The aim of this study was to examine variables for early prediction of successful weaning in chronic obstructive pulmonary disease (COPD) patients during pressure support ventilation weaning.

Design: Thirteen COPD patients were prospectively studied to compare the respiratory pattern (inspiratory time, expiratory time, total breath cycle duration, tidal volume, respiratory rate, minute ventilation), the respiratory drive (airway occlusion pressure at 0.1 sec, tidal volume/inspiratory time), and blood gases after 30 mins of pressure support weaning.

A fibre optics system for the evaluation of airway pressure in mechanically ventilated patients.

Objective: The present study was intended to evaluate the "in vivo" endotracheal (ET) tube resistance and respiratory mechanics in mechanically ventilated patients with respiratory failure by using fiber optic catheters.

Design: Two fiber optic catheters, consisting of a thin probe with a pressure transducer on the tip, were used. The first was placed at the proximal side of the ET tube and the second was positioned distally beyond the end.

[Hemodynamic and respiratory aspects in orthotopic liver transplantation].

Intraoperative hemodynamic and respiratory data from one-year experience of orthotopic liver transplantation with veno-venous bypass (10 cases) were collected. Seven different phases of OLT was submitted to one way analysis of variance. Variability is due to degree and duration of liver disease.

Effects of the heat-moisture exchangers on dynamic hyperinflation of mechanically ventilated COPD patients.

In recent years the use of devices called Heat and Moisture Exchangers (HME) has become widespread as gas conditioners for ICU patients requiring mechanical ventilation. As an important variation of the resistive properties of the HME, related to flow and duration of use, has recently been pointed out during "in vitro" studies, the use of these devices in COPD patients could increase the levels of auto PEEP and dynamic hyperinflation. In this study we have compared the levels of auto PEEP and difference in functional residual capacity (delta FRC) in a group of COPD patients, requiring controlled mechanical ventilation (CMV), at basal conditions and after the insertion into the circuit of three HMEs (Dar Hygrobac, Pall Ultipor, Engstrom Edith) at random: the results obtained excluded a significant increase of auto PEEP and delta (FRC) both with "new" HMEs and after 12 h of continuous use.

Auto-PEEP and dynamic hyperinflation in COPD patients during controlled mechanical ventilation and high frequency jet ventilation.

We investigated the levels of auto-PEEP and dynamic hyperinflation during high frequency jet ventilation (HFJV) and controlled mechanical ventilation (CMV) in six patients with chronic obstructive pulmonary disease within the first 36 h of acute exacerbation. The comparative evaluation was performed at similar conditions of gas exchange in HFJV and CMV: PaO2 77.6 +/- 11 mmHg vs 80.

Pressure support ventilation (PSV) reverses hyperinflation induced isorhythmic A-V dissociation.

We report a case of hyperinflation induced isorythmic atrio-ventricular dissociation with circulatory failure in a patient with chronic obstructive pulmonary disease. The arrythmia was successfully treated by applying "pressure support ventilation" (PSV: 20 cmH2O) which, by decreasing the respiratory rate and increasing the expiratory time reduced the level of auto-PEEP. In order to explain this result the Authors recorded, in the same patient, the level of auto-PEEP and delta FRC obtained with Intermittent Positive Pressure Ventilation (IPPV), Intermittent Mandatory Ventilation (IMV) and PSV at the same gas exchange values.