Inaccurate early assessment of neurological severity in head injury.

Intubation, which requires sedation and myorelaxants, may lead to inaccurate neurological evaluation of severely head-injured patients. Aims of this study were to describe the early clinical evolution of traumatic brain injured (TBI) patients admitted to intensive care unit (ICU), to identify cases of over-estimated neurological severity, and to quantify the risk factors for this over-estimation. A total of 753 TBI patients consecutively admitted to ICU of three academic neurosurgical hospitals (NSH) were assessed.

[An index of daily intensive care unit activity].

Objective: To set up an index for the evaluation of type of interventions and procedures applied a prerequisite for the evaluation of appropriateness of ICU's activity.

Design: Observation prospective study.

Patients: 2507 patients out of the 5030 enrolled in the cohort study.

[Daily survey of procedures as markers of resources utilization].

Objective: To assess and to follow along the time-span of ICU stay the process of resources allocation and utilization.

Design: Prospective study.

Patients: A cohort of 778 patients consecutively admitted to 7 multipurpose general ICU in the Milano area were enrolled in a survey of the daily performed interventions/procedures.

Prone positioning improves pulmonary function in obese patients during general anesthesia.

We investigated the effects of prone position on functional residual capacity (FRC), the mechanical properties (compliance and resistance) of the total respiratory system, lung and chest wall, and the gas exchange in 10 anesthetized and paralyzed obese (body mass index more than 30 kg/m2) patients, undergoing elective surgery. We used the esophageal balloon technique together with rapid airway occlusions during constant inspiratory flow to partition the mechanics of the respiratory system into its pulmonary and chest wall components. FRC was measured by the helium dilution technique.