Intra-hospital transport of brain-injured patients: a prospective, observational study.

Introduction: Discrepant data exist regarding the incidence and severity of clinical problems related to intra-hospital transport of brain-injured patients and no consensus exists whether modern-day intra-hospital transport represents a safe or potentially problematic environment for neurointensive care unit (NICU) patients.

Methods: We examined the incidence of clinical complications and physiological derangements that occurred in 160 neurologically injured patients (90 males, 70 females, mean age 57 ± 17 years) who underwent intra-hospital transport (288 cases, 237 scheduled, 51 unscheduled) for computed tomography scans.

Results: Our findings indicate that (1) at least one significant complication (predominantly hemodynamic) occurred in over one-third (36%) of all transports (p = n.

Gender differences in case mix and outcome of critically ill patients.

Introduction: The potential for gender-related bias in the provision of medical treatments has gained increased interest in recent years. The aim of this retrospective, observational study was to evaluate the association between gender and clinical outcome in an Italian mixed medical-surgical ICU population.

Methods: Data on 1978 patients admitted to the ICU during a 3-year period were analyzed.

A case of ARDS associated with influenza A - H1N1 infection treated with extracorporeal respiratory support.

After the first outbreak identified in Mexico in late March 2009, influenza A sustained by a modified H1N1 virus ("swine flu") rapidly spread to all continents. This article describes the first Italian case of life-threatening ARDS associated with H1N1 infection, treated with extracorporeal respiratory assistance (venovenous extracorporeal membrane oxygenation [ECMO]). A 24-year-old, previously healthy man was admitted to the Intensive Care Unit (ICU) of the local hospital for rapidly progressive respiratory failure with refractory impairment of gas exchange unresponsive to rescue therapies (recruitment manoeuvres, pronation and nitric oxide inhalation).

Ultrasound localization of central vein catheter and detection of postprocedural pneumothorax: an alternative to chest radiography.

Objective: To determine the usefulness of ultrasound to evaluate central venous catheter misplacements and detection of pneumothorax, thus obviating postprocedural radiograph. After the insertion of a central venous catheter, chest radiograph is usually obtained to ensure correct positioning of the catheter tip and detect postprocedural complications.

Design: Prospective observational study.

The relation between the incidence of hypernatremia and mortality in patients with severe traumatic brain injury.

Introduction: The study was aimed at verifying whether the occurrence of hypernatremia during the intensive care unit (ICU) stay increases the risk of death in patients with severe traumatic brain injury (TBI). We performed a retrospective study on a prospectively collected database including all patients consecutively admitted over a 3-year period with a diagnosis of TBI (post-resuscitation Glasgow Coma Score < or = 8) to a general/neurotrauma ICU of a university hospital, providing critical care services in a catchment area of about 1,200,000 inhabitants.

Methods: Demographic, clinical, and ICU laboratory data were prospectively collected; serum sodium was assessed an average of three times per day.

Alpha glucocorticoid receptor expression in different experimental rat models of acute lung injury.

Background And Objectives: Acute respiratory distress syndrome (ARDS) is a frequent form of hypoxiemic respiratory failure caused by the acute development of diffuse lung inflammation. Dysregulated systemic inflammation with persistent elevation of circulating inflammatory cytokines is the pathogenetic mechanism for pulmonary and extrapulmonary organ dysfunction in patients with ARDS. Glucocorticoids (GCs) have a broad range of inhibitory inflammatory effects, including inhibition of cytokines transcription, cellular activation and growth factor production.

Emergence agitation in preschool children: double-blind, randomized, controlled trial comparing sevoflurane and isoflurane anesthesia.

Background: This randomized, double-blind controlled trial was conducted to determine whether the association of sevoflurane for induction and isoflurane for anesthesia maintenance resulted in a lower incidence of postoperative agitation compared with sevoflurane as single agent.

Methods: After Institute Ethics Committee's approval and parental written informed consent, 128 unpremedicated children (1-6 years), ASA I-II, scheduled for elective subumbilical surgery were enrolled. After induction with 8% sevoflurane, patients were randomly allocated to receive sevoflurane or isoflurane 1-1.

Randomized controlled trial comparing the laryngeal tube and the laryngeal mask in pediatric patients.

Background: The laryngeal tube (LT) is a supraglottic ventilatory device used in adults. However, there is limited information about LT use in pediatric patients. This randomized controlled study compares LT with laryngeal mask (LMA) for airway management during spontaneous or assisted ventilation and during fiberoptic laryngoscopy in children.

Anaesthesia with sevoflurane in children: nitrous oxide does not increase postoperative vomiting.

Background: Nitrous oxide (N2O) has been associated with postoperative nausea and vomiting (PONV), but some studies show conflicting data. The aim of this study was to assess whether the combination of N2O/sevoflurane, in paediatric general anaesthesia, increases the incidence of vomiting in the 24 h following surgery compared with sevoflurane alone.

Methods: One hundred and fourteen children, aged 1-10 years, who underwent testicle and inguinal hernia surgery, were randomized to receive one of the following two anaesthetic regimens: sevoflurane with 70% N2O (group A) or sevoflurane alone (group B).

Lower inflection point and recruitment with PEEP in ventilated patients with acute respiratory failure.

The lower inflection point (LIP) on the total respiratory system pressure-volume (P-V) curve is widely used to set positive end-expiratory pressure (PEEP) in patients with acute respiratory failure (ARF) on the assumption that LIP represents alveolar recruitment. The aims of this work were to study the relationship between LIP and recruited volume (RV) and to propose a simple method to quantify the RV. In 23 patients with ARF, respiratory system P-V curves were obtained by means of both constant-flow and rapid occlusion technique at four different levels of PEEP and were superimposed on the same P-V plot.

[Physiopathology of acute respiratory failure in COPD and asthma].

Asthma and chronic obstructive pulmonary diseases (COPD) lead to functional obstruction of airways, identified by increased inspiratory and expiratory resistances. Increased expiratory resistances cause, in turn, a reduction in expiratory flow. The analysis of flow-volume loops shows that, as the disease progresses, the flow generated during expiration of a tidal volume becomes very close to the flow generated during forced maximal expiration.

[P-V curve morphology. Physiological and clinical implications].

The authors describe the main aspects concerning interpretation and clinical implications of P-V curve tracings in patients with ARF; both the homogeneous and the multicompartment models are described.

On-line monitoring of intrinsic PEEP in ventilator-dependent patients.

Measurement of the intrinsic positive end-expiratory pressure (PEEP(i)) is important in planning the management of ventilated patients. Here, a new recursive least squares method for on-line monitoring of PEEP(i) is proposed for mechanically ventilated patients. The procedure is based on the first-order model of respiratory mechanics applied to experimental measurements obtained from eight ventilator-dependent patients ventilated with four different ventilatory modes.

Impact of positive end-expiratory pressure on chest wall and lung pressure-volume curve in acute respiratory failure.

To investigate whether chest-wall mechanics could affect the total respiratory system pressure-volume (P-V) curve in patients with acute respiratory failure (ARF), and particularly the lower inflection point (LIP) of the curve, we drew the total respiratory system, lung, and chest-wall P-V curves (P-Vrs, P-VL, and P-VW, respectively) for 13 patients with ARF, using the supersyringe method together with the esophageal balloon technique. Measurements were randomly repeated at four different levels of positive end-expiratory pressure (PEEP) (0, 5, 10, 15 cm H2O) and from each P-V curve we derived starting compliance (Cstart), inflation compliance (Cinf), and end compliance (Cend). With PEEP of 0 cm H2O (ZEEP), an LIP on the P-Vrs curve was observed in all patients (7.

[Assessment of various new predictive parameters of the outcome of mechanical ventilation weaning].

Objective: To evaluate new indexes predicting weaning outcome from mechanical ventilation.

Experimental Design: Prospective study with two main end-points: a comparison of weaning indexes between successful and unsuccessful groups and an evaluation of their predicting value.

Environment: Surgical-Medical Intensive Care Unit.

[Pneumonia in severe head injury. A prospective study].

Impairment of the state of consciousness is an important contributing factor in the onset of respiratory tract infections; in this study the data were collected prospectively to investigate the incidence and clinical implications of pneumonia in a population of head injured patients. The study was conducted on all patients treated at our centre throughout 1990. The incidence of pneumonia in the head injured was 10.

[Survival of 213 patients who recovered in resuscitation from cardiac arrest].

213 patients who received in-hospital cardiopulmonary resuscitation (CPR) were studied over a period of five years (1985-89) to determine hospital and long-term survival. The following factors were evaluated in determining outcome: age, ECG on admission, clinical history, year, month, hour of admission. A 5-year survival table was complied for all discharged from hospital.