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Farah R.,Technion - Israel Institute of Technology | Makhoul N.,Respiratory Intensive Care Unit
Israel Medical Association Journal | Year: 2011

Background: Community-acquired pneumonia requiring hospitalization is a severe illness with high mortality, especially if the appropriate treatment is delayed. Sometimes diagnosis is difficult due to an equivocal clinical picture or chest film, or to accompanying diseases that mask or simulate pneumonia. Objectives: To assess the usefulness of certain inflammatory markers in differentiating pulmonary edema from pneumonia throughout the hospital stay in patients admitted for pneumonia or pulmonary edema of non-infectious origin and to monitor the response to treatment. Methods: The study group comprised 50 patients admitted for pneumonia, 50 admitted for pulmonary edema and 30 healthy individuals. Blood samples for determination of leukocyte count, erythrocyte sedimentation rate (ESR), fibrinogen, Creactive protein (CRP), albumin, sCD14 and oxidized fibrinogen were drawn upon admission, at 48 and 72 hours after admission, and at discharge from the intensive care unit. Results: The levels of sCD14 were similar in both patient groups but higher than control levels during the first 48 hours (P < 0.03). They decreased gradually with hospital stay. The concentration of oxidized fibrinogen was similar in both patient groups and significantly lower than that of the healthy control group throughout the hospitalization period. Conclusions: Oxidized fibrinogen and sCD14 are not reliable markers for the diagnosis of pneumonia, for its differential diagnosis from pulmonary edema, and for patient follow-up throughout hospitalization. The finding of elevated levels of oxidized fibrinogen in the group of healthy controls warrants further study to identify the factors responsible for altering fibrinogen oxidation. The other markers are more indicative.

Lukacsovits J.,Semmelweis University | Carlucci A.,Fondazione Salvatore Maugeri Pavia | Hill N.,Tufts Medical Center | Ceriana P.,Fondazione Salvatore Maugeri Pavia | And 5 more authors.
European Respiratory Journal | Year: 2012

In a physiological randomised cross-over study performed in stable hypercapnic chronic obstructive disease patients, we assessed the short-term effects of two settings of noninvasive ventilation. One setting was aimed at maximally reducing arterial carbon dioxide tension (Pa,CO2) (high-intensity (Hi) noninvasive positive pressure ventilation (NPPV)): mean±SD 27.6±2.1 cmH2O of inspiratory positive airway pressure, 4±0 cmH2O of expiratory positive airway pressure and respiratory rate of 22 breaths·min-1. The other was performed according to the usual parameters used in earlier studies (low-intensity (Li)-NPPV): 17.7±1.6 cmH2O of inspiratory positive airway pressure, 4±0 cmH2O of expiratory positive airway pressure and respiratory rate of 12 breaths·min-1. Both modes of ventilation significantly improved gas exchange compared with spontaneous breathing (SB), but to a greater extent using Hi-NPPV (Pa,CO2 59.3±7.5, 55.2±6.9 and 49.4±7.8 mmHg for SB, Li-NPPV and Hi-NPPV, respectively). Similarly, Hi-NPPV induced a greater reduction in the pressure-time product of the diaphragm per minute from 323±149 cmH2O·s·min-1 during SB to 132±139 cmH2O·s· min-1 during Li-NPPV and 40±69 cmH2O·s·min-1 during Hi-NPPV, while in nine out of 15 patients, it completely abolished SB activity. Hi-NPPV also induced a marked reduction in cardiac output (CO) measured noninvasively with a Finometer PRO (Finapres Medical Systems BV, Amsterdam, the Netherlands) compared with Li-NPPV. We conclude that while Hi-NPPV is more effective than Li-NPPV in improving gas exchange and in reducing inspiratory effort, it induces a marked reduction in CO, which needs to be considered when Hi-NPPV is applied to patients with pre-existing cardiac disease. Copyright©ERS 2012.

Pisani L.,Respiratory and Critical Care Unit | Carlucci A.,Respiratory Intensive Care Unit | Nava S.,Respiratory and Critical Care Unit
Minerva Anestesiologica | Year: 2012

Noninvasive mechanical ventilation (NIV) has become a standard of care in select patients with both hypercapnic and non-hypercapnic acute respiratory failure (ARF). Consequent to the increasing use of NIV, new interfaces of different designs, shapes, sizes, and materials have been proposed for clinical use in recent years. Te aim of this report is to examine the most relevant physiological aspects related to the choice of interface with particular emphasis on the problems related to dead space and air leaks that may affect the synchrony between the patient and the machine, ultimately determining the patient's compliance and therefore NIV success. © 2012 EDIZIONI MINERVA MEDICA.

Loukeri A.A.,Respiratory Intensive Care Unit | Kampolis C.F.,National and Kapodistrian University of Athens | Ntokou A.,Oncology Unit GPP | Tsoukalas G.,Oncology Unit GPP | Syrigos K.,Oncology Unit GPP
Clinical Lung Cancer | Year: 2015

The average lifelong rate of developing a new primary lung cancer approximates 1% and 6% per year after radical therapy for non-small-cell lung cancer and small cell lung cancer, respectively. The frequency of recorded synchronous and metachronous lung cancers has been increasing in the recent years because of the development of early detection techniques and advances in cancer therapy. The distinction between multiple synchronous or metachronous primary lung cancers and intrapulmonary metastases is based on established clinicopathological criteria, however it is often difficult, although of great importance for the management and prognosis of these patients. Newly developed molecular and genomic methods are expected to contribute to a more solid and clear differentiation. Surgical treatment, whenever feasible, is considered the modality of choice for the management of patients with second primary lung cancers, as opposed to those with metastases. The type and extent of surgery are under discussion. The prognosis of patients with second primary lung cancers largely depends on the time of detection and the stage and location of the second cancer, thus surveillance after surgical resection of the initial tumor is mandatory. © 2015 Elsevier Inc. All rights reserved.

Spataro R.,University of Palermo | Bono V.,University of Palermo | Marchese S.,Respiratory Intensive Care Unit | La Bella V.,University of Palermo
Journal of the Neurological Sciences | Year: 2012

Background: Tracheostomy mechanical ventilation (TMV) is performed in amyotrophic lateral sclerosis (ALS) patients with a respiratory failure or when the non-invasive ventilation (NIV) is no longer effective. We evaluated the clinical characteristics and survival of a cohort of tracheostomized ALS patients, followed in a single ALS Clinical Center. Methods: Between 2001 and 2010, 87 out of 279 ALS patients were submitted to TMV. Onset was spinal in 62 and bulbar in 25. After tracheostomy, most patients were followed up through telephone interviews to caregivers. A complete survival analysis could be performed in fifty-two TMV patients. Results: 31.3% ALS patients underwent tracheostomy, with a male prevalence (M/F = 1.69) and a median age of 61 years (interquartile range = 47-66). After tracheostomy, nearly all patients were under home care. TMV ALS patients were more likely than non-tracheostomized (NT) patients to be implanted with a PEG device, although the bulbar-/spinal-onset ratio did not differ between the two groups. Kaplan-Meyer analysis showed that tracheostomy increases median survival (TMV, 47 months vs NT, 31 months, p = 0.008), with the greatest effect in patients younger than 60 at onset (TMV ≤ 60 years, 57.5 months vs NT ≤ 60 years, 38.5 months, p = 0.002). Conclusions: TMV is increasingly performed in ALS patients. Nearly all TMV patients live at home and most of them are fed through a PEG device. Survival after tracheostomy is generally increased, with the stronger effect in patients younger than 60. This survival advantage is apparently lost when TMV is performed in patients older than 60. The results of this study might be useful for the decision-making process of patients and their families about this advanced palliative care. © 2012 Elsevier B.V. All rights reserved.

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