Unita Operativa di Epidemiologia

Milano, Italy

Unita Operativa di Epidemiologia

Milano, Italy
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Chiumello D.,University of Milan | Consonni D.,Unita Operativa di Epidemiologia | Coppola S.,University of Milan | Froio S.,University of Milan | And 2 more authors.
Annals of Intensive Care | Year: 2016

Background: Esophageal pressure is used as a reliable surrogate of the pleural pressure. It is conventionally measured by an esophageal balloon placed in the lower part of the esophagus. To validate the correct position of the balloon, a positive pressure occlusion test by compressing the thorax during an end-expiratory pause or a Baydur test obtained by occluding the airway during an inspiratory effort is used. An acceptable catheter position is defined when the ratio between the changes in esophageal and airway pressure (∆Pes/∆Paw) is close to unity. Sedation and paralysis could affect the accuracy of esophageal pressure measurements. The aim of this study was to evaluate, in mechanically ventilated patients, the effects of paralysis, two different esophageal balloon positions and two PEEP levels on the ∆Pes/∆Paw ratio measured by the positive pressure occlusion and the Baydur tests and on the end-expiratory esophageal pressure and respiratory mechanics (lung and chest wall). Methods: Twenty-one intubated and mechanically ventilated patients (mean age 64.8 ± 14.0 years, body mass index 24.2 ± 4.3 kg/m2, PaO2/FiO2 319.4 ± 117.3 mmHg) were enrolled. In step 1, patients were sedated and paralyzed during volume-controlled ventilation, and in step 2, they were only sedated during pressure support ventilation. In each step, two esophageal balloon positions (middle and low, between 25–30 cm and 40–45 cm from the mouth) and two levels of PEEP (0 and 10 cmH2O) were applied. The ∆Pes/∆Paw ratio and end-expiratory esophageal pressure were evaluated. Results: The ∆Pes/∆Paw ratio was slightly higher (+0.11) with positive occlusion test compared with Baydur’s test. The level of PEEP and the esophageal balloon position did not affect this ratio. The ∆Pes and ∆Paw were significantly related to a correlation coefficient of r = 0.984 during the Baydur test and r = 0.909 in the positive occlusion test. End-expiratory esophageal pressure was significantly higher in sedated and paralyzed patients compared with sedated patients (+2.47 cmH2O) and when esophageal balloon was positioned in the low position (+2.26 cmH2O). The esophageal balloon position slightly influenced the lung elastance, while the PEEP reduced the chest wall elastance without affecting the lung and total respiratory system elastance. Conclusions: Paralysis and balloon position did not clinically affect the measurement of the ∆Pes/∆Paw ratio, while they significantly increased the end-expiratory esophageal pressure. © 2016, Chiumello et al.


Spinelli D.,University of Milan | Consonni D.,Unita Operativa di Epidemiologia | Garigali G.,Clinical and Research Laboratory on Urinary Sediment | Fogazzi G.B.,Clinical and Research Laboratory on Urinary Sediment
Clinica Chimica Acta | Year: 2013

Background: Casts are well known components of the urinary sediment. For most casts, the clinical associations are known and demonstrated, while for waxy casts they are totally unknown. Methods: Prospective study for the search and count of waxy casts in the urinary sediment of patients with different types of glomerular diseases. Results: Waxy casts were found in 39 out of 287 patients (13.6%), mostly in low number (1 to 9 out of 100 casts evaluated/sample). They were frequent in postinfectious glomerulonephritis and renal amyloidosis (5/9 patients, 44.5%, p=. 0.02 for each condition), while they were rare in membranous nephropathy (4/67 patients, 6.0%, 0.04) and absent in focal segmental glomerulosclerosis (0/23 patients, p=. 0.05). Waxy casts were associated significantly with higher serum creatinine levels (. p<. 0.0001), with the presence of >. 1 leukocyte/HPF, granular casts and leukocytic casts (. p=. 0.001 to 0.008) and with higher numbers of erythrocytes, leukocytes, renal tubular epithelial cells, granular casts, epithelial casts, and leukocytic casts (. p<. 0.0001 to. =. 0.03). Conclusions: Waxy casts are uncommon and few in patients with glomerular diseases and are associated with impaired renal function and with several other structures of the urinary sediment. © 2013 The Authors.


Chiumello D.,University of Milan | Consonni D.,Unita Operativa di Epidemiologia
Intensive Care Medicine | Year: 2013

Purpose: Single studies of Noninvasive Ventilation (NIV) in the management of acute respiratory failure in chest trauma patients have produced controversial findings. The aim of this study is to critically review the literature to investigate whether NIV reduces mortality, intubation rate, length of stay and complications in patients with chest trauma, compared to standard therapy. Methods: We performed a systematic review and meta-analysis of randomized controlled trials, prospective and retrospective observational studies, by searching PubMed, EMBASE and bibliographies of articles retrieved. We screened for relevance studies that enrolled adults with chest trauma who developed mild to severe acute respiratory failure and were treated with NIV. We included studies reporting at least one clinical outcome of interest to perform a meta-analysis. Results: Ten studies (368 patients) met the inclusion criteria and were included for the meta-analysis. Five studies (219 patients) reported mortality and results were quite homogeneous across studies, with a summary relative risk for patients treated with NIV compared with standard care (oxygen therapy and invasive mechanical ventilation) of 0.26 (95 % confidence interval 0.09-0.71, p = 0.003). There was no advantage in mortality of continuous positive airway pressure over noninvasive pressure support ventilation. NIV significantly increased arterial oxygenation and was associated with a significant reduction in intubation rate, in the incidence of overall complications and infections. Conclusions: These results suggest that NIV could be useful in the management of acute respiratory failure due to chest trauma. © 2013 Springer-Verlag Berlin Heidelberg and ESICM.


Fogazzi G.B.,Research Laboratory on Urine | Secchiero S.,Centro Of Ricerca Biomedica | Consonni D.,Unita Operativa di Epidemiologia | Sciacovelli L.,Centro Of Ricerca Biomedica | And 6 more authors.
Clinica Chimica Acta | Year: 2010

Background: EQA programs on urinary sediment are rare. We describe an EQA Italian program which started in 2001 and involves today more than 300 laboratories. Methods: The program, which started with a questionnaire about the methodological aspects on urinary sediment, includes today four surveys per year. These ask the participants the identification and clinical associations of urinary sediment particles shown by colour images (surveys 1 and 3) and the diagnosis of clinical cases presented by both images and a short clinical history (surveys 2 and 4). The results of each survey are then scored and commented. Results: Questionnaire (participants = 287): most methodological aspects were not dealt with properly. Identification: cells, lipids, casts and some contaminants were poorly known. However, when 27 particles were presented for the second time and 16 particles for the third time, the correct identification rate for most of them increased significantly. Clinical associations (No presented = 16): a correct answer was indicated by ≥. 84% of participants for all particles but one. Clinical cases (No presented = 4): lowest correct identification for urine contamination from genital secretion (77.3%), highest for ureteric stone (94.4%). Conclusions: Our program shows that EQA programs are both useful and needed. © 2010 Elsevier B.V.


PubMed | University of Milan and Unita Operativa di Epidemiologia
Type: Journal Article | Journal: Annals of intensive care | Year: 2016

Esophageal pressure is used as a reliable surrogate of the pleural pressure. It is conventionally measured by an esophageal balloon placed in the lower part of the esophagus. To validate the correct position of the balloon, a positive pressure occlusion test by compressing the thorax during an end-expiratory pause or a Baydur test obtained by occluding the airway during an inspiratory effort is used. An acceptable catheter position is defined when the ratio between the changes in esophageal and airway pressure (Pes/Paw) is close to unity. Sedation and paralysis could affect the accuracy of esophageal pressure measurements. The aim of this study was to evaluate, in mechanically ventilated patients, the effects of paralysis, two different esophageal balloon positions and two PEEP levels on the Pes/Paw ratio measured by the positive pressure occlusion and the Baydur tests and on the end-expiratory esophageal pressure and respiratory mechanics (lung and chest wall).Twenty-one intubated and mechanically ventilated patients (mean age 64.814.0years, body mass index 24.24.3kg/m(2), PaO2/FiO2 319.4117.3mmHg) were enrolled. In step 1, patients were sedated and paralyzed during volume-controlled ventilation, and in step 2, they were only sedated during pressure support ventilation. In each step, two esophageal balloon positions (middle and low, between 25-30cm and 40-45cm from the mouth) and two levels of PEEP (0 and 10cmH2O) were applied. The Pes/Paw ratio and end-expiratory esophageal pressure were evaluated.The Pes/Paw ratio was slightly higher (+0.11) with positive occlusion test compared with Baydurs test. The level of PEEP and the esophageal balloon position did not affect this ratio. The Pes and Paw were significantly related to a correlation coefficient of r=0.984 during the Baydur test and r=0.909 in the positive occlusion test. End-expiratory esophageal pressure was significantly higher in sedated and paralyzed patients compared with sedated patients (+2.47cmH2O) and when esophageal balloon was positioned in the low position (+2.26cmH2O). The esophageal balloon position slightly influenced the lung elastance, while the PEEP reduced the chest wall elastance without affecting the lung and total respiratory system elastance.Paralysis and balloon position did not clinically affect the measurement of the Pes/Paw ratio, while they significantly increased the end-expiratory esophageal pressure.


Biselli G.,Presidio | Dell'Amico M.C.,Unita Operativa di Epidemiologia | Vivani P.,Unita Operativa di Epidemiologia
Recenti Progressi in Medicina | Year: 2013

The objective of this study was to verify if the enrollement of patients aged over sixty-five (over 65), in the territorial assistance programs of a mountain area, has reduced and optimized the volume of hospitalizations. During 2009, 422 patients over 65 who were non self-sufficient, with iso-severity level (IL) from 5 to 0 (Regione Toscana, Decreto n. 1354 del 25 Marzo 2010), were enrolled in home care programs. These data were processed despite the following analytical limitations: 1) inability to provide all tax codes (entered manually in database), the corrisponding personal data; 2) necessity to make cross-comparisons among numerous archives of data from different sources; and 3) lack to identify the outcome indicators for each patient. The assisted patients are characterized by a very high hospitalization rate. Among the main diseases, the following needed at least one hospitalization: dementia, stroke, cancer, osteoarticular diseases, cerebrovascular disease and Parkinson's disease. Therefore it is necessary to re-evaluate the current procedures adopted for the management of chronic diseases in the elderly in their own homes.

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