Volpicelli G.,Ospedale Universitario San Luigi Gonzaga |
Skurzak S.,Intensive Care Unit |
Boero E.,Ospedale Universitario San Luigi Gonzaga |
Tengattini M.,Maggiore della Carita University Hospital |
And 6 more authors.
Anesthesiology | Year: 2014
BACKGROUND:: Pulmonary congestion is indicated at lung ultrasound by detection of B-lines, but correlation of these ultrasound signs with pulmonary artery occlusion pressure (PAOP) and extravascular lung water (EVLW) still remains to be further explored. The aim of the study was to assess whether B-lines, and eventually a combination with left ventricular ejection fraction (LVEF) assessment, are useful to differentiate low/high PAOP and EVLW in critically ill patients. METHODS:: The authors enrolled 73 patients requiring invasive monitoring from the intensive care unit of four university-affiliated hospitals. Forty-one patients underwent PAOP measurement by pulmonary artery catheterization and 32 patients had EVLW measured by transpulmonary thermodilution method. Lung and cardiac ultrasound examinations focused to the evaluation of B-lines and gross estimation of LVEF were performed. The absence of diffuse B-lines (A-pattern) versus the pattern showing prevalent B-lines (B-pattern) and the combination with normal or impaired LVEF were correlated with cutoff levels of PAOP and EVLW. RESULTS:: PAOP of 18 mmHg or less was predicted by the A-pattern with 85.7% sensitivity (95% CI, 70.5 to 94.1%) and 40.0% specificity (CI, 25.4 to 56.4%), whereas EVLW 10 ml/kg or less with 81.0% sensitivity (CI, 62.6 to 91.9%) and 90.9% specificity (CI, 74.2 to 97.7%). The combination of A-pattern with normal LVEF increased sensitivity to 100% (CI, 84.5 to 100%) and specificity to 72.7% (CI, 52.0 to 87.2%) for the prediction of PAOP 18 mmHg or less. CONCLUSIONS:: B-lines allow good prediction of pulmonary congestion indicated by EVLW, whereas are of limited usefulness for the prediction of hemodynamic congestion indicated by PAOP. Combining B-lines with estimation of LVEF at transthoracic ultrasound may improve the prediction of PAOP. Copyright © 2014, the American Society of Anesthesiologists, Inc.
PubMed | Ss Croce E Carle Hospital, University of Genoa, Anna University, Cardinal Massaia Hospital and 4 more.
Type: Journal Article | Journal: Journal of contemporary brachytherapy | Year: 2016
We focused the attention on radiation therapy practices about the gynecological malignancies in Piedmont, Liguria, and Valle dAosta to know the current treatment practice and to improve the quality of care.We proposed a cognitive survey to evaluate the standard practice patterns for gynecological cancer management, adopted from 2012 to 2014 by radiotherapy (RT) centers with a large amount of gynecological cancer cases. There were three topics: 1. Taking care and multidisciplinary approach, 2. Radiotherapy treatment and brachytherapy, 3. Follow-up.Nineteen centers treated gynecological malignancies and 12 of these had a multidisciplinary dedicated team. Radiotherapy option has been used in all clinical setting: definitive, adjuvant, and palliative. In general, 1978 patients were treated. There were 834 brachytherapy (BRT) treatments. The fusion between diagnostic imaging (magnetic resonance imaging - MRI, positron emission tomography - PET) and computed tomography (CT) simulation was used for contouring in all centers. Conformal RT and intensity modulated radiation therapy (IMRT) were the most frequent techniques. The image guided radiation therapy (IGRT) was used in 10/19 centers. There were 8 active BRT centers. Brachytherapy was performed both with radical intent and as boost, mostly by HDR (6/8 centers). The doses for exclusive BRT were between 20 to 30 Gy. The doses for BRT boost were between 10 and 20 Gy. Four centers used CT-MRI compatible applicators but only one used MRI for planning. The BRT plans on vaginal cuff were still performed on traditional radiographies in 2 centers. The plan sum was evaluated in only 1 center. Only 1 center performed in vivo dosimetry.In the last three years, multidisciplinary approach, contouring, treatment techniques, doses, and control systems were similar in Liguria-Piedmont and Valle dAosta. However, the technology implementation didnt translate in a real treatment innovation so far.
PubMed | Jacksonville University, Divisione di Cardiologia, Maggiore della Carita University Hospital, Cardiologia Interventistica and Institute of Cardiology
Type: Journal Article | Journal: European heart journal. Acute cardiovascular care | Year: 2016
Intracoronary bolus administration may provide high local bivalirudin concentration without changing the global dose, potentially offering a more favorable antithrombotic effect in the infarct related artery (IRA).The purpose of this study was to investigate the feasibility and safety of intracoronary bolus administration of bivalirudin followed by the standard intravenous infusion in ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI).In 245 consecutive patients treated with primary PCI, bivalirudin bolus was given directly in the IRA, followed by a standard intravenous infusion. Clinical reperfusion markers, postprocedural coronary flow indexes, and bleeding events of the intracoronary group were compared with a propensity score-matched cohort of primary PCI patients (n=245) treated with the standard bivalirudin protocol of intravenous bolus and infusion.Higher rates of 70% ST-segment resolution (72.7% vs 60.0%, p=0.004), lower postprocedural peak CK-MB levels (188.3148.7 vs 242.1208.1 IU/dl, p=0.025) and better Thrombolysis in Myocardial Infarction (TIMI) frame count values (14.7 vs 17.9, p=0.001) were observed in the IC bolus group compared with the standard intravenous bolus group. Rates of bleeding were similar between groups. Only three cases of acute stent thrombosis were observed, all in the intravenous bolus group (p=0.25).Intracoronary bivalirudin bolus administration during primary PCI is safe and improves ST-segment resolution, postprocedural coronary flow and enzymatic infarct size compared with the standard intravenous route.
PubMed | S. Orsola Malpighi University Hospital, Santa Maria Nuova Hospital, Past Chair of the SIAARTI Airway Management Study Group, University of Chieti Pescara and 5 more.
Type: Journal Article | Journal: Minerva anestesiologica | Year: 2016
Proper management of obese patients requires a team vision and appropriate behaviors by all health care providers in hospital. Specialist competencies are fundamental, as are specific clinical pathways and good clinical practices designed to deal with patients whose Body Mass Index (BMI) is 30 kg/m2. Standards of care for bariatric and non-bariatric surgery and for the critical care management of this population exist but are not well defined nor clearly followed in every hospital. Thus every anesthesiologist is likely to deal with this challenging population. Obesity is a multisystem, chronic, proinflammatory disorder. Unfortunately many countries are facing a marked increase in the obese population, defined as globesity. Obesity presents an added risk in hospital, leading health care organizations to call for action to avoid adverse events and preventable complications. Periprocedural assessment and critical care strategies designed specifically for obese patients are crucial for reducing morbidity and mortality during surgery and in emergency settings, critical care and other particular settings (e.g., obstetrics). Specific care is needed for airway management, as are proactive strategies to reduce the risk of cardiovascular, endocrine, metabolic and infective complications; any effort can be fruitful, including special attention to the science of human factors. The Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI) organized a consensus project involving other national scientific societies to increase risk awareness, define the best multidisciplinary approach for treating obese patients in election and emergency, and enable every hospital to provide appropriate levels of care and good clinical practices. The Obesity Project Task Force, a section of the SIAARTI Airway Management Study Group, used a formal consensus process to identify a series of notes, alerts and statements, to be adopted as bundles, to define appropriate clinical pathways for hospitalized obese patients. The consensus, approved by the Task Force and endorsed by several European scientific societies actively operating in this field, is presented herein.
Olivieri C.,Maggiore della Carita University Hospital |
Costa R.,Catholic University of the Sacred Heart |
Conti G.,Catholic University of the Sacred Heart |
Navalesi P.,University of Piemonte Orientale |
Navalesi P.,SantAndrea Hospital
Intensive Care Medicine | Year: 2012
Purpose: Because noninvasive mechanical ventilation (NIV) is increasingly used, new devices, both ventilators and interfaces, have been continuously proposed for clinical use in recent years. To provide the clinicians with valuable information about ventilators and interfaces for NIV, several bench studies evaluating and comparing the performance of NIV devices have been concomitantly published, which may influence the choice in equipment acquisition. As these comparisons, however, may be problematic and sometimes lacking in consistency, in the present article we review and discuss those technical aspects that may explain discrepancies. Methods: Studies concerning bench evaluations of devices for NIV were reviewed, focusing on some specific technical aspects: lung models and simulation of inspiratory demand and effort, mechanical properties of the virtual respiratory system, generation and quantification of air leaks, ventilator modes and settings, assessment of the interfaceventilator unit performance. Results: The impact of the use of different test lung models is not clear and warrants elucidation; standard references for simulated demand and effort, mode of generation and extent of air leaks, resistance and compliance of the virtual respiratory system, and ventilator settings are lacking; the criteria for assessment of inspiratory trigger function, inspiration-toexpiration (I:E) cycling, and pressurization rate vary among studies; finally, the terminology utilized is inconsistent, which may also lead to confusion. Conclusions: Consistent experimental settings, uniform terminology, and standard measurement criteria are deemed to be useful to enhance bench assessment of characteristics and comparison of performance of ventilators and interfaces for NIV. © jointly held by Springer and ESICM 2011.
Olivieri C.,Maggiore della Carita University Hospital |
Carenzo L.,University of Piemonte Orientale |
Vignazia G.L.,Maggiore della Carita University Hospital |
Campanini M.,Maggiore della Carita University Hospital |
And 4 more authors.
Respiratory Care | Year: 2015
Background: Although noninvasive ventilation (NIV) is increasingly used in general wards, limited information exists about its ability to provide effective ventilation in this setting. We aim to evaluate NIV delivered in the ward by assessing (1) overall time of application and occurrence of adverse events and (2) differences between daytime and nighttime NIV application. Methods: We studied subjects with hypercapnic acute hypercapnic respiratory failure not fulfilling strict criteria for ICU admission, and excluded those who interrupted NIV prior to 48 h. Time spent on NIV, presence and extent of air leaks, and occurrence of desaturations were assessed for the overall study period, and compared between daytime and nighttime. Results: We enrolled 42 subjects, 25 of whom received NIV for at least 48 h and were included in the data analysis. NIV was successful for 20 subjects, who did not reach criteria for ICU admission. Both PaCO2 and pH significantly improved on average after 2 h and at the end of the study period. NIV was applied for 64.5% of the overall study period and had absent or compensated air leaks for 62.3% of the overall 48-h period. NIV was applied for 55.8% of daytime and for 79.3% of nighttime (P < .01). Effective NIV application was significantly longer overnight (76.9%) than during daytime (53.2%) (P < .01). Conclusions: In selected subjects with hypercapnic acute respiratory failure not fulfilling criteria for ICU admission, the application of NIV in the ward is feasible; in addition, NIV can be safely administered overnight. © 2015, Daedalus Enterprises.
PubMed | Maggiore della Carita University Hospital, Neuroscience Institute Cavalieri Ottolenghi, b IRCCS Casa Sollievo della Sofferenza and University of Piemonte Orientale
Type: Journal Article | Journal: Expert opinion on biological therapy | Year: 2016
Despite knowledge on the molecular basis of amyotrophic lateral sclerosis (ALS) having quickly progressed over the last few years, such discoveries have not yet translated into new therapeutics. With the advancement of stem cell technologies there is hope for stem cell therapeutics as novel treatments for ALS.We discuss in detail the therapeutic potential of different types of stem cells in preclinical and clinical works. Moreover, we address many open questions in clinical translation.SC therapy is a potentially promising new treatment for ALS and the need to better understand how to develop cell-based experimental treatments, and how to implement them in clinical trials, becomes more pressing. Mesenchymal stem cells and neural fetal stem cells have emerged as safe and potentially effective cell types, but there is a need to carry out appropriately designed experimental studies to verify their long-term safety and possibly efficacy. Moreover, the cost-benefit analysis of the results must take into account the quality of life of the patients as a major end point. It is our opinion that a multicenter international clinical program aime d at fine-tuning and coordinating transplantation procedures and protocols is mandatory.
PubMed | St Georges Hospital, Maggiore della Carita University Hospital, Catholic University of the Sacred Heart, SantAndrea Hospital ASL VC and University of Piemonte Orientale
Type: Journal Article | Journal: Journal of critical care | Year: 2016
During partial ventilatory support, pulse pressure variation (PPV) fails to adequately predict fluid responsiveness. This prospective study aims to investigate whether patient-ventilator asynchrony affects PPV prediction of fluid responsiveness during pressure support ventilation (PSV).This is an observational physiological study evaluating the response to a 500-mL fluid challenge in 54 patients receiving PSV, 27 without (Synch) and 27 with asynchronies (Asynch), as assessed by visual inspection of ventilator waveforms by 2 skilled blinded physicians.The area under the curve was 0.71 (confidence interval, 0.57-0.83) for the overall population, 0.86 (confidence interval, 0.68-0.96) in the Synch group, and 0.53 (confidence interval, 0.33-0.73) in the Asynch group (P = .018). Sensitivity and specificity of PPV were 78% and 89% in the Synch group and 36% and 46% in the Asynch group. Logistic regression showed that the PPV prediction was influenced by patient-ventilator asynchrony (odds ratio, 8.8 [2.0-38.0]; P < .003). Of the 27 patients without asynchronies, 12 had a tidal volume greater than or equal to 8 mL/kg; in this subgroup, the rate of correct classification was 100%.Patient-ventilator asynchrony affects PPV performance during partial ventilatory support influencing its efficacy in predicting fluid responsiveness.
Bellora E.,Maggiore Della Carita University Hospital |
Falzoni M.,Maggiore Della Carita University Hospital
Minerva Pediatrica | Year: 2013
Aim. The aim of this prospective cohort study was to conduct a proactive analysis of procedural errors as revealed after implementation of a surgical safety checklist in the pediatric operating room of the Maggiore della Carità University Hospital, Novara. A further aim was to determine the effect the checklist had on the reduction, prevention, and protection against clinical risk in this setting. Methods. A "Checklist for Patient Safety in the Pediatric Operating Room" was derived from documentation in the international literature and implemented in June 2011. All data were collected by a single observer. Results. In all, 61 checklists were compiled. Analysis revealed 189 errors (absolute frequency), with the highest error incidence (59-78%) recorded for the sign-out phase (percentage cumulative frequency). Two categories of events were distinguished (surgical and orthopedic) and compared. The absolute frequency of near-miss events (n=168) and adverse events (n=21) was then broken down into the five phases of checklist compilation. The percentage cumulative frequency of near-miss was 88.89% and that of adverse events was 11.11%. Conclusion. Safety checklist implementation led to reduction, prevention and protection against adverse events with patient injury in 88.89% of cases. The error incidence in this pediatric operating room was lower than the average rates published in the literature.
PubMed | Maggiore della Carita University Hospital
Type: | Journal: Case reports in dentistry | Year: 2016
Necrotizing sialometaplasia is a rare, benign, self-limiting, necrotizing process involving the minor salivary glands, mainly the mucoserous glands of the hard palate. It is thought to be the result of an ischemic event of the vasculature supplying the salivary gland lobules. Some predisposing factors such as smoking, use of alcohol, denture wearing, recent surgery, traumatic injuries, respiratory infections, systemic diseases bulimia, and anorexia have been described. Herein we present a case of necrotizing sialometaplasia of the hard palate in a patient without known predisposing factors, in our opinion, resulting from the use of topical anti-inflammatory drug. After diagnosis, the patient underwent treatment with chlorhexidine gluconate and a full palatal acrylic guard to protect the exposed bone from food residues during meals. After the sixth week the lesion regressed.