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C Mattia

Publications and source records attributed to C Mattia.

13 recordsLinked to original sources
PubMed1992

Early prediction of successful weaning during pressure support ventilation in chronic obstructive pulmonary disease patients.

OBJECTIVE: The aim of this study was to examine variables for early prediction of successful weaning in chronic obstructive pulmonary disease (COPD) patients during pressure support ventilation weaning. DESIGN: Thirteen COPD patients were prospectively studied to compare the respiratory pattern (inspiratory time, expiratory time, total breath cycle duration, tidal volume, respiratory rate, minute ventilation), the respiratory drive (airway occlusion pressure at 0.1 sec, tidal volume/inspiratory time), and blood gases after 30 mins of pressure support weaning. SETTING: The study was performed in the 20-bed General Critical Care Unit of the Rome "La Sapienza" University Hospital. PATIENTS: We evaluated 13 consecutive COPD patients fulfilling the standard weaning criteria (including clinical status, blood gases, forced vital capacity, maximum inspiratory pressure, and spontaneous respiratory rate after a 30-min T-piece trial) in which we compared respiratory pattern, respiratory drive, and blood gases after 30 mins of pressure support weaning. MEASUREMENTS AND MAIN RESULTS: After 30 mins of pressure support ventilation weaning (pressure support level 20 cm H2O), we measured respiratory pattern (airway pressure and airflow tracing), airway occlusion pressure at 0.1 sec (occluding the inspiratory line during expiration with a rubber balloon), tidal volume/inspiratory time, maximal inspiratory pressure, and blood gases. According to the result of the weaning trial, the patients were divided into two groups (not weaned and weaned), and the statistical difference between the evaluated variables was analyzed in weaned and not weaned groups. We did not observe a significant difference in breathing pattern data and arterial blood gases between weaned and not weaned patients. By contrast, airway occlusion pressure at 0.1 sec and maximum inspiratory pressure measured after 30 mins of weaning trial appeared significantly (p less than .001) different in patients in whom the weaning trial succeeded or failed. Considering maximum inspiratory pressure, we could not separate weaned from not weaned patients, while all patients showing values of airway occlusion pressure at 0.1 sec less than 4.5 cm H2O were easily weaned. CONCLUSIONS: This study confirms that conventional weaning criteria are often inadequate in predicting successful weaning of COPD patients, while airway occlusion pressure at 0.1 sec during the first phase of pressure support ventilation weaning can represent a good weaning predictor.

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PubMed1990

Effects of the heat-moisture exchangers on dynamic hyperinflation of mechanically ventilated COPD patients.

In recent years the use of devices called Heat and Moisture Exchangers (HME) has become widespread as gas conditioners for ICU patients requiring mechanical ventilation. As an important variation of the resistive properties of the HME, related to flow and duration of use, has recently been pointed out during "in vitro" studies, the use of these devices in COPD patients could increase the levels of auto PEEP and dynamic hyperinflation. In this study we have compared the levels of auto PEEP and difference in functional residual capacity (delta FRC) in a group of COPD patients, requiring controlled mechanical ventilation (CMV), at basal conditions and after the insertion into the circuit of three HMEs (Dar Hygrobac, Pall Ultipor, Engstrom Edith) at random: the results obtained excluded a significant increase of auto PEEP and delta (FRC) both with "new" HMEs and after 12 h of continuous use.

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PubMed1990

Oxygen tension monitoring in uremic patients during hemodialysis treatment.

The aim of this study was to evaluate the influence on cerebral and cutaneous vascular regions of PaO2 reduction during acetate dialysis, by monitoring conjunctival oxygen tension (PcjO2) and transcutaneous oxygen tension (PtcO2) during hemodialysis (HD) treatment. The study was performed on 23 patients with end-stage renal disease in chronic HD. All patients underwent dialytic treatment with cuprophan membranes and acetate containing dialysate. PcjO2 and PtcO2 were recorded and PaO2 and arterial carbon dioxide tension (PaCO2) were also measured. Results of the study show that hypoxemia during acetate dialysis with cuprophan membranes is not accompanied by changes of PcjO2 and therefore by changes in cerebral oxygenation. Moreover, PtcO2 remains constant during dialysis treatment. Furthermore, maintenance of normal oxygen tension at the conjunctival level is not obtained at the expense of the peripheral region of the skin.

Adult↗
PubMed1989

Detection of leukotrienes B4, C4 and of their isomers in arterial, mixed venous blood and bronchoalveolar lavage fluid from ARDS patients.

Seven patients with the adult respiratory distress syndrome (ARDS) were studied. As a control group we used 6 surgical patients who underwent minor surgical operation (inguinal hernia). For both groups the same sample collection and analysis was used. The presence of leuktorienes (LTs) B4 and C4 and of their isomers 11-trans LTC4 and delta 6-trans-12-epi LTB4 was determined in arterial, mixed venous blood and in bronchoalveolar lavage (BAL) fluid. The samples, analysed by reverse phase high performance liquid chromatography (RP-HPLC), showed a similar chromatographic picture among ARDS patients, while the control group showed no detectable amounts of LTs in BAL or blood. The distribution of these arachidonic acid metabolites in mixed venous blood, arterial blood and BAL seems to suggest pulmonary metabolism and/or inactivation. It is suggested that these mediators act as humoral factors in pathogenesis of the ARDS.

Adult↗
PubMed1988

High frequency jet ventilation (HFJV) has no better haemodynamic tolerance than controlled mechanical ventilation (CMV) in cardiogenic shock.

Six patients with acute myocardial infarction (AMI) complicated by cardiogenic shock were studied in order to compare the haemodynamic tolerance of controlled mechanical ventilation (CMV) and high frequency jet ventilation (HFJV). The comparative analysis of the two techniques was performed with the same levels of PaO2 (CMV: 101 +/- 13 mmHg; HFJV: 104.2 +/- 14 p = ns); and PaCO2 (CMV: 37 +/- 1.7; HFJV: 35.7 +/- 1.4 p = ns). In this situation the values of mean airway pressure (Paw) did not differ significantly (CMV: 13 +/- 3 cm H2O; HFJV: 12.6 +/- 3.8 cm H2O) and no statistically significant difference in haemodynamic values was observed. These results demonstrate that in patients with cardiogenic shock, there is no difference between HFJV and CMV in terms of haemodynamic tolerance. Because of the more difficult clinical management of HFJV, this technique does not seem indicated as ventilatory support in patients with cardiogenic shock states.

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PubMed1987

Clinical use of differential continuous positive airway pressure in the treatment of unilateral acute lung injury.

In some instances of unilateral acute lung injury (ALI) refractory to conventional ventilatory support, the intact lung is still able to ensure an efficient CO2 washout, the concomitant hypoxaemia being due to the loss of volume of the injured parenchyma. In these cases, the administration of a sufficient selective continuous distending pressure by means of differential continuous positive airway pressure may restore to normal the resting volume and thus the ventilatory performance of the affected lung, contemporarily avoiding the occurrence of pulmonary and systemic barotrauma.

Adult↗
PubMed1986

Clinical applications of independent lung ventilation with unilateral high-frequency jet ventilation (ILV-UHFJV).

Six patients with unilateral acute lung injury (ALI) were treated with a new form of ventilatory support: independent lung ventilation with unilateral high-frequency jet ventilation (ILV-UHFJV). The first three patients suffered from unilateral ALI complicated by a bronchopleural fistula (BPF); they were at first ventilated with HFJV, but remained unresponsive to treatment, showing a progressive impairment of the ventilation/perfusion ratio with a deterioration in clinical condition. After selective bronchial intubation, ILV-UHFJV was started, ventilating the healthy lung with CPPV and the contralateral with HFJV. ILV-UHFJV caused a significant improvement in alveolar gas exchange leading to a rapid fall in Qs/Qt; it was also associated with a stable haemodynamic condition throughout the duration of the treatment. Subsequently, three more patients were treated; their respiratory failure was due to a unilateral ALI without BPF, unresponsive to either HFJV or CPPV. Once again, ILV-UHFJV was followed by a dramatic improvement in respiratory function; the haemodynamics remained unchanged and it was also possible to demonstrate a rapid improvement in individual and overall lung function.

Adult↗
PubMed1986

Modifications of transcutaneous oxygen tension in lower limb peripheral arterial occlusive disease patients treated with spinal cord stimulation.

The current noninvasive techniques for investigating the response to epidural spinal cord stimulation in peripheral arterial occlusive disease patients are far from optimal. Transcutaneous oxygen tension measurements in these patients treated with spinal cord stimulation demonstrated a statistically significant increase during the stimulation and 30 min after the pacemaker has been switched off, suggesting the effectiveness of the spinal cord stimulation on cutaneous oxygenation. The transcutaneous oxygen tension measurements would represent in the future a reliable parameter to predict the effect and to modulate the pacemaker setting in peripheral arterial occlusive disease patients.

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